eHealth in Latin America: Challenges & Opportunities

8/14/2019 eHealth in Latin America: Challenges & Opportunities

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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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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



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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


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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Total Health Expenditure x GDP Per Capita (191 Countries)




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WORLD


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




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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



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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)



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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


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)



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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



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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


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


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)


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




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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





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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 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


B alance inM illions of

U S $


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)


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



NEED RECOGNITION



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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





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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



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


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


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

E-mail

U.S. Survey by Gmez Advisors, Inc. , 2000

HOW THE PUBLIC LEARNS ABOUT HEALTH INFORMATION IN THE WE

%




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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


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


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%


THE LATIN AMERICAN & CARIBBEAN MARKET


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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


THE LATIN AMERICAN & CARIBBEAN MARKET


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Private Insurance18%

Direct Out-of-PocketExpenditure

37%

Central Government23%

Local Governments8%

Social Security14%

PUBLIC AND PRIVATE COMPOSITION OF HEALTH EXPENDITURES (1998-2000)


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)


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)


31.6% HAVE COMPUTERS, OF THOSE ABOUT 54.6% ARE PRIVATE



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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


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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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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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




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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)


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


*

* No DataeHealthStrategies.com

COST OF WIRED CONNECTION


47/73

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


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%


INTERNET USE - PHYSICIANS IN BRAZIL (2)


49/73

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)


DIGITAL INFRASTRUCTURE (1)


50/73

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


PERCENT

* No Data

*

PERSONAL COMPUTERS X 100 PERSONS (1998)


DIGITAL INFRASTRUCTURE (2)


51/73

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)


*

* 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)


54/73

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)


NETWORK ACCESS SPEED


55/73

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)


DEVELOPED COUNTRIES / BROADBAND PENETRATION


56/73



57/73

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



59/73

THE FUTURE OF THE TELECOM INFRASTRUCTURE


60/73

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


BRAZIL - MAGNETIC/BAR CODE/SMART CARD USE


61/73

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)



62/73


63/73

STAKEHOLDERS HAVE DIFFERENT PERSPECTIVES AND MOTIVATIONS


64/73

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




65/73

1

2

3

4

5Need Recognition




General PublicEconomic,cultural andeducationalbarriers

Involvementand

Commitment

ExcessiveexpectationsExpectations

Big picturelackingContext ofUtilization

Poor

recognition ofinteractionsand limitedrecognition ofmanagerialapplications

Vision ofRequired

Applications

Focus onpersonalhealth needsand beliefs

NeedRecognition



66/73



67/73

1

2

3

4

5Need Recognition




Health ICT Experts

Drivers foradoption

InvolvementandCommitment

Most vocaland optimisticExpectations

Understandthecomplexity ofneeds


Excellentrecognition or

requirements

Vision ofRequired

Applications

Clear andbalancedperspective

NeedRecognition


Feel



68/73

1

2

3

4

5Need Recognition




Health ICT Suppliers

Do not seehealthmarket asprovidingreturn oninvestment

Involvementand

Commitment

Pessimisticregardingprogress innext 5-10years

Expectations

Underestimate complexityof healthproducts


Commercialinterestdirectspromotion ofown productsand services

Vision ofRequired

Applications

Feelrestricted

due to lack ofbroadunderstanding of needs

NeedRecognition




69/73

1

2

3

4

5Need Recognition




Generic ICT SuppliersDrivers foradoption

Involvementand

Commitment

Optimistic asresult of e-Commerceand othersectorsadoption ofICT

Expectations

Poorunderstandingon how healthsystems

operate


Perceiveapplicationsas

commoditiessupportingstandardizedprocesses

Vision of

RequiredApplications

Fail todistinguishbetweenclerical,administrative, and clinicalprocesses

NeedRecognition


!

IMPLEMENTATION IN LATIN AMERICA & CARIBBEAN (1)


70/73

! 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




71/73

! 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


!



72/73

!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


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

eHealth in Latin America: Challenges & Opportunities

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