E-Health in Latin America & Caribbean

e-HEALTH IN LATIN AMERICAN
AND THE CARIBBEAN

Roberto J. Rodrigues
eHealthStrategies, Bethesda, MD
Former Regional Advisor on Health Information and Communication Technologies

Pan American Health Organization / World Health Organization
Washington, D.C.
International Conference on Urban Health, Baltimore - Oct 31, 2007

E-HEALTH DEVELOPMENT ISSUES IN LA&C
• DRIVING FORCES AND TRENDS
• TECHNOLOGY
• SECTORAL ORGANIZATION/OPERATION
• WHERE ARE WE?
International Conference on Urban Health

Baltimore, October 31, 2007
• TECHNOLOGY
• HEALTH SECTOR ASPECTS
• WHERE ARE WE?

HEALTH SECTOR IN LATIN AMERICA & THE CARIBBEAN
● 6-17% OF SERVICE SECTOR (50-65% OF ECONOMY)

● 9% GLOBAL HEALTH MARKET ( > E.EUROPE+ASIA)
● 80% URBANIZATION / LARGE URBAN AREAS
● CHANGING DEMOGRAPHICS/EPIDEMIOLOGICAL PROFILE
● KNOW-DO GAP
● TECHNOLOGICAL INNOVATION IMPACT IN COSTS
● W. EUROPE BIOMEDICAL / SOCIAL SECURITY MODELS
● VARIETY OF REIMBURSEMENT MODELS
● HEALTH SECTOR REFORM

CHALLENGES FACED BY LA&C HEALTHCARE SECTOR (1)
● DISSATISFACTION WITH HEALTH SYSTEM

(COVERAGE, ACCESS, QUALITY, CHOICE)
● CONTINUITY OF THE PROVIDER/CLIENT RELATIONSHIP
● PROVIDER ACCESS TO PATIENT DATA AND CARE EVENTS

(DISTRIBUTED MULTIDISCIPLINARY PRACTICE, IMPROVED
DOCUMENTATION, TRANSPARENCY)
● LOGISTICS OF HEALTHCARE / COOPERATION IS PRIORITY

(DYNAMIC SCHEDULING, DATA COMMUNICATION)
● OUT OF STEP INFRASTRUCTURE AND DISTRIBUTION
● WASTEFULNESS / REDUNDANCIES

CHALLENGES FACED BY LA&C HEALTHCARE SECTOR (2)
● ACCESS TO BIOMEDICAL KNOWLEDGE (REFERENCE,

PROTOCOLS OF CARE, REGISTRIES, KNOWLEDGE BASES,
EVIDENCE-BASED PRACTICE, CONSUMER PARTICIPATION)
● INEFFICIENCY OF ADMINISTRATIVE PROCESSES

(ELIGIBILITY, CLAIMS PROCESSING, REIMBURSEMENT,
PROCUREMENT AND SUPPLY MANAGEMENT)
● ANTICIPATION OF NEEDS, DEMAND FOR “CUSTOMER

SERVICE”, AND CONVENIENCE
● TRADITIONAL SYSTEMS DEVELOPMENT X NON-PEER

REVIEWED, SHORT-LIVED, LOCALIZED SYSTEMS

LA&C HEALTH SECTOR REFORM COMMITMENTS
Goals for the Improvement of Healthcare Services
• Equitable (Access, Quality, Choice)
• Efficient (Time, Cost Recovery, Reimbursement)
• Effective (Evidence-informed, Outcomes, Safety)
• Accountability of Providers / Insurers
• Millennium Development Goals (Target #18)

REQUIREMENT IN ORDER TO ATTAIN REFORM GOALS
• PATIENT-BASED INFORMATION SYSTEMS
• ACCESS TO KNOWLEDGE
• PROCESS EFFICIENCY (COST-EFFECTIVENESS)

PATIENT INFORMATION AS DATA SOURCE
INDIVIDUAL GROUPS POPULATION
- SEQUENCIAL - BY CLINICAL ATTRIBUTES - REFERENCE

- CHRONOLOGICAL CLINICAL FINDINGS REFERENCE - HEALTH STATUS
- PROBLEM-ORIENTED GROUP COMPARISONS - SERVICE UTILIZATION
- PERMANENCY IDENTIFY ASSOCIATED ATTRIBUTES AND PRODUCTION
- HISTORICAL RECOVERY - RESEARCH
- COMMUNICATION - BY INTERVENTION CHARACTERISTICS
- RECENT EVENT RECOVERY MANAGEMENT AND REPORTING
DETAIL PROCESS CONTROL
DIFFERENT “VISIONS” OF DATA
DIFFERENT OUTPUTS
INTENSIVE DATA MANIPULATION

