By Rocío Bao
Arnaldo Medina is a doctor specializing in Public Health who holds the position of executive director at the El Cruce-Néstor Kirchner Hospital, which is part of a network of eight public hospitals in Florencio Varela that attends two million people every day.
Previously, he was the Director of Health Programs at the Office of the Undersecretary for Health Planning in the Ministry of Health of the Province of Buenos Aires. He has also been the executive director of the `Mi Pueblo Serious Case Hospital´ and the President of the Argentine Association of Health Economics.
As part of the debate “Perspectives on the Development and Incorporation of Healthcare Technologies” organized by the ISalud University, he spoke exclusively to E-Health Reporter Latin America to explain his stance on ICTs, the market in the country and the advances in complexity at the hospital he runs.
In what aspects do you think that the El Cruce-Néstor Kirchner Hospital meets the needs of high complexity care in the south of Gran Buenos Aires?
The hospital started to function at the beginning of 2008. Before it was built, patients with health problems that exceeded the capacity of second level hospitals had to go to La Plata or Capital Federal and many of them died during the transfer. Today, we have seen innumerable cases of people whose lives have been saved thanks to the professionals, equipment and political will to install these resources in one of the neediest areas of Buenos Aires Province and the country. I am convinced that the construction and running of this hospital is a great act of social justice.
In what phase is the Hospital in regarding the implementation of ICTs?
We have made many advances in the implementation of Information and Communication Technologies at the hospital. This is a digital hospital, a paperless hospital. We have an electronic health record, for example. This is a hospital in which technology is always present; we have 24 data recording information systems which are in the process of being integrated. The most recent one we implemented was the Patient Portal where hospital users can bring up their health records, appointment history, their next appointment and find useful advice without having to go to the health center. This portal functions with a code that the patient is given at the hospital after signing an informed consent agreement.
Have you made advances with regard to telemedicine?
We are making progress toward a monitoring program for chronic diseases. We have already started to use it with patients with congestive heart problems and we are planning to start with diabetic patients who we will contact periodically to detect any deterioration in the disease or to check that they are well and thus avoid their needing to go to the center.
What was the effect of the Director of the PAHO naming the hospital a model for the region and the hospital being named the fifth most important hospital in Latin America by the magazine América Economía?
Both honors have coincided with the hospital reaching maturity. We had a Strategic Plan for the first five years of the hospital that we were able to fulfill thanks to our professionals, commitment and support from the National Government through the National Ministry of Health. We have reached a moment of maturity under very favorable conditions for continued growth, consolidating our position as a leading health center in different areas of activity.
When Carissa Etienne –the director of PAHO– visited us she saw that the hospital is functioning optimally and thought that this experience needed to be shared with other countries, so we were invited to Washington to take part in the CUS (Universal Health Coverage) advisory council. In this context the mention in América Economía is an honor for all the workers but it also encourages us to fulfill the second Strategic Plan.
What does the second Strategic Plan involve?
We need to consolidate what we have achieved so far, the hospital network we belong to and make clear advances toward becoming a University Hospital thanks to the strategic alliance we have developed with the Arturo Jauretche National University.
On your blog you said that the new capabilities offered by ICTs have been a key factor in changing the paradigm that reigned in the 90’s, when technology was synonymous with increased costs in healthcare. How did ICTs specifically help to change this paradigm?
It has been shown across the world that ICTs do not just not affect health costs but to the contrary that they actually reduce costs in the mid to long term. Today networks are discarding the concept of competition between hospitals in favor of cooperation between health centers, integrating the work of, for example the Mi Pueblo, Evita Pueblo, Oller and the Cruce-Néstor Kirchner hospitals. In this regard, ICTs play a fundamental role. You can’t work in a network if you aren’t constantly connected and continuously exchanging information. This can’t be achieved today without the new Information and Communications Technologies. Without a doubt ICTs are here to stay and we must use them to provide better services to citizens.
Do you think that the El Cruce-Néstor Kirchner Hospital is the result of that change of paradigm?
Without a doubt the Hospital was born immersed in the new world where the technology boom has swamped both public and private lives. The network administration system, Clinical Government and Process Management that we have implemented are there to meet the needs of the population with a new vision based in the new paradigms of cooperation, integration, and use of technologies to improve the lives of communities.
At the round table debate organized by the ISalud University, you brought up the problem of the market in Argentina. To what do you attribute that problem?
I was mainly referring to a market problem with regard to issues of scale. We are still far from the market volume of other countries such as our neighbor Brazil. Furthermore, there is still a long way to go in the incorporation of ICTs in the organization of the health system itself. For example, we haven’t got very far in the incorporation of electronic health records and this aggravates the lack of transparency of information in these markets.
There is a lot of promotion, training and regulation that needs to be done so to make the market less asymmetrical and ensure that all the health services, potential users of these technologies, have the necessary capacity and information. In this regard, the efforts being made by HL7, for example, are important. The Hospital Italiano in Buenos Aires, and others, are playing a significant role in promoting interoperability standards for systems. The creation of Medical IT residencies at that institution is also a good move. It also emphasized the cultural problem with regard to investment, evaluation of technology and maintenance.
How, at a high complexity hospital, do you deal with these problems?
The cultural problem must be solved with a new culture. It’s not a simple solution and it can’t be implemented at a single establishment in a short period of time. There are very clear signals from public policy makers in this regard. For example, there is the “Argentina Connected” Program and the modernization of different areas of the State. This is also a problem being experienced in every sector of the health system, both public and private. A point in our favor is that health professionals in general and doctors in particular now see technology as an essential part of our profession.
