July 6, 2020
The practice of telemedicine in Latin America and the Caribbean, henceforth the LAC region, has been growing at a slow and heterogenous pace in the last 20 years. Telemedicine is understood as “the provision of health-care services by means of information and communication technologies (ICTs) in situations where the health professional and patient are located in different places”. As such, telemedicine promises to reduce costs and to overcome the challenges arising chiefly from inequalities in access and quality of health care.
How likely is it that any person in the LAC region receives quality health-care services, when required? This probability depends on (i) availability of health care resources: properly trained health professionals, facilities, equipment and medicine must be available for the diagnosis and treatment of illnesses. (ii) Whether these resources are close to the population requiring them. (iii) Cost of these services to patients and their families.
Through ICTs, the engines of Telemedicine, these factors can be improved. ICTs increase the availability of medical resources and bring the knowledge of scarce specialists to remote areas. It is therefore possible to reduce the need to move patients, while at the same time receiving timely care and cutting costs for families and the health system. In practice, this is applicable to several medical specialties, including teleradiology, telecardiology, telepathology and others.
In the LAC region, a market of approximately 670 million people, the commitment of countries and territories to develop their ICT infrastructure and to implementing nation-wide telemedicine services has been heterogenous. Around the early 2000s almost all of the countries in the region generated Public-private initiatives employing ICT infrastructure to train health care professionals across distances, very few, including Costa Rica, Panama, and Uruguay commenced to use teleconsultation programs. The specialties where teleconsultation has been done include ophthalmology, radiology, and dermatology (1).
LAC governments have started to recognize the importance of telemedicine and e-health to tend to the needs of their largely heterogenous populations. In Colombia, the legal and regulatory framework for the practice of telemedicine commenced to be built in the early 2000. However, regulations have proven to be insufficient and not keeping up with the development of technologies and their practical implications. Furthermore, in Brazil, Mexico, Colombia, and Argentina, a lack of technological literacy and interest among health-care professionals has hindered telemedicine from taking off nationwide. Interestingly, Mexico, Peru and Uruguay are the only countries in which the implementation of electronic medical records-EMRs has received modest attention.
Three key lessons have been learnt so far on the development of Telemedicine in the LAC region. (i) Its success will largely depend on the sustained commitment of governments. (ii) This commitment needs to be ignited by initiatives derived from public-private collaborations to bring ICT knowledge to health care professionals and health systems and (iii) trigger sufficient citizen and healthcare providers engagement.
Should these three factors align to promote telemedicine success in the LAC region, this market may grow from being worth 1.57 million USD in 2019 to 3.5 million USD by 2024 (2). However, early this year, an unexpected player arrived, and it may speed-up the development of Telemedicine in the region.
COVID-19 a boost for telemedicine
In spite of the increasing death toll and the strong impact on the regional economy that COVID-19 is imposing on the region because of lockdown and social distancing rules, the situation seems to be propelling a new way to develop patient-doctor interactions supported by ICT tools. Data from other world regions illustrate this trend. A Mckinsey report on the interest on and use of telemedicine during COVID-19 in the US revealed that telehealth services increased between 50-175 times that in pre-COVID-19 period (3).
Hospitals and healthcare centers pose the highest risks of infection. However, patients still need to visit hospitals for reasons other than COVID-19. The use of smart-technologies may circumvent the need to go to a hospital for non-COVID-19 related attention and get the necessary attention while being at home. This is particularly useful to protecting and tending to high-risk populations (the elderly or patients with morbidities that could worsen in the presence of the new coronavirus) that constantly require medical attention.
Currently, in the LAC region mobility in and out of rural areas is limited and healthcare professionals and resources are geographically unequally distributed. Amidst the current Covid-19 situation, these two factors only make medical care in geographically isolated areas less accessible for a substantial fraction of the population. In the LAC region, the average number of health care professionals per 10.000 inhabitants ranges from 9-49 (except for Cuba, with more than 150). This qualified force is chiefly located in urban centers and has limited mobility into rural areas. Since social distancing is the new rule, health attention centers and patients in rural areas could benefit greatly from well-established and effective teleconsultation.
Through Telemedicine, remote areas can have access to high quality and timely? health care, while saving on expenses and resources. For instance, through a remote diagnosis scheme, key endemic diseases can be detected and treated in situ, avoiding transferring the patient, and saving costs to the patient or to the health system.
Telemedicine in the LAC region in the COVID-19 era and beyond
COVID-19 arrived to a region with populations facing fast and complex epidemiological changes. Both endemic communicable diseases and non-communicable diseases (NCD) coexist, shaping the heterogenous epidemiological landscape of the LAC region. The ratios of communicable to NCD vary within and between countries. While communicable diseases are most prevalent and deadly in low-income regions and countries, such as Bolivia, Paraguay, and Peru, NCDs are becoming more relevant to health systems in urban areas throughout the region. Cities are home to 80% of the population. Population ageing, urbanization, and changes in lifestyles are driving the prevalence of NCDs in LAC countries (4)
The challenge of telemedicine in the LAC region during the COVID-19 era, and afterwards, remains providing effective alternatives to detection of key communicable diseases such as malaria, pneumonia, and diarrhea (5), as well as assisting the treatment and monitoring of patients with NCD, such as diabetes and heart disease.
