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E-HEALTH IN LATIN AMERICAAND THE CARIBBEAN:
CHALLENGES AND OPPORTUNITIES
Roberto J. Rodrigues
eHealthStrategies.com, Bethesda, MDand
The Institute for Technical Cooperation in Health Inc. (INTECH), Potomac MD
Adjunct Professor, Science, Technology, and International Affairs ProgramE. Walsh School of Foreign Service, Georgetown University, Washington, D.C.
8 th International Congress in Nursing Informatics June 22-25, 2003
Rio de Janeiro, Brazil
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! HEALTH SECTOR CHARACTERISTICS
! ICT INFRASTRUCTURE AND MARKET
! IMPLEMENTATION ISSUES
! DRIVING FORCES AND BARRIERS
E-HEALTH PERSPECTIVES IN LATIN AMERICA AND THE CARIBBEAN
eHealthStrategies.com
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! HEALTH SECTOR CHARACTERISTICS
! ICT INFRASTRUCTURE AND MARKET
! IMPLEMENTATION ISSUES
! DRIVING FORCES AND BARRIERS
E-HEALTH PERSPECTIVES IN LATIN AMERICA AND THE CARIBBEAN
eHealthStrategies.com
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n DISSATISFACTION WITH HEALTHCARE SYSTEM (CHOICE, ACCESS,QUALITY, CONTINUITY, LONG-TERM PROVIDER RELATIONSHIP)
n INCREASING DEMAND (DEMOCRATIZATION PROCESSES)
n
ANTICIPATION OF NEEDS
, DEMAND FORCUSTOMER SERVICE
, MADE TO MEASURE CARE , AND CONVENIENCE
n EFFICIENCY OF ADMINISTRATIVE PROCESSES (ELIGIBILITY,CLAIMS,
REIMBURSEMENT, PROCUREMENT AND SUPPLY MANAGEMENT)
n LOGISTICS OF HEALTHCARE / COOPERATION IS A PRIORITY (DYNAMIC SCHEDULING, DATA COMMUNICATION)
HEALTH SECTOR TREND-SETTERS IN LAC (1)
SATISFACTION, QUALITY, AND EFFICIENCY
eHealthStrategies.com
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n NEED FOR DETAILED DATA AND INFORMATION (DISTRIBUTEDMULTIDISCIPLINARY PRACTICE, IMPROVED DOCUMENTATION,ERROR REDUCTION, ACCOUNTABILITY, AND TRANSPARENCY)
n RETRIEVAL OF STRUCTURED AND UNSTRUCTURED HEALTH DAT
n ACCESS TO BIOMEDICAL KNOWLEDGE (REFERENCE,PROTOCOLS OF CARE, REGISTRIES, KNOWLEDGE BASES,EVIDENCE-BASED PRACTICE, CONSUMER PARTICIPATION)
n INTERNET-BASED APPLICATIONS (INFORMATION DISSEMINATION,DISTANT EDUCATION, EHR, REMOTE CARE)
INCREASING DATA REQUIREMENTS OF HEALTH PRACTICE
eHealthStrategies.com
HEALTH SECTOR TREND-SETTERS IN LAC (2)
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2000Canada
3%1996-2000
European Union20%
1996-2000Latin America &
Caribbean9%
1990-1998South Asia
5%1990-1998
Eastern Europe &Central Asia
6%
1990-1998East Asia & Pacific
10%
1990-1998Middle East & North
Africa2% 1990-1998
Sub-Saharan Africa1%
1998United States
44%
THE GLOBAL MARKET FOR HEALTH GOODS AND SERVICES (1)
Source : Casas, JA Trade in Health Services in the Americas:Trends and Opportunities, PAHO/WHO, 2001
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Source : Casas, JA Trade in Health Services in the Americas:Trends and Opportunities, PAHO/WHO, 2001
Total Health Expenditure x GDP Per Capita (191 Countries)
eHealthStrategies.com
THE GLOBAL MARKET FOR HEALTH GOODS AND SERVICES (2)
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WORLD
Source : Casas, JA Trade in Health Services in the Americas:Trends and Opportunities, PAHO/WHO, 2001
HEALTH EXPENDITURES PER CAPITA 1998-2000;
in 1999 International US dollars (Purchase Power Parity)
3,978
2,206
452
144 91216
48
324
1,868
346
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
U S D o
l l a r s
( P P P )
World U.S. Canada EuropeanUnion
LA &Caribbean
East Asia& Pacific
E Europe& C Asia
SouthAsia
Middle East& N Africa
Sub-SaharanAfrica
eHealthStrategies.com
THE GLOBAL MARKET FOR HEALTH GOODS AND SERVICES (3)
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THE CHANGING PRACTICE ENVIRONMENT
Current Approach
n Care based on visitsn Professional autonomyn Professionals control caren Provider owns recordsn Decision based on experiencen Safety is individual issuen Privacy is individual issuen No transparency of operationsn
The system reacts to needsn Cost not controlledn Independent providers
New Model
n Continuous relationshipsn Customized patient caren Patient is source of controln Information flows freelyn Evidence-based decisionsn Safety is a system propertyn Privacy is a system propertyn Transparency is necessaryn
Needs are anticipatedn Control costsn Cooperation is required
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THE CONNECTED CONSUMER
! WELLNESS AND MEDICAL INFORMATION
! SHOPPING FOR PROVIDERS AND SERVICES
! RISK ASSESSMENT TESTING
! BUYING PHARMACEUTICALS AND HEALTH PRODUCTS
! COMMUNICATION WITH SPECIAL INTEREST GROUPS
! E-MAILING TO PROVIDERS AND INSURERS
eHealthStrategies.com
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INFORMATION TECHNOLOGY INFRASTRUCTURE
