Design of a Trustworthy Cloud-Native National Digital Health Information Infrastructure for Secure Data Management and Use

• Published in: Oxford open digital health 2024-01, Vol.2
• Main Authors: Zao, John Kar-Kin, Wu, Joseph Tsung-Shu, Kanyimbo, Kennedy, Delizy, Florian, Gan, Tchin-Tze, Kuo, Hung-I, Hsia, Chih-Hao, Lo, Chuan-Hsi, Yang, Shang-Hui, Richard, Clément Jean Alexandre, Rajab, Billy, Monawe, Maganizo, Kamanga, Blessings, Mtambalika, Nikotelhe, Yu, Kwong-Leung Joseph, Chou, Chih-Feng, Neoh, Choo-Aun, Gallagher, Joseph, O'Donoghue, John, Mtegha, Rebecca, Lee, Hsin-Yi, Mbewe, Alinafe
• Format: Article
• Language: English
• ISSN: 2754-4591; 2754-4591
• DOI: 10.1093/oodh/oqae043

Since 2022, Malawi Ministry of Health (MoH) designated the development of a National Digital Health Information System (NDHIS) as one of the most important pillars of its national health strategy. This system is built upon a distributed computing infrastructure employing the following state-of-art technologies: (i) digital healthcare devices to capture medical data; (ii) Kubernetes-based Cloud-Native Computing architecture to simplify system management and service deployment; (iii) Zero-Trust Secure Communication to protect confidentiality, integrity and access rights of medical data transported over the Internet; (iv) Trusted Computing to allow medical data to be processed by certified software without compromising data privacy and sovereignty. Trustworthiness, including reliability, security, privacy and business integrity, of this system was ensured by a peer-to-peer network of trusted medical information guards deployed as the gatekeepers of the computing facility on this system. This NDHIS can facilitate Malawi to attain universal health coverage by 2030 through its scalability and operation efficiency. It shall improve medical data quality and security by adopting a paperless approach. It will also enable MoH to offer data rental services to healthcare researchers and AI model developers around the world. This project is spearheaded by the Digital Health Division (DHD) under MoH. The trustworthy computing infrastructure was designed by a taskforce assembled by the DHD in collaboration with Luke International in Norway, and a consortium of hardware and software solution providers in Taiwan. A prototype that can connect community clinics with a district hospital has been tested at Taiwan Pingtung Christian Hospital.