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published by the India G20 Presidency and UNDP offers a practical roadmap for countries to design, implement, and sustain inclusive, interoperable digital systems. It outlines how DPI can accelerate national progress toward the Sustainable Development Goals (SDGs), including health equity.

Key Takeaways:

1. This UNDP playbook outlines how core infrastructure (such as digital ID, payments, and consent-based data sharing) can be unbundled and repurposed across sectors to strengthen health systems.
2. DPI implementation demands a shift from closed, siloed systems to open, interoperable ecosystems. Doing so enables integration across health services, reduces duplication, and empowers users with secure, portable digital credentials.
3. A structured, scoping assessment aligns DPI with national priorities, helping countries map gaps in service delivery and determine where shared digital systems can most effectively support UN SDGs. Sustainable DPI requires robust governance, open-source technology, and diverse financing. Countries like India and Estonia demonstrate how layered public-private architectures can support scale, protect rights, and remain adaptable over time.

outlines how open standards, technologies, architectures, and content (STAC) can drive resilient, country-led digital health transformation. The authors present the full-STAC approach as a remedy to fragmented digital health systems. 

Key Takeaways:

1. The full-STAC approach promotes digital sovereignty by advocating for public investment in open infrastructure, ecosystem governance, and modular design. Doing so helps shift countries from using digital health technologies constrained by vendor lock-in to locally adaptable, standards-based digital health ecosystems.
2. Open Standards define how data are structured and exchanged so that different systems can communicate seamlessly. Open Technologies are open-source infrastructure and tools that enable the collection, storage, and use of health data in line with these standards. Open Architectures provide reusable blueprints for connecting system components like registries and services. Open Content consists of validated guidelines, protocols, and workflows that drive consistent clinical and public health decision-making.
3. Currently being piloted across multiple countries, this framework guides countries in developing national digital health strategies, building core registries and application programming interfaces, and promoting sustainable financing aligned with country-owned digital development roadmaps.

Drawing from MHI’s analysis of various country’s experiences implementing digital health interoperability, outlines a context-driven and flexible strategy to build digital health systems. Such systems will meet countries at their technical, financial, and political levels to enable inclusive and sustainable digital transformation.

Key Takeaways:

1. Interoperability is key for building efficient, resilient health systems by enabling secure, seamless data exchange across platforms and institutions. When implemented effectively, it supports key health system goals by reducing fragmentation, improving care coordination, and minimizing administrative burden. In Canada, early estimates from 2018 suggested that full adoption of interoperability could generate annual healthcare savings of approximately CA $4 billion (US $3 billion), about 1.6% of total healthcare spending – through fewer duplicate tests, reduced hospitalizations, and greater administrative efficiency. However, actual savings and impact vary widely depending on the context and quality of implementation. More recent research is likely needed to assess the current cost-saving potential of interoperable systems.
2. Unlocking the benefits of interoperability requires countries to make strategic design choices that extend beyond technical architecture. Research identified three key components – strategic approach, architectural and technical design, and user engagement—broken down into seven key design dimensions. These include decisions on i) governance and operating model, ii) timing and phasing, iii) financing, iv) architecture, data, and infrastructure, v) identification mechanism, vi) adoption, and vii) capability-building.
3. Some key design dimensions are heavily context-specific and shape a country’s interoperability approach. For example, Canada’s decentralized province-led governance model influences funding, architecture, and the adoption of interoperable tools; Tanzania’s financing model that supplements government funding with donor resources has driven its focus on prioritized use cases and open-source principles; and Estonia's more established architecture and infrastructure, including its national e-ID and the X-Road interoperability layer, has guided its architectural and strategic decisions.
4. The research identified common challenges in building interoperable health systems and ways countries have addressed them. Governance inefficiencies often occur, but centralized leadership—as with Estonia’s TEHIK (Estonia’s Health and Welfare Information Systems Center)—can streamline decision-making and accelerate interoperability. Financing constraints, especially in less centralized settings, may be addressed by phasing implementation around high-value use cases to build stakeholder support. Harmonizing data standards often involves balancing international standards with national customization to ensure cost-effective and practical implementation. Low provider adoption can be tackled through various policy tools and incentives, such as Tanzania’s data-sharing mandates or Estonia’s IT subsidies. Finally, early investments in human and technical capacity, like Ontario Health’s clinician-led onboarding in Canada and Estonia’s train-the-trainer programs, can support the adoption of tools dependent on interoperability infrastructure or standards.

provides countries with detailed technical guidance on how to design and implement a Digital Health Platform (DHP), the underlying information architecture supporting robust and interoperable digital health systems.  

