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1 Motivation
WHO defines that "… digital health is understood to mean 'the field of knowledge and practice associated with any aspect of adopting digital technologies to improve health, from inception to operation'. This definition is in line with WHO EB142/20 of 20173 and encompasses eHealth" .
In the same document, it is said that "Moving from eHealth to Digital Health puts more emphasis on digital consumers, with a wider range of smart-devices and connected equipment being used, together with other innovative and evolving concepts as that of Internet of things (IoTs) and the more widespread use of artificial intelligence, big data and analytics. Digital Health is changing the way health systems are run and health care is delivered".
The evolution of advanced digital telecommunication techniques has enabled the development of multimedia systems to support digital health applications, including telemedicine.
Moreover, within the context of the "new normal" forced upon the world by the COVID-19 pandemic, digital health is certainly one of the key elements in the pandemic policy and response, as well as one of the most effective tools to tackle this global issue.
With such a background, this Question is concerned with standardization of multimedia systems and services to support digital health applications.
Here is some additional information on the motivation of the Question.
Digital health uses information and communication technology (ICT) to support health needs, while telemedicine is considered as that part of digital health where telecommunication systems which allow interconnecting remote locations and to access distant resources. Examples of telemedicine applications are teleconsulting, teleradiology, telesurgery, etc. The applicability of the work in this Question includes also diverse patients, carers, and healthcare providers.
"…[T]o assess their use of digital technologies for health, including in health information systems at the national and subnational levels, in order to identify areas of improvement, and to prioritize, as appropriate, the development, evaluation, implementation, scale-up and greater utilization of digital technologies, as a means of promoting equitable, affordable and universal access to health for all, including the special needs of groups that are vulnerable in the context of digital health"1.
"Digital health, or the use of digital technologies for health, has become a salient field of practice for employing routine and innovative forms of information and communications technology (ICT) to address health needs. The term digital health is rooted in eHealth, which is defined as "the use of information and communications technology in support of health and health-related fields". Mobile health (mHealth) is a subset of eHealth and is defined as "the use of mobile wireless technologies for health". More recently, the term digital health was introduced as "a broad umbrella term encompassing eHealth (which includes mHealth), as well as emerging areas, such as the use of advanced computing sciences in 'big data', genomics and artificial intelligence".
The field of digital health is dynamic and progressing rapidly. e-health, medical informatics, health informatics, telemedicine, telehealth and mHealth are some of the terms that have been used over the last five decades, depending on the available technologies and accessibility of the baseline infrastructure. These terms have been used to describe the application of information and communication technologies (ICTs) to areas of health, health care and wellbeing. More recently, the term digital health has been selected to embody integration of concepts yet be flexible enough to foster diversity of purposes, technologies and other specificities.1
NOTE 1 - According to the World Health Organization (WHO), telemedicine is "the use of information and communication technology to deliver medical services and information from one location to another".
This Question focuses on standardization of multimedia systems and services to support digital health applications.
In order to allow a wide deployment of digital health applications, in particular in developing countries, it is important to achieve interoperability amongst systems and to reduce the cost of devices through economies of scale. Consequently, the development of global international standards with the involvement of the major players (governments, inter-governmental organizations, non-governmental organizations, medical institutions, doctors, manufacturers, etc.) is a key factor to achieve these objectives.
Considering the fact that many organizations are already active in this field (with which ITU has existing cooperation agreements) and that, in addition to technical issues, there are a number of other aspects to be considered (e.g. legal, ethical, cultural, economic, regional), it is considered that the various ITU-T study groups can provide the right environment to harmonize and coordinate the development of a set of open global standards for digital health applications.
In the framework of this Question, Study Group 21, consistent with its lead study roles, will coordinate the technical standardization of multimedia systems and capabilities for digital health applications in ITU-T, and will develop corresponding Recommendations and other deliverables.
NOTE 2 - Improvements and additions to the specific characteristics of multimedia systems and terminals under the responsibility of other Study Group 21 Questions will be addressed within those Questions. The Question will consult ITU-T SG20 when discussing IoT and smart city aspects of digital health.
