Making it possible to identify and include marginalized population groups in routine health information systems is a means of digital inclusion. Our study examined the question of How can health information systems be designed and implemented to enable the representation of marginalized population groups? Through a series of iterative quality improvement assessments (2016–2019) of the health information system in Lao PDR a number of substantial changes were made to the routine health information systems. In our analysis we use Zuboff’s notion of representation to illustrate how the development and implementation of a digital register in combination with the family information system enables digital representation of marginalized populations and communities. The impact of the changes implemented over the 4 years has addressed many challenges within the health information that enables representation. But we argue that addressing social exclusion requires more than representation.