! TECHNICAL RESOURCES AND WEB DEMOGRAPHICS
! DATA AND COMMUNICATION STANDARDS
! TECHNOLOGICAL INNOVATION X ACTUAL USE GAP
! OPEN x PROPRIETARY ARCHITECTURE
! COST-BENEFIT JUSTIFICATION
TECHNOLOGY BARRIERS (1)
eHealthStrategies.com
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THE DEVELOPMENT / ANALOG / DIGITAL DIVIDES BY INCOME
Source : Digital Opportunities Taskforce (DOT Force), 2000
0%
10%
20%
30%
40%
50%
60%70%
80%
90%
100%
Population Television Telephone GDP Internet
Low Lower Middle Upper Middle High
Percentage of World Total
eHealthStrategies.com
O hi f P l C i 155 C i C i d b L l f IO hi f P l C t i 155 C t i C t i d b L l f I
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0.01
0.1
1
10
100
N u m
b e r o f
P e r s o n a
l C o m p u
t e r s x
1 0 0 P e r s o n s
( L o g
S c a
l e )
LOW INCOME
LOWER MIDDLEINCOME
UPPER MIDDLEINCOME
HIGH INCOME
m = Arithmetic Mean
m = 0.68
m = 3.64
m = 10.08
m = 31.30
Ownership of Personal Computers in 155 Countries Categorized by Level of IncomeOwnership of Personal Computers in 155 Countries Categorized by Level of Income(Data from: International Telecommunication Union, World Telecom Indicators 2002)(Data from: International Telecommunication Union, World Telecom Indicators 2002)
eHealthStrategies.com
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SELECTED TECHNOLOGY INPUTS BY REGION (1992-1997)
Source : Rodrguez F and Wilson E ( InfoDev , World Bank 2000 ) modified
Region R&D as Technicians Scientists GPD per% of GDP per 10 6 pop per 10 6 pop capita
OECD 1.8 1,326.1 2,649.1 20,113.5Eastern Europe & FSR 0.9 577.2 1,841.3 4,027.4
East Asia 0.8 235.8 1,026.0 6,270.6Latin America & Caribbean 0.5 205.4 656.6 5,635.8Middle East 0.4 177.8 521.0 8,941.5Sub-Saharan Africa 0.2 76.1 324.3 1,971.5South Asia 0.8 59.5 161.0 1,764.3
THE RESEARCH & DEVELOPMENT DIVIDE BY REGION
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3.9196Venezuela7.91,798Germany
8.12,296United States8.71,916France
9.12,187United Kingdom7.81,835Finland10.42,674Sweden12.0228Colombia
5.1731Spain5.446China
9.72,104Singapore7.8360Chile
3.763Russia8.41,911Canada
6.92,445Norway8.4289Brazil
3.2189Mexico8.01,769Belgium
8.33,118Japan7.21,697Austria
5.71,068Italy9.71,992Australia
8.7431Hungary4.1317Argentina
ICTExpenditureas % of GDP
(2000)
ICTExpenditurePer Capita in
US$ (2000)
Country
ICTExpenditureas % of GDP
(2000)
ICTExpenditurePer Capita in
US$ (2000)
Country
Expenditure on Information and Communication Technologies in Selected Countries Expenditure on Information and Communication Technologies in Selected Countries
NATIONAL INVESTMENT CAPACITY IS A MAJOR PROBLEM
Source: World Bank, 2002 World Development Report
eHealthStrategies.com
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GLOBAL INTERNET USERS
Source : International Telecommunication Union, 2000
0
50
100
150
200250
300
350
Developed 30 47 77 124 180 232
Developing 3 7 13 25 51 83
1995 1996 1997 1998 1999 2000
4%
21%
6%
9%
15%
28%
0.1% 0.1%0.3% 0.5%
1%
1.6%
Penetration
Millions of Users
eHealthStrategies.com
GLOBAL INTERNET USERS (APRIL 2001)
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GLOBAL INTERNET USERS (APRIL 2001)
Source : www.netsizer.com
TOTAL NUMBER OF USERS 427,213,610
47.95%
4.12%
0.38%
23.63%
18.58%
4.56%
0.78%North AmericaSouth America
Central AmericaEuropeAsiaOceaniaAfrica
eHealthStrategies.com
NETWORKED READINESS INDEX (75 Countries)
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USA
SWE
NIG
VIE BAN
HONECU
NIC
BOL
GUA
PAR
FIN
NET
SGPAUT
GBR
GER CAN
JPNFRA
ARG
SPA
POLBRA
URUSAR
TUR
MEX
CHI
JOR
PAN
VEN
BUL
PER
ELS
COLEGY IND
JAMRUS
CHN
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
Source : The Global Information Technology Report 2001-2002 (Modified to shown only selected countries)World Economic Forum and Harvard University Center for International Development
NETWORKED READINESS INDEX (75 Countries)Access & Infrastructure) / Policy & Business Environment / Learning & Opportunities / Economy)
IN THE TOP THIRD
14 in Western Europe (best in Scandinavia) 7 in Asia and Oceania (led by Singapore) 2 in North America (U.S. and Canada) 1 in Middle East (Israel)
IN THE TOP THIRD
14 in Western Europe (best in Scandinavia) 7 in Asia and Oceania (led by Singapore) 2 in North America (U.S. and Canada) 1 in Middle East (Israel)
IN THE BOTTOM THIRD
1O in Latin America (led by Peru) 7 in Asia (led by India) 4 in Eastern Europe (led by Bulgaria) 3 in Sub-Saharan Africa 1 in the Middle East (Egypt)
IN THE BOTTOM THIRD
1O in Latin America (led by Peru) 7 in Asia (led by India) 4 in Eastern Europe (led by Bulgaria) 3 in Sub-Saharan Africa 1 in the Middle East (Egypt)
