Health Domains
The architecture layers described elsewhere in this knowledge base are generic. This section covers what changes when they meet a specific health domain: which data is created, which workflows cross organisational boundaries, and which architectural properties become non-negotiable.
Clinical architecture concerns
Common across domains, and worth establishing once:
| Concern | Architectural implication |
|---|---|
| Clinical workflow | Every organisational handoff is an integration requirement. Model workflows before designing exchange — see enterprise architecture. |
| Order entry and results | An order and its result are a matched pair across systems; orphaned results are a permanent operational burden. Correlation identifiers are essential. |
| Medication management | Prescribing, dispensing and administration are three distinct events in three systems. Reconciling them requires a shared drug terminology. |
| Referral and care coordination | The referral must carry enough clinical context to be useful, and the loop must close — an unacknowledged referral is a lost patient. |
| Appointments and recall | Scheduling logic is guideline-derived (see SMART Guidelines) and drives the messaging layer. |
| Clinical decision support | Belongs in a decision service consuming computable guidelines, not embedded in each application. |
| Chronic disease | Requires longitudinal identity and an explicit episode-of-care concept. |
| Emergency care | The one context where break-glass access is genuinely needed, and where a patient summary earns its cost. |
| Mental health | Frequently subject to additional confidentiality rules; category-based access control is a hard requirement, not a refinement. |
The domains
Maternal and child health
Longitudinal by nature: a pregnancy is an episode spanning months, several facilities and often a community health worker. The domain where continuity, scheduling and referral architecture are most visibly load-bearing.
Community health
Care delivered outside facilities, by workers who may be volunteers, on devices that are frequently offline. Household registration, task management, referral and supervision.
Offline-first architecture
The cross-cutting technical response to intermittent connectivity: local stores of record, synchronisation, conflict resolution. Relevant to community health, rural facilities, outreach and disaster response.
Public health surveillance
Detecting and responding to disease events. Indicator-based and event-based surveillance, case reporting, outbreak management, and the laboratory link.
Health supply chain
Product catalogue, stock, distribution, cold chain, and the interoperability between logistics and clinical systems that makes consumption-based forecasting possible.
Health financing
Eligibility, claims, provider payment, and the boundary between the clinical record and the billing record.
Domains not yet covered here
Written honestly rather than filled with thin pages. These are gaps, and are listed in the maturity of this knowledge base:
- Laboratory information systems and the order–result cycle in depth
- Radiology and pathology workflow beyond DICOM
- Pharmacy and medication management architecture
- Immunisation registries and campaign management
- Telemedicine and remote consultation
- Nutrition and growth monitoring
- Non-communicable disease programmes
- Health workforce systems beyond the registry
- Emergency medical services and pre-hospital care
Contributions on any of these are welcome, subject to the same sourcing rules as the rest of the knowledge base.
References
- WHO Classification of Digital Health Interventions — https://www.who.int/publications/i/item/9789240081949
- WHO SMART Guidelines — https://www.who.int/teams/digital-health-and-innovation/smart-guidelines
- OpenHIE architecture — https://ohie.org/