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INTERNATIONAL TELEMEDICINE UPDATE LATIN AMERICA

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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  1. 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

  2. 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

  3. TELEMEDICINE IN LATIN AMERICA

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

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

  10. 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

  11. 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.

  12. LATIN AMERICA AND CARIBBEAN HOSPITALS

  13. 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

  14. INFORMATION TECHNOLOGY GROWTH, 1985-1995 AND 1995-2000 PERCENT SOURCE: International Data Corporation, 1996

  15. Information Technology Growth Application of Technological Options Considering Bandwidth and Connectivity Alternatives

  16. Information Technology Expenditures, Gross Domestic Product and Population as a % for 5 regions

  17. Information Technology Growth Data

  18. Degree of Development of Core Information Function Activities in Latin American Countries

  19. GROWTH OF INTERNET HOSTS NUMBER OF HOSTS JAN 97 JAN 96 JAN 95

  20. GROWTH OF INTERNET HOSTS NUMBER OF HOSTS JAN 97 JAN 96 JAN 95

  21. 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

  22. 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.

  23. Training of Human Resources in Health Information Systems

  24. Training of Human Resources in Health Information Systems

  25. 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.

  26. 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.

  27. 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.

  28. 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

  29. 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

  30. 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.

  31. 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.

  32. 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

  33. TELEMEDICINE IN LATIN AMERICA • Evaluation is most critical

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