Pedro Galván is an expert in technological transfer and is currently heading the technical coordination of the National Telemedicine System of the Ministry of Public Health and Social Wellbeing of Paraguay. In his role as a biomedical engineer, he has contributed to publications by the Pan-American Health Organization (PAHO/WHO) and worked in the Department of Medical Devices.
In conversation with E-Health Reporter Latin America he assesses the first stage of implementation of the interconnected health project, which will provide tele-electrocardiogram, tele-ultrasound, tele-cardiotocography and tele-tomogram services. He also shares his view of the benefits and challenges of creating a national telehealth system.
What are the distinctive aspects of the application software selected by Minsa to provide telemedicine services?
The application software for our National Telemedicine System (SNT) was developed specially by the Departamento de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción (UNA) and is adapted to the needs of local users and the requirements of the Ministry of Health. Other application software was discarded because of the cost of the licenses and because we started with a minimal implementation budget
The Minister of Public Health and Social Wellbeing, Antonio Barrios, stated that the project will reach everywhere with an internet connection. Will the system include rural areas?
The 18 Health Regions of the Ministry of Health have internet services at their hospitals. In 2014, during the first stage of implementation, the 20 most important district hospitals in Paraguay will be included. During said implementation, internet connections will be used with 2 Megabyte Broadband. So with the inclusion of all the regional centers, the supply of telemedicine services is guaranteed to the main hospitals in the Care Network.
It is estimated that in less than three months the telemedicine service will be running in the regional hospitals, when will the implementation process be finished?
Following the implementation schedule, the service has already been set up in three regional hospitals, with an average of three local hospitals a month. This year it will be implemented in every regional hospital and two district hospitals that are in strategic locations for the Ministry of Health. As this project is national in terms of coverage, each Health Region will initially have a service through its regional hospital. And then, in the second and third phases, the other health centers will be included.
How will the professionals in these hospitals be trained to use the system?
The training of users for the Telemedicine System will be carried out by demonstrations and practice of transmission of information led by doctors and technicians in the Telemedicine team. This will be supported with Tele-Training and e-learning tools such as Elluminate and Moodle, which are set up on the Health Ministry’s Telemedicine Platform.
At the end of December, pilot tests were run in the city of Fuerte Olimpo. What were the results?
At the Fuerte Olimpo Regional Hospital the teletraining mechanism was adjusted and we also tested the image transmission mechanism using compression tools to reduce the transfer time on lower internet bandwidth. In short, the methodology tested and approved was “store and forward” with excellent results for ultrasound and electrocardiograms.
When adopting new technologies, one of the greatest worries of the professionals and directors of medical centers is the provision of a secure service for patient privacy, what guarantees does the system have to offer?
All the ethical aspects; confidentiality, quality and security – such as information encryption, the use of access codes by hierarchical level, coding of patient IDs, etc. – are guaranteed by the Telemedicine Quality System, which will also be approved by European experts in telemedicine: this year, two evaluations will be carried out.
What other implementation phases will be undergone in the medium term?
In the second stage, which is planned for 2015, we expect to include health centers and important healthcare posts throughout the healthcare regions. This will be possible once the planned cost-usefulness and cost-effectiveness evaluations are carried. In the third stage we plan to include more than 1500 Family Health Units so that citizens from every community can have direct access to the Telemedicine System via a tablet.
What technological solutions is the Ministry working on?
The technological solutions being researched are: continuous tele-training of healthcare professionals nationally to support different events in a quality, organized manner; laboratory tele-diagnosis to connect all the public health laboratories to the network; tele-microscopy for cytology diagnosis; tele-care of elderly citizens to promote a healthy, productive and occupied old age; and a solution for tele-monitoring of patients during transfer by ambulance.
What are the political pros and cons when projects such as the SNT are proposed?
The Telemedicine Project is part of the Government Program and, as a consequence, it has the support of all the hierarchical levels. However, there is a threat: the paradigm of technological innovation and working habits in certain sectors in the health profession. In order to guarantee successful implementation, this paradigm should be overcome by contextualizing the tools developed. There are also interest groups that can be an obstacle to carrying out studies and using the system. But in conclusion, in spite of the overall positive politics, to ensure the success of the National Telemedicine System, other aspects will have to be evaluated such as technical-budgetary sustainability and empowerment of affected healthcare professionals.