CREATING, SHARING, AND APPLYING KNOWLEDGE
Create
Knowledge
Learn, Innovate,
and Research
by Using Previous
and Imported
Knowledge
Apply
Capture
and Leverage
and Store
Knowledge to
Knowledge: Build,
Act Effectively in
Reuse, and Leverage
the Technical
Knowledge
Cooperation
Repositories
Distribute Organize
Knowledge to and Transform
People & Practices Knowledge to
through Make it Broadly
Technology Available and
Products and Embed in the
Services Organization

LEVELS OF INFORMATION AND KNOWLEDGE SHARING
Knowledge for
specific fields of
expertise
Experts
Decision Makers
• Focus on building “critical mass”
• Foster a culture of learning
• Access to full text references, best practices, research
• Sharing of knowledge through “communities of interest”
Public Health Professionals
Community

• TECHNOLOGY
• WHERE ARE WE?

E-HEALTH = ICT-MEDIATED TRANSACTIONS
Professional Communication among Providers

Logistics of Patient Management
Distributed Provision of Care
Health System Administrative Transactions
Business to Business Transactions
Business to Consumer Transactions
Biomedical Knowledge Management
Decision Support
Electronic Health Record (Computerized Patient Record)
Remote Clinical Care (Telemedicine)
Health Information Delivery to the Public
Distant Education of Health Professionals
Consumer to Consumer Exchanges (Chat and Interest Groups)

E-HEALTH = ICT-MEDIATED TRANSACTIONS
EMERGING NEW E-HEALTH APPLICATIONS:
ORIENTED TOWARD PROFESSIONAL NETWORKING
INTEGRATION OF THE CLINICAL CARE PROCESS MANAGEMENT

(DISEASE MANAGEMENT AND WEB-BASED PATIENT CARE)
DYNAMIC ACCESS/ DISTRIBUTION OF HEALTH INFORMATION
STANDARDIZATION OF DATA-RELATED DEFINITIONS,

PROCEDURES, AND PROCESSES ACROSS ALL SUBSECTORS,
SPECIALTIES, AND LEVELS OF CARE
SECURE AND CONFIDENTIAL PERSON-RELATED DATA

EXCHANGES

E-HEALTH = PEOPLE, DATA, TRANSACTIONS
 FOCUS OF E-HEALTH IS THE CUSTOMER/CLIENT/CITIZEN
 DATA ABOUT CUSTOMERS/CLIENT/CITIZENS AND ABOUT

MARKETS, PRODUCTS, PROCESSES, AND FINANCES IS THE
UNDERLYING RESOURCE OF VALUE
 CLIENT-FOCUSED TRANSACTIONS REPRESENT THE CORE

OF E-HEALTH OPERATIONS
 ESSENCE OF E-HEALTH: PEOPLE, DATA, AND RELIABLE

TRANSACTIONS
 PUBLIC HEALTH AUTHORITIES FREQUENTLY HAVE A

LIMITED OR MISGUIDED VISION OF ICT

EVOLUTIONARY TECHNOLOGIES
● POINT OF CARE TECHNOLOGIES
● PROCESS AUTOMATION
● ELECTRONIC MEDICAL RECORD (CPMR)
● DATA WAREHOUSING
● DATA ACCESS AND SECURITY TECHNOLOGIES
● APPLICATION INTEGRATION
● DECISION-SUPPORT TECHNOLOGIES

REVOLUTIONARY TECHNOLOGIES
● NETWORKED ALWAYS-ON RESOURCES
● ELECTRONIC COMMERCE
● “PUSH TECHNOLOGIES”
● ON DEMAND REMOTELY-BASED APPLICATIONS (ASP)
● MOBILE AND WIRELESS TECHNOLOGIES
● INTELLIGENT AGENTS
● INTERACTIVE TECHNOLOGIES (Voice, Writing Recognition)
● KNOWLEDGE MANAGEMENT (Retrospective >>> Simultaneous)

IS THERE A PLACE FOR E-HEALTH IN LA&C?
 MOST E-HEALTH SOLUTIONS HAVE BEEN DESIGNED FOR

INDUSTRIALIZED COUNTRIES AND LARGE ORGANIZATIONS
 IDEALLY SUITED TO PATIENT-BASED MODELS OF CARE
 PROPOSED AS A GENERAL ANSWER TO HEALTH SYSTEM

MANAGEMENT AND OPERATIONAL PROBLEMS FACED BY HEALTH
ORGANIZATIONS IN DEVELOPING SOCIETIES
 REQUIREMENTS FOR EFFECTIVE E-HEALTH DEPLOYMENT