Key Takeaways:

1. When designing a DHP, it is important to assess existing digital maturity, stakeholder landscape, governance structures, and key health priorities before platform development. Country-specific gap assessments are essential for informing system alignment and planning. Design principles include user-centeredness, privacy-by-design, and alignment with digital public goods.
2. Key components of the DHP architecture are catalogued in detail, including registries, user management, and other data security services, analytics, terminology services, and shared data repositories such as a health record. It supports standards-based data exchange (e.g., HL7® FHIR), modularity, reusability, scalability, and emphasizes open-source tools.
3. The importance of national leadership, stakeholder coordination, phased roll-out, continuous monitoring, and sustainability planning are underscored. Tools and frameworks are provided to support deployment, evaluation, and long-term integration across health programs.

In countries with emerging digital health maturity like Rwanda, digital health systems often comprise a mix of locally-developed and donor-supported interventions, frequently built on open-source platforms like DHIS2. These implementations offer valuable lessons about the foundational, developmental, and scaling requirements for effective digital health adoption. Rwanda’s journey—from early systems such as TracNet, OpenMRS, and RapidPro to more centralized electronic medical record systems (e.g., eBuzima, eFiche, and Medisoft)—reflects a broader shift from standalone electronic registries and trackers toward integrated, interoperable electronic health record systems that support continuity of data and care. 

In digitally-mature countries like Finland, the shift from paper-based systems to electronic health records began in 1994 with its first national digital health strategy. By the early 2000s, various electronic health and patient record system designs were piloted across health centers and hospitals. In 2002, an initiative to promote nationwide interoperability led to the 2007 establishment of the national HIE layer known as Kanta. As Kanta has expanded, healthcare startups and innovators are increasingly using Kanta’s sandbox environment to test the interoperability of new digital health applications (e.g., BeeHealthy, the mobile digital health platform launched by Mehiläinen, one of the largest private healthcare providers in Finland). 

The Ayushman Bharat Digital Mission (ABDM), the public health program leading India’s digital health transformation efforts, developed the National Digital Health Blueprint to guide the development of a unified digital infrastructure aligned with national health priorities, prioritizing interoperability in its design. Clear governance structures, particularly the National Health Authority, play a central role in overseeing and implementing the ABDM across Indian states, ensuring coordination and accountability at the national level.

Strong national programs and governance have been central to Brazil’s digital health transformation, including the development of its national health information exchange, the HIE layer, RNDS. The creation of SEIDIGI, the digital health governance body within the Ministry, has been pivotal in advancing digital health transformation. Most notably, the launch of the SUS Digital program in 2024 assists municipalities and states with improving their digital health infrastructure and capacity.

The successful implementation of Kanta (Finland’s HIE) has been driven by strong government investment, legislation mandating EHR compliance across the public and private sectors, and targeted support for workforce training—particularly in smaller healthcare organizations. Capacity-building efforts include online webinars and peer mentoring for both providers and patients. Furthermore, universities and research institutions play a key role in evaluating user experience through national eHealth surveys and leveraging Kanta data for research to support the secondary use of health data. 

The journey toward mature digital systems starts with the development of key paper and digital foundational building blocks—such as unique health IDs, digital payment systems, and national health registries. ALL Exemplar countries have implemented unique patient identifiers as well as built health facility and/or provider registries as outlined below. 

• Rwanda: The National Identification Number serves as a unique identifier linking individuals’ health data with civil registration and vital statistics. It also enables citizens to access a range of public services—such as health insurance, birth certificates, and marriage licenses—through the national eGovernment platform, Irembo.
• India: The ABDM ecosystem builds on existing digital public infrastructure in India, which includes JanDhan bank accounts, AADHAAR (national citizen identifier), and mobile connectivity. This ecosystem seeks to build unique health IDs, health professional registries, and facility registries, which can be used to identify unique clients and exchange health data across facilities.
• Finland: Finland’s national patient identity number (henkilötunnus), established in the 1960s, enables the seamless exchange of patient data across electronic health records. The national healthcare professional register, introduced in the 1990s, provides a system for verifying the registration status of healthcare and social welfare professionals. 

In the early phases of digital health maturation, digitization may be limited to district-level data aggregation and reporting systems, used primarily for health reporting, planning, and decision-making to support aggregate data analytics and visibility at the national level. 