2 Study items
Study items to be considered include, but are not limited to:
- identification of user requirements (both those providing and receiving healthcare);
- multimedia framework (including overall concept) for digital health applications (e.g., personal connected health, diagnostics, telemonitoring for communicable disease control, telehealth, mobile health and telemedicine) that leverage various types of information (e.g., brain and other neurological information, physiological information and ambient information);
- impact of new areas of study such as artificial intelligence, bioinformatics (genomics in particular), health software, pharmacovigilance, videogaming, esports, virtual reality, metaverse and digital twin in standards for digital health;
- consideration of usability of digital health systems and devices, including accessibility for persons with disabilities and specific needs;
- roadmap for digital health standards;
- generic architecture for digital health applications;
- specific system characteristics for digital health applications (e.g. video and still picture coding, audio coding, security, directory architecture, safe listening, etc.);
- glossary of digital health (e.g., telehealth and telemedicine);
- consideration of structure and format of data (including metadata) for digital health, and methods for inputting, transmitting, storing, querying, finding, identifying, categorizing and processing them;
- personal connected health devices, and personal health devices, systems and services;
- management and exchange of digital health records, including person generated health records and electronic health records;
- leverage multimedia and digital health technologies to meet requirements from, e.g., WHO and other stakeholders (e.g., NCDs, and/or epidemic outbreaks) and considerations on how to use multimedia for e-education related to health;
- development of conformance testing specifications and capability maturity models for standards in the above-mentioned study items.
3 Tasks
Tasks include, but are not limited to:
- support the efforts against medical emergencies such as COVID-19 with standardization;
- continue to support the collaboration with WHO, especially on its "make listening safe" initiative and accessible telehealth;
- continue to support the collaboration with IEEE on "Continua";
- multimedia framework for digital health applications such as UHD, IPTV and mobile;
- considerations on how accessibility to digital health applications may be enhanced;
- maintain a high-visibility web page documenting the progress of the Question;
- roadmap for digital health/telemedicine standards, compiling and analysing standardization requirements from digital health stakeholders and identifying standardization items with priorities;
- update the inventory of existing digital health/telemedicine standards;
- support of ITU-D digital health activities, including capacity building;
- provide inputs for extension and improvement of existing Recommendations on multimedia systems (ITU-T H.323, H.420, H.700-series; H.264, H.265, H.266; V.18, etc.);
- consideration on the application of already existing mature and stable technologies rather than only on future advanced technologies;
- maintain and expand deliverables under the responsibility of the Question: ITU-T F.780.x-sub-series, H.810-H.850 series, H.860, H.861.x sub-series, H.870-series, FSTP-CONF-F780.1, FSTP-RTM, FSTP-SLD-UC, HSTP.CONF-H870, HSTP-H810, HSTP-H810-XCHF, HSTP-H812-FHIR.
An up-to-date status of work under this Question is found in the SG21 work programme (https://itu.int/ITU-T/workprog/wp_search.aspx?sp=18&q=2/21).
4 Relationships
Recommendations:
- ITU-T H.800-series, H.300-series, H.260-series, H.420-series, H.700-series, T.80-series, T.800-series, V.18
Questions:
- All Questions of Study Group 21
Study groups:
- ITU-T SGs 5, 12, 13, 17 and 20
- ITU-R SG5
- ITU-D SG2
Other bodies:
- WHO, ICAO and other relevant international agencies
- FDA, CDC/NIOSH, NIH and other relevant regulatory bodies
- JIC (Joint Initiative Council for Global Health Informatics Standardization), HL7, IHE (Personal Connected Health Alliance/Continua), Association for Advancement of Medical Instrumentation (AAMI), Global Alliance for Genomics and Health (GA4GH), DICOM, GSMA, DAISY Consortium, and other relevant forums and consortia
- ISO (TC215 and its SC1 in particular), IEC (TC100 and TC108 in particular), CEN, CENELEC (TC108X WG03 in particular), ETSI, IETF, IEEE (11073 WGs in particular) and other relevant standardization bodies
- Video Games Europe, Global Video Game Coalition, Global Esports Federation (for safe-listening in esports and gaming) and other relevant industry groups
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