Digital Infrastructure in Global Healthcare: The Present and Possible Futures

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by Leo Petersen-Khmelnitski

The digitalization of healthcare has gained momentum in the last two decades, especially with the rise of innovations like the Internet of Medical Things (IoMT), telehealth and AI based medical tools. Digital health infrastructures are being established and developed.


Digital infrastructures are large scale sociotechnical systems with many characteristics shared with transportation systems and telecommunication networks, i.e., with physical infrastructures. A digital infrastructure is a shared, open, heterogeneous and evolving socio-technical system consisting of a set of IT capabilities, and their users, operations, and design.

Digital infrastructure for the healthcare sector is in intensive and extensive development, as many if not all medical professionals, healthcare providers, insurance companies, patients and other stakeholders need to share data, and this need increases constantly.

National policies behind most national digital infrastructures in the healthcare sector aim to create a digital health ecosystem that supports universal health coverage, through provision of a wide range of data, information, and infrastructural services, to ensure security, confidentiality, and privacy of health-related personal information.

Current State of Affairs

Digital natives such as Apple, Google, Amazon and Tencent invest billions of dollars in new healthcare platforms. These IT giants, health systems themselves, traditional and corporate venture capital, angel groups, accelerators and incubators have invested about $33B in 2011-2019.

The last two years saw an explosion of investments in health-related digital infrastructure. In China, WeDoctor has around 30 million active users per month and was valued at $5.5 billion in the last funding round. Research shows the profit margin for analytics firms in healthcare averages 20%. However, new solutions, available at the market, also require companies to modernize data pipelines and data architecture.

Once digital infrastructure catered mainly to administrative tasks, such as storage of patient records and tracking inventories. Modern healthcare IT has evolved into a digital healthcare infrastructure. It collects, manages, and integrates an enormous volume of clinical, financial and operational data generated by the modern healthcare system, in order to enhance its safety, effectiveness and efficiency.

Among many examples, one can name electronic health records (EHRs), they feature interactive clinical decision assistance tools, which warn of potential problems, such as allergies or critical lab values, and remind about preventive care. Patient portals improve engagement, offer patient education, ensure communication with medical professionals and provide access to personal health information. Financial and operational management is supported by healthcare billing systems, healthcare policy and contract management software, intuitive inventory control systems.

Possible Developments in the Future

The digitization (shift from paper to digital) is either over or will be over soon. Digitalization, or digital transformation, will see national, regional and local deployments of digital infrastructure to encompass all processes, rather than being project or programme oriented as now. Digitalization will take a more holistic approach, by identifying key bottlenecks in data exchange, and resolving them. Integration rather than the present exchange via gateways is expected to become a norm, including international health data exchange, that is still in its infancy. Let’s try to have a look at possible future developments

More Computing Power

AI tools, deep learning, and big data require computing power. The digital infrastructure of tomorrow is expected to provide an adequate response, not only in extensive development (more powerful processors) but in structural changes and employment of decentralised processing.

More IoMT Minimalism

The approach to data collection is expected to change. The slogan of today ‘Data is the oil’, hence the more data you collect the better has proven fruitless in the healthcare sector. The approach results in heaps of unprocessed data that nobody ever touches. Digital infrastructure of tomorrow is expected to collect only the needed data, to process all data, to use much more of the collected data than today. Hence, IoMT adoption may not become as massive as originally intended, but more pointed and efficient.

More Decentralization

Modern digital infrastructure respond to the ever increasing volume and complexity of health data received through multiple channels (from EHRs to IoMT devices) by encompassing decentralisation. While at present focus in the architecture of digital infrastructure in healthcare is on decentralised (cloud based) storage, decentralised processing and resource sharing, especially for computing power hungry AI and big data applications, are expected to gain prevalence in the near future.

Data Ownership Back to Patients

Decentralized digital infrastructure of tomorrow’s healthcare will provide solutions to effective data ownership. Most national legislations place ownership of personal health data to individuals whose health is referred to in this data, however at present few individuals enjoy easy access to this data, let alone possibilities of monetization. Blockchain based solutions may allow to ensure true attribution of health data ownership back to individuals, to provide them with tools to opt out or receive remuneration for use of their health data.

More Interoperability

The above will require more interoperability in digital infrastructures, especially in countries where healthcare is fragmented by internal administrative boundaries (provinces, states) and segmented (coexistence of several national health schemes, based on employment in formal and informal sectors, parallel sectors of civil and military healthcare providers), or where data standards have evolved independently (typical to early digital adopters). Development of common or open data standards is expected to intensify.

Automation of Regulatory Compliance

One of the systemic challenges to further deployment of digital infrastructure in healthcare is an increasingly complex data compliance regulation. Further employment of smart contracts and supporting digital infrastructure (no silos) may provide an adequate response.

More Tokens

Tokenization is another phenomenon that waits to spread to the healthcare data. Digital twins aid clinicians today already, and this trend will continue. However, new classes of digital assets will enter healthcare, such as non-fungible tokens and blockchain-based motivation tokens.

More Personalised Healthcare

The healthcare of tomorrow is expected to be more personalised through the introduction of precision drugs to AI based personal health advisors that permanently process data from IoMT wearables. The digital infrastructure will have to respond by the shift from de/centralized models into models where individual healthcare providers may be able to build their own applications in a common/national digital health ecosystem.

Bypassing Internet

The above restructuring and the need to secure health data exchange between different parties requires them to step up interconnection through controlled data transfers. Implementation of this ability will require to bypass the public Internet, while securing shared ownership/control of communication channels. In this field, competitors will have to come together to collaborate to achieve common healthcare goals.

Money in New Ways

More investment is expected in volume and formats. Distributed autonomous organisations (DAO) are expected to enter the scene of investments in digital health infrastructure. DAOs are basically computer (or rather networks) generated legal entities that are formed to invest in a particular project or programme and dissolve/close when the goals of the project have been reached. Digital infrastructure of tomorrow will have to support these less formal investment formats.