• Rwanda and Ghana: Both countries use centralized Health Management Information Systems (HMIS) built on the DHIS2 platform to collect, aggregate, and analyze health data. These systems operate at the national and district levels, respectively, and are designed to support evidence-based planning, service delivery, and monitoring. They require relatively lower infrastructure and training, and are primarily used by national health authorities to manage data from health facilities across the country.
• India: The National Health Mission - Health Management Information System (NHM-HMIS) portal in India collects data from over 225,000 health facilities which is aggregated and used at the sub-district, district, state and national levels. HMIS captures facility-level service delivery and infrastructure data to conduct gap analysis and support evidence-based planning.
• Brazil: Similarly, there are many national-level health information systems that aggregate data from the subnational levels. One example is the aggregation of PHC facility data into SISAB, Brazil’s national PHC-focused health information system. These data generate key performance indicators of PHC, which are used to inform evidence-based planning and decision making as well as financing to municipalities.
• Finland: Before the launch of Kanta (HIE), regional health information exchange (RHIE) systems were introduced in the 2000s to replace paper-based methods and facilitate data sharing within regions. The success of these regional and national data exchanges was enabled by Finland’s decades-long use of national health registers (e.g., vaccination and primary care registers), and more recently, clinical quality registers (e.g., diabetes data quality register) introduced in 2018. Using these registers–a key digital health architecture component–enabled the systematic monitoring of healthcare quality as standardized data were transformed into insights on outcomes and interventions.

As the enabling environment for digital health transformation strengthens, digitization extends beyond centralized, aggregated systems to encompass health facilities and community-based services. In more digitally advanced settings, the development of a health information exchange (HIE)—supported by unique patient identifiers, health registries, standardized data policies, and strengthened provider capacity—further accelerates progress. These elements enhance data exchange, improve access to health information, and promote continuity of care. Collectively, they bring health systems closer to the ultimate goal: empowering individuals with access to their own health data.

• Rwanda: Epi-Tracker, Rwanda’s electronic immunization registry, uses DHIS2 software to collect, aggregate, and integrate data within its HMIS. Unique birth ID numbers enable integration with the existing Civil Registration and Vital Statistics system.
• India: NextGen eHospital is a cloud-based EHR that serves as a centralized, longitudinal digital repository of patient information. The system integrates 12 modules that cover key hospital workflows, including outpatient and inpatient departments, billing, laboratory, radiology, and pharmacy. NextGen eHospital supports AI-enabled clinical decision support and tele-radiology, adhering to global health data standards such as FHIR, DICOM, LOINC, SNOMED CT, and ICD-10.
• Brazil: As part of the e-SUS APS strategy—which digitized PHC care coordination and provided a freely available EHR for municipalities to adopt amongst public facilities,PHC EHR data are integrated into the national HIE (RNDS) through use of informational models, leveraging FHIR-based APIs and requisite standards (i.e., ICD-10, SNOMED).
• Finland: The Kanta Patient Data Repository is a centralized system that stores and manages patient data—such as medical records, prescriptions, and lab results—from multiple EHR systems. Its Prescription Services component handles all prescription data and renewals, with 100% of Finnish pharmacies using the ePrescription system. Supported by national coding standards, FHIR-based APIs, and clinical terminologies, Kanta ensures seamless health information exchange across all public and private healthcare providers, even during care transitions. Finland’s early adoption and continual adaptation of international standards such as HL7® FHIR and ICD-10 have also been critical to advancing interoperability across levels of care and health services.

Patient access to their health information is often the ultimate goal of a country’s HIE—not only to foster transparency, trust, and continuity of care across providers and settings, but also to empower individuals to actively manage their health.

• Brazil: MeuSUSDigital (or MySUSDigital) is a patient, provider, and manager-facing application that facilitates access to health information. Initially launched in 2020, it pulls relevant information from across the health system through RNDS, the HIE layer. Health information exchanged by RNDS currently includes clinical history, vaccination data and certificates, test results, medications, position in transplant queues, among others. There are efforts underway to expand what is integrated into RNDS as well as what is accessible on MeuSUSDigital.
• Finland: MyKanta Pages is a patient-accessible platform built in 2010 to provide a detailed summary of a person’s prescription data, lab results, medical procedures and diagnoses, imaging studies, and vaccinations. Finland is also currently updating the Kanta Personal Health Record, to enable patient-side input and management of their personal health data, and to link to client-facing health and well-being apps. Sandbox testing environments support the integration of any new digital health tools with Kanta, subject to compliance with Kanta specifications.