HeathcareElectronic Health Record in Peru: When will it be...

Electronic Health Record in Peru: When will it be implemented and how will patient care change?


In our country, the most common is that each person has more than one medical history, the document in which – every time they go to a health center – all medical information is recorded, such as diseases, new diagnoses, treatments, etc.

And many hospitals and clinics still record patient information by hand in medical records, which are stored in places where – many times – papers get lost. This, in addition, since the same system is divided between the dependencies of the Ministry of Health (Minsa), EsSalud, the insurance of the Armed Forces and Police, in addition to the private ones.

Thus, the implementation of electronic medical records is a need that has been talked about for years, but

This technological tool would allow the detailed and updated clinical history to be available anywhere in the country thanks to digital interconnection. Now, the Minsa is taking the first steps for its implementation, which will be part of a unified information system. The goal is that

Trade He spoke with Lic. Liliana La Rosa, general coordinator of the Program for the Creation of Integrated Health Networks (PCRIS) of the Minsa, regarding the deployment of electronic medical records and how it would improve patient care.

“It will be a step towards modernity, so that citizens can better exercise their right to health”, says.

– At this time, how much progress has been made in digitizing medical records?

Different hospitals have compiled their own medical records [electrónica]. Some are already several years old, such as the INEN, the Puente Piedra hospital, and the Villa El Salvador hospital. So each hospital has tried to resolve those situations. Many follow [con las historias clínicas] handwritten, they have not developed another option. It depends a lot on being able to read the letter of the doctor, the nurses and understand the instructions accordingly, and follow them up. Unfortunately, for many years, there has been talk of electronic medical records and a unified system, but it has not been implemented. Now the decision has been made for the first time to implement the electronic medical record, which is a part of the unified information system. We are going to take the experience of EsSalud, which has 498 IPRESS [Instituciones Prestadoras de Servicios de Salud] with electronic medical record; Recognizing this progress, we will enter into an agreement with them, summoning the health services of the Armed Forces and the National Police, in an agreement that will be led by the Ministry of Health as the governing body. Right to have your information protected, but that it can be shared according to your needs.

“Since the information will be in a single secure system, you will be protected”

– How would it work?

For example, if you are from Lima, you have your electronic medical record at the health post closest to your home. If you get sick and arrive at the Loayza Hospital and they refer you to a specialized center such as the National Ophthalmology Institute, your history will accumulate, the information should accumulate. Not only [figuraría] what the doctors say, but also what is the prescription, what does nursing say, what is the follow-up, your ultrasounds, your MRI, your tomography … Everything should be accumulating digitally. If one day you have a health problem in Cusco, it is possible – following an information security scheme – that the doctor in a health center in that region can access your story. If you need urgent care, I could know your blood type, know what medicine you are taking. If you cannot speak, if you are unconscious or in a lot of pain that does not even allow you to tell what is happening to you, through history the doctor can prevent you from getting worse. Since the information will be in a single secure system, you will be protected. In that sense, this is a momentous decision for citizens.

– But do the country’s health centers now have the technical and logistical capacity to implement this electronic medical record?

No. This is going to be a great effort, and it will demand a budget allocation, it will require training, education and a lot of commitment from all health professionals who are responsible for making clinical reports, that is, nurses, doctors, obstetricians and professionals who are involved in caring for citizens. Everyone should have, for example, a digital signature, because everyone is responsible for what they report, and you can sign only if you are authorized by your professional association. that these teams are interconnected. We need good connectivity, at the same time we need to strengthen some nodes such as telemedicine, which allows the reading of reports, support tests, remote consultations, and all this can be facilitated through this strengthening of teams of computing that is going to be given at the national level.

As mentioned, the training of staff to use these tools will be key …

The idea, furthermore, is that training can be done because not everyone is used to handling digital technology, therefore, there has to be a great deployment of training. You also have to get used to always filling in the information. What does the citizen gain from it? That your information is legible, that we can all access it, that it has basic international standards, on diagnosis, treatment and supply of the stock of medicines. So… For example, we are going to know how long a consultation lasts, how many people are being treated according to health standards. It will be a step towards modernity, so that citizens can better exercise their right to health and we professionals and health servants can also have clarity about what our standards of compliance with the health offer are.

