The Federación Médica del Interior, (Interior Medical Federation; FEMI), a second grade medical organization made up of union and medical service institutions from around the country, provides care for around 680,000 people through its member institutions. Three years ago, with 50 percent financing from the Inter-American Development Bank, via FOMIN, and the other 50 percent of the finance coming from its union institutions, it embarked upon an ambitious healthcare system reform project which has now been implemented in two institutions and links 9 cities via the introduction of teleconferencing and Balanced Scorecard systems.
To date, investment in the project is calculated to have reached three million dollars, which has gone towards establishing a centralized project architecture in Montevideo, where new tools can be replicated and then implemented in the 23 affiliated medical institutions. The ultimate goals have not yet been achieved, but the experience has already seen the modernization of two important health centers: the Sanitorio Americano and CAMEC. The project head, Doctor Alvaro Vero Suaya, spoke to us about the key aspects of the project’s “slow but sure” approach to success.
EHealth Reporter Latin America: Three years in, how would you assess the progress of FEMI’s digital healthcare project?
Alvaro Vero Suaya: We now have functioning Balanced Scorecard and teleconferencing systems which connect 9 capitals, providing them with access to academic expertise and medical inter-consultation. Clinical histories will be implemented in two years in the Sanatorio Americano and then in the other institutions at the beginning of the following year.
EHRLA: What challenges have you encountered?
AVS: There are many. We are essentially carrying out a structural change in medical practice, and this involves costs which do not have immediate payoffs. Very few people on the medical staff are trained in computing, and while there are a large number of computer technicians out there, very few specialize in medical information technology. It can often be frustrating. This is a path we know we must approach with great optimism, learning as we go about the best ways to manage the change.
EHRLA: Are you referring to more than purely technical difficulties?
AVS: Of course. That’s why, among the many consultants we have working on the project, we have consultants who specialize in change management. We seek to emphasize the virtues of modernization and to demonstrate that it is impossible to go on providing medical information without the help of information technology. Healthcare and economic studies by international organizations show that today, Internet connectivity is a social indicator which can have a profound effect on fundamental human rights. This is interesting, because we implement information technologies to improve the way our system is managed and end up finding that these technologies actually favor social equality. The process is inevitable but slow enough that we can get frustrated and have to start over several times a day.
EHRLA: How do you keep up your optimism?
AVS: There are always examples which show us that we are on the right course. One is the Hospital Italiano in Buenos Aires, who have been something of a godparent for us in the way that they have warned us about the difficulties that we were going to face and helped us to decide the right paths to take. Another is the Hospital de la Universidad de Chile, which is implementing a similar project to ours, also financed by the IDB. When we look at other countries it becomes clear that this is the only way. Computerization, especially the possibility of accessing a clinical history anywhere, gives the patient a security and quality of care to which they would otherwise not have access, and also benefits administration activities.
EHRLA: Do you think that the implementation of new technologies is actually going to result in lower costs for the health system rather than increasing them?
AVS: European accounts calculate the cost of computerization of medical institutions at between 2 and 4 percent of the budget. The cost may be high but the fact is that it has become impossible to practice medicine without the help of this technology. All the sectors involved in health need it: the doctor, the administrator, the nurse, the person working in admissions, the pharmacy and also the companies, many of them multinationals, who will all have to determine what is in healthcare’s best interest and also do everything possible to keep costs accessible to Southern Cone systems where money is usually quite scarce. The issues surrounding budgeting and financing are constrictions we can’t escape.
ABOUT THE PROJECT
The project is being implemented by Geocom Uruguay. To date it has already completed the implementation of the Electronic Clinical History (ECH), a component of the GEOSalud system, in 2 institutions: CAMEC (Rosario) and Sanatorio Americano (Montevideo); and will shortly do the same in 3 other institutions in the Federation. Its long term objective is to apply this system to all 23 FEMI institutions. The project is financed by FOMIN (Multilateral Investment Funds) a member of the IDB Group, and involved an International Public Tender, which awarded 4 lots to Geocom. The implementation of the Electronic Clinical History will make it possible for institutions to share and use information, based on a federated working model, applying technology to HL7 (Health Level 7) standards. These are the first projects to use this technology in Uruguay. The objective is to ensure that the DIGITAL HEALTH project and especially the Electronic Clinical History (ECH) system provide the foundations for national and international recognition of FEMI as a grouping of Uruguayan medical institutions which uses IT in effective, individual and collective ways. To do this three main goals must be achieved:
1. Improving patient safety and satisfaction; via the application of the latest innovations in patient focused health processes, ensuring that the necessary medical information is available and that clinical information is exchanged formally and properly during consults and referrals.
2. Achieving a high grade of efficiency via the proper registration and monitoring of supplies, obtaining real time management indicators for cost control, coordination and auditing of activity throughout the FEMI System.
3. Improving security and legal support for professionals by using coding standards to record information on all health events in the Emergency and Outpatients departments and subsequent treatment courses, providing details on the medical action taken and thus facilitating corrective activity in the processes involved, and the gathering of information related to Healthcare Programs and Goals both for both evaluation and report purposes.
Further information is available at: FEMI and FEMI SALUD DIGITAL
