Healthc Inform Res.  2014 Jan;20(1):3-10. 10.4258/hir.2014.20.1.3.

Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges

Affiliations
  • 1Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. daniel.luna@hospitalitaliano.org.ar

Abstract


OBJECTIVES
Information technology is an essential tool to improve patient safety and the quality of care, and to reduce healthcare costs. There is a scarcity of large sustainable implementations in developing countries. The objective of this paper is to review the challenges faced by developing countries to achieve sustainable implementations in health informatics and possible ways to address them.
METHODS
In this non-systematic review of the literature, articles were searched using the keywords medical informatics, developing countries, implementation, and challenges in PubMed, LILACS, CINAHL, Scopus, and EMBASE. The authors, after reading the literature, reached a consensus to classify the challenges into six broad categories.
RESULTS
The authors describe the problems faced by developing countries arising from the lack of adequate infrastructure and the ways these can be bypassed; the fundamental need to develop nationwide e-Health agendas to achieve sustainable implementations; ways to overcome public uncertainty with respect to privacy and security; the difficulties shared with developed countries in achieving interoperability; the need for a trained workforce in health informatics and existing initiatives for its development; and strategies to achieve regional integration.
CONCLUSIONS
Central to the success of any implementation in health informatics is knowledge of the challenges to be faced. This is even more important in developing countries, where uncertainty and instability are common. The authors hope this article will assist policy makers, healthcare managers, and project leaders to successfully plan their implementations and make them sustainable, avoiding unexpected barriers and making better use of their resources.

Keyword

Medical Informatics; Developing Countries; Public Health Informatics; Health Planning; Health Manpower

MeSH Terms

Administrative Personnel
Consensus
Delivery of Health Care
Developed Countries
Developing Countries*
Health Care Costs
Health Manpower
Health Planning
Hope
Humans
Informatics*
Medical Informatics
Patient Safety
Privacy
Public Health Informatics
Uncertainty

Cited by  4 articles

Building Consensus on the Priority-Setting for National Policies in Health Information Technology: A Delphi Survey
Mona Choi, Mihui Kim, Jung A Kim, Hyejung Chang
Healthc Inform Res. 2020;26(3):229-237.    doi: 10.4258/hir.2020.26.3.229.

Impact of Computer-Based Pregnancy-Induced Hypertension and Diabetes Decision Aids on Empowering Pregnant Women
Azam Aslani, Fatemeh Tara, Lila Ghalighi, Omid Pournik, Sabine Ensing, Ameen Abu-Hanna, Saeid Eslami
Healthc Inform Res. 2014;20(4):266-271.    doi: 10.4258/hir.2014.20.4.266.

Technology and Policy Challenges in the Adoption and Operation of Health Information Exchange Systems
Hyerim Ji, Sooyoung Yoo, Eun-Young Heo, Hee Hwang, Jeong-Whun Kim
Healthc Inform Res. 2017;23(4):314-321.    doi: 10.4258/hir.2017.23.4.314.

Empowering Healthcare through Comprehensive Informatics Education: The Status and Future of Biomedical and Health Informatics Education
Kye Hwa Lee, Myung-Gwan Kim, Jae-Ho Lee, Jisan Lee, Insook Cho, Mona Choi, Hyun Wook Han, Myonghwa Park
Healthc Inform Res. 2024;30(2):113-126.    doi: 10.4258/hir.2024.30.2.113.