IN THE MID THIRD
10 in L America/Caribbean (led by Argentina) 6 in Western Europe (led by Portugal) 4 in Eastern Europe (led by Slovenia)) 1 in Asia (Malaysia)
1 in Africa (South Africa)
IN THE MID THIRD
10 in L America/Caribbean (led by Argentina) 6 in Western Europe (led by Portugal) 4 in Eastern Europe (led by Slovenia)) 1 in Asia (Malaysia) 1 in Africa (South Africa)
eHealthStrategies.com
TELEPHONE LINES DENSITY AND INTERNET USAGE
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TELEPHONE LINES DENSITY AND INTERNET USAGE
Source : The Global Information Technology Report 2001-2002World Economic Forum and Harvard University Center for International Development
* Fixed and mobile subscriptions** Based on individual user who access the Internet at least once a month
eHealthStrategies.com
TELEPHONE LINES DENSITY AND INTERNET USAGE
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Source : The Global Information Technology Report 2001-2002World Economic Forum and Harvard University Center for International Development
* Fixed and mobile subscriptions** Based on individual user who access the Internet at least once a month
TELEPHONE LINES DENSITY AND INTERNET USAGE
eHealthStrategies.com
TECHNOLOGY BARRIERS (2)
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INFORMATION TECHNOLOGY DEPLOYMENT
! INTEGRATION IN THE WORK ENVIRONMENT
! PROJECT MANAGEMENT AND EDUCATION / TRAINING OF
HEALTH PROFESSIONALS
! ACCESS TO RELIABLE APPLICATIONS PRODUCTS ANDSERVICES (INTEGRATION, CUSTOMER SUPPORT, TRAINING)
! VENDOR DEPENDENCY
TECHNOLOGY BARRIERS (2)
eHealthStrategies.com
Technology Exports, Royalties, and Licenses Payments for the Year 2000 Technology Exports, Royalties, and Licenses Payments for the Year 2000
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A r g e n t i n a 9 1 3 4 5 8 - 4 4 5 2 7 6 . 2 - 0 . 1 6B o l i v i a 2 5 - 3 8 . 2 - 0 . 0 4B r a z i l 1 9 1 2 6 1 , 4 1 5 - 1 , 2 8 9 6 1 0 . 1 - 0 . 2 1C h i l e 3 1 0 2 4 4 5 8 6 9 . 8 0 . 0 8C o l o m b i a 7 4 7 1 - 6 7 8 5 . 3 - 0 . 0 8C o s t a R i c a 1 3 1 - 3 0 1 4 . 5 - 0 . 2 1D o m i n i c a n R e p u b l i c 3 0 - 3 0 1 7 . 8 - 0 . 1 7E c u a d o r 6 6 2 - 6 2 1 5 . 3 - 0 . 4 1E l S a l v a d o r 6 2 2 0 - 1 8 1 2 . 6 - 0 . 1 4H o n d u r a s 2 0 1 0 - 1 0 5 . 5 - 0 . 1 8J a m a i c a 0 6 4 1 - 3 5 6 . 9 - 0 . 5 1
M e x i c o 2 2 4 3 4 0 7 - 3 6 4 4 9 7 - 0 . 0 7P a n a m a 0 0 3 0 - 3 0 9 . 3 - 0 . 3 2P e r u 3 5 7 - 5 7 5 3 . 4 - 0 . 1 1U r u g u a y 2 1 1 - 1 1 2 0 - 0 . 0 6
W o r l dL o w a n d M i d d l e In c o m e 1 6 1 , 8 7 3 1 1 , 0 6 4 - 9 , 1 9 1
E a s t A s i a & P a c i f i c 2 5 7 8 4 5 , 4 0 9 - 4 , 6 2 5E u r o p e a n d C e n t r a l A s i a 1 0 3 1 3 1 , 7 5 3 - 1 , 4 4 0L a t i n A m e r i c a & C a r i b b e a n 1 6 5 0 1 2 , 6 6 6 - 2 , 1 6 5M i d d l e E a s t & N o r th A f r i c a 1 1 0 6 6 1 4 - 5 0 8S o u t h A s i a 3 8 7 3 3 8 - 2 5 1S u b - S a h a r a n A f r i c a 8 8 2 2 8 3 - 2 0 1
H i g h In c o m e 2 2 7 0 , 3 2 1 6 2 , 9 8 8 7 , 3 3 3E u r o p e a n C o m m u n i t y 1 6 1 1 , 0 1 9 2 3 , 4 2 2 - 1 2 , 4 0 3
U n i te d S t a t e s 3 4 3 8 , 0 3 0 1 6 , 1 0 0 2 1 , 9 3 0J a p a n 2 8 1 0 , 2 2 7 1 1 , 0 0 7 - 7 8 0
Countries
R oyalties andLicenses
Incom e inM illions of US $
Royaltiesand Licenses
B alance as% of G N I
R oyalties andLicenses
B alance inM illions of
U S $
R oyalties andLicenses
P aym ents inM illions of US $
GrossNational
Incom e inBillions U S $
H igh TechnologyExports as % of
All M anufacturedProductsExported
gy p y ygy p y yfor Selected Countries. (Source: World Bank, 2002 Development Indicators) for Selected Countries. (Source: World Bank, 2002 Development Indicators)
eHealthStrategies.com
HEALTH SECTOR BARRIERS (1)
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! DISSEMINATION STILL LIMITED = HEALTH SECTOR LAGS BEHIND OTHER SECTORS
! MANY PUBLIC HEALTH ORGANIZATIONS ARE NOT TAKING ADVANTAGE OF ICT OPPORTUNITIES
! ROLE IN COMPETITIVENESS AND ORGANIZATIONALSURVIVALIN THE NEW HEALTHCARE ENVIRONMENT
! MOST EXISTING INFORMATION SYSTEMS ARE INADEQUATE TO THE NEW MODELS OF HEALTHCARE = STATISTICAL-EPIDEMIOLOGICAL PARADIGM
HEALTH SECTOR BARRIERS (1)
eHealthStrategies.com
NEED RECOGNITION
HEALTH SECTOR BARRIERS (2)
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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 DATASETS FOR OPERATIONALMANAGEMENT AND CLINICAL DECISION-MAKING
! HEALTHCARE ORGANIZATIONS AND PROVIDERS TEND TOSEE THEIR OWN DATA AS THE ONLY GOOD AND VALID DATA
HEALTH SECTOR BARRIERS (2)
eHealthStrategies.com
HEALTH SECTOR BARRIERS (3)
