Connected Digital Health Systems

Digital health systems are no longer defined only by the adoption of individual technologies. Their value increasingly depends on how data, platforms, workflows and governance structures work together across care settings. Electronic health records, imaging systems, interoperability platforms, cybersecurity frameworks and AI-enabled tools are becoming part of the same operational fabric, shaping how care is coordinated, protected, measured and improved.

As digital infrastructure becomes more interdependent, the challenge is not simply to add more capability. It is to ensure that technology supports clinical priorities, strengthens resilience and remains accountable to patients, professionals and organisations. Its promise depends on trust, usability, standards, governance and sustained investment, particularly as AI moves from experimentation into routine clinical and operational use.

This issue examines how health systems are being shaped by agentic AI, interoperability, cybersecurity, standards, workflow integration, patient safety, data-driven prevention and coordinated models of care. The contributors show that digital transformation creates value only when technology is matched by governance, clinical relevance, accountability and system-wide readiness.

Sara Magdalena Goldberger argues that agentic AI can strengthen health systems only when governance, redesign and accountability come first.

Everton Santos and Jonathan Christensen review global healthcare software rankings, outlining regional differences in EHR, PACS and interoperability platforms.

Steven Lieber and Lorren Pettit introduce a healthcare-specific Zero Trust maturity model aligning cybersecurity with clinical workflows, resilience and executive governance.

Jordi Piera Jiménez explains why clinical AI needs open standards to scale, earn trust and avoid costly dead ends.

Anca del Río argues that agentic AI requires stronger governance, resilience and financing to keep connected digital health systems safe.

Carlos Varela Ferro et al. present a connected ecosystem enabling coordinated, person-centred care for complex conditions.

Dr. Cedric Bohyn shows how AI is becoming a practical and necessary part of radiology through workflow integration, clinically relevant applications and growing operational pressure.

Seni Kamara warns that apparent AI productivity gains can conceal a growing verification burden.

Dr. Agnès Leotsakos examines how AI introduces new failure modes that interact with established mechanisms of patient harm.

Luc Nicolas et al. highlight how lifestyle change and data-driven tools enable earlier, targeted care and reduce disease burden.

I hope this issue offers a clear view of the decisions needed to make digital health systems safe, sustainable and effective.

Happy reading!