Many countries recognize that digital health is essential to attaining universal health coverage, as digitization has the power to unify fragmented health systems and ensure continuity of care for all. Used correctly within a clear digital health governance framework and enabled through durable, backbone digital infrastructure, digital health solutions are transformative. The key is interoperability: the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.
Viet Nam is clearly seizing this opportunity. With over 90% of the population with access to mobile phones, there are around 120 million mobile phone users, and more than half of the population is using the internet. The country is thus moving quickly towards a digital economy.
As one of the developing countries with the highest rate of information and communication technology (ICT) adoption and lowest cost of ICT use, Viet Nam has tremendous potential for digital health. In 2014, the government identified ICT as a unique and powerful lever to foster the country’s economic growth and social development in all sectors, including health.
The Ministry of Health responded to the government’s call by approving a plan to establish a national health information exchange architecture with defined interoperability standards. These standards are especially important to support and report care across the continuum of health services. This in turn requires a governance framework to define who reports what to whom, in which format, and spells out clear privacy and security policies.
Interoperability is game-changer for digital health
As a passionate digital health advocate myself, I welcome Viet Nam’s endeavor to digitize its health system. In reality, however, establishing a whole-system approach with the proposed solutions for integration and interoperability is highly complex. First and foremost success will depend on human interoperability, a clear blueprint, and strong leadership.
I recently attended a workshop organized by the Ministry of Health and its General Department of Preventive Medicine to discuss next steps toward a health information exchange. The goal was to assess the current status of digital health in the country, and discuss the benefits of a standardized, interoperable ICT architecture for health management information systems. For many national health officials, it was the first time to openly talk about such a highly sensitive issue.
During the technical discussions it quickly became quickly clear that we need to identify which data assets should be shared. For example, Viet Nam currently has around 1,000 different laboratory information systems, all based on different standards. This makes it extremely difficult to conduct aggregated reporting. The same is true for electronic medical records at the hospital level, which also lack unified formats and standards.
To illustrate the benefits of an interoperable system, we analyzed the case study of a toddler diagnosed with measles.
Poor health data make people sick
Under the country’s current system, the national electronic immunization system, the electronic communicable diseases information system (eCDS), and the health service information system are not connected. This makes it very hard for health staff to input data, since each system requires separate forms and has different reporting standards. It also leads to missing the “whole picture” of the patient, which is crucial for medical staff to understand the cause for the measles case. The eCDS unfortunately cannot access information about the vaccination coverage of the patients. In the end, the problem was that the child missed the second dose of the measles vaccination because his parents moved to another village; immunization was incomplete, so the toddler became susceptible to infection.
We further learned how standards-based interfaces and an infrastructure component called the Master Patient Index can be used to bridge care between different care programs and systems. The underlying infrastructure, behaviors, and data elements are generic and based on international standards. The case study helped Vietnamese health officials realize why interoperable health information system matters, how ICT solutions can link existing systems without creating an entirely new ICT enterprise, and how data entry burden can be reduced.
The story of the toddler with measles is only one way to demonstrate the power of ICT-driven interoperability in the health sector, but it definitely drove home three points. First, using interoperability standards for data exchange can improve disease surveillance. Second, it enables easier and faster health data sharing. Third, it significantly reduces the data collection burden.
Viet Nam is on the right path toward realizing the potential of digitization in its health sector. Now we need a ministry-wide governance framework, officials willing to work together, and clear policies on data sharing and privacy to make it happen.