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ORGANIZATIONAL AND POLICY-RELATED
! INFRASTRUCTURE , INVESTMENT SUSTAINABILITY,AND DEPLOYMENT CAPABILITY
! DISTRUST OF HEALTH PROFESSIONALS IN OFF-SITE DATASTORAGE AND ACCESS CONTROL
! NATIONAL POLICIES AND STRATEGIES FOR THE STANDARDIZATIONAND COST-EFFECTIVE USE OF TECHNOLOGY AND INFORMATION
! CONSISTENCY AND CONTINUITY OF POLITICAL SUPPORT
HEALTH SECTOR BARRIERS (3)
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AREAS OF KNOWLEDGE MANAGEMENT APPLICATIONS
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AREAS OF KNOWLEDGE MANAGEMENT APPLICATIONS
Source : U.S. Market, The Delphi Group, 2000
0 10 20 30 40 50 60 70 80 90
Medical Records Management
Litigation Support
Other
Function-Centered Desktops
Case Management
Electronic CommerceCorporate Operations
Corporate Portals
Proposal Development
Call Center Support
Research and Development
Competitive Analysis and Intelligence
Customer Relationship Management
Intellectual Asset Management
Intranet Content Management
Collaborative Professional Work
Current Planned
PERCENT
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U.S. PHYSICIANS USE OF COMPUTERS (2000)
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( )
0 20 40 60 80 100
Prescriptions
Telemedicine
ReferralsTreatment Alerts
Patient Records
Managed Care Apps
Patient Reminders
Scheduling
Billing
PERCENTSource: Pricewaterhouse Coopers Modern Physician 2000
eHealthStrategies.com
SOURCES OF INFORMATION ABOUT NEW HEALTH WEB SITES
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61.3
45.7
40.3
32.9
26.5
19.1
17.4
10.26.3
1.2
0.5
0 20 40 60 80
Health Professional
Billboards
RadioMedia Story
Newsprint
TV
Web Banners
Friends/Family
Internet Search
Web Links
U.S. Survey by Gmez Advisors, Inc. , 2000
HOW THE PUBLIC LEARNS ABOUT HEALTH INFORMATION IN THE WE
%
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E-HEALTH PERSPECTIVES IN LATIN AMERICA AND THE CARIBBEAN
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! HEALTH SECTOR CHARACTERISTICS
! ICT INFRASTRUCTURE AND MARKET
! IMPLEMENTATION ISSUES
! DRIVING FORCES AND BARRIERS
eHealthStrategies.com
HEALTH SECTOR IN LATIN AMERICA & THE CARIBBEAN
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! WESTERN BIOMEDICAL / SOCIAL SECURITY MODELS
! 80% URBANIZATION / LARGE URBAN AREAS
! BURDEN OF DISEASE: COMMUNICABLE DISEASES, MATERNAL ANDPERINATAL CONDITIONS, LIFE-STYLE (HIV/TOBACCO/ALCOHOL),CHRONIC-DEGENERATIVE AND CARDIOVASCULAR DISEASES,RESPIRATORY CONDITIONS, INJURIES
! INADEQUATE INFRASTRUCTURE, FACILITY AND SERVICESDISTRIBUTION, POOR ACCESS, AND LOW QUALITY
!LOW INVESTMENT AND INCREASING COSTS ARE A MAJORIMPEDIMENTS TO THE DEVELOPMENT OF THE HEALTH SECTOR
! HEALTH SECTOR REFORM
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DISTRIBUTION OF GROSS DOMESTIC PRODUCT BY SECTOR, 1999
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Source : World Bank, World Development Indicators 1999
0
10
20
30
40
50
60
70
80
Agriculture 6 16 9 3 8 14 14 11 12 11 23 30 18 8 5 26 8 26 8 2 2 9 5
Ind/Manufc 22 17 23 18 16 12 17 16 22 22 13 7 18 15 19 14 9 16 24 8 18 19 12
Ind/Non-Manufc 11 13 6 15 17 13 5 19 11 6 6 13 12 18 8 7 9 6 14 32 8 10 12
Services 61 54 62 64 59 61 64 54 55 61 58 50 52 59 68 53 74 52 54 58 72 62 71
ARG BOL BRA CAN CHI COL COR DOR ECU ELS GUA HAI HON J AM MEX NIC PAN PAR P ER TRT US A URU VEN
Sector
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HEALTH CONTRIBUTION TO THE SERVICES SECTOR
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Source : World Bank, World Development Indicators 1999
ARG
COR
ECU
ELS
HON
MEX TRT
BOL
DORGUA
HAIJAM PAN PAR
PER
USA
URU
VEN
CAN
CHIBRA
COL
NIC
0
3
5
8
10
13
15
18
20
23
25
HEALTH SERVICES AS PERCENTAGE OF THE SERVICE SECTOR%
eHealthStrategies.com
THE LATIN AMERICAN & CARIBBEAN MARKET
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Source : Casas, JA Trade in Health Services in the Americas:Trends and Opportunities, PAHO/WHO, 2001
Latin America & Caribbean, 1998-2000:
National Health Expenditures Per Capita in US$(Countries Grouped by Income Levels)
0
100
200
300
400
500
600
700
800
H A I
N I C
H O N
G U Y
B O L
C U B
G U T
D O R
E L S
E C U
J A M
P A R
C O L
P E R
S V G
B L Z
P A N
V E N
C O R
B R A
C H I
T R T
M E X
U R U
A N G
B A R
N E N
A R G
B A H
US$
HIGHEST INCOME
LOWEST INCOME
MID INCOME
eHealthStrategies.com
THE LATIN AMERICAN & CARIBBEAN MARKET
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Source : Casas, JA Trade in Health Services in the Americas:Trends and Opportunities, PAHO/WHO, 2001
Private Insurance18%
Direct Out-of-PocketExpenditure
37%
Central Government23%
