As informed in the previous article, before the COVID-19 pandemic, Latin America (LATAM) was already dealing with a deteriorating and inefficient healthcare system. The COVID-19 pandemic exposed all these weaknesses and added an extra burden, resulting in the collapse of medical systems in many areas across the LATAM region.
Regarding technology adoption, the LATAM medical culture was – and still is in many sectors – very conservative. The doctors, including myself, have been trained and taught to refuse many new technologies or approaches unless validated in multiple clinical trials and re-validated in systematic reviews. Therefore, although capability and creativity are some of the best qualities in these doctors, early adoption is not the strongest suit of the typical Medical Doctor from LATAM.
It has been 5000 years of in-person medical practice versus 12 years of virtual
However, the level of urgency brought by the public health emergency, the continuously decreasing number of providers (when infected, isolated for at least 2 or 3 weeks plus recovery time), and the social distancing exacerbated the need for remote solutions. As a result, many countries started to implement phone consultations. Yet, they are not as effective and patient-centric as needed, neither are they efficient for the practitioner (or nurse) who needs to be in a specific location or using their personal phones – what’s more, without the privacy guarantees and the possibility of seeing patient records during the consults. This is when, despite the defense against adoption and the non-readiness of the countries, the LATAM region countries decided to implement their historical digital health rollout.
In the case of digital readiness, which has influenced adoption, the digital gap between urban and rural areas in the Americas has played a decisive role in limiting the penetration of medical technology and, therefore, its subsequent adoption. As an analysis of the multifactorial rollout of digital health in the Americas, I would like to describe the situation and the COVID-19-related adoption surge to technology in LATAM by showcasing some countries in the Americas.
According to the President of Red Iberoamericana de Salud Digital RISAD, Augusto Ittig, an early adopter and digital health user for years, the shift of the Argentinian medical practitioners to telemedicine – focused on interactive telecare or video consultations – has accelerated.
Compared with a previous article from 2013 (early medical practitioner adoption in Argentina/Chile was lower than 6%), the levels of adoption dramatically increased, according to Ittig, due to the COVID-19 pandemic.
Regarding the defense against the adoption of digital health and new technologies, Ittig mentions: “It has been 5000 years of in-person medical practice versus 12 years of virtual” – this helps us understand why this resistance against new technologies exists in providers and patients.
Despite many regulatory limitations, Mexico’s digital health implementation during the COVID-19 pandemic has also seen a dramatic increase in the case of providers and patients. According to Dr. Rodolfo Lehmann Mendoza, Director of PEMEX (Petróleos de México) Healthcare services, there has been a drastic change during this pandemic period. “The Public health emergency allowed us to advance ten years in terms of technology use in just a few months and has accelerated this adoption, not only in healthcare but also in the follow-up, monitoring and training of Health personnel.”
Regarding national organizations, such as PEMEX, the future looks digital in a post-pandemic era, even if the regulatory framework takes longer than expected to be created and implemented. In the words of Dr. Lehmann Mendoza: “Today, the adoption of digital tools in health is an obligatory step for patients in Mexico. We can say that the existing technological gap between medicine, connectivity, digital mobile applications, wearables, artificial intelligence and everything that facilitates monitoring or diagnostics has been largely closed.”
According to Dr. Felipe Peralta, MD, ESAN University, the adoption of digital health technologies – referring exclusively to interactive telemedicine – happened because “doctors felt the obligation to perform telemedicine.” In this view, “medicine is turning back to in-person care, doctors feel the need and want to go back. In the specialties where there is little contact with patients, however (Like Psychiatry and other Mental Health services), they see a business model.”
Perú has started opening regulatory pathways and legal frameworks that will impact the future development and adoption of digital health. However, the resistance against new technologies is a challenge that has to be addressed. “A big number of medical practitioners in Peru are older than 50 years old, an inverted pyramid in their demographic classification, these professionals have not received any training on Medical technologies and are not aware of the solutions existing in the space of digital medicine available to them to improve their practices.” Aside from this, the opportunity lies initially in the lowering of costs, where insurance companies are fighting to get better and efficient, given the shortage of personnel in the healthcare system.
Uruguay and Chile
Before the COVID-19 pandemic, many professionals in healthcare and health-tech reflected that there wasn’t a real need or sense of priority for this adoption. According to Rodrigo Alvez, a Medical Technology expert from Accenture claims that “the healthcare system, specifically, the professionals working at the legal framework/regulatory systems seemed not to have any hurry to make the changes that had been already made in other industries for many years.”
The most extensive adoption of digital health has best been reflected and executed in Chile and Uruguay. This is because their policies were already contemplating innovative technologies; even the registration processes are relatively easy to navigate. This allows novel technologies to fall into the hands of medical practitioners faster than in the other countries in LATAM.
In Chile, however, registering devices or solutions in such a fast track poses a risk in terms of quality/efficacy. Hence, such products – that previously might have been refused CE Mark or FDA – would still enter the Clinical space in Chile.
The future of digital health adoption in Latin America
In order to establish adoption and, therefore, to impact healthcare and access in the LATAM region, an educational initiative of national/regional scale is necessary. Practitioners refuse medical technology, specifically digital health, because they are not aware of the entire digital health space, the other types of solutions, besides interactive telemedicine, and the benefits that these technologies can offer to their practice and the quality of life of their patients.
Continuing medical education initiatives in Spanish is necessary. University-led elective courses for postgraduate or even undergraduate students in digital health are some alternatives. A small number of universities in the LATAM region are starting to create educational programs. However, the rollout of education has to be coordinated and effective. This requires the involvement of government institutions and other parties.
Special thanks to: Augusto Ittig, MD | President, RISAD (Argentina), Rodrigo Alvez, MBA | Accenture – Doctari – Lapsi Health (Chile/Uruguay), Rodolfo Lehmann Mendoza, MD | PEMEX Servicios de salud (Mexico), Felipe Peralta, MD | ESAN University (Perú).