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INTERNATIONAL TELEMEDICINE UPDATE LATIN AMERICA Rosa Ana Tang, M.D., M.P.H. UTMB Galveston, Texas Collaborators: Roberto Rodrigues, MD -PAHO, Washington, D.C. Ace Allen, MD-Telemedicine Today, Editor, Kansas Jade S. Schiffman, MD, University of Houston, Texas TELEMEDICINE IN LATIN AMERICA

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INTERNATIONAL TELEMEDICINE UPDATE LATIN AMERICA


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international telemedicine update latin america

INTERNATIONAL TELEMEDICINE UPDATELATIN AMERICA

Rosa Ana Tang, M.D., M.P.H.

UTMB Galveston, Texas

Collaborators:

Roberto Rodrigues, MD -PAHO, Washington, D.C.

Ace Allen, MD-Telemedicine Today, Editor, Kansas

Jade S. Schiffman, MD, University of Houston, Texas

slide2

TELEMEDICINE IN LATIN AMERICA

  • Latin America encompasses 20 countries with almost 1/2 billion people
  • The tele-communications and health care infrastructure, language, education, median income levels, government policies, death ratios and levels of rurality precludes easy telemedicine deployment
slide4

WHAT ARE THE CONSTRAINING

FACTORS FOR DEPLOYMENT?

  • Non-recognition of need
  • Unsolved basic priorities of healthcare
  • Lack of commitment / involvement of

key providers and decision makers

  • Legal, ethical, economic issues of practice
  • Cost of reorganization and new technologies
  • Infrastructure required
  • Competition
  • Lack of organization
slide5

WHAT ARE THE ISSUES AND CHALLENGES?

  • DEVELOPMENT OF DATA AND COMMUNICATIONS STANDARDS
  • ACCESS TO RELIABLE APPLICATIONS PRODUCTS AND SERVICES
  • CAPACITY TO PURCHASE AND MAINTAIN HARDWARE, SOFTWARE AND OTHER EQUIPMENT
  • EDUCATION AND TRAINING OF HEALTH PROFESSIONALS AND ANCILLARY PERSONNEL
  • CONSISTENCY AND CONTINUITY OF POLITICAL SUPPORT
slide6

INFRASTRUCTURE ISSUES IN LATIN AMERICA

  • ACCESS TO COMPUTER TECHNOLOGY & COMPUTER LITERACY
  • POOR ORGANIZATIONAL DEVELOPMENT
  • TELECOMMUNICATIONS AVAILABILITY, QUALITY AND COST
  • MONOPOLISTIC NATIONAL TELECOM STRUCTURE
  • GENERAL EDUCATIONAL LEVEL
slide7

INFORMATION TECHNOLOGY MARKET GROWTH

AUTOMATION OF PROVIDER

AND CONSUMER OPERATIONS

MILLIONS OF USERS

1,000

AUTOMATION OF FRONT-OFFICE

AND REMOTE SITES

100

BACK-OFFICE

AUTOMATION

10

1970

1980

1990

2000

2010

2020

SOURCE: INTERNATIONAL DATA CORPORATION

slide8

1

N. America

6

11

W. Europe

16

Rank in Information Society Index

21

Asia / Pacific

26

31

E. Europe / M. East / Africa

36

Latin America/Caribbean

41

41

36

31

26

21

16

11

6

1

Rank in IT$/GDP

SOURCE: International Data Corporation, 1996

slide9

MAIN TELEPHONE LINES (1995)

LINES X1,000 PERSONS

Source: International Telecommunications Union

slide10

HOSPITAL INFORMATION SYSTEMS

IN LATIN AMERICA & THE CARIBBEAN

TOTAL NUMBER OF HOSPITALS = 16,566

COMPUTERIZED

5,230 (83,45%)

31.57%

6,267 (37.83%)

WITH IS

62.17%

6.25%

10,299

WITHOUT IS

NOT COMPUTERIZED

1,037 (16.54%)

HSP/HSO DIRECTORY OF LATIN AMERICA AND CARIBBEAN HOSPITALS, 1996-1997

latin american hospitals
Latin American Hospitals
  • There is a need to understand the role of health sector in charge of public hospitals such as the Social Security, Ministry of Health, Military and other entities.
infrastructure and telecommunication projects in latin america
Infrastructure and Telecommunication Projects in Latin America
  • Most projects are usually out-source
  • Lack of experience in needs assessment and project development is main barrier to deployment
  • Lack of comprehensive source for guidelines
slide14

INFORMATION TECHNOLOGY GROWTH,

1985-1995 AND 1995-2000

PERCENT

SOURCE: International Data Corporation, 1996

information technology growth

Information Technology Growth

Application of Technological Options Considering Bandwidth and Connectivity Alternatives

degree of development of core information function activities in latin american countries
Degree of Development of Core Information Function Activities in Latin American Countries
slide21

GROWTH OF INTERNET HOSTS

NUMBER OF HOSTS

JAN 97

JAN 96

JAN 95

slide22

GROWTH OF INTERNET HOSTS

NUMBER OF HOSTS

JAN 97

JAN 96

JAN 95

investment requirements to get there to get a head start

Investment Requirements “to get there” “to get a head start”

Initial assessment of capital and recurring costs for the first 5 years amounts to almost $400,000,000 US

See Table

training of human resources in health information systems
Training of Human Resources in Health Information Systems
  • Nearly 1/ 3 of South American countries do not have training programs in health information systems for mid-level and higher management.
  • In the other 2/ 3 of the countries, training is conducted locally and regionally and is of low level.
  • Rarely S.A. countries participate in international training sessions.
specific projects in latin america
SPECIFIC PROJECTS IN LATIN AMERICA
  • ARGENTINA ARGONAUTA PROJECT :international component of a Telemedicine program developed by CONAE
  • ( Argentine Space Station) Operates over POTS for Tele-assistance & education (1998).
  • To May 1999 over 100 medical episodes have been carried out.
specific projects in latin america30
SPECIFIC PROJECTS IN LATIN AMERICA
  • CHILE
  • Clinica y Centro Medico Punta Arenas : Tele-dermatology, endocrinology and OB-GYN consults between Punta Arenas & Santiago.
  • Uses ISDN, POTS and regular mail.
specific projects in latin america31
SPECIFIC PROJECTS IN LATIN AMERICA
  • URUGUAY :from Montevideo
  • National Institute of Cardiac Surgery : transmits about 600 images via store & forward per month for both clinical consults and education.
  • Asociacion de Socorros Medicos : cardiology consults generated here.
specific projects in latin america32
SPECIFIC PROJECTS IN LATIN AMERICA
  • BRAZIL : Tele-radiology project in the Military Hospital System -1998
  • No data available as to number if interactions per month
  • PERU : many projects “ in the works “ on Internet but no numbers available. A pilot is at:
  • Centro de Telemedicina Cayetano Heredia University for consultation & education in Tropical Diseases and Ophthalmology
specific projects in latin america33
SPECIFIC PROJECTS IN LATIN AMERICA
  • COSTA RICA : has the oldest project found : 1994 for education & clinical consults : 15 interactive consults/mo using ISDN, T1
  • Telemedicina en Costa Rica : 1997
  • Education and consults:ISDN,POTS
telemedicine in latin america summary
Telemedicine in Latin AmericaSUMMARY
  • Telemedicine is YOUNG in Latin America with the oldest program operating since 1994.
  • The most common modality of interaction found was with store & forward ( tele-radiology & dermatology ). Internet based applications are used.
  • When interactive video is utilized , dial up ISDN , national digital phone system,microwave or satellite are the ones used.
pre requisites to fulfill for deployment to be successful in latin america
Pre-requisites to fulfill for deployment to be successful in Latin America
  • Develop & secure an appropriate health information infrastructure.
  • Develop & maintain a computer based information system.
  • Develop & maintain in proper functional capacity a Telecommunications infrastructure.
  • Identify, train & reward motivated & skilled users of the technology.
  • Control costs & establish an appropriate level of reimbursement for consultant.
slide36

HEALTH

INFORMATION

MANAGEMENT AND

ORGANIZATIONAL ISSUES

APPROPRIATENESS

SUSTAINABILITY

COST-EFFECTIVENESS

IMPLEMENTATION ENVIRONMENT CONDITIONS

NEEDS, EXPECTATIONS, INFRASTRUCTURE, HEALTHCARE MODELS,

HEALTH ECONOMY, CULTURE, LENGUAGE

PROVIDERS

SOLUTIONS

MARKET

TECHNOLOGICAL

PLATFORM ( HW/SW )

APPLICATIONS

telemedicine in latin america37
TELEMEDICINE IN LATIN AMERICA
  • Evaluation is most critical