Manuscript of paper. Version 25th of August 2003.
Primary
Care Vedado e-Health Project: Outline of the Design, Rationale and Pilot Results.
Marco J.
Albert, MD,(1) Rodolfo J. Stusser, MD,(1) Eng. Juan A. Enríquez,(2) M.Sc. Alfredo
Rodríguez,(2), Dr.Sc. René González,(3) Alain Cuadot, MD,(1) Zulema Quesada,
MD,(1) Julio Lubián, MD,(1) Alberto Vega, MD,(1) Rubén García, MD,(1) Ragni
Puente,(1) Tania Naranjo,(1) Eng. Frank Pompa,(2) M.Sc. Gemma Rodríguez,(3) Eng. Raúl Almeida,(3) Eng.
Alberto Rodríguez,(3) Eng. Esteban Quintana,(2) M.Sc. Leticia Lezcano,(2) M.Sc.
Pedro Urra,(4), Juan García, MD,(5) Dr.Sc. José Fernández-Britto,(6)
(1) Primary
Care Research Unit, Vedado Education Polyclinic (VP)
(2) Centre for Health Informatics Development (CHID)
(3) Centre
for Digital Research (CDR)
(4) Centre for Information on Medical Sciences (CIMS)
(5) Centre for Cybernetics Applied to Medicine (CCAM)
(6) Centre for Atherosclerosis Research and
Reference of
All centres are located at
Corresponding Author: Rodolfo J. Stusser, MD.
PC Research Unit, Vedado Educational Polyclinic,
Calle 18 #163 y 15, Plaza, 10400 Havana, Cuba
Tel. & fax (537) 832-3461
[email protected], [email protected]
http://familydoctor.org/myhavananpolyclinic/
Abstract
The aim of this paper is to give an outline of the “Vedado e-Health Project (VeHP)”. It has the goal to introduce digital and virtual systems in a primary care polyclinic and its family practices in a Havanan health area. An overview of the clinical care, education, research and development (R&D), and managing in the Vedado health area is given, as well as a brief examination of the viability of the project in such area. The expected benefits are the development up to the highest quality of the e-health care of the patients, as well as the e-health education, R&D, and management of the Vedado Polyclinic and its practices. The sub projects of the VeHP briefcase still unbudgeted in informatics, telemedicine, internet, and other information and communication technologies (ICTs), with collaboration of five national R&D centres and of four foreign universities, are described as well as their pilot results. They are as follows: Tele ECG and other Tele Clinical Systems; Polyclinic and Family Practices' Web Sites; APUS, SIDAPS and EMR systems; and e-Health Research Collaboration Program.
Keywords: digital and virtual project, medical informatics, tele health, internet, e-health, ICTs, primary care, family practice, research collaboration, multidisciplinary team.
Introduction
In July 2002, a series of national projects of research and development (R&D) to introduce digital and virtual systems in the Vedado Polyclinic began to be profiled and carried out. The projects’ briefcase is titled the “Vedado e-Health Project” (VeHP).
This integral project has the goal to achieve the definitive take off in health informatics, tele health, medical internet, and other information and communication technologies (ICTs), in primary care (PC) and family practice (FP), in close collaboration with five national R&D centres and four foreign universities that are working on such matters.[1-2]
The aim of this paper is to give an outline of the “Vedado e-Health Project (VeHP)”, after a previous overview of the Vedado Polyclinic and its practices.
Overview
of the Vedado Polyclinic and its Practices
The Vedado Education Polyclinic governs all the integral health PC and FP programs of medical and nursing care, hygiene and epidemiology, health education, R&D, medicines, technology, etc, in an urban health area.
It covers a population of 40 000
inhabitants in the north-western area of Vedado, in the Plaza municipality of
the
It gives auxiliary diagnostic assistance of clinical lab, X-rays, ECG, horizontal and more vertical preventive, diagnostic and therapeutic services (such as physical therapy), alternative medicine, social work and inter consultations to 64 family practices in the communities, and to 17 general practices in day-cares, work centres and schools in the surrounding area.
