As part of the ExpoHospital 2015 congress, held between July 22 and 24 in Chile, a Hospital Moderno module was organized, featuring a technical program of talks about healthcare technology solutions.
Professionals related to the eHealth industry from Chile and Uruguay shared their experiences and spoke about the needs of the sector.
Making progress toward the single Electronic Health Record
The situation in Chile
The informatics engineer René Prieto, an independent consultant and the former CIO of the Ministry of Health (MINSA) of Chile, spoke about electronic health records and emphasized the need to change the healthcare system to a more collaborative model with a focus on patient care. The engineer also spoke about the fragmentation of healthcare services and emphasized how disintegration increases costs and requires more administration. To finish, Prieto spoke about the need to focus on prevention and make patients more participative in their own healthcare.
Meanwhile, Rodrigo Castro, Head of the ICT Sector Management Department (DGST) at MINSA, commented that almost seventy percent of hospitals are implementing the electronic health record in outpatient and emergency departments and outlined the objectives of the office with regard to information systems:
• Single data storage area
• Connected health
• Individual traceability
• Online health record
• Decision making support
Next to speak was Amir Samary, Senior Sales Engineer for InterSystems Chile. His speech was about Integrating the Healthcare Enterprise (IHE), a non-profit international initiative being run by healthcare businesses and professionals. The objective of IHE is to improve communication between different healthcare information systems and to promote the coordinated adoption of international standards to achieve interoperability.
Samary stated that there are three different ways of implementing electronic health records:
1. A single EHR for the entire country
2. An ECR per establishment
3. An integral EHR for the health service
After analyzing the advantages and disadvantages of each he proposed a fourth option: a connected healthcare community, i.e. a care network that works with a single electronic health record and a minimum combination of EHR and ECR systems. This alternative would also occupy an IHE infrastructure for storing local and national clinical documents to provide clinical information for different purposes such as the exchange of clinical overviews between different communities and the generation of statistical information.
“It is key to have regional leadership that supports a connected healthcare strategy and establishes a state policy with clear parameters and financing,” Samary concluded.
The Uruguayan Experience
Pablo Orefice, an engineer and coordinator of the National Electronic Healthcare Project (HCEN) in Uruguay, shared his country’s experience and explained the chosen strategy:
• Meet the needs of the providers that already have projects underway
• Define the rules for technological and semantic interoperability
• Implement pilot applications to test the concept of transversal systems
• Generate the central infrastructure
• Expand to a national level
In addition, Orefice said that they set certain goals such as achieving a unified EHR model with single catalogues, medical terminology standards, interoperability standards and a master index of patients. In fact, he said, once these aspects were established, a pilot test was carried out in September 2014 in the oncology sector.
With regard to security, Orefice explained that the HCEN is not software but that all the information is stored on the Healthcare platform of salud.uy in the presidential datacenter to ensure the confidentiality of the data.
The engineer also illustrated the experience in numbers. Today, in Uruguay, 26 per cent of those affiliated with comprehensive healthcare providers are entered into the EHR. Additionally, six out of ten healthcare providers have implemented an EHR system and five per cent of healthcare establishments have fully digitalized records.
It is important to bear in mind that Uruguay is adopting a five phase plan whose objective is to achieve eighty per cent coverage by 2018.
To finish his speech, Orefice emphasized the importance of continuing with the RACSEL project (American Network of Electronic Healthcare Cooperation) which is financed by the IDB and run by the Uruguayan Julio Ricaldoni Foundation, whose goal is to develop the EHR in Latin America and the Caribbean in three years.
“The countries in the region are progressing at different speeds with EHR without a systematic mechanism to share experiences and solutions,” the engineer said. To finish, he called on his colleagues to take part in south-south cooperation and triangulate with their colleagues in the region.
Digital Hospital, two sides of the same coin
Felix Bendezú, Manager of the Healthcare Division at AQuanta, led a panel entitled “Reducing the breach in timely treatment in healthcare; critical convergent factors in the application of ICTs for remote diagnosis.”
According to Bendezú, the breach occurs in three areas:
• In the healthcare sector, due to the lack of specialists, economic conditions and regulations that enforce ICT solutions and the intelligent use of quality information.
• In the ICT sector, due to a lack of access to communications networks, integration of solutions by different actors and availability of information.
• In general, due to a lack of methodology that takes doctors and administrators into account and that complements ICT solutions with administrative processes and protocols.
Informatization of Care Networks: an assessment
Diddier de Saint Pierre, a civil computation engineer; Gabriela Lissi, who runs the Strategic Project Administration Unit in the DGST at MINSA; Gissela Meier, head of the project’s ICT department; and the Coordinator Alicia Lozano spoke about the Chilean initiative SIDRA (Healthcare Network Information Systems).
The presentation focused on SIDRA’s involvement in the care network in Talcahuano, where the following modules were implemented:
• Agenda, which makes it possible to monitor the performance of each professional, to optimize the available places, automate the appointment system and generate statistics.
• Reference-counter-reference which automates the referral map and monitors the fulfillment of referral protocols, recording their relevance.
• Electronic Clinical Record, which allows information to be shared between teams at primary and secondary level, integrating diagnostics systems and allowing the delivery of medicines to patients.
• Provision of prescriptions, reducing errors in interpretation of prescriptions, monitoring expiry dates, improving stock checking and automating orders and transfers between warehouses.
• Emergency, which makes it possible to calculate the total number of patients, the drugs used, frequent pathologies, waiting times and automatic patient categorization.
• Recording of test referrals, facilitating clinical management and laboratory scheduling and allowing for a clear view of results.
• Archive, which provides automated control of delivery of clinical records, speeds up health record requests and monitors the status of records and their destination.
According to the speakers, the next modules to be developed are the regional health record and real time network indicators. To finish, the representatives of the Chilean Health Ministry listed the government’s goals between now and 2018:
1. Consolidating the implementation of outpatient care
2. Automating emergency room records in hospitals in the region
3. Facilitating the generation of reports and statistics
4. Working on the quality of records
5. REM Automatic receipt of EHRs
6. Implementing updated versions of the system
7. Scheduling specific workshops in implemented areas
Technology at the service of rehabilitation
The final theme of the Modern Hospital was focused on rehabilitation processes supported by technology. Doctor Ricardo Eckardt, for example, described how different tools are of great use for this medical specialty – such as orthotics, prosthetics, robotics, exoskeletons, neural prostheses and three dimensional printing. He also said that tele-rehabilitation is currently the hottest topic.
