The challenges of cybersecurity and AI in the field of health promotion: focal points for the 10th International Conference on Digital Health, held at the UOC

The challenges of AI in the promotion of eHealth
Joan Antoni Guerrero

On 12 September, the Universitat Oberta de Catalunya (UOC) hosted the second day of the 10th International Conference on Digital Health, organized by the Spanish Digital Health Association (ASD) and the Signo Foundation. Following a first session held in Madrid on the 11th, the conference also included two more sessions, to be held in San Sebastián until the 15th. The Barcelona event, which was held in collaboration with the UOC's eHealth Center and the Catalan Digital Health Association, focused on two highly topical aspects of eHealth: cybersecurity in the field of health and the impact of artificial intelligence on health promotion.

Marta Aymerich, director of the UOC's eHealth Center, welcomed the participants and thanked the organizers of the conference for their commitment "to advancing digital health". Regarding the topics to be addressed in the UOC's session, Aymerich stressed that cybersecurity is fundamental because data "are key to digital health" and that "the impact of AI on health" is also significant. "Now that AI is stirring everything up, understanding nuances and concerns is key to moving forward and making e-health a common good for everyone." Aymerich reiterated the eHealth Center's commitment to "the well-being of the population" and shared her certainty that the conference would be a "catalyst for advances for the benefit of society as a whole."

The president of the Catalan Digital Health Association, Jordi Martínez, for his part, thanked the UOC for the "impeccable" organization of the day and presented the aim of the organization he chairs, which is none other than to promote "digital thinking" when facing the challenges facing professionals in the field of health. The organization is made up of various professionals from the world of healthcare, including not just doctors and nurses, but also even economists and engineers, in order to provide "a multifaceted vision" of the subject.

Cybersecurity: a major cyberattack every eight hours

Mònica Espinosa from the Cybersecurity Agency of Catalonia (ACC) opened the first session with a presentation on that institution's work in the field of cybersecurity and eHealth. Espinosa, who heads the ACC's Centre for Security Innovation and Competition, explained that, as well as for the rest of the public administration, the agency is responsible for the security of 68 public hospitals in Catalonia. She warned that hospitals are currently the target of a major cyberattack every eight hours, and most of these can be stopped.

Espinosa pointed out that cyberattacks with malware such as ransomware are growing at the fastest rate and pose a danger to hospitals, as the use of new devices means that user data are increasingly exposed. These cyberattacks are carried out by gangs of cybercriminals that target hospitals because lives are at stake and they have very sensitive data, which leads these criminals to believe that their demands for ransom are more likely to succeed, explained Espinosa. These attacks have a major impact on people's health. According to the data for the whole of Spain presented by the expert, mortality has increased in one out of every four hospitals that have suffered a cyberattack, a fact that came as a surprise to more than a few participants.

Protecting the cybersecurity of organizations' connected devices

In the same session, Enrique Soto, a cybersecurity architect at Telefónica Tech, explained the importance of controlling the cybersecurity of devices in organizations, particularly healthcare ones. It should be borne in mind that there may be consequences, such as the suspension of services or the interruption of devices connected to patients. "We have many devices. These generate a lot of information resulting in huge diagnostic possibilities but, at the same time, we're filling the networks with many connected devices that, in terms of cybersecurity, increase the area that can be attacked, the entry vectors," he said.

Soto explained the steps that should be taken by hospitals to protect their devices. One of the steps that should be taken is drawing up an inventory of the devices in existence in order to quantify the vulnerabilities. This way, key points can be identified and security breaches closed, an improvement that can also result in more efficient device maintenance.

The challenges of AI in the promotion of eHealth

Eulàlia Hernández, a researcher at BDLab and a member of the UOC's Faculty of Psychology and Education Sciences, opened the round table on artificial intelligence and health promotion. Hernández, who is working on a project on young people and mental health, explained that "AI would have to be very smart to meet the needs" of young people, because they "seek information and support in a very random and diverse way". Regarding the e-health literacy of chronic patients, the challenge, according to Hernández, is "to ensure that AI doesn't leave anyone out of the algorithm" and for health professionals to make clear to patients what AI can and can't do for them. In addition, the UOC expert warned that professionals are not yet sufficiently well-trained to integrate AI into their work. "It's a skill in which they're not yet being trained," she said.

During the event, Imma Grau, head of the mHealth & Digital Health Observatory at the Hospital Clínic de Barcelona, shared her experience of developing a digital platform to help patients with breast cancer. This is a platform edited by an oncologist that has updated information based on scientific evidence. The initiative consists of a website and an app for monitoring patients in order to record the side effects of treatments. This tool provides important information to treat each patient individually according to their profile.

In this regard, Yasmina Okan, a Psychology doctoral degree holder, Ramon y Cajal senior researcher and decision research expert, spoke about the challenges of personalization posed by AI due to the difficulties that can arise when conveying health risks and benefits. "We've been working for years on how to personalize communication because, when it comes to conveying risks and benefits, we often find that information is difficult to understand," said Okan, who has worked on the design of simple visual media to help people understand all kinds of information in order to make better informed decisions about their health.

Digital skills for health professionals

Antoni Sisó, a GP and president of the Catalan Society of Family and Community Medicine (CAMFIC), asserted in the same session that AI is already having an impact on the field of health, "although some professionals aren't aware of it". Warning of the danger of cybersecurity issues leading to cyberbusiness and "generating mistrust" as a result, Sisó said that one of the first problems is professionals' own "language" and literacy in relation to AI. Sisó argued in this regard that it is necessary to have "a certain level of digital skills" because "it's imperative that GPs be the ones who support the public and facilitate this language, answering any questions." "We're already surrounded by AI tools without knowing it," insisted Sisó, referring to a Canadian study that identified those areas in which AI can help primary care: in natural language processing (to enter clinical histories), in triage to prioritize cases according to the level of care required, and in accessibility, using AI to design schedules that give levels of priority to appointments based on criteria of greater patient vulnerability and risk of hospitalization and death. "There are many initiatives, and the challenge is to harmonize them, something that should be done by a public entity," he said.

Manuel Armayones, an expert in behavioural design in the field of health and health promotion and coordinator of the Behavioural Design Lab at the UOC's eHealth Center, was the scientific coordinator of the day organized at the UOC. Armayones led the event and moderated the round table dedicated to generative AIs and health promotion. For a full recording of the session, click on this link.