It has more practices than any other health
area in
The polyclinic includes an emergency family practice and an emergency central unit with ambulances connected by microwave with the base University Hospital Gral. Calixto Garcia, and --exceptionally in an urban area-- a complete dental clinic with 16 dental complexes. This polyclinic is offering ultrasound examinations, and will offer endoscopic examinations soon, as well as other specialised services.
It educates undergraduate medical students and postgraduate doctors and residents of general integral medicine in PC and FP. It has recently opened electives in PC internships for foreign medical students in Spanish and English. So far, its R&D has been mainly the medical thesis of residents, but since the opening of its Research Unit, it is planning to convert it to an experimental clinic, community, and field for the scientific evaluation of advanced national and world biomedical technology and ICTs.
Outline
of The Vedado e-Health Project Concept
The VeHP expected
benefits are the development up to the highest national and world standard, of
the quality of the PC and FP programs of e-health care of the patients, as well
as of e-health education, R&D, and management, as much in the polyclinic as
in its family practices.[3-6]
In contrast with the precariousness involved in the continuing operation of the computer network continuing operation, the R&D projects have been conceived by meticulous design and are being carried out rigorously to allow the application of their results to the whole national health system (NHS), if the expected benefits are realized.
The viability of the VeHP
has been facilitated by the interest of some national R&D centres to
develop the PC and FP, which resulted in the presence of researchers in the PC
Research Unit of the Vedado Polyclinic and in the teaching of the methodology
of the investigation and informatics to key general internists and family
physicians.
Hopefully, most of the project’s achievements will be extended to more than 440 polyclinics and 30 000 family and general practices, in day-care centres, schools, and work centres, in interrelation with 280 hospitals and institutes of the NHS.[7]
The VeHP at the moment is carrying out the sub projects as follows:
- Tele ECG and other Tele Clinical Systems
- Polyclinic and Family Practices’ Web Sites
- APUS, SIDAPS and EMR Systems
- e-Health Research Collaboration Program
A brief characterisation of the design and rationale of each sub project still unbudgeted, grade of execution, and pilot results follows below:
Tele
ECG and other Tele Clinical Systems
The Tele ECG sub project is a clinical
trial of tele electrocardiography network with CardioCid PC (CDR,
A multidisciplinary team of the Vedado
Polyclinic, CDR and CHID execute the R&D tasks. A pilotage of the tele ECG
with CardioCid PC of automated ECG with four family doctors and two internists
of the Vedado Polyclinic between July 2002 and January 2003 was made. A tele
consultation pilotage via modem point to point in emergencies and by email in
elective cases in the PC between February and July 2003 is being carried out.
In a second phase, also the emergency and CAD services of the University
Hospital Calixto Garcia and
In 2003 until June, more than 400 Tele ECG consultations have been made and three myocardial infarctions and a tachy arrhythmia have been diagnosed, in spite of having faced much instability of the electricity, many blackouts and interruptions of work due to the campaigns against the mosquitoes transmitters of the Dengue Fever.
Tele ECG will be the advanced sub project of a multi-technological integrative project of Tele Cardiology of the NHS. This more comprehensive project, will develop other tele cardiologic sub projects in ambulatory care integrating other detection and exclusion tests of CAD and non-CAD diseases, as stress-ECG with ErgoCid PC, Hipermax Holter of frequency and pressure (CDR, Havana), Doppler echocardiogram, in adults and children, in some polyclinics. These sub projects will meet other tele cardiologic sub projects with diagnostic tests of exclusion and confirmation that are more complex, invasive, risky and expensive, such as the myocardial perfusion gammagraphy, angiography, catheterization, as well as with therapeutic clinical and surgical procedures, that will come from the institutes and cardiac centres to the hospitals, conforming an entire National System of Tele Cardiology and Cardiovascular Surgery.
