Promoting international telemedicine in Latin America

Francesc Saigí,[i] Imma Alberch,[ii] and Juan Blyde[iii]

Over the past year, the COVID-19 pandemic has accelerated the adoption of new telemedicine services to improve people’s health. Likewise, social distancing measures, the lack of experts, and the large extensions of countries of Latin America and the Caribbean (LAC) drove the adoption of international telemedicine.

The rise of digitization and telemedicine services in countries such as Chile and Argentina is a major opportunity for LAC to export this type of cross-border services, for instance, to neighboring countries. However, the region needs to tackle a series of challenges to do so.

To understand these barriers in greater depth, the Integration and Trade Sector at the Inter-American Development Bank (IDB) coordinated the recently published “Study on International Telemedicine in Latin America: Motivations, Uses, Outcomes, Strategies, and Policies” (available in Spanish). The report is based on a thorough, extensive literature review, an online survey of 1,443 health professionals from 19 countries in the region, and in-depth interviews with 29 telemedicine experts.

The report proves there is a positive relationship between the use of international telemedicine and the productivity and efficiency of health professionals. For example, 49% of survey participants responded that cross-border telemedicine services are directly related to an improvement in their professional skills, which has been corroborated through statistical analysis.

The use of international telemedicine is also associated with better returns for national health systems. For example, 43% of respondents associate it with a reduction in social inequalities in health, 42.6% with an improvement in the provision of national health services, and 40% with gains in their countries’ health status. These figures have also been verified through statistical analysis.

Despite these benefits, the survey found that only 17.4% of health professionals use international telemedicine systems, on average. However, a slightly higher share (20.6%) intends to start doing so. There are also minor differences between countries in the region.

Recommendations for exporting telemedicine services

The development of international telemedicine in Latin America faces a series of challenges. The study came up with the following policy recommendations to promote international telemedicine in LAC:

1. Promote mechanisms that foster consensus on telemedicine among countries, such as creating an ‘International Telemedicine Agency for the Americas’ and/or the strengthening of existing networks, including regional integration agreements. It is important to develop governance structures that facilitate coordination between countries.
2. Promote sound and sustainable national telemedicine public policies, incorporated into a national health strategy. Since the viability of international telemedicine is conditioned by its national use, sustainable country-level policy guidelines need to be put in place.
3. Strengthen the government agencies responsible for the digital transformation of health, including telemedicine. For national public policies to be implemented effectively, there needs to be an agency responsible for the digital transformation of health that can convene a dialogue between the relevant parties within the country and be responsible for leading, supporting, supervising, and evaluating telemedicine services.
4. Establish a clear framework for a payment system to practitioners for the provision of telemedicine services. An explicit set of rules that all healthcare providers can use is important for making telemedicine a standard practice.
5. Promote the regulation, registration, and monitoring of these services when the doctor and patient are in different countries. To encourage the use of national and international telemedicine, the lack of legal clarity arising from the absence of specific legislation needs to be remedied, and regulations must be compatible across borders.
6. Facilitate the standardization of international professional licenses. One solution to licensing laws when the physician and patient are in different countries is the creation of an international registry that automatically allows medical licenses from a given country to be recognized internationally, based on the recognition of each country’s national standards.
7. Promote security and privacy measures when dealing with international patient data. Countries should reach agreements to regulate the administration of privacy, confidentiality, and data protection among them.
8. Promote the interoperability of health information technology systems among countries in the region. The lack of international interoperability is another impediment to sharing data and enabling the exchange of basic information and knowledge needed to provide international telemedicine services.
9. Encourage the inclusion of universities and academic networks in these initiatives to augment the knowledge that allows increasing trust in telemedicine among patients and health professionals. This would help alleviate skepticism and resistance to change in response to telemedicine opportunities.
10. Facilitate professional training in the use of digital health tools.One of the limitations to the use of telemedicine is the lack of training in such instruments.

Telemedicine is a practical option that can help reduce the health gap and address health equity problems, thus accelerating the achievement of United Nations Sustainable Development Goal 3 (SDG 3), which is part of the 2030 Agenda. International trade in telemedicine services among countries in the Americas can contribute to achieving these objectives.

International organizations like the IDB have a key role in promoting international telemedicine in the region. They provide essential support for national health systems’ institutional, legal, and administrative areas, which are the basis for enhancing the exports of telemedicine services. An example of such support is the IDB’s work to help define common standards for creating a regional electronic health record.

International telemedicine is a vital tool for improving the accessibility of health services and reducing costs. That is why it is important to overcome the challenges facing its adoption and development in the region.

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[i] Associate Professor of Health Sciences at the Universitat Oberta de Catalunya (UOC). Director of the WHO Collaborating Centre for eHealth

[ii] Communications Expert at the eHealth Center (UOC)

[iii] Lead Economist. Integration and Trade Sector, Inter-American Development Bank