Rossana Rivas 1 , Cesar Galindo 2 , J. Tobey Clark 3

1. Abstract ID. 163 - Ehealth: Improving Health Services Quality & Effectiveness in Peru, Chile, US Rossana Rivas1, Cesar Galindo2, J. Tobey Clark3 Senior Advisor, WHO Collaborating Center for Health Technology Management, Technical Services Partnership, University of Vermont Board, National Center in Health Information systems CENS Director, WHO Collaborating Center for Health Technology Management, Technical Services Partnership, University of Vermont rivasperupucp@gmail.com

2. Conflictofinterest We declare this work does not have conflicts of interest with third parties. Acknowledgement The authors acknowledge the contribution from stakeholders of Peru, Chile and USA.

3. Telemedicine and “IntegratedHealth Networks-IHN” in Peru • Directorate General of Telehealth, Reference and Emergencies was created on March 2017. Telemedicine supports the Integrated Health Networks-IHN, which is a cost-efficient care system aimed at the primary level of care. • The National Telehealth Network connects tele-consultant centers located in organizations with low resolutive capacity and tele-consultant centers with greater resolutive capacity. They communicate by Its and provide specialized patient care and distance training. Reference: Ministry of Health of Peru, August, 2018.

4. 2017-2018 Results In 2017 Teleconsultation were provided by 82 organizations of the regions: Amazonas (21), Huánuco (19), Tacna (13) Ucayali (9), Lima (8), Huancavelica (7), Ancash (2), Loreto (2) and Cajamarca (1). (ref.: National Telehealth Network, 2017). Since June 2018, the “Reference and Counter Reference Unit” interacts with “Integrated Health Networks-IHN”. On October 2018 (ref.: Ministry of Health of Peru, 2018): Specialties of highest demand: 1-Pediatrics and related specialties; 2-Gynecology and Obstetrics; 3-High-risk patients 2,059 teleconsultations carried out from the regions of: Loreto (32%); Piura (13%) and La Libertad (10%) occupy the first places in% of teleconsultations attended. 7,533 women attended with tele-mamography. The highest demand corresponds to the regions of: Junín (2,657); Piura (1,445) and Ancash (796)

5. Next stepsonimprovingHealthcare’simpact • On 2018: • 210 health facilities interconnected in 25 regions of Peru; • more than 1,500 tele-consultations; • 1,254 tele-trainings registered. • Future steps: "Zero Lines Plan"; "E-Qhali“ Information System for health records, development of regulation and elaboration of the Health Strategy for Digital Government. MoHcoordinates with Ministry of Transport and Communications (MTC) to achieve the interconnection in the regions using fiber optic network by 2021. Reference: MinisterofHealthof Peru, EhealthReporterLatin America, October, 2018.

6. TheChileanChallenge: Center HealthBenefitsonPatients Use of IT is Integral Part of the Plan

7. TheAmbitious Plan: Virtual Hospital, in the Cloud Patient Cloud Chilean Digital Transformation in Health, basedon Digital Hospital. HealthCareServicesbasedonTelemedicine and InformaticsPlataformsforservices

8. Ambitious Plan Considering: • Terminology Services (MPI, HPI, TFC, Semantic Server) • National Clinical History that can be shared by HealthCare Providers • On Line Services for Patients • Big Data for Secondary Use of Data BIG DATA

9. Electronic Health Record Experience in the USA • 1960’s: the development of the Problem Oriented Medical Record by Larry Weed from the University of Vermont introduced the idea of using electronic methods of recording patient information. • 1972: the first electronic medical record system was developed by the RegenstriefInstitute in Indiana. • 2004: National Coordinator for Health Information Technology was created • 2009: Health Information Technology for Economic and Clinical Health Act (HITECH Act) and the American Recovery and Reinvestment Act (ARRA) • Funding and incentives to healthcare professionals who adopt electronic medical systems and follow the concept of “meaningful use” (Obama)

10. Office of the National Coordinator for Health Information Technology (ONC) is at the lead national EHR governmental organization • Under the Office of the Secretary for the U.S. Department of Health and Human Services • Equivalent to the Ministry of Health in other countries • Meaningful use - the goal of hospital's implementing the EHR & a measure of these criteria must be met to receive payments • Stage 1 – promoting adoption • Stage 2 - clinical decision support, care-coordination requirements and rudimentary patient engagement rules • Vital signs, laboratory values, ventilation, medications, etc. from devices integrated into EHR • Meaningful use requirements withdrawn by the current Trump administration

11. Results Use of EHRs as of 2015 • 84 percent of the ~5500 non-federal acute care hospitals • 9 percent in 2008 • 58 percent of office-based physicians • 17 percent in 2008 Future 2019 Proposed Actions • Advance interoperability through continued work to address information blocking, advance health information exchange, significant improvements in clinical data liquidity, and administrative provider burden 2019 Budget • $39 billion in 2019 • Over $60 billion USD in 2017