Liz Nerad is Director of Digital Solutions in Palladium’s Data, Informatics and Analytical Solutions practice, which specialises in developing and implementing digital health systems. Palladium is a member of the advisory council of the Global Digital Health Network and was a sponsor of the Health Information Systems Architecture track at the 2020 Global Digital Health Forum.

The COVID-19 pandemic has both accelerated adoption of and increased the need for digital health solutions. The use of digital health tools can increase access to care and facilitate people-centred approaches, while simultaneously providing essential data for public health experts and policymakers to plan, finance, deliver, and monitor critical health services.

In December, Palladium joined other digital health leaders at the 7th Annual Global Digital Health Forum. The forum brought together digital health technologists, researchers, donors, government stakeholders, and implementers to exchange experiences, innovations, and trends around the theme of “making digital health work for everyone.” The theme was especially relevant, as the forum took place in its first-ever entirely virtual format, drawing more than 1,500 participants from 92 countries.

Palladium’s Digital Health Advisor for the Data.FI Project, Richard Ngethe, spoke at a plenary session with executives from USAID, the World Bank, and Google. They discussed how national digital health architectures could drive alignment across governments, donors, implementing partners, and the private sector.

“Well defined digital architectures allow governments, donors, implementing partners and the private sector to pool resources around common standards, and build upon common gains towards greater ones,” noted Ngethe.

The topic of digital health architecture resonated throughout the conference sessions, especially as USAID’s recently released Vision for Digital Health emphasises architectures as one of four strategic priorities for investments in health sector digital technologies and data solutions. In 2021, aligning digital health tools within a broader digital architecture will be crucial for the continued response to COVID-19 and building more resilient health systems to withstand future shocks.

A Data Blueprint

Digital health architectures serve as the blueprint to connect data, systems, and stakeholders, aligning them to achieve a country or organisation’s health objectives. Consider the purpose of a blueprint when constructing a home. It guides the construction to ensure that the floorplan, foundation, plumbing, and electricity are appropriately connected, up to code, and ultimately meet the expectations of those who will live there.

Health system architecture similarly specifies how information will be exchanged and by which standards and through what hardware so that clinicians, public health experts and policymakers have the right information to deliver better patient care through strengthened health systems.

Designing how the parts make up the whole provides a blueprint for the exchange of data through connected systems. Ultimately, digital architectures prevent health information from becoming siloed and failing to connect data across multiple health services and locations. For example, digital health architecture enables an individual’s health record to link with lab results, drug dispensing, and provision of payment.

Architectures also aligns how individual-level data can be aggregated and transformed to provide policymakers and public health experts with population-level insights about where to mobilise supplies, and human and financial resources.

Aligning Interests

Architecture drives stakeholder alignment, providing a roadmap for investing in, coordinating, and scaling digital health innovations. This is especially crucial when considering how private-sector innovations can advance public health goals.

However, in many countries, there is no clear value proposition that aligns the shared interests of both the public health sector and private sector actors. When it comes to digital health, promising innovations developed by the private sector are often unable to scale, simply due to a lack of integration within public sector health systems and service delivery models.

For example, in April, Apple and Google released technology to enable COVID-19 contact tracing through mobile devices. Despite the potential to reach nearly 3 billion people globally, adoption has been low. This lack of adoption is attributed primarily to the fragmentation of local governments’ public health surveillance systems and ultimately, their overall COVID-19 response strategy.

In this case, clearly defined digital architectures would provide the framework for how digital tools can and should be adopted in alignment with the health system’s objectives, facilitating data exchange across the many different actors as needed to coordinate the COVID-19 pandemic response.

Enabling Self-Care

As in-person health services shifted to telehealth and digital platforms, the pandemic forced a steep rise in digital health usage to support self-care.

The World Health Organization defines self-care as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without a healthcare provider's support. Digital tools can enable self-care approaches and serve as the self-care intervention when patients cannot see a provider in person. But these digital tools can only be scaled when linked to a digital architecture that aligns with health sector objectives.

For example, digital tools can also facilitate continuity of care through linkage to the health system, as seen recently with the uptick of HIV and COVID-19 self-testing services. However, uncoordinated digital self-care coupled with the many competing digital products in the marketplace doesn’t always connect the dots between individuals and the health system.

Coordination and a clear connection to a country’s digital health strategy and architecture are needed to reap the benefits of digitally enabled self-care. But to do that, the industry needs to re-envision how digital health architectures capture data outside of an individual’s interaction with the health system and ensure policies that enable digital self-care and minimise individual privacy risks.

Digital Health Architecture for the Future

As a new phase of the pandemic begins and vaccine distribution increases daily, the global health community is re-envisioning how health systems must adapt to be more resilient and responsive, especially in times of crisis.

Through digital health architectures, there’s an opportunity to strategically lay the groundwork to effectively align stakeholders, investments, and incentives to accelerate health outcomes and make digital health work for everyone.