Reference Architecture
0.1.0 - ci-build
Reference Architecture
0.1.0 - ci-build
Reference Architecture, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/litlfred/smart-ra/ and changes regularly. See the Directory of published versions
| Official URL: http://smart.who.int/ra/ImplementationGuide/smart.who.int.ra | Version: 0.1.0 | |||
| Draft as of 2025-04-01 | Computable Name: RA | |||
Digital Public Infrastructure (DPI) is a concept that encompasses shared digital systems that are secure, interoperable, and built on open standards. These systems facilitate equitable access to public services, drive development, and promote innovation. Recognized as a critical enabler of inclusive digital transformation, DPI is essential for achieving sustainable development goals (SDGs), particularly in the health sector. Digitalization can positively contribute to the attainment of many SDG targets by increasing the cost-effectiveness, the scope, the coverage, and the quality of many essential services. In this context, Foundational Digital Public Infrastructure (DPI-F) serves common cross-sectoral requirements, while health-specific DPI (DPI-H) provides capabilities exclusive to the health sector, which together can be designed to both amplify the potential opportunities for digitalization and mitigate the associated risks. DPI offers an alternative to the traditional siloed approach to digital development by emphasizing people-centered, interoperable digital building blocks that can simultaneously enable a variety of services and systems across public and private sectors. This strategic shift is conducive to local innovation, enabling ecosystem players to develop new services on top of the existing infrastructure – within and across sectors.
The important enabling role of DPI in sustainable development has been acknowledged in several international policy documents, and the UN has launched a High Impact Initiative on DPI to promote inclusive and open digital ecosystems for the SDGs. Both the Digital Public Good Charter and the Second Revision of the Global Digital Compact also commit to contributing to development of safe, inclusive and secure DPI. A study led by the United Nations Development Programme (UNDP)-estimates that implementation of sectoral DPIs in LMICs can accelerate GDP growth by 20-33% and enable access to some essential social services for tens of millions of people by 2030.
The WHO and the International Telecommunication Union (ITU) are spearheading an initiative under the Global Initiative on Digital Health (GIDH) to draw from country experiences and a growing corpus of technical guidance, to develop a reference architecture and reference country implementations for health systems leveraging DPI to achieve health objectives. The primary goal of the development of the DPI Reference Architecture Toolkit for National Digital Health Transformation as a flagship activity for GIDH is to build global momentum among countries to lead and secure sustainable financing for DPI-based digital transformation of the health sector to achieve one or more of their broader health goals (please see illustrative list above). The work will include creating comprehensive guidance that encompasses a digital reference architecture, implementation guidance, training curriculum, technical specifications for health-specific DPI building blocks that build on foundational cross-sectoral DPI components, and a clearinghouse that curates digital solutions that have been assessed against the reference architecture and technical specifications for health.
The health sector is one of the main potential beneficiaries of DPI. However, while the health sector's digital transformation promises significant social and economic benefits, it cannot be achieved in isolation. Cohesive digital transformation requires an integrated approach that would allow the health sector to leverage and interoperate with foundational digital solutions and systems from other sectors (e.g. registries, digital identity, payment systems). This integration empowers the health sector to harness the cross-cutting components and DPI building blocks while also seamlessly introducing solutions that address the unique needs of a person-centered healthcare delivery (i.e. health-specific DPI components).
The relevance of DPI to health has been underscored in the WHO-ITU Digital Health Platform Handbook (DHPH) and the WHO/UNICEF/UNFPA/PATH Digital Implementation Investment Guide (DIIG) in 2020., The Global Initiative on Digital Health, a World Health Organization (WHO) Managed Network of Networks, launched in 2023 under the leadership of the India G20 Presidency and currently one of the priorities of the Brazil G20 Presidency also emphasizes the critical role of DPI in advancing global health outcomes.,
Despite its potential, there is insufficient investment in foundational and health-specific DPI. Many countries are burdened by time- and resource bound, product-based demonstration projects that do not facilitate a digital transformation of the health sector or create an enabling ecosystem for standards-based, modular digital health solutions that are extensible and sustainable. These fragmented efforts often fail to meet the varying needs of the health sector comprehensively.
The DHPH highlights that a successful DPI for Health must be outcome-driven, rooted in common standards, and consider diverse stakeholder perspectives, including patients, health workers, and health systems. Quality-assured health and data content (Open Content) mapped to open interoperability standards play a pivotal role in shaping the DPI, enabling new services aligned with the SDGs. The adherence to these standards will help safeguard the integrity of the health information infrastructure, facilitate systems modularity, and make possible “built-to” specifications based on consistency in semantic and syntactic standards across the ecosystem. They ensure interoperability and information exchange among diverse applications, fostering an ecosystem where digital health solutions are inherently people-centered, inclusive, equitable, and respectful of human rights. This approach aligns seamlessly with the requirements set forth by the UN High Impact Initiative on DPI, reinforcing the importance of standardization in DPI for Health.