Local Governments8%
Social Security14%
PUBLIC AND PRIVATE COMPOSITION OF HEALTH EXPENDITURES (1998-2000)
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HOSPITAL MARKET
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100.01,097,965100.016,566Total
6.51,087No Data
93.45,479Sub-Total
3.943,0970.229>1000
11.5126,1691.1186501-10005.458,9510.8133401-500
7.784,8111.5242301-400
12.1133,2253.3544201-300
22.1242,77010.31,703101-200
17.3189,55915.82,61551-100
20.0219,38360.510,0271-50
PercentNumberPercentNumber
Beds AvailableHospitalsNumber of Beds
Hospital Size in Latin America and the Caribbean by Number of Beds Hospital Size in Latin America and the Caribbean by Number of Beds
(Source: PAHO Directory of Latin America and Caribbean Hospitals, 1996-1997) (Source: PAHO Directory of Latin America and Caribbean Hospitals, 1996-1997)
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HOSPITAL MARKET
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100.00---5,230100.00---11,336100.016,566Total
0.5523.20290.8476.80960.75125Military
9.6539.335056.8760.667797.751,284Philanthropic
54.6636.732,85943.4363.264,92446.987,783Private
8.3750.004383.8650.004385.29876Public Social Security
26.7421.521,39944.9878.475,09939.226,498Public Non-Social Security
In GroupIn ClassIn GroupIn Class
PercentNumber
PercentNumber PercentNumber
WITH COMPUTERSNO COMPUTERS ALL FACILITIES
HOSPITAL GROUPS
OWNERSHIPCLASS
Legal Ownership of 16,566 Hospitals and Computerized Information Systems Legal Ownership of 16,566 Hospitals and Computerized Information Systems
in Latin America and the Caribbean, period 1995-1997 in Latin America and the Caribbean, period 1995-1997 (Source: PAHO Directory of Latin American and Caribbean Hospitals Database) (Source: PAHO Directory of Latin American and Caribbean Hospitals Database)
eHealthStrategies.com
31.6% HAVE COMPUTERS, OF THOSE ABOUT 54.6% ARE PRIVATE
E-HEALTH PERSPECTIVES IN LATIN AMERICA AND THE CARIBBEAN
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! HEALTH SECTOR CHARACTERISTICS
! ICT INFRASTRUCTURE AND MARKET
! IMPLEMENTATION ISSUES
! DRIVING FORCES AND BARRIERS
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HEALTH INFORMATION TECHNOLOGY DEVELOPMENT INDICATORS
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LIMITATIONS OF INFORMATION TECHNOLOGY METRICS
! LACK OF STANDARDIZED DEFINITIONS FOR IT COMPONENTS
! DATA ON IT RARELY COLLECTED ON A SYSTEMATIC BASIS
! ABSENCE OF COST DATA
! INFORMATRION ON HOW IT IS BEING ACTUALLY USED
! LACK OF EVALUATION OF POSITIVE AND NEGATIVE IMPACTS
! RAPIDLY CHANGING TECHNOLOGY
eHealthStrategies.com
THE INCOME BARRIER (1)
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0
10
20
30
40
50 60
70
80
90
U.S.Rural
Urban
U.S. 15.9 12.3 15.9 21.2 25.7 35.8 50.2 66.3 79.9Rural 11.9 8.1 13.8 22.1 24.7 34.0 51.0 64.2 76.5
Urban 16.9 13.6 16.6 20.8 26.1 36.5 50.0 67.1 80.8
Under5,000
5,000-9,999
10,000-14,999
15,000-19,999
20,000-24,999
25,000-34,999
35,000-49,999
50,000-74,999
75,000+
0 10
20
30
40
50
60
70
80
90
U.S.Rural
Urban
U.S. 15.9 12.3 15.9 21.2 25.7 35.8 50.2 66.3 79.9Rural 11.9 8.1 13.8 22.1 24.7 34.0 51.0 64.2 76.5
Urban 16.9 13.6 16.6 20.8 26.1 36.5 50.0 67.1 80.8
Under5,000
5,000-9,999
10,000-14,999
15,000-19,999
20,000-24,999
25,000-34,999
35,000-49,999
50,000-74,999
75,000+
PERCENT OF U.S. HOUSEHOLDS WITH COMPUTERBY LEVEL OF INCOME (1998)
Source: U.S. National Telecommunication and Information Agency, DOC, 1999
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THE INCOME BARRIER (2)
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BRA CAN CHI COL DOR ECU GUA HON MEX NIC P
Hi Q 14,105 37,661 14,629 7,563 5,404 3,307 5,013 2,265 13,04th Q 4,046 22,041 4,341 2,285 2,073 1,417 1,480 769 4,2963rd Q 2,211 16,483 2,614 1,378 1,318 945 835 457 2,640 2nd Q 1,216 12,362 1,583 820 835 625 462 277 1,611
Lo Q 553 7,187 839 373 433 359 167 133 805 99
SELECTED COUNTRIES - GNP PER CAPITA BY POPULATION QUINTILES (1999)SELECTED COUNTRIES - GNP PER CAPITA BY POPULATION QUINTILES (1999)
Source: Data from the World Bank Development Report, 2000
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THE INCOME BARRIER (3)
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0
2,500
5,000
7,500
10,000
12,500
15,000
17,500
20,000
22,500
25,000
A R B O L
B R C H I
C O L
C O R
D O R
E C U
E L S
G U H A I
H O N
J A M
M E X N I
C P A
N P A
R P E
R U R
U V E
N
Hi 10% 5th Quintile (Hi 20%) 4th Quintile 3rd Quintile 2nd Quintile 1st Quintile (Low 20%)
SELECTED COUNTRIES - GNP PER CAPITA BY POPULATION QUINTILES (1999)
Source: Data from the World Bank Development Report, 2000
eHealthStrategies.com
THE INCOME BARRIER (3)
