How Digital Square supports standards

Standards for Health Information Exchange

Digital health technology is at the core of modern, equitable health care systems. When designed and employed effectively, systems can seamlessly exchange information, leading to improved clinical decisions and outcomes, care coordination, and operational efficiency. This interoperability is made possible through health data standards for digital technologies, which ensure data is uniformly and efficiently exchanged across systems. Digital Square supports the global digital health community, including country governments, in understanding, aligning, and applying these standards.

Creating interoperable systems prepared to swiftly advance digital health transformation

Interoperable software enables different systems to speak the same language, regardless of differences in interfaces, platforms, and technologies. A suite of interoperable information systems can track and communicate varied data such as staff availability, number of supplies or equipment, or patient health records.

This smooth data exchange is possible because the software exists in an integrated digital ecosystem that adheres to a common set of standards rather than in data silos. According to Health Level Seven International (HL7), a nonprofit standards development organization, software standards act as “a set of rules that allow information to be shared in a uniform and consistent manner across any application.” Interoperability based on standards enables not only faster implementation but also higher-quality data and improved maintainability, thus positively impacting healthcare workers’ and patients’ lives

Investing in standards development, adoption, and dissemination is key for having interoperable systems. This investment is recognized as essential to the delivery of public services by the United States Agency for International Development (USAID) and is integral to the World Health Organization’s (WHO’s) digital health strategy. Standards investments also lead to a wide range of improvements. As government and facility workforces adopt and become familiar with these systems, digital tools can generate the following benefits to advance health outcomes:

• Facilitate operational ease and efficiency for policymakers, health workers, and facility managers.
• Create new opportunities for data sharing, visualization, and analytics to enable quicker decision-making.
• Reduce the time and cost of troubleshooting information technology (IT) and operational problems such as managing stockouts, conducting data entry, and implementing digital workarounds.
• Reuse existing work and lower the cost of the development of new features and software among users, increasing efficiencies in the health system.
• Provide the basis for systems and people to collaborate so the focus can be on the health and well-being of patients.

By establishing a common foundation and set of tools, software can rely on consistent input from other systems, creating space for stakeholders to swiftly propel digital innovations forward while focusing on what counts: the provision and management of health care.

Engaging with countries and the broader global goods community to support the development of and adherence to standards

Digital Square is committed to transforming digital ecosystems to advance health equity and is therefore, very active in the standards space. The initiative has adopted a multipronged approach to supporting adherence to standards by focusing on advocacy, leadership on standards committees, knowledge sharing, support for global goods partners, solving for country and partner needs, and collaboration with global leaders.

Advocacy

Digital Square’s advocacy efforts promote the appropriate use of standards in health system design and support technical teams in adopting standards in their tools. This work also considers ways to improve upon these tools and advocates for consistent ways to standardize software to address common problems implementers face.

Leadership on standards committees

Digital Square also holds active and chairing positions across many standards development organizations. In these roles, our technical team helps refine and develop standards, building on our experience working with global goods partners and country implementers. The following are committees where Digital Square holds leadership roles, including chair and co-chair positions:

• Integrating the Healthcare Enterprise’s (IHE’s) IT Infrastructure Technical Committee. This committee supports the implementation of standards-based interoperability solutions to improve information sharing, workflow, and patient care. The committee assesses the feasibility and scope of proposals, develops detailed documentation of approved proposals, and develops and maintains the IHE Technical Framework. Much of our engagement has been in co-authoring standards profiles (i.e., mCSD, PMIR, SVCM) related to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) systems and OpenHIE activities.
• HL7 Belgium. This committee provides advice and accelerates standardization to consequently improve time to market and safety of connected health systems. It also grows and sustains the HL7 implementer community, gathers health care standardization efforts, and contributes to the HL7 Fast Healthcare Interoperability Resources® (FHIR®) community. Finally, HL7 Belgium showcases Belgium’s FHIR adoption as a strong example of rapid and proper adoption of a new standard.
• Open Health Information Exchange’s (OpenHIE’s) Architecture Review Board. The board makes decisions about standards and specifications for OpenHIE. Committee members develop and inform a dynamic, viable, and reusable OpenHIE architectural model based on countries’ experiences implementing standards.