In the same way there will be carry out tele imagenology sub projects with support from the CDR and
CHID in prenatal, paediatric and clinical tele ultrasound and radiology;
superior and inferior digestive tract tele endoscopy; tele dermatology; tele
ophthalmology, and other tele clinical ones, bringing near the specialized care
close to the general setting. This sub project has received intentions of
collaboration from the
Polyclinic
and Family Practices’ Web Sites
The opening of the full access to the Intranet and to the Internet through the same Infomed server is being coordinated since July 2002. It will be materialized soon in the polyclinic library for the doctors, nurses, technicians, and students, and it will give controlled access to the services of national and international e-mails and to the Intranet selected pages of the world wide web: bibliographical and webliographical searches with PubMed, MedScape, Health Inter-Net, Virtual University and Library, Super Courses, News, Databases, Statistical, Directories, Courses, Electronic Journals and Books, Software for FTP, Web Site hosting and design, and many more resources.[8]
Since November 2002, the building of a web
site in Spanish of the Vedado Polyclinic is being coordinated with Infomed. In
December 2002, a Vedado Polyclinic web site in English with the fixed format of
the
Since then, with more potent foreign servers, it has being coordinating the building of web sites in English of the polyclinic and of the first family practices. These will have the goals, function, structures, health diagnosis and program, results, and achievements of the Cuban PC and FP programs.
The Cuban and foreign sites will facilitate the exchange in Spanish and English with most of the countries of the world and will give web space aid for the necessary databases for tele health care, education, R&D, and management through the Internet.
APUS,
SIDAPS and EMR Systems
The APUS System is a system that automates the statistical data of the population, health situation and activities. It was first programmed experimentally in the late 1980s in the Plaza Polyclinic, and is being completed by the CHID in 2002-2003 in the Vedado Polyclinic.[10] Its initial goal was to support the health management of the polyclinic, facilitating the data retrieval with introduction in a polyclinic server of all the data written in forms of the polyclinic and its family practices. Subsequently, it will feed via modem a web database in the Havana City Node of the Infomed Network.
The SIDAPS is an informatics system that automates the follow up of patients in a family practice, by the categories that follow: apparently healthy, with risk factor(s), with disease(s), with handicap(s). A family doctor in the Capdevila Polyclinic together with the CCAM designed it. The extension and test of the SIDAPS system in family practices of the Vedado Polyclinic is being coordinated.
In addition, we have received assistance from expert family doctors of the Medical Network of the School of Medicine of the University of Washington at Seattle, for the development in the Vedado Polyclinic of the automation of the patient consultation and Electronic Medical Record (EMR), angular stone of the PC and FP digitization, a goal that the AAFP plans to reach in 2005 in the family practices of the United States of America (USA).[11]
A unique e-clinical history project accessed by health passport using universal smart cards of each Cuban citizen and physician --with access to other government databases--, is in preparation with the CIDH, CCAM, and Havana University Informatics Faculty, and will be evaluated in our polyclinic, when the programming and put to point finish.
e-Health Research Collaboration Program
Since November 2002, the webliography and the national experience in CHID and Infomed have been extensively revised. It
has also been promoting
scientific exchanges and internships in English at
As result of this search for exchange and
collaboration, it has been established the need and the possibility of an e-Health
Research Collaboration Program sub project --the most abstract of which is the VeHP.
It has been used the experience of the last decade in the
The conceptual and operational bases of an online tele e-health research program of collaboration between Cuba and USA, and other western biomedical powers, with new methods and tasks of scientific research, training, and collaboration in the PC and FP programs, is being defined, as well as for the rest of the levels of the NHS, that are important for the research collaboration South-North, North-South, and South-South.[12,13]
The proposal of initiative made in July
2003 by the Vedado Polyclinic to the “Call for Grand Challenges in Global Health”
of the Bill and Melinda Gates Foundation, will be presented at
Upon evaluation of the VeHP, we are not satisfied with the initial and slow work we have done. We require much more foreign collaboration, assistance, and funding for such a type of effort, since we are dealing with very expensive ICTs.
Conclusion
The Primary Care Vedado e-Health Project’s design,
rationale and pilot results have been presented with all its strengths and
weaknesses. The team is studying and working hard to upgrade our primary care
and family practices to the state of the art in ICTs for the health benefit of
the population to whom we give heath care in
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