‘Digital health’ is an overarching concept that currently lacks theoretical definition and common terminology. For instance, this broad and emerging field includes all of the following terms within its lexicon: mHealth, Wireless Health, Health 2.0, eHealth, e-Patient(s), Healthcare IT/Health IT, Big Data, Health Data, Cloud Computing, Quantified Self, Wearable Computing, Gamification, and Telehealth/Telemedicine [1]. However, whilst a definition is difficult to provide, in this overview it is considered that digital health is the use of digital media to transform the way healthcare provision is conceived and delivered. We consider it does this through three basic features.

Firstly, digital health provides individuals with easily accessible information in a range of formats to empower them to track, manage and improve their own and their family’s health. Secondly, digital health refers to the technological developments that underpin its ability to provide support at a personal level including, the internet, social media, wireless devices and mobile networks as well as software sensing technologies and hardware sensors. Thirdly, digital health provision seeks to improve access to healthcare whilst improving the quality of service, reduce costs and deliver an increasingly personalised service.

The interest in digital health was driven by the proliferation of mobile devices, such as mobile phones and tablets, which in tandem with easily accessible mobile networks (mobile broadband and wi-fi) means the digital-enabled public has access to healthcare information at any time and almost anywhere. Significantly, in the United Kingdom (UK), over half of adults access the internet via their mobile phone, increasing to 86 % for smart phone users. Furthermore, 2 out of every 3 mobile devices is now driving a third of UK internet traffic. Importantly, it is not only younger people who make up these statistics. ComScore [2] reported that 55+ year old internet users are now accounting for 20.4 % of the online population.

But users are not just accessing information via the internet, they are increasingly turning to Mobile Applications or ‘apps’. In 2012, more people used apps and browsed the web on their mobile devices [3]. In 2013, Apple reported there had been 50 billion app downloads and that customers were downloading around 800 apps every second amounting to around 2 billion apps per month. Consequently, apps are emerging as high demand sources of health information and patient self-management tools and there are approximately 1,000 new releases of health related apps every month with many existing health-related apps being updated. In order to introduce quality into this burgeoning market the US Food and Drug Administration (FDA) have introduced regulation for some types of medical apps and this is also being adopted by the UK National Health Service (NHS) [4].

The role social media can play in influencing individual health outcomes remains under-explored. Social media refers to a group of internet-based applications built on the ideological and technological foundations of Web 2.0, that allow the creation and exchange of user-generated content [5]. It is an umbrella term for a range of user-generated platforms including blogs and micro-blogs (WordPress, Google Blog, Twitter); social networking sites (Facebook, Pinterest, LinkedIn); collaborative projects (Wikipedia); content communities (You Tube, Pinterest, Instagram); virtual social worlds (Second Life) and virtual gaming worlds (World of Warcraft). Utilising a range of these applications, patients can generate and use content related to health education, information, networking, research, support, goal setting and tracking personal progress [6]. It is estimated that in the UK 64 % of users use at least one social networking site [7]. Theoretically at least, extending patient participation beyond the physical space of the doctor’s surgery and healthcare unit seems achievable if clinicians, academics and the general public can harness social media effectively. However whilst it would seem social media has the potential to be an effective addition to the armoury of digital patient support, currently health providers’ use of social media to enhance patient services remains relatively limited [8].

This section relates the concept of digital health to breast imaging. For clarity, we refer to asymptomatic service-users, such as those of the breast screening service as clients. Symptomatic service-users are referred to as women. In the UK there is sparse evidence that digital health has been employed to its full potential within medical imaging and more specifically the asymptomatic breast imaging service. At the time of press, digital patient information, via the NHS Breast Screening Programme (NHSBSP) website, is still driven by web 1.0 technology. This provides useful information for helping women make decisions but does not enable user-generated content to be created. Women are therefore unable to engage with others via user forums or networks resulting in lack of support and a paternalistic approach to what information they can access. This is contrary to the empowerment agenda and ideology which underpins digital health. Outside the UK, and in particular in the United States of America (USA), web 2.0 technology has been used more widely to promote breast screening mammography. Pinky Swear is a Facebook site that was designed to remind women aged over 40 to attend scheduled mammography and has evolved as “a promise between friends to commit to annual mammogram screenings and promote breast cancer awareness”. The fact that this was created and promoted by a private medical centre, may suggest women in the USA benefit from improved digital information because of their health service’s imperative to attract business, an imperative which does not exist in the UK. Cancer charities are also prolific sources of digital health information and support through digital health approaches. For instance, in the UK, Breakthrough (etc) Breast Cancer has released a breast awareness app which promotes and advises on self-examination.

Access to digital information and support for symptomatic women in the UK is slightly better than that for asymptomatic women. However, again this is mainly as a result of externally provided resources (i.e. external to the imaging department). For example, a number of charity-run, digital health resources exist which are dedicated to patients with breast cancer, including approximately ten Facebook sites such as Breast Cancer Campaign and Breast Cancer Awareness. Many women share information in tweets about breast cancer on Twitter, and Breast Cancer Care has a strong Twitter presence.

A number of breast imaging centres have exploited digital health’s potential for improving service access by trialling text messaging services for appointments and reminders, but the outcomes have yet to be published.

Currently there is still a long way to go in terms of imaging professionals becoming fully expert in ways of exploiting digital health for improving women’s experiences within the breast screening service.

The NHSBSP has national targets and one of the key performance indicators (KPIs) is to increase numbers of women attending for first and subsequent appointments. The innovative use of digital health technology by the BSP could enhance the woman’s experience and therefore positively influence these KPIs. The following suggestions take the reader through the woman’s NHSBSP journey, identifying potential points throughout this journey where the three benefits of digital health (information, personal support and improved access) might be realised.