AND FEATURES RELATED TO:
- CHARACTERISTICS OF THE REGION'S HEALTH SECTOR

- MARKET CONSIDERATIONS
- PREPAREDNESS FOR TECHNOLOGICAL INNOVATION
DEPLOYMENT AND OPERATION
GLOBAL HEALTH ICT TREND-SETTERS (1)
● TELEMEDICINE / TELEHEALTH / E-HEALTH MOVING AWAY FROM

THE VIDEOCONFERENCING PARADIGM TO BROADER SCOPE
● GLOBAL MARKET PLACE AND INTERACTIVE COMMUNICATION

NETWORKS OF PRODUCERS, SUPPLIERS, AND CUSTOMERS
● LEASING, MEMBERSHIP, SERVICE AGREEMENT, STRATEGIC

ALLIANCES REPLACE OWNERSHIP OF PHYSICAL ASSETS AND
LONG-TERM ORGANIZATIONAL STRUCTURES
● LIFE-TIME CUSTOMER REPLACING “ONE TIME SELL”
● ECONOMIES OF SPEED REPLACE ECONOMIES OF SCALE
● CUSTOMIZATION OF PRODUCTS AND SERVICES
● MAXIMIZE CONVENIENCE AND “JUST-IN-TIME” PROCESSES

GLOBAL HEALTH ICT TREND-SETTERS (2)
● ONLINE PROCUREMENT MARKET 27.3 BILLION (2004)
● TECHNOLOGY CONVERGENCE , MOBILE TECHNOLOGIES, AND

PORTABLE DATA MEDIA (SMART CARDS)
● OUTSOURCING IT SERVICES / DATA STORAGE / PROCESSING
● B2B GROWTH (6 BILLION IN 1999 >>>348 BILLION IN 2004)
● ADDRESS COST OF ADMINISTRATIVE TASKS (26%) AND

REIMBURSEMENT (13%)
● CONNECTIVITY OF PROFESSIONALS AND THE PUBLIC TO THE

INTERNET
● STORAGE REQUIREMENTS - TERA (1012) >>> PETA (1015) BYTES
● INTERNATIONAL EXPERIENCE (E.U., U.S., CANADA, JAPAN)

ICT DEVELOPMENT ISSUES IN LA&C
 EXTERNALITIES RELATED TO TECHNOLOGY DISTRIBUTION,

ACCESS, AND UTILIZATION – THE INFRASTRUCTURE
 READINESS FOR INCORPORATION OF ICT ON A BROAD NATIONAL

CONTEXT – NEED / OPPORTUNITY RECOGNITION AND HUMAN
FACTORS
 PRESENCE OF AN ENABLING ORGANIZATIONAL AND GOVERNANCE

ENVIRONMENT – LACK OF AWARENESS AND RESOURCES
 MARKET FOR TECHNOLOGICAL PRODUCTS AND SERVICES – LITTLE

INCENTIVE FOR R&D AND DEPLOYMENT
 GOVERNMENT ENGAGEMENT – LEADERSHIP AND INVESTMENT

TECHNOLOGY BARRIERS (1)
INFORMATION TECHNOLOGY INFRASTRUCTURE
● RESOURCES (MAINLY HUMAN!) AND SERVICES
● HEALTH DATA AND COMMUNICATION STANDARDS
● TECHNOLOGICAL INNOVATION / ADOPTION / ACTUAL USE
● INTEGRATION IN THE WORK ENVIRONMENT
● INCREMENTAL DEVELOPMENT X BIG BANG
● SECURITY AND PERSON-IDENTIFIED DATA PROTECTION
● OPEN x PROPRIETARY ARCHITECTURE
● COST-BENEFIT JUSTIFICATION

TECHNOLOGY BARRIERS (2)
INFORMATION TECHNOLOGY DEPLOYMENT
● SECURITY, PRIVACY AND CONFIDENTIALITY
● ALIGNMENT TO INSTITUTIONAL GOALS, IMPROVEMENT OF

HEALTH AND EXPECTATIONS OF PROVIDERS, CLIENTS,
PAYERS AND REGULATORS
● VOLUME AND VARIETY OF SOURCES NEED ADVANCED

DATABASE / CONTENT MANAGEMENT / SEARCH FEATURES
● EDUCATION / TRAINING OF HEALTH PROFESSIONALS AND

ACQUISITION OF NEW SKILLS
● ACCESS TO RELIABLE APPLICATIONS PRODUCTS AND
SERVICES (INTEGRATION, CUSTOMER SUPPORT, TRAINING)
● VENDOR DEPENDENCY

• TECHNOLOGY
• WHERE ARE WE?

