With a plethora of stakeholders in the healthcare space and an expanding list of digital tools, it can be a challenge to find a starting place for a national digital health strategy. France decided to put ethics at the center of its approach to creating digital health services. 

"In France we have a patient-centered approach … We want the patients to be full members of their healthcare team. So we want the patient to be informed, we want the patient to be involved in the digital process, we want the patient to be in control of their data and we want them to be really engaged," Dr. Brigitte Séroussi, Director of Projects in charge of digital health ethics at the eHealth Delegation of the French Ministry of Health, said this during a panel discussion of HIMSS22. 

"There are some concerns about the counterparts of digital health. Patients are very conscious about the fact there should be a face-to-face relationship when they request it. They want to have real transparency of the data processing. Who has access to their data, when and why? They want AI solutions guaranteed to have no bias. They also want to have digital health that is conscious of the environmental impact."

The team took into account the four principles of medicine: beneficence, autonomy, non-maleficence, justice and the Hippocratic Oath. They then combined these with digital health principals. 

"We have to cross the ethical dimensions related with the dimensions with digital ethics. When you have a digital tool you want a tool that is easy to use, that is accessible to use, that is at the user's service, not the reverse. … When you cross these two dimensions you … have information transparency, then you have information transparency with trust, and then we have adoptions."

But the government didn't just look at traditional health ethics metrics. It also explored how digital's environmental impact. 

"Digital is not material, but it has an environmental impact, and this has to be taken into account when deploying digital health. We know the digital economy is 3.5% of greenhouse gas emission worldwide, and in France we know the health sector is 8% of greenhouse gas emissions," she said. 

Now France is helping to spread their digital health methods in other parts of the E.U. 

"What is at stake is to provide the right services to the E.U. citizen," Isabelle Zablit-Schmitz, eHealth Europe and International Director for the French Ministry of Health, said during the panel. 

Séroussi said that at the end of the day having patients lead the efforts is crucial, and patients need the assurance of an ethical system.