M O V E R SS H A KE R S
HEALTHCARE IT IN LATIN AMERICAA CONVERSATION WITH INDUSTRY LEADERS
August 2014
“We Accelerate Growth”
CONNECTED HEALTH PROGRAM
MOVERS & SHAKERS
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Interviewed by Federico Baguear, Industry Analyst, Healthcare – Latin America
Introduction
An analysis of the Latin American Hospital Information System (HIS) market is showing some interesting and promising results. In 2012, the Latin American market reached $550 million and is expected to reach $1100 million in 2018 with a compound annual rate of 14.9%, as the region is now in a growth phase for health IT.
Federico Baguear, industry analyst with Frost & Sullivan, interviewed CSC, everis and NoemaLife as part of the healthcare IT market trends analysis in Latin America.
Guillermo Ramas is industry general manager for Southern Europe & Latin America within the Healthcare division of CSC. Ramas has been part of the management in companies such as Lawson, Agresso Spain, Agfa Healthcare IT and Shared Medical Systems. In 2008, he became iSoft’s healthcare director for South Europe and Latin America, a position he still holds in CSC Healthcare after the fusion of the companies in August 2011.
Mario Chao is healthcare partner and global director with everis, based in Mexico D.F. He has more than 20 years of consulting experience and 10 years in healthcare and government.
Cristián Power has been general manager with NoemaLife Chile and Peru since 2011. He has 15 years of experience in IT. After obtaining a MSc in Image Processing at the University of Paris, Power returned to Chile to develop several projects related to RIS, PACS, LIS and EMR.
This Movers & Shakers interview focuses on five points centric to the current situation in Latin America: healthcare IT growth, challenges presented in system adoption, the public sector role, market needs, and strategies each company is applying to access the market.
Frost & Sullivan is honored to feature Ramas, Chao, and Power as part of its Movers & Shakers series, and thanks them for sharing their views and perspectives on the Latin American HC IT market.
Guillermo Ramas Healthcare Industry General Manager for Southern Europe &
Latin America CSC (formerly iSoft)
Mario Chao Healthcare Partner and
Global Director everis
Cristián Power General Manager NoemaLife Chile
Movers & Shakers Interview with
HC IT INTERVIEW
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Federico Baguear: There is a global trend toward the use of healthcare IT (HC IT) systems to improve healthcare administration and patient treatment. Which trends are you seeing in Latin America? What are the main benefits of HC IT solution adoption?
Guillermo Ramas: There is a big interest in using technology information systems in healthcare in Latin America. Mexico is seen as a reference standard in the region because it represents one of the most advanced countries in terms of specific regulations and regional projects. Other countries like Ecuador, Panama and Honduras are facing ambitious technology projects in which one of the main objectives is to implement electronic medical records (EMR).
The use of information and communication technologies (ICT) systems offers numerous benefits to the healthcare system. Organizations and healthcare delivery institutions increase management effectiveness and efficiency in both financial and clinical areas. This allows healthcare professionals to focus on providing better-quality patient care. EMR enables professionals to have information whenever it is needed, leading to major process control and better diagnosis.
In the long term, these solutions allow optimization of resources by increasing productivity, thereby helping healthcare institutions to be more competitive and provide better services to their patients.
Mario Chao: The informatization of the healthcare sector warrants process efficiency and decision support by providing access to the right information at the right time.
The use of EMR provides an opportunity to improve healthcare, more comprehensive control of population health, better patient safety, reduced waiting times for information, and increased precision of diagnosis. This comes about through multidisciplinary information-sharing at the same time, and ability to precisely control and manage expenses and costs. That is the reason EMR is the cornerstone of healthcare industry transformation. The EMR provides the basic platform that allows building an ecosystem based on registers and events because it records all the transactional health movements.
EMR is not the only important solution; there are many eHealth applications that by working together, will allow the information to move across all the healthcare actors involved. Also, IT will help solve clinical practice access problems, such as connecting medical specialists with rural towns using telemedicine. Moreover, IT can help improve mental health assistance, rehabilitation and transplant management, among many other areas.
Technological innovation, together with IT capabilities and mobile devices, will play a key role to generate new ways to provide healthcare assistance. Importantly, as in other industries, ICT solutions provide the platform to more efficiently manage areas, including logistics, human resources and administrative procedures.
