Lessons from the pandemic: more international collaboration, better health

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Sílvia Bravo (Ubik Media)

The discussion in the third and final session of the UOC's eHealth What if Forum focused on how international collaboration can help achieve the digital transformation of health. This marked the end of the eHealth Center's latest venture, as its director, Albert Barberà, discussed in his final conclusions. This first edition of this forum for academics, health professionals, health managers and users concluded with interviews with experts from various Latin American countries. The first two sessions focused on the needs and involvement of both users and professionals, and on the health system paradigm shift the digital transformation entails. 

The session, which was moderated by Francesc Saigí, Director of the World Health Organization (WHO) collaborating centre for eHealth and a member of the UOC's Faculty of Health Sciences, began with a presentation of the conclusions reached in the recently published study organized by the Inter-American Development Bank (IDB) under the leadership of the Universitat Oberta de Catalunya (UOC): Study on international telemedicine in Latin America: motivations, uses, results, strategies and policies.

The study, which involved an extensive review of the relevant literature, an online survey of 1,443 health professionals in nineteen countries and in-depth interviews with twenty-nine telemedicine experts, concluded that there is a positive correlation between the use of international telemedicine and health professionals' productivity; that international telemedicine provides a good return for national health systems, and that international telemedicine is nevertheless still hardly used in Latin America. Experts make ten recommendations to help it achieve its full potential. These include creating a supranational agency to make it easier to reach consensus between the various players involved and to develop a set of common governance and interoperability mechanisms. 

The study was undertaken following a number of international telemedicine initiatives that arose more or less spontaneously in the region to address the pandemic. Details of some of these initiatives were given in the initial speeches by the speakers on the discussion panel: Daniel Otzoy, Executive Director of the Central American Health Informatics Network (RECAINSA); Walter Curioso, member of the World Health Organization Digital Health Roster of Experts and Vice Provost for Research at Universidad Continental, in Peru; Sandra Gallegos, a surgeon and member of the Colombian Ministry of Health; and Janine Sommer, a nurse and coordinator of telemedicine projects at the Hospital Italiano in Buenos Aires.

Furthermore, two of the experts interviewed for the IDB's study watched the session live and made contributions through the live chat facility: Myrna Martí, an international consultant in Digital Transformation and Health Information Systems at PAHO/WHO; and Pablo J. Orefice, head of Salud.uy at the Electronic Government and Information and Knowledge Society Agency of the Presidency of the Oriental Republic of Uruguay.

Although telemedicine resources during the pandemic were mainly devoted to reinforcing local telehealth activities – for outpatient and home treatment of chronic diseases, mental health and paediatric patients, as well as ICUs and hospitalizations – the experts pointed out the importance of raising awareness of international experiences in the management of the health crisis resulting from COVID-19. As they explained, these experiences have enabled them to improve the legislation in their own countries or launch regional initiatives much more rapidly, as they were based on evidence from other countries' similar experiences.

In fact, the Latin American experts stressed that this transfer of knowledge and technologies is crucial not just for cementing national implementations, but also for creating a common stage on which consensus and agreements can be built so that international telemedicine can be developed to reach its full potential. 

Many countries in Latin America at present lack their own telemedicine legislation. The pandemic accelerated the arrival of some tools and solutions, such as e-prescriptions or virtual platforms for appointments with patients and meetings among professionals. However, the needs and challenges go well beyond this. 

According to the experts, networks such as RECAINSA and RITMOS now include researchers and technology experts, as well as health managers and health professionals, to enable practice and knowledge communities to foster the design and implementation of e-health tools and solutions. These networks include experts from every country in Latin America, as well as from other parts of the world. The networks thus provide a collaboration platform that is crucial for sharing experiences and carrying out research projects and new training programmes, among other things. Furthermore, they provide continuity for public policies and initiatives which can often flounder as a result of the political interests prevailing in each country at any given time.

How was international telemedicine useful at the peak of the pandemic? The speakers agreed that it was undoubtedly useful in counteracting the effects of the infodemic or excess information - often of poor quality - on what was happening, and how it could be addressed by citizens and institutions. In addition, ties with PAHO and the IDB were reinforced, and a guide to the implementation of telemedicine programmes was promoted with the aim of accelerating quality e-health solutions.

The more diverse the region, the greater the challenges it presents. The organizational and technological challenges shared by the implementation of telemedicine anywhere in the world are compounded by those arising from Latin America's geographical and socio-cultural context: pockets of poverty, isolated communities, multilingualism, the absence of health infrastructure and experts, a lack of trust between countries, and many more.

However, the experts reiterated that it is essential to understand these challenges in order to develop not only better local health systems, but also international telemedicine initiatives that can work together.

In this context, efforts must be focused on managing change, starting with the provision of training for citizens as well as health professionals, establishing partnerships between public and private sectors, and creating a legal and conceptual telemedicine framework for each country that meets its local needs and challenges and lays the foundations for building international bridges for the benefit of everyone involved. 

Regarding the proposal for a supranational telemedicine agency, the experts expressed great support for its creation, while stressing the need to include and involve the players that have been pushing e-health in the region thus far: the networks, universities, professionals and managers that have spearheaded the development of e-health in their countries or organizations to date. 

The agency must lead the way, while always making sure everyone is involved. Mechanisms are needed to regulate and standardize telehealth services, create environments in which contracts for such services can be safely concluded between countries, help raise awareness of the benefits of telemedicine, and establish evidence for future international telemedicine tools and services.

According to the experts, the strategic framework could be similar to the one for international legal practice, with specific training programmes that take into account not only technological skills, but also sociological, economic and cultural skills. We cannot create an international telemedicine system that fails to take into account the problems specific to each country, such as endemic diseases or deficient bilingualism, or without developing soft skills such as intercultural digital communication. 

Apart from the issue of international collaboration in Latin America, the experts mentioned the opportunities for north-south partnerships between countries and south-south partnerships across continents. Creating an efficient international telemedicine system that is sensitive to local circumstances can thus have an impact and scope of application far beyond the boundaries of Latin America. 

The session, and therefore also this first edition of the UOC's What if Forum, was brought to a close by Albert Barberà, the Director of the eHealth Center, who shared his conclusions about the event. The pandemic has undoubtedly acted as a catalyst for the implementation of digital tools and solutions, and this is a time for reflection at every level. We have realized that the digital transformation of health systems is not so much a technological challenge – although there is still a long way to go in this regard – but a cultural and organizational change. 

We are now moving towards a hybrid model that includes both face-to-face medicine and telemedicine, and both local and international medicine, which will lead to improved management of our health. We have more data every day, and we must use it to build evidence on which public policies can be implemented. In order to make this possible, obtaining political commitment at local, national and supranational levels is a matter of urgency. 



You can also listen to how the experts answered questions including: 

Presentation of the conclusions of the Study on international telemedicine in Latin America.

Can international collaboration lead to more flexible and higher quality healthcare in Latin America?

Can many more health challenges in LATAM now be addressed – or better addressed – thanks to international telemedicine programmes?

Are there too many barriers to the implementation of true international telemedicine? 

Do we need an International Telemedicine Agency for the Americas?

Questions by Myrna Martí, PAHO/WHO consultant, and Pablo J. Orefice, head of Salud.uy in Uruguay.

Questions by Fernanda Hernández, a doctor specializing in epidemiology, and editor and presenter of the health section of Noticias Caracol, in Colombia.

Closing speech of the first edition of the eHealth What if Forum given by Albert Barberà, Director of the UOC's eHealth Center.

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