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A Roadmap for the Development of Health Information Technology in Chile

Core Content

The RAND Corporation was commissioned by the Ministry of Economy, Development and Tourism (MIDECON) in Chile to develop a roadmap for health information technology (IT) as part of the country's 11 Strategic Programs aimed at fostering economic sector development over the next decade. The roadmap outlines five key objectives and associated activities to promote the adoption and implementation of health IT in the public health care system of Chile.

Main Objectives

1. Develop institutional capacity to facilitate and monitor the implementation of the roadmap.
2. Broaden use of interoperable online appointment, referral, medical leave, and integrated payment systems by 2021.
3. Scale up promising telemedicine projects targeting the prevention and treatment of highly prevalent conditions by 2022.
4. Successfully implement an interoperable electronic health record (EHR) by 2021.
5. Implement a trackable pharmaceutical and medical device ordering system as part of the EHR by 2023.

Key Activities and Timeline

Each objective includes a series of activities and a recommended timeline for their execution. These activities are categorized into three main phases:

• Preparation for implementation: Identifying and evaluating current systems, defining evaluation criteria, and establishing incentive programs.
• Implementation: Integrating health IT systems into the public health care environment.
• Evaluation: Measuring the success of the implementation efforts and adjusting strategies accordingly.

Objective 1: Develop Institutional Capacity

• Create an institution to oversee and monitor implementation.
• Identify and allocate necessary resources.
• Establish a task force to determine key changes for health IT growth.
• Support the standard and certification organization.
• Develop technical infrastructure.
• Timeline: Ongoing over the 10-year Strategic Program period.

Objective 2: Interoperable Online Systems by 2021

• Evaluate current national health fund (FONASA) projects.
• Determine evaluation design and success metrics.
• Scale up projects by 2021.
• Collect and evaluate data on implementation success.
• Timeline: Activities to be completed by 2021.

Objective 3: Scale-Up Telemedicine by 2022

• Establish priorities for high-impact telemedicine projects.
• Identify successful existing telemedicine projects.
• Develop legal regulations for distance care.
• Collect and evaluate data on implementation success.
• Timeline: Activities to be completed by 2022.

Objective 4: Implement EHR by 2021

• Establish EHR system standards and interoperability criteria.
• Select an EHR system.
• Develop an incentive system to encourage adoption.
• Conduct implementation activities.
• Collect and evaluate data.
• Timeline: Activities to be completed by 2021.

Objective 5: Implement Pharmaceutical/Device Tracking by 2023

• Establish system standards.
• Select a system compatible with the EHR.
• Determine evaluation design and success metrics.
• Conduct implementation activities.
• Collect and evaluate data.
• Timeline: Activities to be completed by 2023.

Key Challenges

The development of health IT in Chile faces several challenges, which are grouped into four categories:

1. Lack of coordination between the public and private health care systems.
2. Lack of health IT infrastructure, including telecommunications, hardware, and software.
3. Lack of stakeholder coordination, leading to disjointed project implementations.
4. Workforce shortages in health IT, affecting project development, implementation, and evaluation.

Recommendations

Based on the findings, the following recommendations are proposed for the Ministry of Economy, Development and Tourism:

1. Develop the health IT workforce through training programs and education.
2. Implement incentive programs that align with health IT adoption and use, similar to those in other countries.
3. Clearly define measures of success and consistently collect baseline and follow-up data for evaluation.

Supporting Research

The report also includes additional research on incentive programs for health IT adoption. It highlights that other countries have used provider payment incentives to promote health IT use, with varying degrees of success. Chile is advised to carefully consider these models before selecting an appropriate incentive structure.

Limitations

The study has several limitations:

• Resource estimation was not possible due to the scope and timeline of the project.
• Limited data on current Chilean health IT projects and their costs.
• Only ten key informant interviews were conducted, though feedback from a briefing with stakeholders was incorporated.
• Lack of publicly available information on interactions and incentives within the Chilean health care system, including data ownership and reimbursement policies.

Conclusion

The roadmap is intended to guide the Chilean government and key stakeholders in the planning and implementation of health IT projects over the next ten years. It emphasizes the need for institutional development, interoperability, stakeholder coordination, and workforce training. The success of the roadmap depends on the involvement of key stakeholders in defining activities, timelines, and resource allocation.

The report serves as a framework for achieving the Strategic Program's goals and provides recommendations for improving the adoption and implementation of health IT in Chile.