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ICT in Health (R.J.Rodrigues), Version 2 
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Information and Communication Technologies in Health Practice
Adoption and Challenges in Latin America and the Caribbean
Roberto J. Rodrigues 
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Information systems, communications, and collaborative work are critically important to the delivery,accessibility, and quality of healthcare; for the logistical management of health systems; and for the proficientoperation of health organizations. Since the early 60’s, incorporation of computer systems into the operation ofhealthcare services of developed countries led to the progressive automation of libraries; business offices; themanagement of physical assets, stocks, and patient administrative data; instrumentation and diagnosticequipment; and the implementation of departmental systems, initially in the clinical laboratory and later in manyclinical care areas and health organizations.Information and communication technologies (ICT) are the enabling components that support processes carriedout by health institutions, care providers, and health programs. The imperative for ICT in the health sector isconcrete and essentially driven by the operational requirements of healthcare services and organizations -- ofwhich there are many in terms of national models, institutional formats, and governance -- all functioning inshifting social, economic, and political environments. In the last two decades the health sector has shown:
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Growth of complex and segmented health service markets
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Ubiquity of interactive communications and networks of producers, suppliers, customers, and clients
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Expectations about solutions for telehealth services, second opinion, communities of practice, evidence-based decision support, consumer-oriented information, and health promotion
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Growing importance and need for professional continuing education
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Efficiency in service management, strategic alliance models replacing traditional business organizationsbased on ownership of physical assets and long-term structures
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Need for rapid responses and forecasting demand
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Demand for customization capable of achieving a “one of a kind” product or service and customersatisfactionIn the past 15 years, advances in ICT and the dissemination of networked data processing and interactiveapplications created an environment of universal access to information resources and technologies along withthe globalization of communications, businesses, and services with both optimistic and alarming implications forthe future of health practice. Promising health ICT applications are oriented to professional networking,integration of the clinical care process management, standardization of patient records and providercommunications; and the delivery of network-based health information and services, including remotemonitoring and direct care. This expanded view of health ICT has been promoted by the ICT industry,professionals, and development agencies as the final stage in bringing online the entire healthcare system.
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eHealthStrategies 
, Bethesda MD, USA and
Information and Knowledge Management Area (DD/IKM),
 
Pan American Health Organization/Pan American Sanitary Bureau 
, Regional Office of the World Health Organization, Washington DC,USA
 
 
ICT in Health (R.J.Rodrigues), Version 2 
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1. Medical, Social, Economic, and Organizational Issues in the Health Sector
In developed as well in developing societies, and in any health sector organizational model, four coreperformance and outcome challenges are present: increase coverage; provide an ever-expanding range ofhealth services; ensure equitable access to quality services; and reduce or, at least, control costs.
1.1. Healthcare Services in Latin America and the Caribbean
The following critical issues have been identified for the health sector of Latin America and the Caribbean, [1]:
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Changing demographics, particularly age structures and the “graying” of the population in mid-incomecountries, lifestyle, urbanization, and growing industrialization. Aging population groups require greatersubsidized medical care and a growing demand for high-cost diagnostic and therapeutic resources.
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Large number of individuals without access to basic healthcare and health information, many living inmarginal urban areas with multi-sector shortcomings (housing, sanitation, education) and a healthcaresystem with chronic deficiencies in terms of infrastructure, distribution, personnel, and services.
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Shifting epidemiological profiles putting an increasing burden on healthcare services and on the society. Inhigh- and middle-income countries, about 40% of the population has been shown to suffer from one ormore chronic conditions and in some, chronic conditions account for up to two-thirds of costs.
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The “know-do gap” -- scientific knowledge and significant opportunities do exist to improve health status butstill there is a considerable prevalence of preventable diseases and premature deaths, both in absolute andrelative terms due to inadequate access to evidence-based knowledge.
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Despite the fact that the health sector is essential to the welfare of the population, to the formation ofhuman capital, and for economic advancement, it has not kept up the pace with the momentum of changeexperienced in recent years by other productive segments of society.
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Uneven access to basic and specialized health services results in many regions, communities, and socialgroups being left without access to even the most basic care or, when it exists, there is poor linkage tosecond and tertiary levels for consultation and management of problems identified at the primary level.
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Disconnected actions in the provision of care, overlapping of responsibilities, and wasteful use of resourcesleading to quantitative and qualitative deficiencies in the delivery of services.
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In most countries the health sector is underfinanced, there is inefficient or wasteful allocation of scarceresources, and lack of coordination between health subsectors, institutions, academic and researchcenters, and other social agents and stakeholders.
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Health sector expenditures comprise 6.0% to 17% of the service sector that, in turn, accounts for 50% to65% of the GDP in almost all countries. The market for health goods and services in the countries of theregion represent 9.0% of the global health market, more than Eastern Europe and Central Asia combinedand just below that of East Asia and the Pacific. The 1999 average per capita expenditure in health in LatinAmerica and the Caribbean in PPP dollars was US$ 452. Compare this value with US$ 1,868 for theEuropean Union, US$ 2,206 for Canada and US$ 3,978 for the United States [2]. There is a markedvariation on the national expenditures among countries, even for countries of comparable income levelalthough healthcare expenditures typically are concentrated to a limited set of health conditions— the“80/20 Rule”.
 
 
ICT in Health (R.J.Rodrigues), Version 2 
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Rising costs are mostly driven by technological innovation such as drugs, diagnostic and therapeuticmodalities, instrumentation, and digital devices. Although innovation and technological changes in medicineare not new phenomena and picking up speed since the 16th century, what is new, however, is the numberof innovations and the momentum by which they are disseminated and incorporated into medical practiceand ICT are fast becoming a significant cost component in healthcare organizations.
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Who sets priorities for the deployment and access to technological innovation and who are those thatbenefit from scientific and technological developments are major issues of social, political, and economicsignificance and carry a heavy weight in national politics.
1.2. Reforming the Health Sector
In many countries, including significant segments of the population of industrialized societies, individuals still donot have access to appropriate care or cannot afford it. Traditional revenue streams that have supportedindigent care, public health interventions, medical research, and education are insufficient or are being reduced,prompting the search for new methods to support those essential activities. Health sector reform is a processaimed at introducing substantive changes into the health sector and in the relationships among stakeholdersand their roles, with a view to increase equity in benefits, efficiency in management, and effectiveness insatisfying the health needs and expectations of the population. [3, 4, 5, 6]. In market economies, competition,merger of provider organizations, aggressive contracting by payers, and increasing involvement of employerand government purchasers have characterized health system reform processes [7, 8, 9].Health reform in Latin America and the Caribbean countries has commonalities but different facets, no singlemodel being adopted by all. Each country is moving at a different pace in the implementation of its ownparticular health system model but the economic and globalization changes of the last years have brought anew urgency to reform processes. Common trend-setters and responses that characterize the objectives ofmost health sector reform processes occurring in the Region are: [3, 8]:
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The universalization of a high cost-benefit basic package of health services with a set of standardizedpublic health interventions;
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Cost containment and recovery;
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Administrative decentralization and operation of healthcare services;
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Recognition of the role of the private subsector and the intersectorality of health interventions;
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Health models oriented towards primary care and centered on people;
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Focus on quality and accountability; and
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Moving away from the reactive delivery of care to a more proactive management approach of the healthstatus of individuals and population groups.
2. Information and Communication Technologies in the Health Sector
In the health sector, ICT is diffusing at a rate consistent with other similar service sectors that require complex,highly networked products. From an outcome, performance, and efficiency driven perspective, information andcommunication technologies have been important enablers of change, particularly in the conduction of routine
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