In the past thirty years, digital technology has transformed entire societies and the global economy. The extent of this transformation can be compared to previous industrial revolutions.

Health lags far behind other sectors in harnessing the potential of data and digital technology, missing the opportunity to save a significant number of lives and billions of dollars.

This chapter provides the key findings and overarching themes of the entire report Health in the 21st Century: Putting data to work for stronger health systems, which explores how digital technologies – and especially electronic data, can be put to work with the goal of effecting positive health system transformation. This question is approached from several perspectives: improving health service delivery models, empowering patients and health system users, readying the health workforce to make the most of digital technologies such as artificial intelligence (AI), using big data in public health policy, the importance of cross-border collaboration, using routine and real-world data to generate evidence on treatments and therapies, and improving overall health system governance and stewardship. The overarching messages from these studies are outlined here. The chapter also provides an estimate of the potential health and economic return of investing in a digital transformation of the health sector in OECD countries.

Health care delivery supported by information and communications technology (ICT) has great potential to make health systems more effective in improving health, more equitable and more efficient. ICT and data can be harnessed to redesign health services according to needs and to deliver services in an integrated and people-centred way. The increasing number of patients with complex needs in OECD countries stand to gain the most from new models of care delivery. ICT can help identify such patients, inform them about their own health and care, improve communication and coordination between them and their providers, increase the accuracy of diagnoses and clinical decision-making, and help monitor their health remotely and deliver appropriate services across geographical distances. However, without an overarching architecture that ensures that new tools are interoperable and can be integrated with existing information systems, ICT may entrench and even exacerbate fragmentation and inequity. Many OECD countries still appear to be far from realising this potential for transforming care delivery.

An informed and engaged patient is critical to creating a people-centred, sustainable health system. Across the OECD, patients are increasingly turning to new technologies to gather health information, using tools from both within and outside the health system. Physician consultations and electronic health records are far from the only sources of information for patients today. Patient engagement with new technologies is increasingly driven by tools outside traditional health data, with patients increasingly consulting the internet and using new health technologies to monitor and engage with their own health. These developments bring both significant opportunities and challenges for individuals and the health system more broadly. This chapter reviews how health systems users are interacting with new digital tools to engage in their own health, and how health systems are responding to these new developments to facilitate access to information and improve health and digital literacy for patients.

Digital transformation, which includes the generation of electronic health data as well as its appropriate use, bears the promise to help address the increasing demand for health services by improving the effectiveness and productivity of health service delivery. This chapter discusses how the health workforce matters for a successful implementation of digital technologies in general and for making the best use of data collected across a health system in particular. It also discusses how the deployment of various digital innovations can affect the health professionals, for example, in terms of their roles and the way their daily tasks are carried out. The chapter describes also the skills needed to best put health data to work as well as examples of national approaches to ensure an adequate supply of these skills, to appropriately engage health workers, and build their trust in the digital technologies.

Changing disease patterns and escalating costs of care make prevention, health promotion and public health pressing concerns and key parts of addressing the challenges facing health systems. Already, the technical capacity exists to pursue a new type of ‘precision’ public health – applying the principles and technology of precision medicine to disease prevention and public health policy. As the need for evidence-based policies grows, big data seems to hold the key to dramatic, rapid improvements to help promote health and prevent disease. At the same time, health systems have been slow to adopt new technologies, and must consider how these new approaches will affect privacy. In the face of these developments, public health policy makers need to discern the most effective ways in which they can leverage big data, as well as how to best address the challenges associated with these novel technologies.

Sharing data and information across borders for the advancement of human health has taken place for a long time. With the proliferation of electronic health data, cross-border collaboration is necessary as it is increasingly clear that research breakthroughs will require large, high quality datasets that describe a range of determinants of health and disease. Challenges to cross-border collaboration and sharing of health data for research and health system performance improvement include data localisation laws and policies; data security threats that discourage data sharing; lack of global standards for data content and interoperability; and commodification and sale of health data on a world market. Some countries and institutions, such as the European Union, are making significant investments in health information infrastructure, health data governance and other steps to overcome these challenges. However, broader international collaboration is needed to coordinate and unite a global effort to address challenges.

Routine and real-world data (RWD) – data that are generated during normal health system activities – can be deployed to advance evidence for medical technologies such as drugs, medical devices, combination products and precision medicine. Health systems have typically relied on evidence generated through prospective trials to inform the biomedical technology ecosystem, including discovery, research, policy and practice. While highly rigorous, clinical trials have a number of limitations. Scientific advances and changing global health needs, together with growing volume of electronic data and the technology to analyse them, mean that evidence from prospective trials can and should be complemented by real-world evidence (RWE) generated from routine data. Using examples and survey results, the chapter discusses the opportunities, challenges and policy implications of using RWD in regulating, pricing and using biomedical technology. It provides recommendations for policy makers and other stakeholders on how to implement a new data-driven approach to manage biomedical products more effectively.

Health systems could harness information and communications (ICT) technology and data in several ways to improve governance and guide resource allocation. Despite the availability of technologies, institutional and organisational artefacts of the pre-digital era are a barrier to progress. While digitalisation makes long-standing fragmentation more apparent and can catalyse reforms, it can also lead to further fragmentation if ICT systems are not interoperable. Policy also needs to constrain the incentives for private owners of data to turn them into a scarce commodity and prevent other entities with legitimate interests from accessing and analysing them. Countries can make progress by defining comprehensive and inter-sectoral strategies, by instituting data governance frameworks and infrastructure to make data readily available for legitimate purposes while protecting privacy, and by investing heavily in capacity to generate knowledge from data and to deploy this knowledge to improve health system performance.