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Second Presidential Summit of the Americas (1998) Area: Health Information and Surveillance Systems
Proposal prepared by R.J.Rodrigues, Regional Advisor and Coordinator, Health Information System, Pan American Health Organization, Washington DC and submitted to the organizing Committee of the Second Presidential Summit of the Americas, Santiago Chile 1998

A. Summary of Recommendations from the Summit

1. Areas of Action
a. Strengthen and improve existing national and regional networks of health information and surveillance systems, so that stakeholders have access to data to address critical health issues in order to support appropriate clinical and managerial decisions. b. Development, implementation, and evaluation of needs-based health information systems and technology (IS&T) c. IS&T, including telecommunications, to support: epidemiological surveillance, operation and management of health services and programs, health education and promotion, telemedicine, computer networks, and investment in new technologies.

2. Strategy
a. Make every effort to ensure that the necessary resources are allocated for development of plan. b. Technical support will be provided by PAHO. c. Promote bilateral and multilateral collaboration. The Inter-American Development Bank, the World Bank, and other financial and technical cooperation institutions will support the programs and activities. d. Develop mechanisms for evaluating relevance, cost, and efficacy of introduced technologies.

B. Proposed General Perspective for the Development of Information Systems

1. Goals
a. The Presidential Declaration made clear that all countries of the Americas have a common stake in improving access to and delivery of healthcare through communications and information technology. b. Efforts involving the Pan American Health Organization and other stakeholders in fulfilling that mandate will necessarily concentrate on the public sector but must involve the private sector to result in a significant impact on the health of individuals and communities. c. Joint investment and development involving users, governments, academic and financing institutions and agencies, technical cooperation agencies, and industry interests are seen as

necessary, and projects have been started with the participation of the two major financing institutions in the Region, the Inter American Development Bank and the World Bank. d. Partnerships with the informatics industry are absolutely fundamental and, in the case of general informatics tools, the industry practically drives the solutions. A concerted effort is needed to secure a clearly defined and specified partnership with the informatics industry at the global and national levels aimed at application development at acceptable cost. e. Consistent to these objectives, the mission of the Pan American Health Organization to its constituency -- the public health sector of Latin America and the Caribbean Regions -- in the area of information systems, technology, and information systems management, primarily involves the transfer of knowledge, technical support, facilitation of the exchange of experiences between countries, and fostering the use of appropriate technology and knowledge assets.

2. Health Informatics Development Scenario

Health Informatics is appropriate for the Region, National priorities deployment, and capabilities will determine Health Informatics

Appropriate strategy will ensure the success of project development, Deployment and operational costs and obsolescence will be minimized, and Interaction with the all the stakeholders will be promoted

3. Policy and Technology Objectives

a. Develop telecommunications infrastructure that is comprehensive, reliable, ubiquitous, and compatible across applications b. Provide technological interfaces that facilitate effective use of the infrastructure and its components c. Promote changes in policies, regulation, and legislation in the area of telecommunications and informatics equipment and shape the legal and regulatory infrastructure in ways that will facilitate clinical and administrative communications d. Develop rational, technologically neutral policies for public and private payers e. Develop technical guidelines, norms, and standards for mission critical projects f. Develop infrastructure through core systems development and incorporating informatics into existing multilateral projects, supported by a combination of funding programs, incentive grant programs, and prototype application development funding programs g. Provide appropriate content to consumers, patients, and providers that will enhance healthcare outcomes h. Establish education and training programs

C. Collaborative Work Realized with the Inter-American Development Bank

1. PAHO and the IADB Health Component of the Informatics 2000 Initiative
A set of recommendations regarding strategies, priorities, and areas for immediate action emerged from the Expert Consultation Meeting on Telecommunications in Health and Healthcare, held in November 1996 in Washington, and from five technical meetings of the Informatics 2000 Health Task Force, held during the year of 1997 and 1998 in Miami, Mexico City, Washington, Santiago, and Washington organized in collaboration with PAHO. The recommendations reflect the experience of over 300 professionals of the Region. They were reiterated at the Sector th Leaders Roundtable and at the Fourth Health Task Force Session, held on April 17 , in Santiago, Chile, on the occasion of the Second Presidential Summit of the Americas. This consultative group, known as the Regional Health Informatics Initiative, is coordinated by the IADB and technical orientation of PAHO.