HEALTH SECTOR BARRIERS (1)
HEALTH SECTOR REQUIREMENTS SPECIFICATION
● LOW DEFINITION LEVEL OF CONTENTS (DELIVERABLES)

OF HEALTH INTERVENTIONS
● DETERMINATION OF OBJECTIVES AND FUNCTIONALITIES

(COMPLEXITY AND VARIETY OF TECHNICAL CONTENTS)
● CONFLICTS IN DEFINING MINIMUM DATA SETS FOR OPERATIONAL

MANAGEMENT AND CLINICAL DECISION-MAKING
● HEALTHCARE ORGANIZATIONS AND PROVIDERS TEND TO

SEE THEIR OWN DATA AS THE ONLY GOOD AND VALID DATA

ORGANIZATIONAL AND POLICY-RELATED
● INFRASTRUCTURE, INVESTMENT SUSTAINABILITY AND

DEPLOYMENT CAPABILITY
● DISTRUST OF HEALTH PROFESSIONALS IN OFF-SITE DATA

STORAGE AND ACCESS CONTROL
● NATIONAL POLICIES AND STRATEGIES FOR THE STANDARDIZATION

AND COST-EFFECTIVE USE OF TECHNOLOGY AND INFORMATION
● CONSISTENCY AND CONTINUITY OF POLITICAL SUPPORT

TECHNICAL (CARE PROVISION) OPERATION
● COMPARTMENTALIZATION AND NON-INTEGRATION OF

TECHNICAL AND ADMINISTRATIVE WORK PROCESSES
● BEHAVIORS AND TECHNOLOGICAL TOOLS TO SUPPORT

COLLABORATIVE WORK AND SHARING FOR INNOVATION AND
CREATION OF KNOWLEDGE
● SHARING AND ACCESS TO PUBLIC HEALTH, ORGANIZATIONAL,

AND PARTNER KNOWLEDGE
● INTEROPERABILITY OF INFORMATION AND KNOWLEDGE

REPOSITORIES

ASSESSMENT AND EVIDENCE SOURCES
LIMITATIONS OF INFORMATION TECHNOLOGY METRICS
● LACK OF STANDARDIZED DEFINITIONS FOR COMPONENTS
● DATA ON PROJECTS RARELY COLLECTED ON A SYSTEMATIC BASIS
● NO COMPREHENSIVE AND SUSTAINED INFORMATION SOURCE
● LACK OF SOURCE FOR LESSONS LEARNED
● ABSENCE OF COST DATA
● INFORMATION ON HOW IT IS BEING ACTUALLY USED / IMPACT
● RAPIDLY CHANGING TECHNOLOGY

INFORMATION MANAGEMENT AND
IN HEALTH ORGANIZATIONAL ISSUES
APPROPRIATENESS
SUSTAINABILITY
COST-EFFECTIVENESS
IMPLEMENTATION ENVIRONMENT CONDITIONS

NEEDS, EXPECTATIONS, ICT INFRASTRUCTURE, HEALTHCARE MODELS,
HEALTH ECONOMY, CULTURE, LANGUAGE, LEGAL & REGULATORY ISSUES
PROVIDERS
SOLUTIONS
MARKET
APPLICATIONS TECHNOLOGICAL
PLATFORM ( HW/SW )

• TECHNOLOGY
• HEALTH SECTOR ASPECTS
• WERE ARE WE?

THREE QUESTIONS…
The present situation:
WHERE ARE WE NOW
The desired future:
WHERE WE WANT TO BE
Actions to achieve the desired future:
HOW TO GET THERE

HOSPITAL MARKET
Hospitals in Latin America and the Caribbean by Number of Beds

(PAHO HSP/HSO Directory of Latin America and Caribbean Hospitals, 1996-1997)
Number Hospitals Beds

Beds
m=21.8 n % n %
1-50 10,027 60.5 219,383 20.0

51-100 2,615 15.8 189,559 17.3
101-200 1,703 10.3 242,770 22.1
201-300 544 3.3 133,225 12.1
301-400 242 1.5 84,811 7.7
401-500 133 0.8 58,951 5.4
501-1000 186 1.1 126,169 11.5
>1000 29 0.2 43,097 3.9
Sub-Total 15,479 93.4 1,097,965 100