Cristian Power: Nowadays there is a growing need to use IT solutions in healthcare institutions; this is seen in private healthcare institutions as well as in public healthcare systems in order to improve their management processes. In my opinion there is one big benefit that overcomes the rest–patient treatment. Patient care will be improved as long as the hospital information system has capabilities to support clinical processes enabling the IT system to deliver clinical decision support and be more than just an electronic register. HC IT implementations also provide economic management improvements in areas including stock management, treatment management and accountability benefits. The influence of these benefits can be appreciated by viewing management performance indicators, and the board of a healthcare institution will be able to define their strategic vision regarding costs and patient treatment. In other words, better knowledge of service costs and the improvement of treatment services can allow doctors to determine the best treatment for the patient and at the same time optimize payments.
FB: Based on your experience, what are the main barriers that companies face when they enter the Latin American HC IT market? How can the adoption rate be improved in the region?
GR: The main point is that the solution complies with the regulations and requirements of the healthcare system in
MOVERS & SHAKERS
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each country. Latin America is a very fragmented market with different health systems tailored to the needs of its population. ICT providers must ensure that the system meets local needs. Therefore, companies cannot access the entire region with a single standard strategy. We have to treat each country, sector, public and private, separately.
The adoption rate can be increased by showing success cases, which involves working closely with clients–listen, analyze and define together. The results obtained in countries already applying information technology to their health processes serve as an example to others. For us, the success of our clients is our greatest reward.
MC: The HC IT market in Latin America is currently at an immature stage.
There is still some way to go in properly understanding the general healthcare transformation and the use of IT in this context. Healthcare in Latin America is changing, and each country shows specific problems, but the common factor seems to be the desire to introduce technologies in an aggressive way. This point means good news for IT companies, but there is a serious problem of expectations when organizations think that implementing a HC IT solution is just about buying hardware and software. The leveraging of ICT in healthcare is much more complex than buying supplies; it is a long and complex process that involves rethinking the way things are done. It requires, as any profound change, a well-designed and executed strategy and, of course, major change management across all industry participants. We see cases of countries trying to achieve impossible things, both in form and in substance; for instance, laws that demand the use of EMR for a specific date without considering the factors necessary to promote and encourage the use of these tools.
The early stage of the market is not only reflected in buyers, but also within the HC IT industry. There are many vendors who offer “quick fixes” and overpromise results, which can generate frustration and disappointment among customers. The immaturity of the sector also generates multiple barriers to entry, which is can be seen in low levels of investment, and shortage of human resources in HC IT.
CP: The main barriers faced by a supplier looking to enter the Latin American market can be grouped into two fundamental aspects: cultural and economic. Regarding cultural, each Latin American country has a different understanding of hospital information systems. The scope is defined by this understanding, which many times cannot differentiate a world-class system from a local solution that just partially responds to local problems in each country. In this scenario, highly configurable systems that are capable of generating clinical forms or documents dynamically can be viewed as not providing greater benefits than a system that has been developed under the classical programming paradigms. Note that there are countries in Latin America that have started later than others; in turn, they have learned after others experienced setbacks.
The other big barrier to companies seeking to enter the Latin American market is related to understanding the purchase power in each country. In general, foreign companies come to the region with higher prices than what is expected by customers. In some cases, prices can reach three or four times the prices of local products or suppliers that are more in tune with the local country’s reality.
Improving the adoption rate of information systems in emerging markets will require a process of “evangelization” or training for all industry players, doctors, engineers, those who buy and those who sell well. So to the extent that higher education, undergraduate or graduate courses incorporate information technology into their careers, this will provide more coverage and understanding of the scope of clinical information systems, thus facilitating the entry of international suppliers.
FB: The Latin American region is very dependent on the public healthcare systems. Do you think that governments are looking forward to HC IT solutions for the public scenario? Which countries in Latin America are more advanced regarding healthcare IT solutions?
GR: Both private and public healthcare are making great efforts in the implementation of HC IT solutions. For both sectors, the most important thing in the short term is to achieve the implementation of EMRs, which allow stakeholders to better manage administrative, financial and clinical information, as well as hospital patients.
HC IT INTERVIEW
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Directly related to our business, I can say that the governments of Honduras, Mexico, Panama and Ecuador are working hard to modernize their health systems through the application of ICT. For our company, it is an honor to be their technology partner for strategic projects that will have a positive impact on improving the quality of healthcare of patients and the welfare of society in general.
MC: Big economies such as Brazil and Mexico have HC IT implementation as a key governmental focus. However, there is an imbalance between intent and concrete implementation plans. In many countries, a rigorous and well-planned digital healthcare agenda is missing to enable achieving needed changes and to be considered as state policy.