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BRAZIL - CELLULAR TELEPHONY AND COMPUTERS USE BY SOCIAL CLASS
40.8
24.1
11
51
17.9
3.8
30.2
8.5 2
0
10
20
30
40
50
60
CELLULAR MICROCOMPUTER INTERNET
A/BCD/E
CLASS
PERCENT
Source: Ministry of Health, Brazil (1999)
eHealthStrategies.com
THE EDUCATIONAL BARRIER
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PERCENT OF U.S. HOUSEHOLDS WITH COMPUTERBY LEVEL OF EDUCATION (1998)
Source: U.S. National Telecommunication and Information Agency, DOC, 1999
0
10
20
30
40
50
60
70
80
U.S.RuralUrban
U.S. 7.9 15.7 31.2 49.3 68.7Rural 6.3 17.2 33.2 51.7 69.7
Urban 8.7 15.0 30.3 48.6 68.5
ElementarySome High
SchoolHigh School
or EquivSome
Collegue B.A. or more
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TELECOM INFRASTRUCTURE
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WIRED (FIXED) TELEPHONE LINES X 100 PERSONS (1998)
0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
B E R
U V I
U S A
C A N
A N T
S K N
G D L
M A R
B A R
B A H
N A T
A R U
P U R
G R E
F G U
U R U
S L U
D O M
C H I
T R T
C O R
A R G
S V G
J A M
S U R
P A N
C O L
B R A
B E L
M E X
V E N
D O R
E C U
E L S
G U Y
P E R
B O L
P A R
G U A
H O N
C U B
N I C
H A I
A N G
B V I
C A Y
M O N
T U C
PERCENT
Source : International Telecommunication Union, 2000
*
* No DataeHealthStrategies.com
COST OF WIRED CONNECTION
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ANNUAL RESIDENTIAL SUBSCRIPTION AS
PERCENTAGE OF GNP x CAPITA (1997)
Source : International Telecommunication Union and PAHO Basic Indicators
0
2
4
6
810
12
14
16
18
20
A N G
A N T
A R G
A R U
B A H
B A R
B E L
B E R
B O L
B R A
B V I
C A N
C A Y
C H I
C O L
C O R
C U B
D O M
D O R
E C U
E L S
F G U Y
G R E
G D L
G U A
G U Y
H A I
H O N
J A M
M A R
M E X
M O N
N A T
N I C
P A N
P A R
P E R
P U R
S K N
S L U
S V G
S U R
T R T
T U C
U S A
U R U
U V I
V E N
0
2
4
6
8
10
12
14
16
18
20
A N G
A N T
A R G
A R U
B A H
B A R
B E L
B E R
B O L
B R A
B V I
C A N
C A Y
C H I
C O L
C O R
C U B
D O M
D O R
E C U
E L S
F G U Y
G R E
G D L
G U A
G U Y
H A I
H O N
J A M
M A R
M E X
M O N
N A T
N I C
P A N
P A R
P E R
P U R
S K N
S L U
S V G
S U R
T R T
T U C
U S A
U R U
U V I
V E N
PERCENT
eHealthStrategies.com
INTERNET USE - PHYSICIANS IN BRAZIL (1)
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0
10
20
30
40
50
60
Group
User
Non User
SAMPLE SIZE: 42,744 PHYSICIANS *
1999 SURVEY (In 1996 there were 205,828 physicians)
585858
424242%
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INTERNET USE - PHYSICIANS IN BRAZIL (2)
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SAMPLE SIZE: 24,603 PHYSICIANS
LOCATION FROM WHERE INTERNET IS ACCESSED
Site of Access0
10
20
30
40
50
60
70
80
90
HomeUniversityOfficeHospital
%
8585
1010
1999 SURVEY (In 1996 there were 205,828 physicians)
eHealthStrategies.com
DIGITAL INFRASTRUCTURE (1)
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0
5
1 0
1 5
2 0
2 5
3 0
3 5
4 0
4 5
5 0
U S A
C A N
U V I
G D L
S L U
S K N
B E L
F G U
G R E
M A R
B A H
U R U
S V G
D O M
B A R
C H I
T R T
M E X
A R G
V E N
J A M
C O R
B R A
P A N
C O L
G U Y
E C U
P E R
E L S
P A R
G U A
H O N
B O L
N I C
A N G
A N T
A R U
B E R
B V I
C A Y
C U B
D O R
H A I
M O N
N A T
P U R
S U R
T U C
Source : International Telecommunication Union, 2000
PERCENT
* No Data
*
PERSONAL COMPUTERS X 100 PERSONS (1998)
eHealthStrategies.com
DIGITAL INFRASTRUCTURE (2)
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0 . 0
0 . 1
1 . 0
1 0
. 0
1 0 0
. 0
U S A
B E R
C A N
U V I
U R U
S K N
B E L
A N T
C H I
B A H
C O R
D O M
P U R
M E X
A R G
G R E
B R A
J A M
B A R
S V G
S U R
V E N
P A N
P E R
T R T
C O L
S L U
F G U
E L S
G U A
M A R
G D L
B O L
N I C
P A R
G U Y
H O N
D O R
C U B
E C U
H A I
A N G
A R U
B V I
C A Y
M O N
N A T
T U C
INTERNET CONNECTIVITY X 100 PERSONS (1999)PERCENT (LOG SCALE)
Source : International Telecommunication Union, 2000
*
* No DataeHealthStrategies.com
INTERNET USERS IN LATIN AMERICA & CARIBBEAN (2000) IN MILLIONS
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Source: NUA Internet Surveys
TOTAL POPULATION CONNECTED 17,135,000
0.300 0.150 0.5200.400
0.4000.600
0.625
0.900
2.500
9.840
BRAMEXARGCHI
COLPERVENURU
COROTHER
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INTERNET USE - LANGUAGE
NUMBER OF NATIVE SPEAKERS ONLINE (MARCH 2001)
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Source: Global Reach, Internet Statistics
Russian2.3%
Dutch2.1%
Portuguese2.5%
Other6.2%
French3.7%
Italian3.1%
Korean4.4%
Spanish4.5%
German6.1%
Japanese8.6% Chinese
9.0%
English47.5%
NUMBER OF NATIVE SPEAKERS ONLINE (MARCH 2001)
eHealthStrategies.com