No Data 1,087 6.5
Total 16,566 100.0

ECLAC / ICA / @LIS (PROTIC) - LOCATION
Projects reported in 91 locations. National projects 56% (51/91) were reported

for Colombia, Peru, Brazil, Venezuela, Argentina, Bolivia, and Cuba
Source: OSILAC – Observatory for the Information Society in LAC May 2007.
The PROTIC database has 1,491 projects recorded (May 2007) of which
eighty-eight (88) are in the health sector, representing 5.9% of the database
Project Location N %
Regional 13 14.3
Subregional 4 4.4
Global 1 1.1
19.8% (18/91)
Colombia 11 12.1
Peru 9 9.9
Brazil 8 8.8
Venezuela 7 7.7
Argentina 6 6.6
Bolivia 5 5.5
Cuba 5 5.5
Chile 3 3.3
Ecuador 3 3.3
Mexico 3 3.3
Costa Rica 2 2.2
Dominican Republic 2 2.2
El Salvador 2 2.2
Honduras 2 2.2
Paraguay 2 2.2
Belize 1 1.1
Canada 1 1.1
Guyana 1 1.1
Total 91 100

ECLAC / ICA / @LIS (PROTIC) – PROJECT FOCUS
Objective of 45.5% (40/88) is to establish a knowledge repository of technical /scientific

publications, guidelines, best practices, and lessons learned. Next most frequent
Objective (15.9%) is to provide access to ICT resources. This is followed by education
and prevention applications (13.6%). Only 11.4% (10/88) of projects were focused in
the establishment of direct clinical care, epidemiology, or in-practice education
Project Focus N %
Access to ITC resources andtraining, connectivity, infrastructure, deploymentand
8 9.1
needs assessment, impact evaluation
Applicationandsoftwaredevelopmentandinstrumentation 6 6.8
Basic research 1 1.1
Communication 5 5.7
Community of Practice 2 2.3
Education, Prevention 12 13.6
Evaluation 1 1.1
Healthservicemanagement 2 2.3
Knowledgerepository 17 19.3
Knowledgerepository, lessons learned, bestpractices 23 26.1
Management 1 1.1
Telemedicineclinical care, epidemiology, education 10 11.4
Total 88 100

ECLAC / ICA / @LIS (PROTIC) – HEALTH ISSUES ADDRESSED
Thematic areas (areas of application) for 88 projects. Nearly half of the projects (47.7%)
are related to access to technical and scientific reference and to clinical care
(primary and other levels), family care, immunization, and mental health
Health Issue Addressed by Projects N %

Access to technical and scientific reference 21 23.9
Clinical care (primary and other levels), family care, immunization, mental health 21 23.9
Access to ICT and e-Health deployment 6 6.8
Environmental health, Water and Solid Waste 4 4.5
Health education, promotion 4 4.5
Professional education 4 4.5
Food safety, Veterinary medicine 3 3.4
HIV/AIDS 3 3.4
Physiological data 3 3.4
Sexual & Reproductive Health 3 3.4
Service management, logistics of patient administration 3 3.4
Drug abuse 2 2.3
Epidemiologic surveillance 2 2.3
None indicated 2 2.3
Disaster prevention & mitigation 1 1.1
Healthy life styles, commercial product promotion 1 1.1
Imaging technology 1 1.1
Neural physiology 1 1.1
Self-help 1 1.1
Traditional medicine 1 1.1
Violence against women 1 1.1
Total 88 100

ECLAC / ICA / @LIS (PROTIC) – DRIVERS AND FUNDING
The private sector was found to be the most frequent driver 31.8% (28/88) followed by
international agencies and the national public subsector, each driving 23.8% (21/88).
International agencies were the most frequent funding source
Project Drivers Main Funding Source
UNAgency
UNAgency
Int Agency
Int Agency
Academic
Academic
-PAHO
Private
Private
PAHO
Public
Public
Project Location N %
Non
Global 1 1.1 1 1
Regional 13 14.1 3 5 1 5 1 6 5 2 1
Subregional 4 4.3 3 1 4
Argentina 6 6.5 1 1 2 1 1 3 2 2
Belize 1 1.1 1 1
Bolivia 5 5.4 2 2 1 1 1 2 2
Brazil 8 8.7 4 3 2 1 2 3 3 1 2
Canada 1 1.1 1 1
Chile 4 4.3 2 1 1 1 1 1 3
Colombia 11 12.0 5 1 4 1 1 3 4 1 3 3
Costa Rica 2 2.2 1 1 1 1 1
Cuba 5 5.4 4 1 1 3 1
Dominican Republic 2 2.2 2 1 1 1
Ecuador 3 3.3 1 2 1 1 1
El Salvador 2 2.2 1 1 1 1
Guyana 1 1.1 1 1
Honduras 2 2.2 1 1 2 1
Mexico 3 3.3 1 1 1 1 1 2
Paraguay 2 2.2 1 1 1 1 1
Peru 9 9.8 2 5 3 1 2 1 5 3
Venezuela 7 7.6 3 3 1 1 3 4
Total 92 100 12 21 28 21 18 8 23 26 23 28 2

