ICTworks

The Digital Health Platform Handbook from the International Telecommunication Union and World Health Organization aims to assist countries with the advancement of their national digital health system, specifically through the use of a digital health platform, or DHP.

This digital platform provides the underlying foundation for the various digital health applications and systems used to support health and care services. It enables individual applications and systems to interoperate and work together in an integrated manner.

The DHP Handbook is primarily designed for health sector planners and enterprise architects who are responsible for the design of a national digital health system, regardless of the country’s level of digital development. Software developers and solutions providers should also read this handbook, to understand how their efforts can integrate with and benefit from the digital health platform.

Moreover, since a DHP will improve how health applications and systems work together and accelerate innovation, countries at varying levels of digital health maturity will benefit from this handbook.

• Countries with relatively advanced digital health systems will learn how to better integrate and optimize their assets.
• Countries in earlier stages of digital maturity will learn how to lay down an initial foundation on which all future innovations will be built.

Working behind the scenes rather than directly with users, the DHP ties applications together through a standards-based, information infrastructure, called the “infostructure” that consists of an integrated set of common and reusable components. DHP components are core technology services required by many (or even all) applications running in your digital health system, such as registries, identity authentication, or data repositories.

Need for a Digital Health Platform Handbook

The concept of the DHP emerged from a recognition that most digital health progress thus far has arrived in the form of individual applications and information systems. While they do successfully accomplish specific tasks, these digital tools often operate independently from each other. They collect, manage, or process data within a siloed, ‘vertical’ environment, resulting in islands of isolated information that have yet to generate efficiency and improve health outcomes as hoped.

Some of the problems generated by these siloed digital health applications and systems include:

• poor data management due to a lack of integrated applications and systems
• increased burden on health workers from system redundancies
• constraints to innovation because software developers spend time writing redundant code in individual applications that could be shared as common core technologies
• higher long-term project and legacy costs because resources are not pooled for core technology creation and integration, resulting in a need for re-engineering later on
• distraction from building a national infrastructure that connects multiple systems together
• absence of system-wide information and communication technology impacts due to the narrow focus of investments.

In examining these problems, a key lesson learned is the importance of taking a holistic view when developing a digital health system. A system-wide approach to application and architecture design that emphasizes the development of an integrated and interoperable whole is far better than a piecemeal approach that results in fragmented and isolated digital health tools.

Common DHP Infostructure for Interoperability

The DHP’s common infostructure serves as the foundation for a cohesive system. Its integration capabilities and use of core, reusable components tie together standalone applications and systems; in this manner, the DHP provides the ‘horizontal’ foundation for the ‘vertical’ applications.

This use of common components also streamlines your digital health system and makes your investments more cost effective. Instead of investing and re-investing in the development and deployment of application components that can be provided more efficiently by a DHP, your digital health budgets can focus on innovation and ongoing sustainability. Moreover, when scaling up existing and future applications within the underlying DHP infostructure, your return on investment will be greater.

Taking a holistic approach to digital health system building can also impact care delivery and health system operations. By focusing on interoperability amongst all of the digital health applications used by patients and facilities alike, information exchange can be improved across your system. A DHP facilitates this interoperability, enabling applications to exchange information even though they are not directly integrated.

Importantly, this information exchange is standardized, so the data transmitted via the DHP are consistent and understandable. Better data access and quality improve operations throughout the health system. Having abundant and reliable data on hand can drive better decision-making in patient care, staff training and management, resource allocation, and policy-making. It can also help health planners leverage the latest technology trends such as big data, artificial intelligence, or the Internet of Things. As a result, your country’s health goals can be achieved more efficiently, more effectively, and with reduced risk.

DHP Phases and Components

Building this cohesive digital health system requires multiple tasks and DHP development phases. It builds upon a country’s national eHealth Strategy, or similar digital health roadmap, and employs a requirements gathering process to determine which applications and platform components are needed to realize national objectives.

An important part of this process is identifying the technology components that are common to multiple applications in your system design; these generic, reusable components will form the basis of your DHP. You will also recognize which infostructure requirements can be satisfied by repurposing or modifying existing digital health assets, and which will demand the development or procurement of new components and applications.

Decisions will need to be made about overall design principles, standards for ensuring interoperability, software type and licensing, and implementation paths. You will also need to formulate an operations plan for governing the DHP infostructure as well as activities to promote uptake and innovations that will be built on the new platform—essential steps for successful implementation and ongoing sustainability.

DHP Infostructure Benefits

Ultimately, this process should produce a few key outputs for moving forward with DHP infostructure implementation:

• a set of engaged stakeholders for guiding DHP design and promoting its use;
• a high-level blueprint of the DHP infostructure, diagramming the platform’s common components and how these will work with the applications;
• a national eHealth standards framework for defining the standards your national system will use to promote interoperability;
• a set of requests for proposals describing the DHP’s various functional and technical requirements needed by system integrators and solutions providers to build or modify digital health applications and DHP components;
• an implementation roadmap for monitoring DHP infostructure rollout and defining the way forward;
• a governance framework detailing leadership and staffing responsibilities for overseeing, supporting, testing, and maintaining the DHP over time.

The DHPH helps you undertake this development process. It shows you how to outline your initial DHP infostructure architecture and requirements, leading you through the various design and implementation questions that you need to consider. At each step, relevant stakeholders are identified as well as resources for furthering the reader’s knowledge.

The DHPH also offers a variety of tools to assist with DHP design, including a mini-catalogue of common, core components, a breakdown of different types of standards and their uses, and templates for creating user stories and mapping components and standards to them.

Finally, the DHPH illustrates the DHP development process with examples of countries that have already implemented a digital health platform or have laid the foundation for doing so. It is hoped that your country will soon join this growing group.

A slightly edited executive summary of the Digital Health Platform Handbook from the International Telecommunication Union and World Health Organization