Sustainable and Responsible ICT Innovation in Healthcare: A Long View and Continuous Ethical Watch Required

  • Tony Cornford
  • Valentina Lichtner
Part of the IFIP Advances in Information and Communication Technology book series (IFIPAICT, volume 386)


Healthcare is of central importance to all communities and generally has a high political profile. Access and availability of care, rising costs, and emerging new relationships between experts (doctors and nurses) and users (patients, citizens) pose new challenges. ICT-based innovation is often proposed as a solution, accompanied by optimistic accounts of its transformative potential, both for the developing world and the developed. These ambitions also implicitly endorse new social agreements and business models. In this respect, as in others, technology is not neutral or simple in the service of modernization; it has its own politics. This paper discusses ICT innovation in healthcare in these terms focused on issues of sustainability and responsibility adapting two economic concepts: redistribution and externalities. The analysis reveals ICT innovation in health care as essentially raising ‘trans-scientific’ questions – matters of policy and intergenerational ethics rather than narrow science


healthcare ICT technological innovation sustainability ethics redistribution externalities 


  1. 1.
    Jha, A.K., Doolan, D., Grandt, D., Scott, T., Bates, D.W.: The use of health information technology in seven nations. Int. J. Med. Inform. 77, 848–854 (2008)CrossRefGoogle Scholar
  2. 2.
    Suk, J.E., Semenza, J.C.: Future Infectious Disease Threats to Europe. American Journal of Public Health 101, 2068–2079 (2011)CrossRefGoogle Scholar
  3. 3.
    Hanvoravongchai, P., Coker, R.: Early reporting of pandemic flu and the challenge of global surveillance: a lesson for Southeast Asia. Southeast Asian J. Trop. Med. Public Health 42, 1093–1099 (2011)Google Scholar
  4. 4.
    NHS: London Health Programmes: Tuberculosis (2012), (last accessed March 17, 2012)
  5. 5.
    Bates, D.W., Gawande, A.A.: Improving Safety with Information Technology. New England Journal of Medicine 348, 2526–2534 (2003), (last accessed April 30, 2012)Google Scholar
  6. 6.
    Jackson, G., Krein, S., Alverson, D., Darkins, A., Gunnar, W., Harada, N., Helfrich, C., Houston, T., Klobucar, T., Nazi, K., Poropatich, R., Ralston, J., Bosworth, H.: Defining Core Issues in Utilizing Information Technology to Improve Access: Evaluation and Research Agenda. Journal of General Internal Medicine 26, 623–627 (2011)CrossRefGoogle Scholar
  7. 7.
    Joint Services, DLA and USCD: Digital Imaging Systems. In: P2 Opportunity Handbook, Joint Service Pollution Prevention and Sustainability Technical Library, A Website Supported by the Joint Services, the Defense Logistics Agency, and the U.S. Coast Guard, (2008), (last accessed March 26, 2012)
  8. 8.
    Mathieson, S.A.: Videoconference consultants boost emergency stroke care. The Guardian (February 16, 2011), (last accessed March 17, 2012)
  9. 9.
    DoH: ’3 million lives’ initiative. Department of Health, UK, (last accessed March 17, 2012)
  10. 10.
    Nuffield Council on Bioethics: Medical profiling and online medicine: the ethics of personalised healthcare in a consumer age. The Nuffield Council on Bioethics (2010), (last accessed April 30, 2012)
  11. 11.
    Magee, M., Isakov, A., Paradise, H.T., Sullivan, P.: Mobile phones and short message service texts to collect situational awareness data during simulated public health critical events. Am. J. Disaster Med. 6, 379–385 (2011)Google Scholar
  12. 12.