CONCLUSIONS (1)
◆ DISSEMINATION STILL LIMITED - HEALTH SECTOR LAGS BEHIND

OTHER SECTORS
◆ MOST EXISTING HEALTH INFORMATION SYSTEMS ARE INADEQUATE

FOR THE NEW MODELS OF HEALTHCARE
◆ MANY PUBLIC HEALTH ORGANIZATIONS ARE NOT TAKING

ADVANTAGE OF ICT OPPORTUNITIES AND ITS ROLE IN
COMPETITIVENESS AND ORGANIZATIONAL SURVIVAL IN THE NEW
HEALTHCARE ENVIRONMENT
◆ EXPECTATIONS X STRUCTURAL FACTORS OF THE SECTOR
◆ ANALOG/DIGITAL DIVIDE CONSEQUENCE OF SOCIAL AND

ECONOMIC INEQUITIES IN BOTH DEVELOPED AND DEVELOPING
COUNTRIES

CONCLUSIONS (2)
◆ INFRASTRUCTURE AND “PREPAREDNESS” OF COUNTRY, SECTOR,

AND HEALTH PROFESSIONALS
◆ E-HEALTH DEVELOPMENT INTEGRATES TECHNOLOGY,

GEOGRAPHY, CULTURE, LANGUAGE, AND….HEALTHCARE SYSTEMS
THUS MARKET SEGMENTATION >>> NO SINGLE “COOKBOOK” OR
“TRANSPORTED” SOLUTION
◆ COUNTRY AND SUBSECTOR DIFFERENTIATED SOLUTIONS
◆ CAREFULLY CRAFTED PARTNERSHIP x PURE VENDOR-CLIENT

RELATIONSHIP
◆ MECHANISMS AND PROCESSES FOR NATIONAL CONSENSUS AND

ACTION WITH HIGH LEVEL POLITICAL SUPPORT AND LEADERSHIP
◆ BEST PRACTICES AND AVOIDANCE OF REDUNDANCIES

CONCLUSIONS (3)
◆ GROWING MARKET POTENTIAL (SAAS? OUTSOURCING?)
◆ IDENTIFICATION OF OPPORTUNITIES, MARKET DEVELOPMENT,

AND CONTINUITY OF FUNDING IS A DIFFICULT PROCESS
◆ PROACTIVE ROLE OF INTERNATIONAL COMMUNITY
● G-8 Digital Opportunity Task Force (Okinawa Charter)

● U.N. Health InterNetworks Initiative
● World Bank InfoDev
● Summit of the Americas (2o. Santiago/3o. Québec/4o. Mar del Plata)
● CITEL (Plan of Action of Quito)
● UNESCO Information Society Initiative (Geneva / Tunis)
● ECLAC and ICA (InfoLAC)

CONCLUSIONS (4)
◆ PRIORITY AREAS FOR ACTION BY NATIONAL GOVERNMENTS
● PROMOTION OF EDUCATION, TRAINING, AND NATIONAL

PLANNING CAPACITY
● CONVENING GROUPS FOR THE IMPLEMENTATION OF STANDARDS
● FUNDING RESEARCH AND DEVELOPMENT
● ENSURING EQUITABLE DISTRIBUTION OF RESOURCES
● TESTBED FOR PUBLIC HEALTH AND COMMUNITY APPLICATIONS
● PROTECTING RIGHTS OF PRIVACY, INTELLECTUAL PROPERTY,

AND SECURITY/CONFIDENTIALITY OF SYSTEMS
● REGULATE JURISDICTIONAL BARRIERS TO COOPERATION,

PARTICULARLY WHEN THERE ARE CONFLICTING REGULATIONS

AND THE CARIBBEAN
STATS

GLOBAL ICT INDICATORS

GLOBAL ICT INDICATORS
Global Gini Coefficients for Common ICT Indicators (UNCTAD, 2006)
With the exception of Internet hosts, distribution inequalities have declined

during the period, indicating increasing equality among countries

THE ANALOG AND DIGITAL DIVIDE BY INCOME
Percentage of World Total
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Population Television Telephone GDP Internet
Low Lower Middle Upper Middle High

Source: DOT Force, 2000

BRAZIL - CELLULAR TELEPHONY AND COMPUTERS USE BY SOCIAL CLASS
PERCENT
60
50
51
40 CLASS
40.8
A/B
30
30.2 C
20 24.1 D/E
17.9
10
11 2
8.5
3.8
0
CELLULAR MICROCOMPUTER INTERNET
Source: Health Card Project Studies - Ministry of Health, Brazil