Regarding Malaria, the key role of telemedicine is its diagnostic. In a telemedicine system, malaria diagnosis is made via e-mailing of smear images from isolated health attention centers, with modest laboratory resources, to experts in specialized head health centers. Although this approach is currently in practice, technology improvements are needed so that diagnoses can be done quick and effectively. Thus far, up to 30% of the smears transmitted from isolated attention centers to head hospitals are deemed as unreadable (6), and specimen preparation and visualization still requires light microscopes attached to bulky camera sets for digitalization.
The alternative here is a microscope coupled to mobile of phone-based image transfer. Moreover, a technology that overcomes the need of light microscopes is even more promising. Lensless Digital Holographic Microscopes are portable devices that digitally reconstruct microscopic images of specimens without using any lenses (7). Consequently, these can be made much smaller, lighter and at a lower-cost. Image transmission still depends on the existing mobile network infrastructure (6).
Diabetes is one of the NCDs that affects urban populations in LAC countries. Diabetes is a target of telemedicine chiefly because of its association with obesity, heart disease, stroke, high blood pressure, and respiratory disease, which also affect urban LAC populations. According to the World Bank, the prevalence of diabetes in LAC populations increased to at most 8% since 2005, and it will increase to an average of 12% by 2025 (8,9). With a condition, such as Type-2-diabetes, telemedicine offers healthcare providers a window to improve the management of their patients’ blood glucose levels. Thanks to teleconsultation, checking on patient’s adherence to treatment regimens and their careful follow-up can be done without having them leaving their homes, missing work, or other scheduled activities.
Heart disease stands out as relevant diabetes comorbidity in the LAC region. Telemedicine can also play a key role in its treatment. A recently concluded study by the Latin America Telemedicine Infarct Network—LATIN in Argentina Brazil, Colombia, and Mexico met its goal in optimizing triage, attention, and transport of patients reporting to attention centers in isolated localities. The study increased emergency attention and substantially decreased mortality rates (10). The project also saved in costs of emergency encounters and unneeded transfers. If such endeavors continue, telemedicine can thrive, as a way to effectively assist heart disease patients in the LAC region.
Action is needed to develop telemedicine in the LAC region
In the COVID-19 era, and beyond, telemedicine represents a safe alternative to addressing patient needs under conditions of limited mobility. LAC governments and their healthcare systems need to develop and promote the use of telemedicine and its effective functioning. However, telemedicine and ICT companies should also demonstrate governments, payers, and users the need for and the benefits of implementing telemedical solutions in the region.
Research is needed to generate data in support of telemedicine both for infectious diseases and NCDs in the LAC region. The time has arrived to commence generating and communicating data on telemedical solutions for a large market in dear need of strategies to circumvent the inequity in access to health services. Through research, innovative telemedical companies can realize how their technologies and services can be adapted to current infrastructure in the LAC region, gain valuable insight into this target market, and generate and communicate data that persuade key stakeholders.
At Support Advisors Consulting Group, we provide an array of market research and strategy services to innovative and small telemedical and ICT companies willing to explore the LAC market. We also offer clinical research management and stakeholder-oriented communication strategy plans that ensure rapid and effective market penetration and development.
Get in touch with us!
4. Barreto SM, Miranda JJ, Figueroa JP, et al. Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol. (2012) 41:557-571. doi:10.1093/ije/dys017
5. Prieto-Egido I, Simó-Reigadas J, Liñán-Benítez L, García-Giganto V, Martínez-Fernández A. Telemedicine Networks of EHAS Foundation in Latin America. Front Public Health. (2014) 2:188. doi:10.3389/fpubh.2014.00188
6. Pham, N.M., Karlen, W., Beck, H. et al. Malaria and the ‘last’ parasite: how can technology help? Malar J (2018) 17:260. doi: 10.1186/s12936-018-2408-0
7, Yichen Wu, Aydogan Ozcan,Lensless digital holographic microscopy and its applications in biomedicine and environmental monitoring, Methods, (2018) 136: 4-16. doi.org/10.1016/j.ymeth.2017.08.013
8, Aschner P. Diabetes trends in Latin America. Diabetes Metab Res Rev. (2002) 18 Suppl 3:S27-S31. doi:10.1002/dmrr.280
9, Calderon MN, Espinoza MA, et al. Diabetes in Latin America: Prevalence, Complications, and Socio-Economic Impact. Int J Diabetes Clin Res (2019) 6:112. doi.org/10.23937/2377-3634/1410112
We also recommend
TELL US ABOUT YOUR PROJECT
We are happy to hear about your ambitions and determine the best actions for your project.