Reference

1. World Health Organization Global Observatory for eHealth. Building foundations for eHealth : progress of member states : report of the WHO Global Observatory for eHealth. Geneva, Switzerland: World Health Organization;2006.
2. Dick RS, Steen EB, Detmer DE. Committee on Improving the Patient Record, Institute of Medicine. The computer-based patient record: an essential technology for health care. Washington (DC): National Academy Press;1997.
3. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington (DC): National Academy Press;2000.
4. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academy Press;2001.
5. Douglas GP, Deula RA, Connor SE. The Lilongwe Central Hospital Patient Management Information System: a success in computer-based order entry where one might least expect it. AMIA Annu Symp Proc. 2003; 833.
6. Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N, et al. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc. 2003; 10(4):295–303.
Article
7. Lewis T, Synowiec C, Lagomarsino G, Schweitzer J. E-health in low- and middle-income countries: findings from the Center for Health Market Innovations. Bull World Health Organ. 2012; 90(5):332–340.
Article
8. Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care. 2008; 16(2):139–145.
Article
9. Gerber T, Olazabal V, Brown K, Pablos-Mendez A. An agenda for action on global e-health. Health Aff (Millwood). 2010; 29(2):233–236.
Article
10. Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised health information systems: hard lessons still to be learnt. BMJ. 2003; 326(7394):860–863.
Article
11. Gordon AN, Hinson RE. Towards a sustainable framework for computer based health information systems (CHIS) for least developed countries (LDCs). Int J Health Care Qual Assur. 2007; 20(6):532–544.
Article
12. Madani S, Aronsky D. Factors affecting the sustainability of information technology applications in health care. AMIA Annu Symp Proc. 2003; 922.
13. Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010; 29(2):244–251.
Article
14. Latourette MT, Siebert JE, Barto RJ Jr, Marable KL, Muyepa A, Hammond CA, et al. Magnetic resonance imaging research in sub-Saharan Africa: challenges and satellite-based networking implementation. J Digit Imaging. 2011; 24(4):729–738.
Article
15. Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Glob Health Action. 2012; 5:1–8.
Article
16. Simba DO, Mwangu M. Application of ICT in strengthening health information systems in developing countries in the wake of globalisation. Afr Health Sci. 2004; 4(3):194–198.
17. Fraser HS, Jazayeri D, Nevil P, Karacaoglu Y, Farmer PE, Lyon E, et al. An information system and medical record to support HIV treatment in rural Haiti. BMJ. 2004; 329(7475):1142–1146.
Article
18. Barclay E. Text messages could hasten tuberculosis drug compliance. Lancet. 2009; 373(9657):15–16.
Article
19. Asangansi I, Braa K. The emergence of mobile-supported national health information systems in developing countries. Stud Health Technol Inform. 2010; 160(Pt 1):540–544.
20. Moore GE. Progress in digital integrated electronics. IEEE Solid-State Circuits Newsl. 2006; 20(3):36–37.
21. Plan Ceibal entrega la computadora 1 millón [Internet]. Montevideo, Uruguay: Ceibal;c2013. cited at 2014 Jan 2. Available from: http://www.ceibal.org.uy/index.php?option=com_content&view=article&id=1025:iplan-ceibal-entrega-la-computadora-1-millon&catid=63:noticias-slider-home.
22. Conectar Igualdad [Internet]. Buenos Aires, Argentina: National Social Security Administration;c2013. cited at 2014 Jan 2. Available from: http://www.conectarigualdad.gob.ar/.
23. OLPC Rwanda [Internet]. [place unknown]: [publisher unknown];c2013. cited at 2014 Jan 2. Available from: http://wiki.laptop.org/go/Rwanda.
24. PostgreSQL: About [Internet]. [place unknown]: The PostgreSQL Global Development Group;c2013. cited at 2014 Jan. Available from: http://www.postgresql.org/about/.
25. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006; 529–533.
26. Mohammed-Rajput NA, Smith DC, Mamlin B, Biondich P, Doebbeling BN. Open MRS Collaborative Investigators. OpenMRS, a global medical records system collaborative: factors influencing successful implementation. AMIA Annu Symp Proc. 2011; 2011:960–968.
27. Fraser HS, Biondich P, Moodley D, Choi S, Mamlin BW, Szolovits P. Implementing electronic medical record systems in developing countries. Inform Prim Care. 2005; 13(2):83–95.
Article
28. World Bank. 2006 world information and communications for development report: trends and policies for the information society. Washington (DC): World Bank;2006.
29. World Health Organization. International Telecommunication Union. National eHealth strategy toolkit. Geneva, Switzerland: World health Organization;2012.
30. Canada Health Infoway. Pan-Canadian Electronic Health Record: executive summary. Toronto: Canada Health Infoway;2005.
31. National e-Health and Information Principal Committee. National e-Health strategy. London: Deloitte Touche Tohmatsu Limited;2008.
32. Connected Digital Health in Denmark. National strategy for digitalisation of the Danish healthcare service 2008-2012. Copenhagen: Connected Digital Health in Denmark;2007.