    Swan, M.: Crowdsourced Health Research Studies: An Important Emerging Complement to Clinical Trials in the Public Health Research Ecosystem. J. Med. Internet. Res. 14, e46 (2012), (last accessed April 30, 2012)
  13. 13.
    Leadbeater, C.: We-Think: Mass innovation, not mass production: The Power of Mass Creativity. Profile Books (2008)Google Scholar
  14. 14.
    Anderson, C.: Free: how today’s smartest businesses profit by giving something for nothing. Hyperion, New York (2010)Google Scholar
  15. 15.
    Winner, L.: Do Artifacts Have Politics? In: The Whale and the Reactor: A Search for Limits in an Age of High Technology, pp. 19–39. University of Chicago Press, Chicago (1986)Google Scholar
  16. 16.
    UN General Assembly: Our Common Future, Report of the World Commission on Environment and Development, World Commission on Environment and Development. In: Published as Annex to General Assembly document A/42/427, Development and International Co-operation: Environment (1987), (last accessed March 17, 2012)
  17. 17.
    Barry, C.: Redistribution. In: Zalta, E.N. (ed.) The Stanford Encyclopedia of Philosophy (2011), (last accessed March 17, 2012)
  18. 18.
    Vikkelsø, S.: Subtle Redistribution of Work, Attention and Risks: Electronic Patient Records and Organisational Consequences. Scandinavian Journal of Information Systems 17, 3–29 (2005)Google Scholar
  19. 19.
    Ash, J., Sittig, D., Campbell, E., Guappone, K., Dykstra, R.: An unintended consequence of CPOE implementation: shifts in power, control, and autonomy. In: AMIA Annu. Symp. Proc., pp. 11–15 (2006)Google Scholar
  20. 20.
    McAlearney, A.S., Chisolm, D.J., Schweikhart, S., Medow, M.A., Kelleher, K.: The story behind the story: Physician skepticism about relying on clinical information technologies to reduce medical errors. Int. J. Med. Inform. 76, 836–842 (2007)CrossRefGoogle Scholar
  21. 21.
    Motulsky, A., Sicotte, C., Lamothe, L., Winslade, N., Tamblyn, R.: Electronic prescriptions and disruptions to the jurisdiction of community pharmacists. Social Science & Medicine 73, 121–128 (2011)CrossRefGoogle Scholar
  22. 22.
    Berg, M.: Lessons from a Dinosaur: Mediating IS Research Through an Analysis of the Medical Record. In: Proceedings of the IFIP TC9 WG8.2 International Conference on Home Oriented Informatics and Telematics,: Information, Technology and Society, pp. 487–506. Kluwer, B.V. (2000)Google Scholar
  23. 23.
    Ash, J.S., Sittig, D.F., Poon, E.G., Guappone, K., Campbell, E., Dykstra, R.H.: The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry. Journal of the American Medical Informatics Association 14, 415–423 (2007)CrossRefGoogle Scholar
  24. 24.
    OECD: Externalities. In: Glossary of statistical terms (2012),, (last accessed March 17, 2012)
  25. 25.
    Pigou, A.C.: The Economics of Welfare. Macmillan (1946)Google Scholar
  26. 26.
    Cornes, R., Sandler, T.: The theory of externalities, public goods, and club goods. Cambridge University Press, Cambridge (1996)CrossRefGoogle Scholar
  27. 27.
    Samuelson, P.A.: Foundations of economic analysis. Harvard University Press, Cambridge Mass. (1948)Google Scholar
  28. 28.
    NORC: Health Information Exchange Economic Sustainability Panel: Final Report. Prepared for the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology, NORC at the University of Chicago (2009)Google Scholar
  29. 29.
    Aanestad, M.: Information Systems Innovation Research: Between Novel Futures and Durable Presents. In: Chiasson, M., Henfridsson, O., Karsten, H., DeGross, J.I. (eds.) Researching the Future in Information Systems. IFIP AICT, vol. 356, pp. 27–41. Springer, Heidelberg (2011)CrossRefGoogle Scholar
  30. 30.