CP: In my opinion, the countries making the greatest efforts to incorporate HC IT are those countries with ordered national health services with political stability to support long-term solutions. Thus, according to my experience, I can include in this group of countries Chile, Peru, Colombia, Antilles, Panama, Brazil, Mexico and Costa Rica.
FB: During our research we have found that key solution groups in the Latin American HC IT market come from IT vendors, IT integrators as well as homegrown solutions. What is your opinion about them, and how do you think the Latin American HC IT market will evolve?
GR: The healthcare industry is moving toward connected models; it is crucial to offer an interoperable solution with connectivity and traceability of information standards, in addition to local legislation and standards requirements. In our case, the integration of our systems xHIS and eSIAP allows us to offer a global solution for hospital management and EMRs, which ensures coordination between hospital care areas and first level of care, offering our clients an integrated view of healthcare encompassing clinical process workflows, as well as different key areas and services. It is very important that through our model we can meet the needs of each customer with the level of customization that can fulfill and satisfy their particular expectations.
MC: There is no single solution that meets the requirements of all customers. There is a strong debate between “world-class” solutions versus made-in-house (“homegrown”). In everis we believe that none of them is particularly better; it all depends on what the client needs. We are also convinced that the success of eHealth projects depends on not only implementing one product over another, but a holistic approach that considers the client’s processes, technologies and people.
On the one hand, world-class solutions incorporate a great deal of knowledge, but also require a local adaptation that often creates serious problems to meet the reality of the customer. On the other hand, “homegrown” solutions are much slower to achieve the “time to market” because they must be developed, and have trouble growing nationally or internationally. In both cases, it requires specialized personnel for proper implementation, and these resources are scarce today.
In everis, we are working with a strategy that seeks a balance between the time to market and combining a world-class technology approach with the flexibility of a homegrown solution. An eHealth-oriented architecture (ehCOS framework) gives finished products (e.g., medical record system, ehCOS cLINIC) the ability to be configured in a fast, flexible and efficient way.
CP: The companies best positioned to meet the needs of the market are those companies whose main business line, and preferably only one, is the development and implementation of HC IT solutions. Large integrators as well as IT vendors (hardware) have little interest in understanding the industry, providing little value and introducing significant costs to solutions.
The best positioned, in the sense of the most suitable to meet the needs of Latin American markets, are specialist suppliers of clinical information systems, for both large international projects–such as those with products made in-house (homegrown)–to smaller-scale projects.
FB: How is your company focusing on this new market, and what is your strategy to differentiate itself from other competitors in the segment?
MOVERS & SHAKERS
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GR: At CSC we push for a coordinated health model, where we position the patient at the center of the health system. To achieve this, it is necessary to have a specific knowledge architecture to support the definition of workflow processes, formats and data structures, and common standards for the exchange and storage of information. As noted above, we get it through our systems integration xHIS and eSIAP.
Healthcare Ministries from countries like Mexico, Ecuador, Panama and Honduras have chosen our model of coordinated health. In Mexico we lead the market. Our healthcare expertise and the ability to adapt our solutions to the needs of each healthcare system are part of the key to our success.
MC: We believe that the best positioned companies will be those that are able to react to continuous changes in the industry, providing sufficient innovation to deliver effective and efficient solutions tailored to the economic and social reality of Latin America. Local solution “national champions” that do not look beyond their borders and incorporate innovation constantly will limit success. The road will also be blocked for “world-class” solutions that do not understand or cannot be adapted to the Latin American reality.
everis is working with a global and regional vision by adapting the solutions to local realities of each country and innovating in key aspects of the industry. Because of its technological approach, our technology, ehCOS, gives us this flexibility, while we respect the standards and international best practices. We
generate an ecosystem of customers and partners to help improve a modular and scalable solution.
CP: NoemaLife’s strategy is to penetrate markets by supporting local distributors. We generate strong alliances with IT suppliers and healthcare IT specialists; we transfer technology and knowledge to distributors by providing training and commercial support until they are able to work autonomously. We are always available to support them on sales processes.
Regarding our differentiation strategy, we base our work on three main principles:
• Honest delivery; we deliver all our knowledge and leverage the customer to form a joint project in both sales and implementation processes
• Professionally face each project
• Cultural and economic respect for each market
We believe that the best way to penetrate the market and differentiate ourselves from our competition is ensuring successful project implementations and keeping focus on supporting service excellence.
Note: This Movers & Shakers piece was originally published in Spanish in Q3 2013.
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DANIEL RUPPAR
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Healthcare & Life Sciences
EDUARDO GOLISANO
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