The Digital Era has been evolving for about 30 years, and it is advancing quickly.

Global ecosystems have been developed as a result of this evolution, and they are characterized

by the widespread use of digital technology in business and society, including computers,

networks, platforms, clouds, algorithms, and machine learning. (Ruotsalainen, P. Blobel, B.,

2017) Significant structural barriers that worsened health disparities among those at risk of

overdosing were brought to light by the COVID-19 pandemic. Some of these obstacles may be

overcome by digital health technologies; however the creation of these tools frequently excludes

drug users and other important community stakeholders from the development and dissemination

process. Because of this, the digital divide and health disparities among poor, extremely

susceptible drug users may become worse. Recently, there has been interest, primarily among

health system providers, in the need for systems that enable semantic data exchange. Various

researches investigate methods for resolving interoperability issues. Adopting health standards

and technologies for acceptable data representation ontologies, databases, clinical models that

ensure healthcare practitioners manage the data effectively, however, is challenging.

Serbanatti LD, Ricci FL, Mercurio, G, Vasilateanu, (2011) studied the use To take on an

obstacle like the shift in the health paradigm, systematic deployment of information technology
in healthcare (IT) is regarded as more than just a chance, but also a requirement. With IT

assistance, chronic disease management, at-home recuperation, and patient empowerment and

coordinating multiple clinical pathways Actors could exist. Adoption of IT enables innovation

and re-engineering. Healthcare industries must support the long-term viability of healthcare

services and raise the calibre of them. IT in healthcare is also the tool that will revolutionize

healthcare to fight the cost curve that is not tenable. For this, software, procedures, and We need

work processes that will increase quality, safety, access, and cost effectiveness.

For the duty of transmitting information to the patient, a reliable system is necessary.

System dependability, responsiveness, and adaptability are just a few examples of the functional

characteristics that have traditionally been the focus of system quality metrics. However, patients

who schedule appointments online may anticipate not just the aforementioned elements but also

an intuitive user interface and a quick response time. E.R, D. W. (2003). The Delone and

McLean model of information system success. Web-based aftercare interventions have been

created in the past. And assessed specifically for inpatients with psychosomatic disorders, for

instance, Internet-based cognitive behavioural therapy (CBT) platforms (Ebert D, Tarnowski T,

Gollwitzer M, Sieland B, Berking M. 2013)or mobile interventions delivering a combination of

health practices (Webb TL, Joseph J, Yardley L, Michie S. 2013)

An open, loosely connected, domain clustered, self-organizing agents' habitat where

each species is proactive and responsive for its own gain or profit is what is meant by a digital

ecosystem. This explanation implies that every creature found in a digital ecosystem actively

contributes in order to accomplish anything. Digital ecosystems have similar definitions By

(Hadzic and Dillion, 2018) suggest that digital ecosystem components that interact should be

connected. However, (Briscoe and De Wilde, 2018) contend that members of a digital ecosystem

are connected without being physically present in that place. By defining a digital ecosystem as

"a community of digital devices and their environment functioning as a whole," (Kolb, 2013)

offers a distinct viewpoint on digital ecosystems. Information is provided by digital devices to

the ecosystem's other elements. The creatures in a natural ecosystem are represented by the

actions that the digital environments imitate. (Hadzic M., Dillon TS, Chang E, 2017)

The authors' statements that these components were connected to digital health, innovation,

and digital ecosystems as well as the definitions and explanations of these concepts utilized in
this study were used to choose the digital health, innovation, and digital ecosystems components.

Other pertinent elements of the digital health, innovation, and ecosystems did not satisfy our

criteria as a consequence. Possible exclusion of inclusion criteria could have impacted the

outcomes. However, the inclusion criteria for further research may be widened to cover

additional pertinent aspects of digital health, innovation, and ecosystems. Future research could

look into how the elements of the conceptual framework suggested in this study have been

utilized in established (Blobel, 2019)

This study adds to the growing body of knowledge on ecosystems for digital health

innovation. Within the academic sphere, a definition of digital health innovation ecosystems and

a list of its components is given. It is suggested to use a conceptual framework for digital health

innovation ecosystems. The results of this study may serve as a starting point for more research

on digital health innovation ecosystems and a step toward establishing a shared understanding

among practitioners, professionals, and academics in the field of digital health.( Ion M, 2018) .