    Mort, M., May, C.R., Williams, T.: Remote Doctors and Absent Patients: Acting at a Distance in Telemedicine? Science, Technology, & Human Values 28, 274–295 (2003)CrossRefGoogle Scholar
  31. 31.
    Dussault, G., Franceschini, M.C.: Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health 4, Published online (2006), (last accessed April 30, 2012)
  32. 32.
    Rao, B., Lombardi, A.: Telemedicine: current status in developed and developing countries. J. Drugs Dermatol. 8, 371–375 (2009)Google Scholar
  33. 33.
    Mort, M., Smith, A.: Beyond Information: Intimate Relations in Sociotechnical Practice. Sociology 43, 215–231 (2009)CrossRefGoogle Scholar
  34. 34.
    Sarasohn-Kahn, J.: The wisdom of patients: Health care meets online social media. California Healthcare Foundation (2008), (last accessed April 30, 2012)
  35. 35.
    Adams, S.A.: Sourcing the crowd for health services improvement: The reflexive patient and “share-your-experience” websites. Social Science & Medicine 72, 1069–1076 (2011)CrossRefGoogle Scholar
  36. 36.
    Adams, S.A.: “Letting the people speak” or obliging voice through choice? In: Harris, R., Wyatt, S., Wathen, N. (eds.) Configuring Health Consumers. Palgrave Macmillan, Houndmills (2010)Google Scholar
  37. 37.
    Zimmer, M.: The Externalities of Search 2.0: The Emerging Privacy Threats when the Drive for the Perfect Search Engine meets Web 2.0. First Monday 13 (2008), (last accessed April 30, 2012)
  38. 38.
    Edwards, L.: Privacy and data protection online: The laws don’t work? In: Edwards, E., Waelde, C. (eds.) Law and the Internet, pp. 472–473. Hart Publishing, Oxford and Portland, Oregon (2009)Google Scholar
  39. 39.
    Ribisl, K.M., Jo, C.: Tobacco control is losing ground in the Web 2.0 era: invited commentary. Tobacco Control 21, 145–146 (2012)CrossRefGoogle Scholar
  40. 40.
    Luxton, D.D., June, J.D., Fairall, J.M.: Social Media and Suicide: A Public Health Perspective. American Journal of Public Health 102, S195–S200 (2012)Google Scholar
  41. 41.
    Trotter, G.: The Moral Basis for Healthcare Reform in the United States. Cambridge Quarterly of Healthcare Ethics 20, 102–107 (2011)CrossRefGoogle Scholar
  42. 42.
    Dobson, J.E.: Big Brother has evolved. Nature (2009), (last accessed March 23, 2012)
  43. 43.
    Sennett, R.: The craftsman. Yale University Press, New Haven (2008)Google Scholar
  44. 44.
    Weinberg, A.M.: Science and trans-science. Minerva, 209–222 (1972)Google Scholar
  45. 45.
    Mumford, E.: Systems design: ethical tools for ethical change. Macmillan, Basingstoke (1996)Google Scholar
  46. 46.
    Vickers, G.: Making Institutions Work. Associated Business Programmes (1973)Google Scholar
  47. 47.
    Vaughan, D.: The Challenger launch decision: risky technology, culture, and deviance at NASA. University of Chicago Press, Chicago (1996)Google Scholar
  48. 48.
    Perrow, C.: Normal accidents: living with high-risk technologies. Basic Books, New York (1984)Google Scholar
  49. 49.
    Cornford, T., Klecun-Dabrowska, E.: Ethical Perspectives in Evaluation of Telehealth. Cambridge Quarterly of Healthcare Ethics 10, 161–169 (2001)CrossRefGoogle Scholar
  50. 50.
    Walsham, G.: Are we making a better world with ICTs? Reflections on a future agenda for the IS field. Journal of Information Technology advance online publication (2012), (last accessed April 30, 2012)

Copyright information

© IFIP International Federation for Information Processing 2012

Authors and Affiliations

  • Tony Cornford
    • 1
  • Valentina Lichtner
    • 1
  1. 1.London School of Economics and Political SciencesInformation Systems and Innovation GroupLondonUnited Kingdom

Personalised recommendations