What sort of health system do we want to implement in the face of the imminent arrival of artificial intelligence and robotics in medical practices? The Covid-19 health crisis has demonstrated the importance of digital technologies in the care of patients and their families, as imperative attention was called to ethics and relational practice.

This book analyzes numerous sources of feedback to reveal the multiple facets of this so-called Medicine 4.0. It reveals the extent to which digital medicine requires new forms of organization and new approaches to co-conception, in a logic that is resolutely collaborative with patients. The book concludes with legal and ethical points of view in order to challenge the reader on their duty to truly be an "actor" of their health care.

Jerome Beranger is a scientific expert on the ethical approach of the digital revolution and Ethics by Evolution. He is a co-founder of ADELIAA and is also an associate researcher in the Inserm BIOETHICS team at the University of Toulouse III, France.
Roland Rizoulières is a health economist, a lecturer at Sciences Po Aix, France, and a researcher at INSERM. He is also a senior commissioner at the Army Health Service (Army Epidemiology and Public Health Center).

Foreword xi
Dominique PON, Stéphane OUSTRIC, Jérôme BÉRANGER

Acknowledgements xv

Introduction xvii
Jérôme BÉRANGER and Roland RIZOULIÈRES

Part 1. The Health System and Digital Technology: Challenges, Issues, and Transformations1

Introduction to Part 1 3
Roland RIZOULIÈRES

Chapter 1. Digital Integration and Healthcare Pathways in the Territories 5
Roland RIZOULIÈRES

1.1. Introduction 5

1.2. What lessons can be learned from integrated American and Swiss models? 8

1.2.1. The cradle: the United States 8

1.2.2. The Swiss model of the Delta network 13

1.3. Digital technology as a challenge for territorial integration in the context of healthcare in France 16

1.3.1. Healthcare territories: starting from the patient-user rather than from the offer of health and medico-social actors? 17

1.3.2. An exemplary structuring of the territory? The TSN program and the E-Parcours 20

1.3.3. What lessons can be learned? 23

1.3.4. PTAs and CPTS: the Alpha and Omega of healthcare territory structuring? 23

1.3.5. Launch of SNAC in regions 25

1.4. Digital integration and aging in France: from health pathway to life pathway 26

1.5. Conclusion 27

1.6. References 28

Chapter 2. Digital Technology in a Cancer Patients Primary-Secondary Care Journey 35
Marie-Ève ROUGÉ-BUGAT

2.1. Introduction 35

2.2. Organization of cancer care 36

2.2.1. Cancer plans 36

2.2.2. Primary care actors 36

2.3. Regional health organization for patient management 38

2.3.1. Healthcare supply 38

2.3.2. Transmission of information 40

2.4. Theoretical pathway of a cancer patient 41

2.5. Cancer announcement 44

2.6. Management of treatment-related adverse events 45

2.7. Patient follow-up 47

2.7.1. After cancer 47

2.7.2. Alternating monitoring 48

2.8. Ethics to support the primary to secondary care journey 49

2.8.1. Deontology 50

2.8.2. Ethical questioning 51

2.8.3. Impacts and consequences of digital technology on the healthcare pathway 52

2.9. Conclusion 53

2.10. References 54

Chapter 3. A Smart Health Record for Better Coordination: A Sociological Analysis of the Organizational Dynamics of the Calipso Project57
Valentin BERTHOU

3.1. Solving health problems through better coordination 57

3.1.1. A context conducive to home automation technologies in healthcare 57

3.1.2. A digital liaison notebook to facilitate the transmission of information 59

3.2. Historicity of the Calipso project 62

3.2.1. A bundle of information for thinking about the digital liaison notebook 62

3.2.2. Territorial anchoring of the project in an already established network of actors 63

3.3. Collaboration as an object of study and theoretical framework 64

3.3.1. A multidisciplinary team to carry out a project in Living Lab mode 64

3.3.2. What theoretical framework for dealing with complex situations? Knotworking, the core of reflection on the activity 66