Additionally, in the field of health care, frequently utilized privacy principles such because

security, transparency, and choice have failed, and institutional trust based on belief will not

work. in the dynamic, unsafe, distributed, multi-vendor, and multi-stakeholder Digital Ecosystem
of health Additionally, the customer is frequently given with service providers' privacy

assurances as There is no room for negotiation in this "take it or leave it" manifesto without any

possibility to negotiate on it (Rowan, W. 2017)

At the moment, in digital health It is challenging, if not impossible, for a person, and

particularly a patient, to understand what PHI is who is data is gathered, how it's used, and who

discloses it for what primary and secondary goals. Additionally, it is challenging to determine

which privacy policies and laws service providers adhere to, and how reliable they do. Currently,

it is practically hard to control how applications behave in digital health ecosystems. Share PHI

with other programs and hardware. The individual or patient who utilizes health-related E-

services must decide whether to be used without having access to adequate and trustworthy

service information. Aspects of the provider's and their information systems' privacy, their level

of trust, as well as their ethical standards, value

1. Ruotsalainen, P.; Blobel, B. Trust—Essential Requirement and Basis for pHealth

Services. In pHealth 2017, Studies in Health Technology and Informatics; Blobel,

B., Goossen, W., Eds.; IOS Press: Berlin, Germany, 2017; Volume 237, pp. 25–33

2. E.R, D. W. (2003). The Delone and McLean model of information system success.

3. Ebert D, Tarnowski T, Gollwitzer M, Sieland B, Berking M. A transdiagnostic

internet-based maintenance treatmenhances the stability of outcome after inpatient

cognitive behavioral therapy: a randomized controlled trial. Psychother Psychosom

2013;82(4):246-256. [doi: 10.1159/000345967] [Medline: 23736751]

4. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health

behavior change: a systematic review and meta-analysis of the impact of

theoretical basis, use of behavior change techniques, and mode of delivery on

efficacy. J Med Internet Res 2010;12(1):e4 [FREE Full text] [doi:

10.2196/jmir.1376] [Medline: 20164043

5. . Serbanatti LD, Ricci FL, Mercurio, G, Vasilateanu, A. Steps towards a digital

health ecosystem. J. Biomed Inform 2011

Int Conf on Digital Ecosystems and Technologies, 2018, Phitsanulok: IEEE,543-

547

7. Briscoe G, De Wilde P. Digital ecosystems: Optimisation by a distributed

intelligence. 2nd IEEE Int Conf on Digital Ecosystems and Technologies 2018;

Phitsanulok: IEEE, 192-197.

8. Kolb A. What does the brand ecosystem mean for digital strategy. 2013. Retrieved

February 21, 2016 from ttp://www.slideshare.net/

9. Hadzic M., Dillon TS, Chang E. Use of digital ecosystem and ontology technology

for standardization of medical records. Inaugural IEEE Int Conf on Digital

Ecosystems and Technologies, 2017, Cairns: IEEE, 595-601.

10. Blobel, B.; Ruotsalainen, P. How Does GDPR Support Healthcare Transformation

to 5P Medicine? In MEDINFO 2019, Studies in Health Technology and

Informatics; Ohno-Machado, L., Séroussi, B., Eds.; IOS Press: Berlin, Germany,

2019; Volume 264, pp. 1135–1139

model for digital ecosystems. 2nd IEEE Int Conf on Digital Ecosystems and

Technologies 2018; Phitsanulok: IEEE, 461-469.

12. O’Connor, Y.; Rowan, W.; Lynch, L.; Heavin, C. Privacy by Design: Informed

Consent and Internet of Things for Smart Health. Procedia Comput. Sci. 2017,

113, 653–658.

13. Nissenbaum, H. Privacy as Contextual Integrity. In Washington Law Review;

George Washington University Law School: Washington, DC, USA, 2004;

Volume 79, pp. 119–157.

14. President’s Council of Advisors on Science and Technology, Report to the

President, Realizing the FullPotential of Health Information Technology to

Improve Healthcare for Americans: The Path Forward,President’s Council of

Advisors on Science and Technology. December 2010. Available online:

https://www.broadinstitute.org/files/sections/about/PCAST/2010%20pcast-health-

it.pdf (accessed on 25 April 2020)

Trans. Comput. Interact. 2018, 25, 1–47.