An ontology of health impacts and value chain enablers of digital health solutions

Cyber attacks on healthcare settings increase in frequency and magnitude. They cause significant damage to infrastructures, compromising both continuity and quality of services. Accordingly, policy makers recognise cyber attacks as a growing public health problem (e.g. von der Leyen, 2024). Its urgency will increase due to the accelerating digitisation of healthcare and roll-out of AI-enabled and connected devices. Apart from causing significant economic damage, cyber attacks can cause harm to patients by delaying diagnosis and treatment or interrupting emergency services, leading to adverse health outcomes, e.g. illness, impairment or death. Yet, the severity of this problem is presently not fully known: available data are sparse or contradictory. There is currently no comprehensive and consistent framework for generating reliable data on cyber incident characteristics that would enable collaboration across the value chain. Here we propose a foundational ontology of categories of concepts that we consider part of the value chain of digital and AI-enabled health solutions. This ontology is part of a forthcoming framework for cyber incident characterisation including causal links to adverse health outcomes. The ontology consists of a systematic structure of concepts on 1) general cybersecurity, 2) IT infrastructure, 3) enabling technologies. As a fourth category we include health impacts in order to support causality inquiries between cyber attacks and what happened to the most vulnerable party of a cyber attack, the patients.