3.4. Identifying specific coordination problems to propose a general technological solution 68

3.4.1. Building on problems identified in the field 68

3.4.2. A design for experimentation, functionalities for the needs of professionals 69

3.4.3. Through the projection of professional standards in the tool, misunderstanding of coordination and collaboration 70

3.4.4. Technology, neutral ground for cooperation? 72

3.5. Methodological course of the tailor-made experimental device 73

3.6. (Preliminary) results and conclusions 74

3.7. References 78

Part 2. Digital Technology and Transformations in the Relationships between Professionals and Patients 81

Introduction to Part 283
Roland RIZOULIÈRES

Chapter 4. Use of AI Systems in the Care Relationship, Redefining Patient and Physician Roles85
Anthéa SÉRAFIN

4.1. Progressive affirmation of individualized healthcare in the service of patient autonomy 86

4.1.1. Reinforcing the patients responsibility in the healthcare relationship 86

4.1.2. Increasingly personalized medicine 91

4.2. Integration of digital and ethical concepts in the training of health personnel and in the education of citizens 93

4.2.1. Global challenge of developing citizens digital skills 93

4.2.2. Issues specific to the training of healthcare professionals 96

4.3. References 100

Chapter 5. Artificial Intelligence Ethics in Medicine103
Loïc ÉTIENNE

5.1. Artificial intelligence in question 103

5.2. The doctor-patient relationship 106

5.3. Digital medicine ecosystem 109

5.4. Medicine 4.0 112

5.5. Question of ethics 113

5.6. What lessons can be learned? 115

5.7. Real benefits of artificial intelligence 117

5.8. References 118

Chapter 6. Digital and Public Health in West Africa119
Alpha Ahmadou DIALLO

6.1. Introduction 119

6.2. Context and questions 120

6.3. Theoretical framework of analysis and associated concepts 125

6.4. Practical illustrations 128

6.5. Challenges and capitalization of experiences and potential for transformation 134

6.6. Conclusion and lessons learned 135

6.7. References 136

Part 3. Supporting Digital Healthcare139

Introduction to Part 3 141
Jérôme BÉRANGER

Chapter 7. Designing and Innovating in Digital Healthcare: Co-design for Taking Patients Needs into Account143
Corinne GRENIER, Rym IBRAHIM and Susana PAIXÃO-BARRADAS

7.1. Introduction 143

7.1.1. New approaches to healthcare innovation 145

7.2. Methodological approach of co-design in healthcare 147

7.2.1. Co-design in healthcare 147

7.2.2. A grid for analyzing the processes of co-design in healthcare 148

7.3. Illustrations 154

7.3.1. Service design workshops to envision collective and smart housing for the elderly 154

7.3.2. Designing digital tools to improve the performance of athletes by taking their emotions into account 159

7.4. Conclusion 164

7.5. References 165

Chapter 8. Ethical Governance and Responsibility in Digital Medicine: The Case of Artificial Intelligence169
Jérôme BÉRANGER

8.1. Introduction 169

8.2. Artificial intelligence applied to the world of healthcare 170

8.3. Problems and ethical risks specific to digital technology 172

8.4. Ethical and moral questions related to AI 176

8.5. Framework based on general ethical principles associated with AI 180

8.6. Algorithmic responsibility 186

8.7. Conclusion 187

8.8. References 189

Chapter 9. Legal Focus on the Notions of Telemedicine and E-Health191
Lina WILLIATTE

9.1. Introduction 191

9.2. Telehealth: a different adoption depending on the country 192

9.2.1. A word with different meanings in different countries 192

9.2.2. E-health: a service provision 200

9.3. Standard applicable to data 201

9.3.1. General framework 203

9.3.2. Rights of the data subject: founding principles of personal data processing 205

9.3.3. The accountability principle 207

9.4. Conclusion 209

9.5. References 209

List of Authors 211

Index 213