Providing a variety of health services at a distance and in various locations, telemedicine has proven to be a useful tool to improve the health of communities. This was the argument of experts from different organizations and countries, who shared success stories on this subject at the 9th Regional Congress on Health Information Sciences (CRICS9), held 22-24 October at the headquarters of the Pan American Health Organization/ World Health Organization (PAHO/WHO) in Washington, DC.
The use of telemedicine in healthcare and prevention of patients, especially in hard to reach areas, as well as the regulations and processes that led to its practice in various countries was the focus of the plenary session titled "Telehealth: service models and programss" during CRICS9, organized by PAHO/WHO in conjunction with its Latin American and Caribbean Center on Health Sciences (BIREME).
"More and more are using mobile technology as a strategy for health," said Patricia Mechael, Executive Director of the mHealth Alliance, who noted that in a recent survey by the World Health Organization (WHO) at least 83% of countries surveyed indicated that they had a mobile health initiative.
Mechael spoke of the types of telehealth services that can be useful in monitoring pregnancy, making diagnoses, providing treatment support, dealing with diseases and epidemics, managing the supply chain, training health workers, and conducting remote data collection. She also spoke of advances in using cellular telephony to examine patients and view laboratory tests. She emphasized that these technologies can be helpful to people suffering from non-communicable diseases such as diabetes and hypertension, as well as being of use in all facets of maternal and child health care.
As regards impediments to the advance of telemedicine, Mechael said that the need for further scientific tests as well as systematic tests on the health effects of telemedicine is recognized, and that limited integration and technological interoperability, as well as financial constraints, are also obstacles. “Foundations have been a source of investment in many cases,” she said, “but the countries themselves have not. We need to think about how these technologies are going to be sustained in the long run.” Moving from policy to practice, and providing training on what telemedicine is and implies, are additional challenges, she indicated.
Dr. Fernando Menezes of Brazil’s Ministry of Health shared details of his country’s experiment with using telemedicine in primary health care, explaining that the program is already operational at “pioneering centers” in 11 of Brazil’s 27 states, with a particular focus on family health.
Dr. Menezes described how integrated care networks were developed based on the municipalities’ management of the health services involved, which range from initial patient visits to hospitalization where necessary. A network that began in academia now includes care facilities and municipalities, and there are currently 1,500 telehealth sites for 900 municipalities. He emphasized that the next challenge for telemedicine is training.
Dr. Tomás Sanabria of Venezuela-based Telesalud Internacional reported on the experience of the “Maniapure Program: 18 years of closing the gap for the excluded in healthcare access technology.” He explained that this experiment took place in a part of Venezuela where access to the population is difficult. A polyclinic was built first, to provide support for the presence of a doctor in the community and pave the way for medical students from different specialties to spend time and gain experience there. In fact, the inspiration for the telemedicine practices now current in the community came precisely from many of these young people.
“With telemedicine we have made it easier to solve problems, from the simplest to the most difficult,” Dr. Sanabria said. He related the case of a child whose diagnosis had been impossible, but who was able to begin treatment without leaving the community because a local doctor was able to exchange information with other specialists via internet. In other cases, he said, similar sharing of information through telemedicine has paved the way for transferring patients who required care outside the community. “This type of experiment should be replicated and expanded to other places,” he said.
Sandra Gallegos, a specialist from Colombia’s Ministry of Health and Social Protection reported on experience in her country, which has a telehealth policy designed to improve health conditions for all of its population, with a special focus on those living in remote places. She explained that Colombia has a substantial body of normative provisions relating to telehealth services, and added that the country has adopted the eHealth Strategy approved by the PAHO Member States in 2011.
Work on distance learning is now under way at the Ministry, Ms. Gallegos explained, and working groups have been created involving the National Academy of Medicine, as well as health programs at other educational institutions, to define the relevant competencies needed by health sector personnel, among other issues telemedicine issues. Of particular note, she said, is a public sector experiment in providing telemedicine linkages for health care providers that has facilitated some 20,000 consultations, at least 5,000 of which were for diagnostic procedures.
Recognition for Best Practices in Telehealth for Latin America
As the plenary session concluded, the winners of the Best Practices in Telehealth for Latin America award were announced. This recognition is part of a project funded by the Inter-American Development Bank with coordination from the Federal University of Minas Gerais and RUTE (the University Telehealth Network) and participation by the Brazilian Ministry of Health. The project includes the universities and ministries of health of the following participating countries: Brazil, Chile, Ecuador, El Salvador, Uruguay, Mexico, Peru, Argentina, Colombia, Suriname, Guyana, Venezuela, Guatemala, and Costa Rica.
As part of the project, an Inter-American Committee on Best Telehealth Practices has been formed, consisting of international reference institutions in telehealth, including ABRASCO, PAHO, ECLAC, the Inter-American Development Bank, ATALACC, REDPAN, ACTO, and FIOCRUZ.
Humberto Alves of the Federal University of Mines Gerais introduced the winners: CENETC (Mexico’s National Center of Technological Excellence in Health), Brazil’s Ministry of Health (Medical School of Brazil), the Zacatecas Health Services in Mexico, the University of Caldas in Colombia, the University of the State of Amazonas in Brazil, the National Research Network of Brazil, and the Teaching Hospital of the Federal University of Minas Gerais, also in Brazil.