– In this sense, will this be one of the first steps towards the unification of the health service provider systems in the country?

It is a central node for networking. We need to network, overcome the fragmentation of the health system. After more than 200,000 deaths in this tragic pandemic, with all that it has meant for the unattended people because we have been focused on facing the covid and we remain focused on it, after verifying that we have such a delay in the health system in terms of our ability to control outbreaks, in terms of prevention and promotion, this leap to modernity is more than necessary. Because talking about the right to health is not talking about an entelechy [algo que solo existe en la imaginación]It’s a beautiful phrase, but you have to seriously guarantee it. So one way to do it is to work so that the entire public system is articulated. If we are talking about a policeman who lives in an urban-marginal area instead of going to the Police Hospital, what he can do is go to the nearest service, he does not pay for the service, but rather by exchange of benefits and because we are in a Only unified health system, We need to get to that level. To do this, first, we have to work in unity; second, we must have a networking.

“The important thing is that all services will now progressively attend 12 and 24 hours”

– What does it mean to network in the health system?

That there are no longer six-hour services with a technician, but that all services progressively – at the national level – must always have a doctor, a nurse, the necessary nursing technicians and even obstetricians guaranteed. The important thing is that all services will now progressively attend 12 and 24 hours. So you get to the 12-hour, the doctor evaluates you and will send you to a 24-hour center if necessary. There will be a necessary health team and also a surgical center in case you need minor surgery.

So, in that 12-hour health center there will be an ambulance for the transfer. If in the other center they find that the issue is more serious, it is sent to the regional referral hospital. For this, a fund must be created to transport it by air, land or river, and even hire a private one, and all this with an electronic reference system. What is the new thing that would happen? We have managed to have him treated, transferred to him. So, now the doctor at the place of reception will fill out the medical record with the indications for the doctor at the health center where the patient comes from. We are seeing the whole circuit for the first time through this unification of the system.

– Is there a standard or team that is already working on this issue?

A work commission was installed with EsSalud a few weeks ago, there is a work commission. This working commission has already generated an agreement proposal for articulated action. We are making progress on the basic agreement. I believe that very soon we will have this great news of the signing of the agreement between the Minister of Health and those responsible for the health of the Armed Forces, Police and EsSalud. There are already preliminary agreements.

– There are already some hospitals that have implemented their own electronic medical records …

The idea is to build on what’s advanced. It does not mean that the stories that have been advanced so far will no longer be valid, in any way. Everything will add up; The idea is to make interoperable what the INEM, EsSalud and other hospitals have done. It is a starting point. We are also working with regional governments, which would constitute our preliminary intervention laboratory, which means approximately 1,400 services.

The clinical information generated in a health center does not accumulate with the total data of the patients.  (Pixabay)

“We hope that by the end of next year we will have the first steps of the implementation of the clinical history”

– Is there any forecast on the start of the first pilot for the implementation of the digital medical record?

We are going to do a validation process in those [29] integrated networks next year, we hope that the signing of the framework agreement with all public institutions will take place as soon as possible, and thus in the first semester of next year there will be a validation and adjustment process. At the end of next year we should already have the clinical history in the networks on trial. Uruguay took 10 years and there are no more than 3 and a half million people. The good news is that we have already started, we are together and we know the route. With the acquisition of the equipment, the assurance of connectivity with the Ministry of Transport and Communications and the regional governments, we hope that by the end of next year we will have the first steps in the implementation of the clinical history.

– The amount of information that will be generated will be important. This data can serve to improve decision-making in public health.

It is a huge challenge, there are different parts that must be built for unification and to make this an intelligent system. This information system will give us a prospective look, it will allow us to have the capacity to plan the public health of the country, such as knowing how many nurses we have to train, how many doctors I have to train in the country, how many do I need to be trained in the next 10 years for a population like ours. This information system will allow us to prospect for the first time, now we do it a bit fumbling. Now we will be able to have more control over what the country needs. People are aware of how bad the health system has been and how important this decision is. This is not a trivial decision, it is a decision that opens the doors to modernity. Without information we cannot guarantee the care of citizens.

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