Lessons from Cuba: Healthcare Infrastructure and Information Systems
I watched a fantastic presentation by the folks at the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU). They have an online journal “On Informatics” where they have a recent video presentation titled “Cuba’s Medical System: A Public Health Paradox?” (The video is below)
If you want to learn something about a very interesting health system and how they are using ICTs/medical infomatics I highly recommend watching it. The focus of the video is on Cuba’s national health information portal, INFOMED, which on paper sounds amazing. I have posted some bullet points directly from the video below in case you want the “cliff notes” version. Additionally last week there was a major conference on medical informatics in Cuba. Check the posts on this blog from 2/13/07 – 2/16/07 for their notes directly from the conference. If you are not familiar with Cuba’s healthcare system, it is a fascinating case of what happens when a country devotes massive investment in health. To be sure there are some criticsims, but you can get a general idea of how well Cuba seems to have done with population health under extreme political and economic duress. The graphs give you some basic aggregate facts (figure credit: BBC News) on Cuba’s health system, which speak for themselves.
Cuba has made investment in their primary healthcare a system a top priority (funded in part by gutting their defense budget). So when they had a severe economic crisis in the 1990s, population health did not plummet as much as would be expected. They are not allowed to import US made medicines and medical supplies (such as pace makers, mammogram film and medical textbooks) due to the economic embargo, consequently they have had to innovate to take care of their population. One other noteworthy fact is their susbstantial biotechnology sector.
This video is a presentation of their health system, the major challenges they face, and the phenomenal informatics infrastructure they have. Here are some highlights and thoughts from the video:
1) There is a doctor and sometimes an associated nurse living in every neighoborhood/local area (known as a Consultorio) which is the base of their health system. The implications include a strong infrastructure and systems in place (exactly what Laurie Garrett is advocating) along with:
- Quick determination of an outbreak because there is a medically trained person in every neighborhood
- Strong knowledge of available resources AND local habits that may have caused outbreaks
- Years of excellent medical records that can be mined and tracked
- Consultorios have strong communtiy civil groups for education, women’s groups, etc. and the doctor is involved in these groups
2) Availability of longitudinal medical history with consolidated information systems. Cuba doesn’t have much in the way of EMR’s due to economics and patient privacy issues, however, the have –INFOMED:
- Serves as center and backbone of national medical informatics
- Is a central repository for clinical practice guidelines, link to the cochrane collaboration, virtual library, and more
- Every neighborhood clinic is supposed to have a computer with access to INFOMED
- Used for telemedince and continuing education
For more information on INFOMED see this 2006 article: A Case Analysis of INFOMED: The Cuban National Health Care Telecommunications Network and Portal by Ann C Séror, PhD. LINK
As I commented at the OHSU On Informatics online journal, it might be difficult for other developing countries to learn from Cuba’s experience precisely because they do not have such an organized model, infrastructure, or I am assuming a similar investment in health. However, on a community or hospital system scale, perhaps lessons can be applied. The Aravind Eye Care System in Tamil Nadu, India has developed an excellent health system and this has allowed them to utilize the power of ICT in several ways. So perhaps best practices can be developed and then shared on a case by case basis.
Last reference, check Steven Mansour’s site for someone who works on ICT in Latin America and has been to Cuba.