Вопрос 14-3/2: Информация и электросвязь/икт для электронного здравоохранения


Комплект материалов по национальной стратегии в области электронного здравоохранения МСЭ-ВОЗ



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4.2 Комплект материалов по национальной стратегии в области электронного здравоохранения МСЭ-ВОЗ

2Потребность в национальном планировании


Опыт показывает, что использование ИКТ для целей здравоохранения требует осуществления стратегических и согласованных действий на национальном уровне, позволяя тем самым максимально эффективно использовать существующий потенциал и в то же время заложить прочную основу для инвестирования и инноваций. Определение основных направлений, а также планирование необходимых детальных действий являются ключом к достижению долгосрочных целей, таких как обеспечение эффективного функционирования, реформирование или коренное преобразование сектора здравоохранения. Центральное место в этой деятельности занимает сотрудничество между секторами здравоохранения и ИКТ как государственными, так и частными. Как основные учреждения Организации Объединенных Наций, занимающиеся вопросами здравоохранения и электросвязи, соответственно, Всемирная организация здравоохранения (ВОЗ) и Международный союз электросвязи (МСЭ) признают важность сотрудничества в решении вопросов электронного здравоохранения на глобальном уровне, что стимулирует страны к разработке национальных стратегий в области электронного здравоохранения: этот комплект материалов поддерживает эти рекомендации.

Министры здравоохранения играют решающую роль не только в удовлетворении потребностей людей в медицинской помощи и защите общественного здравоохранения, но и в сохранении существующих систем здравоохранения на протяжении определенного периода времени. Министры информационных технологий и электросвязи играют ключевую роль в развитии всех сфер и могут внести важный вклад в сектор здравоохранения. Общие цели и предсказуемая среда ИКТ позволяют осуществлять согласованные действия: достижение консенсуса по вопросам политики, стимулирование более эффективного использования общих ресурсов и вовлечение частного сектора, а также инвестирование в знания и инфраструктуру для улучшения результатов мероприятий по охране здоровья.


Цель и аудитория


Комплект материалов по национальной стратегии в области электронного здравоохранения является ресурсом, предназначенным для разработки и обновления стратегий стран в области электронного здравоохранения, начиная со стран, которые только ставят перед собой такую задачу, до стран, которые уже вложили значительные инвестиции в систему электронного здравоохранения. Сюда относятся страны, пытающиеся опереться на обнадеживающие результаты пробных инициатив, заложить основы для масштабирования проектов в области электронного здравоохранения или обновить существующие стратегии, чтобы отразить в них меняющиеся условия. Этот комплект материалов может использоваться руководителями государственного сектора здравоохранения в министерствах, управлениях и агентствах, которые будут руководить разработкой стратегии в области электронного здравоохранения. Ее применение требует наличия команды опытных специалистов в области стратегического планирования, анализа, связи и взаимодействия с заинтересованными сторонами.

Рисунок : Комплект материалов для разработки национальной стратегии электронного здравоохранения





Краткое описание комплекта материалов


Комплект материалов состоит из трех частей, причем каждая часть основывается на работе предыдущей части:

 Часть 1: Предусматривает разработку концепции развития национального электронного здравоохранения, отвечающей целям в области здравоохранения и развития. В ней поясняется, почему требуется национальный подход, какой план будет осуществлен и как он будет разработан.

 Часть 2: Предусматривает разработку дорожной карты реализации, отражающей приоритеты страны и контекст электронного здравоохранения. В этой части приведена структура видов деятельности на среднесрочный период и в то же время закладывается основа действий на длительную перспективу.

 Часть 3: В этой части устанавливается план мониторинга реализации и управления соответствующими рисками, показан прогресс и результаты реализации, а также средства обеспечений долгосрочной поддержки и инвестирования.

В каждом разделе содержится описание требуемых видов деятельности, наряду с практическим советом, основанным на фактическом опыте.

Страны могут осуществлять весь набор видов деятельности или те, которые подходят для их контекста и учитывают их ограничения. То, как этот комплект следует использовать и какими будут конечные результаты, будет зависеть от контекста, приоритетов и концепции той или иной страны.

Комплект материалов доступен по адресам: http://www.itu.int/ITU-D/cyb/app/e-health.html и http://www.who.int/ehealth.


Annexes


Annex I: Case Studies: Lessons Learned from e-Health Implementation

Annex II: Lessons Learned from e-Health Implementation: Knowledge

Annex III: Compendium of e-Health projects for RMNCH implemented in CoIA countries

Annex IV: Composition of the Rapporteur Group for Question 14-3/2

Annex V: Glossary


Annex I: Case Studies: Lessons Learned from e-Health Implementation

1.1 Argentina: Highlights of ICTs for e-Health in Argentina

1.1.1 Introduction


0Accessibility to resources, goods and services in healthcare, regardless of geographical location and socioeconomic status, is one of the key factors to ensure that citizens of every nation effectively exercise their Health of Right. Telemedicine, as long as it involves the provision of health care services using information and communication technologies (ICT) for the prevention, diagnosis and treatment of disease, as well as for research and continuing medical education, has become one of the conceptual developments with the greatest potential for ensuring access to health services that meet appropriate quality and coverage standards.