33. Carnicero J, Rojas D. Application of information and communication technologies for health systems in Belgium, Denmark, Spain, the United Kingdom and Sweden. Santiago, Chile: CEPAL;2010.
34. Health Metrics Network. World Health Organization. Country health information systems: a review of the current situation and trends. Geneva, Switzerland: World Health Organization;2011.
35. Ajami S, Arab-Chadegani R. Barriers to implement Electronic Health Records (EHRs). Mater Sociomed. 2013; 25(3):213–215.
Article
36. Were MC, Meslin EM. Ethics of implementing Electronic Health Records in developing countries: points to consider. AMIA Annu Symp Proc. 2011; 2011:1499–1505.
37. Amatayakul MK. Electronic Health Records: a practical guide for professionals and organizations. 2nd ed. Chicago (IL): American Health Information Management Association;2004.
38. Campbell AV. The ethical challenges of genetic databases: safeguarding altruism and trust. Kings Law J. 2007; 18(2):227–245.
Article
39. Chalmers D, Nicol D. Commercialisation of biotechnology: public trust and research. Int J Biotechnol. 2004; 6(2-3):116–133.
Article
40. Meslin EM. Shifting paradigms in health services research ethics. Consent, privacy, and the challenges for IRBs. J Gen Intern Med. 2006; 21(3):279–280.
Article
41. Institute of Medicine, Committee on the Role of Institutional Review Boards in Health Services Research Data Privacy Protection. Protecting data privacy in health services research. Washington (DC): National Academy Press;2000.
42. Detmer DE. Capacity building in e-health and health informatics: a review of the global vision and informatics educational initiatives of the American Medical Informatics Association. Yearb Med Inform. 2010; 101–105.
Article
43. Fadare JO, Desalu OO, Jemilohun AC, Babatunde OA. Knowledge of medical ethics among Nigerian medical doctors. Niger Med J. 2012; 53(4):226–230.
Article
44. Glaser J. Interoperability: the key to breaking down information silos in health care. Healthc Financ Manage. 2011; 65(11):44–46. 4850
45. Hammond WE, Bailey C, Boucher P, Spohr M, Whitaker P. Connecting information to improve health. Health Aff (Millwood). 2010; 29(2):284–288.
Article
46. Sass M, Feko A. The emergence of telemedicine and e-health in Hungary. Telemed J E Health. 2011; 17(5):388–395.
Article
47. World Health Organization. eHealth standardization and interoperability [Internet]. Geneva, Switzerland: World Health Organization;2013. cited at 2014 Jan 2. Available from: http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_R8-en.pdf.
48. Hersh W, Margolis A, Quiros F, Otero P. Building a health informatics workforce in developing countries. Health Aff (Millwood). 2010; 29(2):274–277.
Article
49. The Rockefeller Foundation. From silos to systems: an overview of eHealth's transformative power. New York (NY): The Rockefeller Foundation;2010.
50. Hersh W, Williamson J. Educating 10,000 informaticians by 2010: the AMIA 10×10 program. Int J Med Inform. 2007; 76(5-6):377–382.
Article
51. Otero P, Hersh W, Luna D, Lopez Osornio A, Gonzalez Bernaldo de Quiros F. Translation, implementation and evaluation of a medical informatics distance learning course for Latin America. In : Proceedings of the 12th World Congress on Health (Medical) Informatics; 2007 Aug 20-24; Brisbane, Australia. p. 421–422.
52. Margolis A, Joglar F, de Quiros FG, Baum A, Fernandez A, Garcia S, et al. 10×10 comes full circle: Spanish version back to United States in Puerto Rico. Stud Health Technol Inform. 2013; 192:1134.
53. US National Institute of Health, Fogarty International Center. Informatics Training for Global Health (ITGH) [Internet]. Bethesda (MD): National Institute of Health;c2013. cited at 2014 Jan 3. Available from: http://www.fic.nih.gov/programs/pages/informatics.aspx.
54. American Medical Informatics Association. AMIA global programs (GHIP) [Internet]. Bethesda (MD): American Medical Informatics Association;c2013. cited at 2014 Jan 3. Available from: http://www.amia.org/programs/global-programs-ghip.
55. Murthy KR, Murthy PR, Kapur A, Owens DR. Mobile diabetes eye care: experience in developing countries. Diabetes Res Clin Pract. 2012; 97(3):343–349.
Article
56. Mars M, Holmes JH, Richards J, Otero P, Marcelo AB, Luberti AA. Informatics capacity building in the developing world-working towards an international educational model and curriculum. Stud Health Technol Inform. 2013; 192:1250.
57. Paton C, Househ M, Malik M. The challenges of publishing on health informatics in developing countries. Appl Clin Inform. 2013; 4(3):428–433.
Article
58. Vose PB, Cervellini A. Problems of scientific research in developing countries. IAEA Bull. 1983; 25(2):37–40.
59. International Medical Informatics Association Working Group on Health Informatics for Development (IMIA HI4Dev) [Internet]. [place unknown]: [publisher unknown];c2013. cited at 2014 Jan 3. Available from: http://imia-wg4dev.org/.
Full Text Links
  • HIR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr