INTERNATIONAL TELEMEDICINE UPDATE LATIN AMERICA

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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

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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

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TELEMEDICINE IN LATIN AMERICA
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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

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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

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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

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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
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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
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MAIN TELEPHONE LINES (1995)
LINES X1,000 PERSONS
Source International Telecommunications Union
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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
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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.

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LATIN AMERICA AND CARIBBEAN HOSPITALS
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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

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INFORMATION TECHNOLOGY GROWTH, 1985-1995 AND
1995-2000
PERCENT
SOURCE International Data Corporation, 1996
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Information Technology Growth

• Application of Technological Options Considering
  Bandwidth and Connectivity Alternatives

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Information Technology Expenditures, Gross
Domestic Product and Population as a for 5
regions
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Information Technology Growth Data
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Degree of Development of Core Information
Function Activities in Latin American Countries
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GROWTH OF INTERNET HOSTS
NUMBER OF HOSTS
JAN 97
JAN 96
JAN 95
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GROWTH OF INTERNET HOSTS
NUMBER OF HOSTS
JAN 97
JAN 96
JAN 95
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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

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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.

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Training of Human Resources in Health Information
Systems
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Training of Human Resources in Health Information
Systems
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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.

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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.

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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.

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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

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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 consultsISDN,POTS

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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.

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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.

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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
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TELEMEDICINE IN LATIN AMERICA

• Evaluation is most critical