Why Digital Health Architecture is the Next Big Thing?

India is emerging as a digital powerhouse rapidly building and expanding its digital health infrastructure. The National Digital Health Mission (now Ayushman Bharat Digital Mission or ABDM) which was established in 2020 with a singular vision of providing robust and integrated digital health infrastructure across the country is now laying the foundation for the country’s digital health ecosystem.

What is a digital public infrastructure and how does it link to digital health architecture?

Digital Public Infrastructure (DPI) is a pre-requisite for successful implementation of Digital Health Architecture. DPI comprises of population level technology systems that allows the operation of digital economy, identity systems, social registries and data exchanges. Once a nation has a DPI, digital health architecture can serve as a framework to connect health data, systems, and stakeholders, aligning them to achieve a country’s health objectives.

Digital architecture lays out how the information will be exchanged, by which standards and through what hardware so that clinicians, public health experts and policymakers have the right information to deliver better patient care. This allows for individual-level data to be aggregated and then transformed to provide policymakers and public health experts with population-level insights on where to mobilize supplies and human and financial resources. Eventually, digital architectures prevent health information from becoming siloed.

Many countries are now adopting digital health architectures widely especially after the pandemic. In Denmark, the Danish government has built an integrated network with the main focus on patients and the safety of their data. Healthcare professionals get access to recent prescription-medicine overview to cooperate better with other healthcare facilities and decrease inequalities.

In India, the Ayushman Bharat Digital Mission supports the nation's integrated digital health infrastructure. ABDM strives to build the foundational elements and through digital highways, aims to close the gap between stakeholders in the healthcare ecosystem. ABDM ensures better data availability which will allow for more informed decision-making. Additionally, it makes monitoring possible based on location and demographics which will support the informed formulation and implementation of health policies and programs.

Open-source technologies facilitate easy adoption of digital health interventions

A digital health architecture won't be useful if there are no digital tools to leverage the provided framework. However, developing these digital tools are time taking and expensive. It is the availability of open-source tools and systems that allows for the fast adoption of digital technologies in a timely, structured, and cost-efficient way.?For an open-source technology, the source code is freely accessible to anyone to adopt after customization as per the organisation’s needs.?Any nation/organization willing to adopt a solution does not have to go through the development phase. Thus, open-source software gives healthcare systems flexibility and scalability in their digital health architecture enabling them to adopt new digital solutions in a quick manner that will enable future improvements in patient care.

As open-source platforms largely comply with standards like FHIR (Fast Healthcare Interoperability Resources?), HL7 etc. they lead to interoperability and ensure system integration at various levels. The plethora of code, data, description, and digital information of an open-source system freely available for one to adopt also makes them a Digital Public Good (DPG). This may help health systems avoid the data interoperability issues that make it difficult to exchange health information between electronic health records and other health IT systems.

There are many DPGs, open-source systems being leveraged across the globe for improving public health. More than 73 countries worldwide use DHIS2 for collecting and analyzing health data in one integrated system. Bahmni is another easy-to-use, complete, open-source DPG for Electronic Medical Record (EMR) and Hospital Information System (HIS). Bahmni aims to meet the needs of hospitals in low-resource environments by leveraging existing open-source products. This is now also being developed with ABDM compatibility which will allow for large-scale adoption.

There are several open-source software in healthcare for various purposes. Rocket Chat is a versatile open-source software that can be used in healthcare to connect with patients and helps improve digital communication. Open EMR is a popular open-source electronic health record and medical practice management solution. Healthcare providers can utilize it for scheduling appointments, e-prescribing and medical invoicing. OpenMRS is a Medical Record System with the core functionality of holding and managing medical records. ?

Are open-source technologies secure?

Hearing the words open source obviously raises security concerns. How can a freely available source code escape hacking and not breach the privacy and confidentiality of protected health data?

Open-source code should be “enterprise grade” before healthcare organizations can use it in a commercial environment. Enterprise-grade open source can be used successfully in a healthcare setting as this code is taken by a vendor and made secure for the enterprise. It also follows data security standards like HIPAA(Health Insurance Portability and Accountability Act) compliance. Besides, more people working on the source code means that developers can quickly modify the code and improve security prompting organizations to be more proactive with their network security. Open source is in fact the key to fast health IT innovation enabling healthcare to overcome some of its biggest technological challenges that is privacy and security.

Digital Health Architecture for the future

Despite the considerable progress, many countries still require institutional support for the development and consolidation of digital health strategies and architecture. Digital health should be an integral part of health priorities and should be implemented in a way that is ethical, safe, equitable and sustainable. These systems need to be built through an inclusive multi-stakeholder approach including actors from both public and private sectors with clear guidance on legislation, ethics policies and compliance. Because only when the free exchange of information and interoperability is achieved, digital health can become the future.