NETWORK ACCESS SPEED
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35%Regional Average 22%Ecuador
27%Venezuela
31%Colombia
31%Argentina
33%Brazil
37%Chile
39%Peru
42%Mexico
Organizations withAccess > 56 KbpsCountries
Connectivity Speed in Selected Countries of Latin AmericaConnectivity Speed in Selected Countries of Latin America(Source:(Source: HarteHarte -Hanks CI Technology Database, 2001)-Hanks CI Technology Database, 2001)
eHealthStrategies.com
DEVELOPED COUNTRIES / BROADBAND PENETRATION
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E-MARKET IN LATIN AMERICA
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Source : www.xplane.com, 2000
1101001,00010,000
Brazil
Mexico
Argentina
Venezuela
Colombia
Chile
Peru
Other
2005 4,256 1,542 1,094 348 336 312 164 277
1999 121 25 15 7 7 4 5 8
Brazil Mexico Argentina Venezuela Colombia Chile Peru Other
MILLIONS OF US DOLLARS, LOG SCALE
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THE FUTURE OF THE TELECOM INFRASTRUCTURE
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TELEPHONY INSTALLATION - BRAZIL
Source : ANATEL, 2000
0
5
10
15
20
25
30
35
40
45
50
1998 1999 2000 2001 2003*
Fixed LinesMobile
Millions of Lines
Privatization of Telecommunication Markets have Resulted in Expansion of Infrastructure -In Brazil, in a Period of Four Years the Telephony Density Increased from 13.6 Fixed
and 4.5 Mobile Lines per 100 People to 28.5 and 26.2 Respectively
eHealthStrategies.com
BRAZIL - MAGNETIC/BAR CODE/SMART CARD USE
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0 10 20 30 40 50
Bank Card
Health PlanCard
Store Card
Credit Card
No Card
PERCENT OF POPULATION
Source: Ministry of Health, Brazil (1999)
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STAKEHOLDERS HAVE DIFFERENT PERSPECTIVES AND MOTIVATIONS
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1
2
3
4
5Need Recognition
Vision of Applications Required
Context of UtilizationExpectations
Involvement/Commitment
Government Health Authorities
Lack ofcontinuity andsustainabilityStaff notengaged
Involvementand
Commitment
Uninformedregarding ICTopportunities
Expectations
Laggingbehind allother sectors
Context ofUtilization
Highlyaggregated
data ofmortality,morbidity, andutilization
Vision ofRequired
Applications
Constrainedby statistical / epidemiologyparadigm
NeedRecognition
eHealthStrategies.com
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1
2
3
4
5Need Recognition
Vision of Applications Required
Context of UtilizationExpectations
Involvement/Commitment
General PublicEconomic,cultural andeducationalbarriers
Involvementand
Commitment
ExcessiveexpectationsExpectations
Big picturelackingContext ofUtilization
Poor
recognition ofinteractionsand limitedrecognition ofmanagerialapplications
Vision ofRequired
Applications
Focus onpersonalhealth needsand beliefs
NeedRecognition
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STAKEHOLDERS HAVE DIFFERENT PERSPECTIVES AND MOTIVATIONS
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1
2
3
4
5Need Recognition
Vision of Applications Required
Context of UtilizationExpectations
Involvement/Commitment
Health ICT Experts
Drivers foradoption
InvolvementandCommitment
Most vocaland optimisticExpectations
Understandthecomplexity ofneeds
Context ofUtilization
Excellentrecognition or
requirements
Vision ofRequired
Applications
Clear andbalancedperspective
NeedRecognition
eHealthStrategies.com
Feel
STAKEHOLDERS HAVE DIFFERENT PERSPECTIVES AND MOTIVATIONS
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1
2
3
4
5Need Recognition
Vision of Applications Required
Context of UtilizationExpectations
Involvement/Commitment
Health ICT Suppliers
Do not seehealthmarket asprovidingreturn oninvestment
Involvementand
Commitment
Pessimisticregardingprogress innext 5-10years
Expectations
Underestimate complexityof healthproducts
Context ofUtilization
Commercialinterestdirectspromotion ofown productsand services
Vision ofRequired
Applications
Feelrestricted
due to lack ofbroadunderstanding of needs
NeedRecognition
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1
2
3
4
5Need Recognition
Vision of Applications Required
Context of UtilizationExpectations
Involvement/Commitment
Generic ICT SuppliersDrivers foradoption
Involvementand
Commitment
Optimistic asresult of e-Commerceand othersectorsadoption ofICT
Expectations
Poorunderstandingon how healthsystems
operate
Context ofUtilization
Perceiveapplicationsas
commoditiessupportingstandardizedprocesses
Vision of
RequiredApplications
Fail todistinguishbetweenclerical,administrative, and clinicalprocesses
NeedRecognition
eHealthStrategies.com
!
