Digital transformation of health: 10 lessons from a case study.

What would you say if you could see what was registered and indicated by your doctor when you left your medical consultation? Or even see the results of your clinical analysis as soon as they are available? This is already a reality for 95% of Uruguayans who have electronic medical records. To do this, Uruguay has implemented a kind of digital highway. This great interoperability platform in health allows clinical data to move between health providers with the necessary protection and security so that health care is of higher quality, improving the continuity of care. In this way, the information reaches both professionals and patients safely, complete, and timely manner. How did this country do it?

The case of Salud.uy
Through the National Integrated Health System (SNIS), Uruguay has promoted the sector’s digital transformation. It has placed so much emphasis on digital health for its citizens that at the end of 2012, it created the Salud.uy initiative to prioritize the intensive use of information technologies (ICT) in the sector.
Salud.uy is a team of medical informatics specialists who go hand in hand with the actors of the country’s health ecosystem. To this end, they have formed multidisciplinary and intersectoral work areas and thus co-create the guidelines for action.
The National Electronic Clinical Record (HCEN), Salud.uy’s flagship, allowed the health system to begin a process of digital transformation in all its health providers and the governing body. The SNIS comprises 42 comprehensive non-profit private providers and several public providers.

All of them began the incorporation of ICT, having electronic medical record systems to comply with national regulations that make the use of the HCEN mandatory so that its users have information in digital format. Today, 100% of the SNIS providers have their own EHRs, which use standardized data and standards to connect to the HCEN highway.
With mi had to access, each Uruguayan can access their electronic medical record and view their integrated information, regardless of the health facility where they generated their clinical data, where who performed their diagnostic or laboratory tests, or where who prescribed their medication…
Although the creation of the HCEN is still developing for a complete analysis, Uruguay showed a solid commitment to monitoring and verifying that the HCEN is indeed achieving improvements in the use, quality, and efficiency of care. Since 2014, it has implemented a survey of users, establishments, and health professionals every two years. This survey indicates that seven out of ten professionals consider that the HCEN and access to patient information improve the quality and efficiency of health services.

The infrastructure built for the HCEN was also critical to the fight against COVID-19 since ad-hoc mechanisms did not have to be invented to share information. These were already constructed, and health providers only had to follow new guidelines and protocols. This made it possible to share information, for example, on laboratory tests or available beds through the same infrastructure used for the HCEN.
The HCEN case study is a new document that recounts the steps followed by Uruguay, through Salud.uy and the digital health ecosystem, to achieve the sector’s digital transformation. In this way, the country puts each citizen at the center of the system to empower them with their health care.

Ten tips on digital transformation
Based on this experience, we share ten tips for countries embarking on similar projects:
Always place the patient at the center of the design, emphasizing equity.
Build a vision of what you want to achieve with everyone and for all the actors in the system (public and private sector, academia, professionals, citizens, etc.).
Have a team of professionals specialized in digital health with clear objectives.
Develop a strategy that converts the national vision into an implementation plan as a state policy aligned with the country’s health system.
Approve the necessary regulations so that who can use the technological tools and the applicable model.
Accompany the ecosystem with knowledge, workshops, artifacts as public goods, and collective documentation construction to carry out their digital transformation processes in organizations.
Think and create an incentive scheme that pushes suppliers to make investments
necessary ones (economic incentives, legal obligations, penalties, etc.).

Generate early victories as part of the strategy of long transformation processes and deploy a national architecture that supports future functions.
Invest in continuous monitoring of progress, for example, through recurring surveys.
Remember the human factor; both people involved in the sector’s digital transformation and citizens, in general, must be accompanied by change management plans.
If you want to know more about the process of digital transformation in the health area of Uruguay, download the HCEN Case Study.