Moreover, the Open Health Information Exchange (OpenHIE) community of practice has focused on developing an architectural framework for digital health, drawing from other work developed by the Integrating the Healthcare Enterprise (IHE). The DPI Reference Architecture for Digital Health Transformation integrates these frameworks, promoting a standardized approach to building health information systems that are interoperable and scalable. OpenHIE’s contributions are instrumental in creating a cohesive infrastructure that supports comprehensive health information exchange, crucial for achieving the health sector’s digital transformation goals.
Importantly, implementing a robust DPI for Health would catalyze and enable locally owned innovation in integrated and interoperable digital health solutions. This transformation enables the health sector to achieve its goals in a more efficient and cost-effective manner while minimizing risks. The benefits extend across multiple dimensions:
Continuity of Care: Enhancing overall continuity of care by facilitating seamless information exchange across health care providers.
Quality of care: Promoting adherence to evidence-based clinical guidelines and best practices through standardized protocols to ensure quality of care.
Reducing burden on health workers: Reduce inefficiencies in administrative processes health workers are responsible for, to optimize health workers’ skills and time when there is a global health work force shortage. Efficiency and Affordability: Optimizing the efficiency and affordability of services by reducing duplication of effort and ensuring effective resource utilization.
Health Financing: Influencing health-financing models and processes through enhanced data availability and standardization.
Regulation and Oversight: Strengthening regulation, oversight, and patient safety by leveraging performance data and reducing errors.
Data-driven Policy-Making and Resource Allocation: Informing health policy-making and resource allocation through improved data quality and insights.
The development of technical specifications for Digital Public Infrastructure (DPI) in health is crucial for ensuring that governments and software developers can build interoperable, scalable, and secure digital health systems. For governments, clear technical specifications enable the consistent evaluation and procurement of digital solutions that align with national health goals and global standards. For software developers, these specifications provide a framework to ensure their products meet the needs of diverse health systems, fostering innovation while adhering to best practices in privacy, security, and interoperability. However, to ensure that these digital solutions meet the established criteria, there is a need for a clearinghouse mechanism. Such a clearinghouse would serve as a trusted repository, curating DPI-based digital health solutions that have been rigorously assessed against the technical specifications. This would provide stakeholders with reliable, quality-assured solutions, driving confidence in the adoption of digital technologies that are essential for advancing health outcomes, particularly in low-resource settings.
This initiative focuses on learning from country experiences and developing comprehensive guidance to help nations achieve six priority health goals through effective digital transformation. This project aligns with the Global Strategy on Digital Health 2020-2025, which aims to improve health for everyone, everywhere by accelerating the development and adoption of digital solutions for health.
Building on the foundational work on DPI pioneered under India’s G20 Presidency, this project leverages digital solutions for public good and promotes inclusive digital transformation. The principles and frameworks established during India’s G20 Presidency are integral to the project’s approach to developing digital public infrastructure for health. The project was officially launched by WHO and ITU at the ‘GIDH Multistakeholder Dialogue on National Digital Health Transformation: Supporting Health Systems of the Future through Robust Foundations and Digital Public Infrastructure’ at the World Summit on the Information Society +20 High Level Event under the C7 eHealth Action Line in late May 2024. This launch saw participation from more than 60 countries and 152 organizations and institutions and underscored the importance of international cooperation and shared learning in achieving digital health transformation.
Through the use of the DPI Reference Architecture for National Digital Health Transformation, countries will be supported to achieve their broader national health system goals. These goals can include, but are not limited to:
1. Establish Trusted Personal Health Records - “every person has a right to their own health record”: Develop a secure and universally accessible digital system for maintaining and retrieving personal health records. This system supports routine immunization and cross-border verifiable International Patient Summary (IPS).
2. Ensure Quality and Continuity of Care - “health workers have access to up-to-date care protocols and patient history”: Implement task-sharing and digital decision support systems to improve the continuity and quality of patient care across healthcare facilities,over time to achieve integrated, person-centred care. Focus areas include maternal and child health, HIV, and community health workforce.
3. Digital Financing and Payment in Healthcare - “Informed financial planning and accountability, and protection for health system users”: Utilize digital solutions to streamline healthcare financing and strategic payment processes for improved efficiency and transparency. This applies particularly to non-communicable diseases like diabetes and hypertension.
4. Optimize Supply Chain Management - “no more stock outs”: Deploy digital tools for real-time monitoring and management of health product inventories to minimize stock outs and ensure timely availability. Focus areas include reproductive health (family planning), infectious diseases (HIV), and non-communicable diseases.
5. Digitally-enabled Health Workforce – “Timely Pay, Proven Skills, Continuous Growth”: Ensure all health workers receive timely payments by adopting reliable digital payroll systems. This includes maintaining a health workforce registry to ensure qualification, retention, capacity building, and career development.
6. Enhance Climate Resilience and Disease Surveillance in Health Systems with Predictive Capabilities - “The health system is dynamically responsive to evolving climate impact”: Integrate digital technologies with predictive analytics to strengthen the adaptability and proactive response of health systems against climate-related disruptions. Focus areas include cholera and telehealth.
7. “Timely detection, assessment, reporting and action for public health risks” - Digitally Strengthen Public Health Surveillance and Response Systems