BRAZIL - CELLULAR TELEPHONY AND COMPUTERS USE BY AGE GROUP
PERCENT
30
25
AGE GROUP
20
14-19
15 20-35
36-45
10
46 +
5
0
CELLULAR MICROCOMPUTER INTERNET
Source: Health Card Project Studies - Ministry of Health, Brazil

CONNECTIVITY COSTS
Affordability of Internet Subscription Tariff

by Country Income Group, 2003 (World Bank, 2006)
Internet Use Internet Price as

Income Group Monthly Cost in % of GNI x
US$ capita
High 23.51 1.7
Upper-middle 30.27 13.3
Lower-middle 31.82 32.2
Low 56.31 258.3
World 36.91 88.7
Although historical data shows improvement of teleaccessibility

there is an immense digital divide between high-income, upper
middle-income, intermediate, and lower middle- and low-income
countries and between income groups inside a country

ICT DEVELOPMENT INDICES (1)
UNCTAD Diffusion (2004) and ITU Digital Opportunity (2005) - Indices for 16 Countries
of the Region of the Americas That Responded to the WHO Global Survey
CAN
0.7
HON CHI
0.6
PAR 0.5 COR

0.4
0.3
ELS SUR
0.2
0.1
0
PER ARG
PAN BRA
VEN MEX
BLZ DOR
UNCTAD DIFFUSION INDEX ITU DIGITAL OPPORTUNITY INDEX

NETWORK READINESS INDEX (CID)
Index for 13 countries of the Region of the Americas - Scores and Rankings
(Harvard Center for International Development and WHO Global Survey, 2006)
Countr Score Rank Rank Evoluti

ies 2005 2005 2004 on
CAN
SUR
1.50
CHI ARG -0.38 71 76 5
1.00 BRA -0.04 52 46 -6
BLZ BRA
0.50 CAN 1.54 6 10 4
0.00 CHI 0.52 29 35 6
BAR MEX
-0.50
COR -0.37 69 61 -8
-1.00
DOR -0.73 89 78 -11
PAR -1.50 ELS
ELS -0.24 59 70 11
HON -0.89 100 97 -3
HON PAN MEX -0.14 55 60 5
PAN -0.33 66 69 3
DOR COR PAR -1.23 113 98 -15
PER -0.70 85 90 5
PER ARG
VEN VEN -0.65 81 84 3
UNCTAD INDEX OF ICT DIFFUSION
Evolution of the UNCTAD Index of ICT Diffusion in selected countries of the
Region of the Americas - Rankings for the Period 1997-2004 (UNCTAD, 2006)
1997 1998 1999 2000 2001 2002 2003 2004
0
5 CAN
10
15
20
25
30
35 BAR
40
45
50
55 ARG
60
COR
65
SUR
70
CHI
75
DOR
80
85 VEN
90 BRA
95 PAN
100
MEX
105 BLZ
110 PAR
115
PER
120
ELS
125
130 HON
135
140
St. Kitts andNevis 26.1
PCs x 100 inhabitants
CostaRica 21.9
95 Martinique 20.8
Guadeloupe 20.3
90 Dominica 18.2
85 FrenchGuiana 18.0
St. Lucia 16.3
80 Grenada 15.7
75 Barbados 14.9
70 Chile 14.8
Uruguay 13.3
65 St. VincentandtheGrenadines 13.2
60 Mexico 13.1
Brazil 10.5
55 Peru 10.0
50 Argentina 8.4
45 Venezuela 8.2
Trinidad&Tobago 7.9
40 Paraguay 7.5
35 Jamaica 6.2
El Salvador 5.1
30 Panama 4.6
25 Colombia 4.2
20 Ecuador 3.9
Guyana 3.9
15 Cuba 3.4
10 Bolivia 2.3
Guatemala 1.8
5
Honduras 1.6
0

IT DEVELOPMENT ISSUES IN LA&C
Internet Users x 100 inhabitants in the Region of the Americas (ITU, 2005)
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0

Internet Penetration Rates by Country Type (ITU 1995-2004)

CONTEXT OF USE IS MORE IMPORTANT THAN INDICATOR
Inte r ne t Us e r s pe r 100
PCs pe r 100 inhabitants
inhabitants
USA 63 USA 76.22