Digital Square staff are also members of the following committees:

• IHE’s Quality, Research, and Public Health Committee
• IHE’s pharmacy committee
• HL7
• ISO TC 215 Working Group

Knowledge Sharing

Digital Square facilitates webinars, workshops, and open discussions to raise awareness of standards, increase feasibility, and contribute to a range of tools that allow users to recognize the short- and long-term impact of the standards. The initiative also provides many opportunities for knowledge sharing and continued learning to support implementation teams’ widespread development and understanding of standards. Through the use of webinars, trainings, and implementation guides, Digital Square creates opportunities for partners to deeply engage in the subject matter and feel equipped to begin transforming their own digital health systems.

• One notable webinar series centered on the FHIR standard. Through the series, Digital Square delivered workshop-like sessions to recap the basics of the standard and guide partners through its implementation.
• This series was accompanied by monthly, audience-led “FHIR-side” chats, which allowed partners to engage more deeply on the topic, pose questions to experts, and establish connections to the broader FHIR community.

Support for Global Goods Partners

To complement this work, Digital Square actively convenes a cadre of approved global goods partners and provides ongoing support to a range of other global goods partners within the space. The initiative funds select projects proposed by global goods partners and ensures these projects promote interoperability, the adoption of appropriate standards, and documentation of standard adherence as needed. Examples of Digital Square’s funding to take standards activities forward include the following:

• Digital Square is funding the reference instantiation of the WHO Digital Adaptation Kit for Antenatal Care in key software tools. Digital adaptation kits (DAKs) are software-neutral documentation that transform clinical and public health guidelines into a format easily understood by digital systems. The DAK on antenatal care tailored this documentation.
• Digital Square has funded the social enterprise technology company Ona for its work on the global good Open Smart Register Platform (OpenSRP). Ona is taking an “all-in” approach, the next generation of OpenSRP to be built with a FHIR Core base.
• Digital Square has supported and engaged with WHO, Ona, and Google. These organizations have engaged in developing the FHIR SDK, a set of libraries to build healthcare applications using the FHIR standard, to better facilitate the adoption of HL7 FHIR on mobile devices.

Digital Square has and continues to be one of the leading advocates for the adoption of FHIR in the global goods community and supports the incorporation of the standard in global goods tools (e.g., Everwell, Reveal, OpenHIM, OpenMRS, OpenIMIS, and more).

Solving country and partner needs

Digital Square is also collaborating with a range of stakeholders to identify and improve upon frequently occurring challenges to deploy solutions more effectively. These solutions include:

• Promoting standard data architecture to avoid misaligned common data models.
• Managing data to facilitate the sharing of product catalogs.
• Addressing challenges to feasibility to increase access to flexible digital solutions.
• Ensuring a consistent approach to population data analysis to generate high-quality data.

Developing documentation for standards, including documentation in a range of languages, to facilitate ease and efficiency.

Collaboration with global leaders

In addition to advising on standards development and technical ecosystem design, Digital Square has engaged more broadly with global leaders to advance the ecosystem of standards for open-source technologies. The initiative:

• Supports WHO in adapting health guidelines to a computable form, improving the adherence of digital tools to clinical guidelines.
• Advocates for the widespread adoption of the HL7 FHIR standard in partnership with WHO and USAID.
• Chaired the OpenHIE COVID-19 Task Force, a group that addressed the need for data-sharing and interoperability at the onset of the COVID-19 pandemic, exemplifying how standards accelerate the strategic use of tools in epidemics and pandemics.

Continuing standards advancement for high-quality and contextualized health data systems

Digital Square will continue advancing interoperability standards to increase the world’s preparedness for sharing data, facilitate the seamless connection of health data sources, and enable high-quality and secure data-sharing. At the same time, these efforts will strive to continue supporting the different contexts, processes, needs, and pace of communities.

“Standards [do not impose] one single model for providing health care but rather enable the required variability that allows the different models and processes central to health care—along a patient’s life and across the globe—[to] seamlessly interoperate.” — ROB HORN, SYSTEM ARCHITECT

As an initiative that closely collaborates with both standards committees and country implementation teams, Digital Square is uniquely positioned to feed insights back from on-the-ground implementers to committee members. This feedback loop helps ensure that standards are realistic and valuable to country teams. These attributes are essential for seamless implementation and long-term sustainability of digital health interventions.

Resources

• TechChange Video—Standards and Interoperability in Digital Health.
• Digital Square on FHIR