Hosting Infrastructure

Background

Hosting is a key element of the technological infrastructure requirement for the setup of a DAT. Reliability, speed, security, and the ability to scale up are some of the top considerations when choosing a hosting provider. Cloud-based hosting can often represents the best option meeting these criteria, combining the reliability of remote backup servers, the speed of dedicated hosting, the security of professionally-managed IT and the ability to provision additional resources as needed. However there are several considerations to be made in terms of data privacy and patient confidentiality that requires in-country hosting of data.

Goals

  • Understand the technology infrastructure required to set up digital adherence technologies

  • Be able to choose the appropriate infrastructure option for your country setting

 


 


Option 1: In-country global standard cloud hosted solutions

Where available, the best option is to host data in a cloud-based solution with in country servers. For example, there are global data centers such as Microsoft Azure, Amazon Web Services etc, that have server parks in many countries all over the world. Using this option, all of the benefits of industrial/corporate standards can be leveraged while still hosting data in country. The strong benefits are robust, proven, and otherwise maintained instances that institutions like banks, universities, government institutions, and private companies all rely on. They are dynamically scalable to handle variable loads, cost efficient, and require no additional personnel to maintain the infrastructure.


Option 2: In-country national standard cloud hosted solutions

Where globally dominant cloud hosted solutions are not available, the next option can be national data hosting centers – these would not often have the global robustness or demonstrated scalable global standard solutions, however they would come not only with data storage but also management software and Service Level Agreements for ensuring up time and maintenance throughout the project. Most governments have selected agencies, or providers, that are certified to host government data – i.e. where government websites or national banks would host their private and secure data.


Option 3: Hybrid data hosting, with private data in country and the adherence platform hosted separately

In countries which already have local data servers to host private patient data (e.g, eTB-Manager, DHIS2), the adherence data could be abstracted without any patient specific information and hosted on an international global cloud, with the remaining patient information stored locally. This hybrid model would allow the flexibility and robustness of cloud services, without hosting any patient-identifiable information outside of the country.


Option 4: In-country installation of servers and data infrastructure

Where all the above options do not exist, a newly installed on-premises server installation could host the platform and the data. This option would require the procurement of hardware and software locally to store the data, and run the necessary software processes to collate adherence information from all sources and serve the web platform that accesses the data for programmatic registration and monitoring of patients. Beyond procurement, this option also requires on-site support to host/monitor the servers and ensure up-time and maintenance. It is noteworthy to mention that locally hosted server must be physically secured to protect against theft, damage, power outages and hacking.  Security protocols (e.g., encryption, not sharing passwords, etc.) must also be implemented to ensure data security.


Country examples (Philippines to be added)

  • Technical issues (Internet connectivity, issues on SureAdhere platform, mobile phone data storage limitations, slow downloading time for videos)


Tools and resources