On 31 March 2022, WHO published Digital Documentation of COVID-19 Certificates: Test Result technical specifications and guidance document for countries and implementing partners on the technical requirements for issuing digital certificates for SARS-CoV-2 diagnostic test result. The full guidance can be found here. This document is the second of two guidance documents on digital documentation of COVID-19 related data of interest: vaccination status and test result.
Similar to the Digital Documentation of COVID-19 Certificates: Vaccination Status Technical Specifications and Implementation Guidance document, this guidance on test results aims to guide countries and technologist in how to develop or adopt digital systems in support of verifiable proof of test results for domestic and cross-border purpose. It provides technical specifications and implementation guidance that details
interoperability standards, facilitated by a common digital architecture, for a digitized test result certificate which can be used as proof of negative test results or proof of previous SARS-CoV-2 infection for international travel, or as a means for protection policies that reduce public health risk in public or private venues – in accordance with individual Member States’ public health policy and their risk-based approach to addressing COVID-19. Additional technical details to support the adoption of open standards for interoperability and approaches for implementing a DDCC:TR solution can be found in the WHO DDCC Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) implementation guide.
A SARS-CoV-2 diagnostic test result certificate can be purely digital (for example, stored in a smartphone application) and replace the need for a paper test result certificate; or it can be implemented as a digital augmentation of the traditional paper-based record. A digital certificate should never require individuals to have a smartphone or computer.
Future directions
Digital Documentation of COVID-19 Certificates’ (DDCC) specifications (for vaccination status and test results) set the foundations for secure personal health records based on the international patient summary standard. DDCC records contain the most important health and care information needed to demonstrate verifiable proof of vaccination and test results. As countries consider adopting personal health records including digital health wallets, the HL7 FHIR international patient summary standard (IPS) is at the foundation of the DDCC; serving as an expandable approach that will evolve with the needs of the individual, the public health policies, and the health system. The specifications are designed using the IPS and architected for future use, such as preparation for future pandemics.
DDCC provides an “umbrella” specification that can be used to generate multiple representations of a test result certificate or vaccination certificate. However, a global framework to enable convenient use and interoperability of these credentials between systems – while also allowing domestic autonomy over their use – does not exist and is critically needed. Under the current G20 Indonesian presidency, G20 countries are working together on a goal for a harmonized interoperable framework for COVID-19 certificates.
To enable the establishment of interoperable trust networks and allow for trusted exchange of COVID-19 certificates and other health data (e.g. routine immunization data, home-based records) consistent with IPS between systems, the WHO will convene, in collaboration with The Organization for Economic Cooperation and Development (OECD) and the Global Digital Health Partnership (GDHP), a technical consultation on interoperability between digital health trust networks for digital COVID-19 credentials. This technical consultation will inform the development of guidance and technical artifacts to address priority needs of Member States and regional networks that are implementing digital health trust networks for COVID-19. The focus of this consultation will be on the technical underpinning of trust networks, protocols for interoperability, and the health content (including core data sets and business rules).