2. Proposed Area for Immediate Action

Discussions held with leaders in the area of application of telecommunications in health and healthcare, regional intergovernmental agencies, and the industry indicated the: Priority of promoting the development and implementation of core health applications. Need for the rapid definition of specifications for core applications prototypes that considers: Health service requirements Health information infrastructure Data processing infrastructure Telecommunications infrastructure Interest in developing application packages that will facilitate procurement, financing, and implementation of core applications.

3. Program Proposed
a. Promoting Core Health Information Systems Use of Core Systems should be widespread because of : Address generalized user needs Standardized packages of solutions Significant cost savings Significant improvements in quality of care and outreach Examples of possible Core Systems: Distant Education of Health Professionals Electronic Patient Health Record Epidemiological Reporting Systems Call Centers

Interactive Health Promotion Applications Specialized Applications (e.g., radiology, pathology) Small Clinic Management and Operation Systems Small Hospital Management and Operation Systems Emergency Services Systems Drug/Cosmetics/Food Registration, Management and Control Systems b. Investment Profile of Core Systems Definitely needed Generic solutions - individual site needs little or no requirement analysis Spectrum of solutions packages for same application area (low-end to high-end) Although solutions are generic, some customization must be possible Solution packages options consider existing health service requirements and infrastructure (health information, data processing, and telecommunications) Relatively small price tags $5,000 to $1,000,000 Financing decision is largely one of financial capacity of buyer

3. Solution Packages Components

a. Project Development and Management Support to Project Formulation Support to Project Implementation Training Project Evaluation Dissemination and Promotion of Experiences b. Telecommunications Infrastructure Analysis of Communications Services and Technology Requirements for each Application Area Connectivity Standards Data Communication Equipment and Components c. Technology Analysis of Technological Requirements for each Specific Application Area Hardware General Equipment (computers, basic workstations, teleconferencing equipment, scanners) Specialized Medical Equipment Software Procurement, Selection and Acquisition Installation User Training Maintenance

4. Proposal for Multilateral Collaboration

Justification Why This New Business Model is Important to Healthcare in the Region: Enables rapid deployment No lengthy, redundant, and expensive needs assessments Significant price advantage from economies of scale Expected to result in immediate demonstrable health benefits Implemented sites serve as reference for other deployments Strategy Build on existing experiences giving preference to countries and institutions that reached a degree of organization and decision making maturity, that will maximize the successful deployment of technology. Justification that contemplates the national priorities, infrastructure, and commitment. Accurately defined recommendations. users requirements consolidated in technically appropriate

Application solutions that optimize the provision of care, health surveillance, resource management, the development of human resources, and health promotion, prioritizing interventions at the primary care level. Implementation of partnerships with centers of excellence, academic and research institutions, multilateral and technical cooperation agencies, and the industry. Designate project implementation sites as reference sites for telehealth applications. It is expected that approaches and methodologies in use at the site will serve as prototype for generalized utilization by developing countries. Tasks and Responsibilities Regional Health Informatics Initiative (Stakeholders) Prioritize core systems Identify generic user requirements for core systems Identify functional requirements for applications categorized according to specific area of application and technological complexity Define medical or technical expertise needed for operation and training required for each professional category Define indicators of achievement of expected results and impact Validate that solution provider proposed solution packages meet specifications Solution Providers Analyze the options regarding hardware and software under generic scenarios identified by the participants of the Regional Health Informatics Initiative Develops solution packages for each application area and level of technological complexity

Assemble market validated system packages Regularly update package components Define approximate cost by component Inter American Development Bank Establishes loan program to support purchases of preferred and recommended solution packages PAHO and other International and Multilateral Technical Agencies Contribute to the Regional Health Informatics Initiative technical recommendations through the following activities: Consultation meetings with participation of key PWRs and national authorities Consultation with external organizations and agencies Preparation of concept paper, coordinated by HSI and with the collaboration of HSP/HSR, HCP, HDP, HPP, DBI, and PED Establishment of four Consultative Groups of External Experts to draft action plans for the following areas: (a) Policies, Regulation and Legislation (b) Core Projects (c) Technical Guidelines and Norms (d) Education and Training of Health Professional Promote the use of recommended solution packages by the public and private sectors Support users in initial stage of project formulation Promote exchange of experiences among users Conduct independent evaluation studies Users Develop project proposals Apply for financing Implement projects Project Financial Management Separate entity handles financing and execution

R.J.Rodrigues PAHO/HIS Sep15, 98