Information and communication technology (ICT) infrastructure includes core IT technologies like networks, servers, software, and human resources, which are supported by the relevant standards, methods, directives, and frameworks. Countries most commonly address this dimension of the DT. It encompasses devices (computers, servers, personal digital assistants, tablets, smart phones) and people who administrate and operate the ICT.₁ In the health sector, this dimension includes medical technology like biomedical monitors, diagnostic imaging equipment, and other technologies.

ICT devices are connected via different network topologies.² These interconnections act as an organized whole and allow users to send, receive, and share data, voice, video, and messages, while also connecting them to the Internet.

The starting point for defining and structuring the digital health infrastructure has to be the country’s health system model, as this will determine the type of architecture and connectivity needed to support the ecosystem. Connectivity and architecture plans therefore must take into account and incorporate the specific characteristics of the health ecosystem, where multiple health promoters and providers and users constantly interact, generating an ever-larger quantity of data.

To be more specific, an information system’s architecture shows its functions at the hardware and software level, as well as how it interrelates with other components, bodies and institutions, the health system, and users. Meanwhile, integrated health service delivery networks are often made up of different establishments (hospitals, primary care centers, specialty centers, and others) located in different geographical areas.

For example, each establishment generates health data from its different activities. Depending on the architecture used,³ this data can be safeguarded in different ways. It can be centralized within the organization or distributed among different establishments, or even according to rules based on the data’s characteristics like use, useful life, size, or geographic distribution.

Meanwhile, exchanging data—at the national or regional level or even within a single organization—presents different challenges that impact each government’s information system architecture. However, models for exchanging data in a healthcare ecosystem loosely fall into three general categories.

Today, many health and government organizations evaluate and plan their architectures based on cloud computing, a technology that allows users to remotely access software, store files, and process data online from anywhere and at any time, without having to connect to a PC or local server. There are currently 3 dominant models:

• SAAS:⁴Software as a Service
• IAAS:⁵ Infrastructure as a Service
• PAAS:⁶ Platform as a Service

Past steps a country has taken to build its infrastructure are often a deciding factor for which architecture it will use because it is not easy to quickly switch to a different system architecture. In these cases, system designers need to identify infrastructure needs and gaps in the existing architecture to design systems based on the health service delivery model.

Each country should find its own health infrastructure solution to match its specific reality. Some, like Finland and Estonia, use centralized storage and systems. Others, like Israel, use completely decentralized storage and a hybrid architecture. Some do not even have infrastructure for exchanging information and data on a national level. In LAC, for example, Peru has a centralized database in its digital health architecture for its clinical content, while Uruguay has a hybrid model where each organization has its own systems and controls its own data.

The infrastructure for digital health should have a well-defined architecture in order to use resources efficiently. It also requires coordination between actors outside of the health sector, like ministries of innovation or communications, to make sure basic investments are made where health services have the greatest needs. While this is a complex task, a proper governance scheme makes it easier.