IMPLEMENTATION IN LATIN AMERICA & CARIBBEAN (1)
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! RELIABILITY OF SERVICE DEPENDENT ON QUALITY OF NETWORKAND INFORMATION TECHNOLOGY INFRASTRUCTURE
! ELECTRONIC TRANSACTIONS REQUIRE SUBSTANTIAL AMOUNT OF DETAILED OPERATIONAL INFORMATION BEFORE AN
"E-ARCHITECTURE" CAN BE EFFECTIVELY IMPLEMENTED
! TECHNOLOGICAL BEGINNING-TO-END SOLUTION , LINKINGDIFFERENT PLATFORMS, LEGACY AND PROPRIETARY SYSTEMS
INVOLVING PROVIDER, INSURER, PAYER, PATIENT AND EMPLOYERDATA
! ORGANIZATIONS AND PROVIDERS WITH COMPUTERIZED
INFORMATION SYSTEMS IN PLACE, MUST FIGURE OUT HOW TOLINK INTO THE NEW APPLICATIONS, INCORPORATE ITS LEGACYSYSTEMS, OR START ANEW
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! INFRASTRUCTURE AND PREPAREDNESS: ANALOG/DIGITALDIVIDES ARE CONSEQUENCE OF INEQUITIES THAT MUST BE BRIDGED
! INCENTIVE THROUGH REGULATION ! MECHANISMS AND PROCESSES FOR CONSENSUS
AND ACTION WITH HIGH-LEVEL POLITICAL SUPPORT
! LEADERSHIP AND CONTINUITY AND SUSTAINABILITY OF INVESTMENT ! BEST PRACTICES, AVOIDANCE OF REDUNDANCIES AND
AVOIDANCE OF DOWNSIDE ASPECTS OF POWER CONCENTRATION
! RETURN ON INVESTMENT THAT JUSTIFIES CAPITAL INVESTMENTAND OPERATIONAL COSTS
eHealthStrategies.com
!
IMPLEMENTATION IN LATIN AMERICA & CARIBBEAN (3)
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!GROWING MARKET WITH GREAT POTENTIALBUT IDENTIFICATION OF OPPORTUNITIES AND MARKET DEVELOPMENT MAY BE ALONG AND DIFFICULT PROCESS
! E-HEALTH DEVELOPMENT NEEDS INTEGRATION OF TECHNOLOGY,GEOGRAPHY, CULTURE, LANGUAGE, AND.HEALTHCARE SYSTEMS
! NO SINGLE COOKBOOK OR TRANSLATED SOLUTION
! COST-EFFECTIVE AND COUNTRY-DIFFERENTIATED SOLUTIONS! PROACTIVE ROLE OF THE INTERNATIONAL COMMUNITY
G-8 Digital Opportunity Task Force (Okinawa Charter)
U.N. Health InterNetwork InitiativeWorld Bank InfoDevU.N. Economic and Social Council (ECOSOC)U.N. ICT Taskforce
eHealthStrategies.com
INFORMATION AND COMMUNICATION TECHNOLOGIESHEALTH SERVICES PLANNING AND MANAGEMENTINFORMATION AND COMMUNICATION TECHNOLOGIESHEALTH SERVICES PLANNING AND MANAGEMENT
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Web: http://www.ehealthstrategies.com
E-Mail: [email protected]
Web: http://www.ehealthstrategies.com
E-Mail: [email protected]
HEALTH SERVICES PLANNING AND MANAGEMENT
CLINICAL CARE SYSTEMSEMERGENCY AND CRITICAL CARE SERVICESMEDICAL TECHNOLOGYCLINICAL AND ADMINISTRATIVE DOCUMENTATIONPROJECT MANAGEMENTRESEARCH DESIGN
HEALTH SERVICES PLANNING AND MANAGEMENTCLINICAL CARE SYSTEMSEMERGENCY AND CRITICAL CARE SERVICESMEDICAL TECHNOLOGYCLINICAL AND ADMINISTRATIVE DOCUMENTATIONPROJECT MANAGEMENTRESEARCH DESIGN