The purpose of the following presentation is to synthetically describe Telemedicine strategies, programs and projects currently under development in Argentina.


1.1.2 Objectives and Strategies


The geographic and demographic characteristics of the country, the diversity of systems to health care access and the unequal distribution of professional resources and equipment, allow planning strategies in which the use of telemedicine, in the widest sense of Telehealth, assist in ensuring the effective exercise of the Right of Health throughout the hole national territory.

In this regard, it has been deemed necessary:

 To develop Telemedicine tools and to implement Telehealth programs and models with adequate standards of quality, social impact, cost – benefit relationship, and interoperability, which allow all citizens reach a better and more equalitarian health care.

 To promote consensus that may unify criteria that will ensure, in the medium term, a legislative and political regulatory framework of ICT and Telemedicine in Argentina.

 To take advantage of already existing resources and programs, engaging them to new local developments and those more significant at national and international level.

1.1.3 Activities Implemented


From a general perspective, although there are some legislative initiatives, to date the country does not have a policy framework for the implementation of ICT in Telemedicine. Likewise, Telemedicine projects have not always benefited from properly manage or support, suffering the vicissitudes of economic and political changes and progressing sporadically and irregularly.

As background, we can mention the National Program for the Society of Information about ICT inclusion in the public sector. This program supported the National Telemedicine Project (2000) which sought the extension of a telemedicine network, establishing clinical and technological reference centers, deploying new terminals systems and mobile solutions (Resolution 10,869 of the National Communication SecretarySECOM). The socio-economic crisis of 20012002 prevented its realization.

Currently, Argentina has a General Plan for ICT (Resolution 1357/97) leaded by the General Secretary of Communications, several interagency plans related to equalitarian access policies (Argentina Connected, Decret 1552, 2010), and Integrated Health Information System (SISA) under the Ministry of Health. The latter is a project of information technology with gradual implementation stages and based on a federal concept, meant to record health facilities, health professionals, research, congenital diseases, immunizations, blood donors and evaluation of health technology.

In an overview of the possible applications of ICT in various sectors concerning national development lines (White Paper on ICT-Project Foresight 20202009) the Ministry of Science and Technology (MST) considers e-Health as a paradigmatic shift needed to cope with Argentine Health System deficiencies. To achieve this, a drastic restructuring of the health system is necessary, combining the concepts of Telemedicine and Primary Attention Strategy (APS). In 2010 the MST passed a document entitled "Strategic area for information and communications technologies" (Order 004/10d) where Telehealth is considered as a priority issue.

Regarding the development of telemedicine specific tools, it is appropriate to highlight the background related to electronic health records (EHR). Many Argentine provincial states and municipalities followed the line of free software, such as the Group of Buenos Aires BioLinux and the National University of Rosario.

In the province of Salta, Telecom Argentina implemented, in 2009, a web EHR system for management of primary care (ACUARIO SIGMA), developed by the Iberoamerican Foundation of Telemedicine. This system links 49 public health centers with more than 2,000 users, managing 250,000 HER and scheduling 4,000 patients visits by day. GCBA managed several initiatives coordinated by the Health Information Systems General Directory who created a Telehealth Platform. The province of Santa Fe has a video collaboration platform based on open source software for synchronous training and teleconsultations, also allowing surgeries and ultrasounds transmissions. Similarly, in 1995, the Angel Project created the first complete and free medical software, taking into account the laws for Professional Practice (17132), Digital Signature (25506) as well as the Code of Ethics of the Medical Association of Argentina, being compatible with HL7.

Concerning specific education, we should mention that most of the innovative processes, programs and developments in telemedicine and e-Health are concentrated in the academic units of public medical schools in Buenos Aires, La Plata, Rosario, Cordoba, Mendoza, Entre Rios and Tucuman. The valid curricula to train future doctors at these centers include telemedicine and ICT. Also, there is a residence of Medical Informatics at Italian Hospital of Buenos Aires, Biomedical Informatics at GCBA and a postgraduate degree in Biomedical Computing Introduction at the Italian Hospital of Buenos Aires.

In the health care setting, several major hospitals provide projects and programs where ICT and Telemedicine are protagonists. We must mention the program of referral and contra referral of the Garrahan Hospital, which allows remote communication with pediatricians located in provinces that have joined the National Network Tele-Pediatrics. The hospital established the Latin-American Medical Telepresence Pilot Program and offers a Telemedicine Program in Infectious Diseases.

