Without this seal of quality, services financed by public insurance will not be possible. Composed of five universities, the National Centre for Health Information Systems (CENS – acronym in Spanish) signed an agreement with FONASA to evaluate remote consultation platforms. An estimated 80% of consultations in Chile carried out remotely during the health emergency are done on platforms that do not meet the minimum requirements for information security, usability, and other must-have characteristics for these platforms.
The directors of FONASA and the National Centre for Health Information Systems (CENS) signed a collaboration agreement that would allow for the evaluation of telemedicine platforms used to provide benefits financed by public insurance.
Like this, once the constitutional state of exception ends, FONASA will demand that benefits financed by it be carried out through remote care technologies that have obtained this certification.
According to figures provided by the Ministry of Health, more than 50% of medical care in Chile has been carried out remotely since the beginning of the emergency. Of these, “an estimated 80% of consultations were done via mechanisms that did not meet the minimum requirements for information security, patient usability, and other characteristics required for this type of service,” says May Chomali, executive director of CENS.
The public health specialist assessed this agreement, stating that “it represents a great advance in ensuring the quality of care to benefiting both patients and the health professionals who provide such medical services.”
CENS is recognised by FONASA as a qualified organisation able to certify telemedicine platforms that will be used to provide care financed by public insurance.
The Telemedicine Quality Seal is the result of work promoted by FONASA and the Medical Society, led by CENS since last year. The Telemedicine Guides were also developed during this period, being the first of their kind at a regional level and receiving recognition by the Pan American Health Organisation.
“With the purpose of facilitating access to health care in safe sanitary conditions, a great variety of ways of providing care from a distance have been used, including telephone, video calls, and telemedicine platforms. Some of these are very sophisticated wherein it is possible to prepare an electronic prescription, for example. [There are] others wherein information security is not completely guaranteed for the user ”, said Dr. Chomali.
The doctor warned that telephones or videoconferences are not designed to carry out health care services and their use is only understood in a health contingency scenario like the current one.
“With the pandemic, the call to not delay follow-up monitoring or outpatient care, as well as the use of these tools are understood in that context. In a later stage, though, considering the benefits of telemedicine in terms of access as well, we need to move towards a new relationship with these systems; patients and professionals deserve better care conditions ”, he said.
Evaluation of solutions falls on the CENS Quality team, an area where professionals and academics from universities that are members of the centre born under the auspices of CORFO come together to work. The certification contemplates a qualitative review of platforms and issues a final result, which will certify compliance with the technical bases defined and worked on in collaboration with FONASA.
The model operates under international standard ISO 25010, created to describe software quality via compliance with its characteristics. For this particular case, the protocol evaluates reliability, usability, safety, and compatibility in two dimensions: technical and clinical.
The seal analyses the entire care process and is aligned with two instruments: the Guide to Good Practices and Recommendations for the Use of Telemedicine during the COVID-19 Pandemic in Chile (also created by CENS and recently highlighted by the Pan American Health Organisation) and Guidelines for the Development of Telemedicine and Telehealth in Chile from the Ministry of Health.
As highlighted by CENS, its purpose is to inspire confidence in the entire ecosystem and promote the use of solutions that respond to the quality objectives established by a technical body that brings together the largest experts in ICT in health in the country. To date, there is no technical body in Chile in charge of verifying the quality of teleconsultation software.
The evaluation process includes verifying responses and evidence given by providers. This information, alongside a demo of the solution, is then checked during the review to determine that support is consistent with the problem that developers claim to address with the product. If the analysis is successful, the provider receives the CENS Seal of Software Quality in Telemedicine.
“We think it is very important that FONASA recognises the urgency of using certified platforms and enforces an evaluation protocol that will encourage the entire ecosystem to evolve into more trustworthy technologic solutions. This will not only help to strengthen the quality of care but to make adverse effects resulting from inefficient communication between doctor and patient less likely with minimal security bases ”, Chomalí points out.
Preliminary work developed in 2020 by CENS evaluated four modules: one for home health care with video calls; one for telerehabilitation; and two for vital sign monitoring. Amongst its conclusions, the study found that these systems had various opportunities for improvement; e.g., design, excessive validations and clicks, and the lack of training of professionals regarding the use of these digital tools.
On the contrary, video quality, the use of interoperability standards, the possibility of sharing information by the patient, and its “responsive” design (or use on any touch device) appeared as the main strengths.
CENS recently projected that in the coming years, the local health system will have an increase in the use of information and communication technologies, mainly in the primary sector. In this context, the collaboration agreement with FONASA addresses other axes to enhance areas like interoperability, system development, and advanced human capital training.
The technologic centre –which brings together the Universities of Chile, Católica, Valparaíso, Talca, and Concepción– estimated a deficit of at least 3,500 professionals and technicians specialized in ICT in health in the Chilean health system. Through a reference framework for the training and design of “profiles”, the country is expected to have 2,000 NEW specialists in the field by 2022.
The agreement also considers collaborations in various areas, with the purpose of supporting innovation and technologic development in health informatics and the governance of interoperability standards to advance in relevant actions in this field. “The adoption of certification of telemedicine platforms is only the first step in a long-term alliance”, highlights the executive director of CENS.
“The use of technology in the provision of health services is a growing phenomenon. In particular, telemedicine has come to stay after the pandemic. Before we experienced this emergency, these technologies were surrounded by fears arising amongst patients and professionals, including that technologic tools were not available. The benefits of improved access, timeliness, and continuity of care have been amply demonstrated. We hope, through this cooperation with FONASA, to continue contributing to improve the quality of care through the adoption of these technologies ”.
The alliance between FONASA and the CENS technology centre seeks to materialise actions such as training and advice for public and private providers, in addition to adjusting costs and financing models for this type of care.
(By: Luis Francisco Sandoval. Inés Llambías Communications Agency).
To read the original article in Spanish, click here.