Hundreds of millions of dollars have been spent on digital health technology for low and middle-income countries (LMICs) over the past decade. However, these multi-year investments have not reliably produced the benefits that were expected. For example, the most common outcome of substantial country-level investments in disease-specific electronic health records (EHRs) and national health information exchanges are systems that have neither scaled nor achieved sustainability. Many such systems are now facing end of life. Even in the relatively well-funded domain of health information systems (HIS) for HIV/AIDS, the most advanced patient-level EHRs implemented in LMICs are being replaced. Despite steady investments and the passion of stakeholders, digital health in LMICs is not predictably demonstrating impact.
Digital health professionals offer a variety of explanations. Some say it’s due to overly siloed or insufficient funding, which stems from an under-estimation of solution complexity and a dearth of evidence that greater investment will have significant impact. The lack of in-country capacity to build and sustain digital systems is also cited as a significant barrier. Other arguments focus on the digital health system architecture. The architecture is not lean enough. It’s full of redundancies and inefficiencies. The current informatics-based approach, centered on the use of data standards to coordinate interaction between electronic systems, is technically sound but does not correspond well to the activities of end users and decision makers. Another architectural challenge is that systems are evolving piecemeal as funds are available or technologies advance. There is no intentional process for integrating system improvements into digital health standards. The result is a global collection of national digital health systems grappling with unique challenges to realize the vision of significantly improved health services and outcomes. What is needed is a thoughtful, critical process of assessing what the true inhibitors to digital health impact are and how they might be eliminated.
In the coming months, Vital Wave and other digital health stakeholders will examine these issues in a series of in-depth discussions. On December 9, at the Global Digital Health Forum in Washington D.C., we’ll challenge a panel of digital health experts to identify the root causes of underperformance in digital health. Discussions will focus on the importance of these impediments, their potential solutions, and associated practicalities. This includes questions such as: 1) Should the current informatics-based approach to system architecture be replaced? If so, with what? 2) Should existing systems be overhauled incrementally or rebuilt from the ground up? 3) Are current national solutions truly fit for purpose in LMICs? To join this discussion or learn more about this initiative, contact Vital Wave. Intentional evolution of digital health systems will require many architects.