Santiago. In Latin America, trying to gain access to health systems when you fall ill is no joke. Although it includes both positive and negative aspects, in general health care is far from being the best in the world. This is not because healthcare professionals in this region are any less skilled than their European or Asian counterparts, in fact many countries, such as Cuba, have made great advances in medical knowledge in recent years.
But the fact is that in this area, as in many others, Latin America as a whole has fallen behind in terms of technological advances that result in accelerated development. For example, in Britain, the National Health Service (NHS), computerized its entire health system a number of years ago, meaning that patients attended in any health center in the country know that their personal data is available to the doctor who sees them, wherever they may be.
This is one of the several advantages of the British NHS, said Mariano Groiso, a computer engineer and head of South American Health Care at IBM, who took part in the European initiative and is now planning to repeat it within the region. In conversation with Aetecno, he explains health care information technology in more detail.
– Is medical technology in Latin America well-established or is it in its early phases?
– It is in its early phases. I’ve just spent 9 years working in London on the new computer system project for the NHS, which is a pioneering model for the rest of the world to follow. During my work on the project, I often traveled to Latin America to present the project to different countries in the region. What I’ve found is that the area is now growing very rapidly, but it is certainly in an earlier phase than the levels reached in Europe or the USA.
– But what do these levels mean? I understand that the NHS project is related to computerization of procedures but not advances in medical equipment…
– I’m speaking more about the information technology, not so much the medical equipment.
– So from the information technology perspective, does the fact that the region is in the early phases mean that medical information held in health centers is poorly coordinated?
– Yes, the disparity is significant. In Latin America some hospitals are computerized to a fairly high degree and others are not at all. The same disparities exist in cities and regions in Latin America. For example, some countries are implementing national programs, such as in Mexico where they are building a national clinical history project which will integrate both the public and private sectors, while other countries are working on regional projects, such as Brazil where each of the 27 states is putting together its own unique clinical history program whilst the Ministry of Health is trying to integrate them. Each country has its own particular characteristics.
– But in general terms, which country is making most effort to integrate new technology into their health care system?
– Chile is a very advanced country because the government is investing a lot in technology in this area. In many countries in South America, new technologies first arrive in the private sector, for example, in Colombia the top health institutions are becoming increasingly computerized but the government is rather lacking in this area, although a recent plan to improve this state of affairs is in progress. In contrast, in Chile, the health ministry has an IT plan with well-defined projects and an allocated budget which could be seen as a model for the rest of Latin America.
– In this sense, do you believe that moving on to the second phase depends more on governmental decisions than private ones?
– Essentially, the public sector is very important. In Britain, Tony Blair decided that this was how the public system was going to be, but this is what is lacking in Latin America: the political will across the different countries.
– What tangible benefits does this information technology model have to offer users and companies?
– Firstly and most importantly, is the benefit to customers and improvement in the quality of care. Here, technology will make the system more efficient and improve care, with appointments made more quickly and better quality assessment of cases and test results. Secondly it is also important to make administration more efficient to save on costs, be they incurred by governments, health insurance companies or private hospitals.
– What do you personally think it means for a country in the region to adopt an efficient administration model for health care? What areas should this involve?
– The most important thing is to prevent diseases and managing networks is a key aspect of this. Technology that combines clinical histories with primary and secondary health care is also very important. Long-distance diagnosis and telemedicine will be very important for Latin America’s development, especially in rural areas where there is always a lack of doctors. This will help to lower costs by diagnosing patients without their needing to travel or be transported. These are the most important factors.
– How can the security of patients’ personal data be ensured when they have one universal file available on any computer in any hospital?
– This is a very important and sensitive topic. In Britain, after the NHS project began the government had to approve a law stating that patients could choose whether they want to make their information available or not. Now, in countries where these projects are also being implemented it is very important that governments consider the issues surrounding confidentiality, which involve both legal and technological aspects.
– I ask you because this information can be used by insurers, pharmacies, etc. for their databases. Wouldn’t it be easy to create patient and group profiles with this information…?
– Yes, this information must be carefully protected. It can’t be passed on or sold. In every instance access is based on roles; it is granted according to the role the doctor plays (indicated by a personal identification number). They can only see the information if they can prove a legitimate relationship with the patient. This is all in the system.
– I imagine that the sale of this information is outlawed and punished in countries like Britain…
– Yes, there are very large fines for any breach of confidentiality, even more so as regards health care, which is governed by very strict contracts signed between the government and the technology provider companies.
– Are the problems associated with patients’ personal data protection a barrier to entry for this kind of technology in the region?
– There is always resistance, because obviously everyone has their own point of view. It goes against some people’s interests to have this information available on a network or a centralized database and there are also doctors who don’t like to change their procedures or the technology they’re already using. That is why it is very important to manage change properly in these projects. The process of winning people over is just as or even more important than the technological aspects.