Developed
CAN 62.36 CAN 69.82
Developed
BER 60.99 SKN 26.07
BAR 59.48 COR 21.89
JAM 39.87 MAR 20.76
SAL 34.49 GDL 20.32
BAH 29.18 DOM 18.23
DOR 28.75 FRG 18.03
MAR 27.09 SAL 16.3
ANT 24.84 Transitional GRE 15.65
Transitional
COR 23.54 BAR 14.87
PUR 22.12 CHI 14.75
GUY 21.3 URU 13.27
URU 20.98 SVG 13.22
FRG 20.77 MEX 13.08
GRE 18.64 BRA 10.52
CHI 17.96 PER 10.01
GDL 17.83 ARG 8.37
ARG 17.78 VEN 8.19
MEX 17.4 TRT 7.9
PER 16.45 PAR 7.47
BLZ 13.41 JAM 6.2
TRT 12.24 ELS 5.09
BRA 11.96 PAN 4.56
Developing
DOM 10.53 COL 4.15
COL 10.39 ECU 3.89
ELS 9.26 GUY 3.86
Developing
VEN 8.84 CUB 3.35
SUR 6.72 BOL 2.33
SVG 6.61 GUA 1.82
PAN 6.39 HON 1.57
HAI 6.09
GUA 5.97
BOL 5.23
ECU 4.66
PAR 3.25
HON 3.18
CUB 1.69

AND THE CARIBBEAN
Q&A

E-Health in Latin America &amp; Caribbean

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E-Health in Latin America &amp; Caribbean

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e-HEALTH IN LATIN AMERICAN

AND THE CARIBBEAN

Former Regional Advisor on Health Information and Communication Technologies

International Conference on Urban Health, Baltimore - Oct 31, 2007

• DRIVING FORCES AND TRENDS

• WHERE ARE WE?

International Conference on Urban Health

• DRIVING FORCES AND TRENDS

• HEALTH SECTOR ASPECTS

• WHERE ARE WE?

International Conference on Urban Health

● 6-17% OF SERVICE SECTOR (50-65% OF ECONOMY)

International Conference on Urban Health

● DISSATISFACTION WITH HEALTH SYSTEM

● CONTINUITY OF THE PROVIDER/CLIENT RELATIONSHIP

● PROVIDER ACCESS TO PATIENT DATA AND CARE EVENTS

● LOGISTICS OF HEALTHCARE / COOPERATION IS PRIORITY

● OUT OF STEP INFRASTRUCTURE AND DISTRIBUTION

International Conference on Urban Health

● ACCESS TO BIOMEDICAL KNOWLEDGE (REFERENCE,

● INEFFICIENCY OF ADMINISTRATIVE PROCESSES

● ANTICIPATION OF NEEDS, DEMAND FOR “CUSTOMER

● TRADITIONAL SYSTEMS DEVELOPMENT X NON-PEER

International Conference on Urban Health

Goals for the Improvement of Healthcare Services

• Equitable (Access, Quality, Choice)

• Efficient (Time, Cost Recovery, Reimbursement)

• Effective (Evidence-informed, Outcomes, Safety)

• Accountability of Providers / Insurers

• Millennium Development Goals (Target #18)

International Conference on Urban Health

• PATIENT-BASED INFORMATION SYSTEMS

• PROCESS EFFICIENCY (COST-EFFECTIVENESS)

International Conference on Urban Health

INDIVIDUAL GROUPS POPULATION

- SEQUENCIAL - BY CLINICAL ATTRIBUTES - REFERENCE

International Conference on Urban Health

International Conference on Urban Health

Public Health Professionals

International Conference on Urban Health

• DRIVING FORCES AND TRENDS

• WHERE ARE WE?

International Conference on Urban Health

Professional Communication among Providers

International Conference on Urban Health

EMERGING NEW E-HEALTH APPLICATIONS:

ORIENTED TOWARD PROFESSIONAL NETWORKING

INTEGRATION OF THE CLINICAL CARE PROCESS MANAGEMENT

DYNAMIC ACCESS/ DISTRIBUTION OF HEALTH INFORMATION

STANDARDIZATION OF DATA-RELATED DEFINITIONS,

SECURE AND CONFIDENTIAL PERSON-RELATED DATA

International Conference on Urban Health

 FOCUS OF E-HEALTH IS THE CUSTOMER/CLIENT/CITIZEN

 DATA ABOUT CUSTOMERS/CLIENT/CITIZENS AND ABOUT

 CLIENT-FOCUSED TRANSACTIONS REPRESENT THE CORE

 ESSENCE OF E-HEALTH: PEOPLE, DATA, AND RELIABLE

 PUBLIC HEALTH AUTHORITIES FREQUENTLY HAVE A

International Conference on Urban Health

● POINT OF CARE TECHNOLOGIES

● ELECTRONIC MEDICAL RECORD (CPMR)

● DATA ACCESS AND SECURITY TECHNOLOGIES

International Conference on Urban Health

● NETWORKED ALWAYS-ON RESOURCES

● ON DEMAND REMOTELY-BASED APPLICATIONS (ASP)

E-Health in Latin America & Caribbean

E-Health in Latin America & Caribbean