Mendoza has a Telehealth Network formed by universities, the Ministry of Health and private institutions. The Zaldivar Institute (devoted to ocular surgery) in Mendoza has a telemedicine program for monitoring post-surgical patients, first visits, second opinions and training of residents. The Northeastern University has a telemedicine program designed to support rural doctors in Chaco.

Doctors living in small towns of Córdoba province could reach the portal developed by the Telemedicine Center of the National University of Córdoba (UNC) in order to have second medical opinions. The “Mario Gulich Institute”, emerging as a collaborative initiative between UNC and the National Commission for Aerospace Activities (CONAE), is developing various tools for applications of aerospace information to health care, including risk stratification tools for vector-borne diseases and training programs of health applied geographical processing.

Finally, in a country with 51.891 million subscribers to cellular networks, the concept of m-Health should not be neglected. There are more than 5,000 health-related apps for different smart phone models. In addition, several organizations representing health insurance systems and private prepaid companies operate with cellular messaging systems for different events, such as doctor's arrival, confirmation of appointments, etc.

In the regional context, since October 2011, the Ministries of Health of Latin America and the Caribbean approved the Regional Strategy and Plan of Action on e-Health, whose development the Panamerican Health Organization, World Health Organization (PAHO/WHO), has the mandate to coordinate. This strategy envisages that by 2017 a large percentage of countries have developed their own ALAC National e-Health strategy and represents a challenge and an opportunity for advancement and mobilization for action in Argentina as in all countries of the Region.


1.1.4 Technologies and Solutions Deployed


The key to establish a national telemedicine project is to take advantage of the already installed technology and new programs under development, to promote professional training and to reach agreements on regulatory requirements. In this sense, the Integrated Health Information System (SISA) appears as a possible starting point for major developments and projects in telemedicine.

A program to be considered of immediate usefulness is the national fiber optic network of the Ministry of Federal Planning, Public Investment and Services. Also depending from this Ministry we can find the Argentina Connected Program, as a comprehensive connectivity strategy as well as the three national communication satellites (ARSAT-1, 2 and 3).

National Universities have developed tools for remote support to patients. The Telemedicine Center of the UNER has prototypes and platforms of great social impact potential and low cost. The Institute of Bioelectronics in Tucumán has developed a Rural Telemedicine Application. The Faculty of Medicine of the National University of Rosario has launched a mobile telemedicine station (ETMo) containing sophisticated diagnostic tools built into a suitcase transportable by air, sea or land, able to provide the physician in disaster and/or geographical detachment situation, diagnostic and therapeutic aid from academic specialist located at the university in real time.

1.1.5 Outcomes Achieved. Challenges and Success Factors


Beyond the technical advances, ideas and projects conceived, the Argentina Telemedicine Community achievement has been sustaining internal stability in their working groups, showing the potential social impact of telemedicine and ICTs related to health topics and, last but not least, progressively installing at institutional and government levels the idea that telemedicine is not only important but essential in a Federal and Democratic Integrated Health System.

The unsolved challenges are related to absence of specific legislation, scarcity of means to finance the various projects, the need to train health professionals in the management of the Telemedicine tools, and the slow incorporation of knowledge about the concept of Telemedicine in potential system users and authorities.

A possible successful alternative should be the integration of efforts, the sheared use of technological equipment and human capital available, with the input from the various government levels, investors and private providers of technical resources, as well as academic and hospital medical staff.

Following this vision, emerged the Telehealth Network of the Americas, an organization developed within the OAS-CITEL, which has been formally joined by all medical schools of public administration, various national high complexity hospitals and Ministries of Health of some provinces.


1.1.6 Lessons Learned and Next Steps


The country current situation, with all its infrastructure developments and policies of inclusion and equity, together with the actions of the State and international organizations, to generate a optimistic picture. That is already assembled and tuned the expert protagonists in e-health, appointed before, working together. Is imminent an remarkable progress of e-Health in the country, involving the National State, international agencies, academic and welfare institutions, and the experts who are developing projects and programs worldwide reference.

Каталог: dms pub -> itu-d -> opb -> stg
stg -> Вопрос 17-3/2: Ход деятельности в области электронного правительства и определение областей применения электронного правительства в интересах развивающихся стран
stg -> Вопрос 10-3/2: Электросвязь/икт для сельских и отдаленных районов
dms pub -> Рекомендация мсэ-r m. 1036-4 (03/2012)
stg -> Вопрос 7-3/1: Внедрение универсального доступа к широкополосным услугам
stg -> Вопрос 19-2/1: Внедрение основанных на ip услуг электросвязи в развивающихся странах


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