From July 23-25th 2024, representatives from seven Caribbean countries and international partner organizations gathered in Kingston, Jamaica for Caribbean Connect: Building the Pan-American Highway for Digital Health. Hosted by the Inter-American Development Bank (IDB) and the Pan-American Health Organization (PAHO/WHO), the objective of the conference was to provide a platform for information sharing, learning, and strategic priority setting among Caribbean countries with active IDB operations related to digital health. Caribbean Connect also introduced participants to the vision for the Pan-American Highway for Digital Health (PH4H), an initiative led by the IDB and PAHO/WHO, and engaged countries to contribute to the initiative in advance of its formal launch in October 2024. Caribbean Connect advanced the participating countries visions for digital health by 2030 by creating a platform for sharing knowledge and building capacity among information technology and healthcare professionals, policymakers, and government leaders. These deliberations were centered around how to implement and leverage digital health solutions effectively. The conference aimed to foster a sense of sub-regional solidarity and cooperation, as countries shared their experiences, challenges, and solutions, paving the way for collaborative projects and initiatives that can have a broader impact in the Caribbean.
Authors
- DOI
- http://dx.doi.org/10.18235/0013204
- Pages
- 52
- Published in
- United States of America
Table of Contents
- REPORT 1
- Caribbean Connect Building the Pan-American Highway for Digital Health 1
- July 23-25 2024 Kingston 1
- Graphic Design: Wagner Rech 2
- Acknowledgements: IDB thanks The Bahamas, Barbados, Belize, Guyana, Jamaica, Suriname, and Trinidad and Tobago and regional partners for their active participation and insights that made this event and report possible 2
- Copyright © 2024 Inter-American Development Bank (“IDB”). This work is subject to a Creative Commons license CC BY 3.0 IGO (https://creativecommons.org/licenses/by/3.0/igo/legalcode ). The terms and conditions indicated in the URL link must be met and... 2
- Table of Contents 3
- Introduction 5 3
- Opening Plenary 6 3
- Keynote Address 8 3
- Concurrent Session 1 10 3
- Leadership Forum: Sustainability of Digital Health Transformation – Human Capital and Financing Challenges and Strategies 10 3
- Technical Session 1a: Health Information Exchange Architecture – Design and Standards for Interoperability 11 3
- Technical Session 1b: Principles, Policies, and Program – The Protection of Personal Health Information in Digital Transformation 14 3
- Concurrent Session 2 16 3
- Leadership Forum: Digital Health Architecture and Strategies for Leaders 16 3
- Technical Session 2a: Data for Decision Making – Data Management and Analytics 17 3
- Technical Session 2b: Designing and Building for Digital Health Infrastructure Resilience – Approaches for Cybersecurity and Business Continuity 19 3
- Innovation Event 21 3
- Concurrent Session 3 22 3
- Leadership Forum: Information Systems for Health (IS4H) Governance for Strategy, Coordination, and Standards 22 3
- Technical Session 3a: Digital Health Solutions – Lessons Learned from the Front Lines 23 3
- Technical Session 3b: Digital Health Regional Public Good Initiatives in the Caribbean 25 3
- Plenary Session: Regional IS4H and Digital Health Strategies 27 3
- PAHO Plan of Action for Strengthening Information Systems for Health 2024-2030 27 3
- Pan-American Highway for Digital Health (PH4H) 28 3
- Panel Discussion 28 3
- Concurrent Session 4 30 3
- Leadership Forum: Accelerating Digital Health in the Caribbean – Strategies for Sub-Regional Knowledge and Resource Sharing 30 4
- Technical Session 4a: Change Management for Digital Health Transformation 31 4
- Technical Session 4b: Strategic Procurement of Digital Health Solutions – Best Practices and Lessons Learned 33 4
- Plenary Session: Strategic Planning Session 35 4
- Closing Plenary 38 4
- Conclusions and Recommendations 39 4
- Appendix 41 4
- Caribbean Connect Agenda 41 4
- PH4H Document 45 4
- PH4H Flyer 52 4
- Introduction 5
- From July 23-25th 2024, representatives from seven Caribbean countries and international partner organizations gathered in Kingston, Jamaica for Caribbean Connect: Building the Pan-American Highway for Digital Health. Hosted by the Inter-American Deve... 5
- Group photo with country representatives, leaders from the IDB and PAHO/WHO, and Jamaica’s Minister of Health and Wellness. A full video on the event can be found here. 5
- One of the key lessons learned from global experiences is that digital health requires a multi-disciplinary approach at both the technical and strategic levels. A successful digital transformation of the health sector requires leadership and technical... 5
- The conference encompassed a variety of modalities, including concurrent sessions focused on discussions in technical and leadership streams that included presentations from partner and country experts, as well as a strategic planning plenary session ... 5
- Caribbean Connect advanced the participating countries’ visions for digital health by 2030 by creating a platform for sharing knowledge and building capacity among information technology and healthcare professionals, policymakers, and government leade... 6
- Opening Plenary 6
- Mr. Anton Edmunds, Manager of the Caribbean Countries, and the Jamaica Country Representative, IDB opened the conference. After welcoming delegates, he highlighted the significance of the event by noting that the Information Systems for Health strateg... 6
- Mr. Ian Stein, PAHO/WHO Representative to Jamaica, emphasized the importance of Caribbean Connect in reference to the launch of IS4H 8 years prior, which was spearheaded by the Honorable Minister Dr. Christopher Tufton. Mr. Stein highlighted the progr... 6
- Dr. Pablo Ibarrarán, Social Protection and Health Division Chief, IDB, further elaborated on the significance of the PH4H initiative, outlining the goals and benefits, as well as the steps for countries to join and contribute to the project. Dr. Ibar... 7
- Keynote Address 8
- Delivered by Dr. the Honorable Christopher Tufton, Minister of Health and Wellness, Government of Jamaica 8
- Minister Tufton opened the conference by speaking about the importance of establishing a strong framework and vision for digital health transformation that goes beyond the procurement and implementation of technologies and electronic systems. He refer... 8
- As the Caribbean countries strive towards digital transformation, Minister Tufton highlighted the value in bringing conversations around challenges to the forefront to foster a culture of learning and continuous improvement. This sentiment reinforced ... 8
- “Our digital transformation journey has not been simple or straightforward…We should accept from the start that we are prepared to deal with the obstacles that we face. We will face them, and we will try to help our partners to change.” 8
- Minister Tufton ended by speaking about key factors to ensure sustainability of digital transformation, highlighting four areas: 8
- • Human resources – A lack of adequate human resources is often the biggest bottleneck of digital transformation. Minister Tufton spoke about the importance of developing strategies to train and retain individuals to drive processes and support the on... 8
- • Cross-border interoperability – Minister Tufton emphasized the potential for cross-border data sharing and the need for ongoing dialogue and cooperation for it to be a success. 9
- • Digital literacy – Digital literacy for health system planners, health care providers and citizens was highlighted as a key component of digital innovation and an area that requires greater focus as countries strive towards digital transformation. 9
- • Change management – Minister Tufton spoke about technology as a tool for transformation, and the importance of adopting a change in mindset to ensure successful transformation. These ideas reinforced the notion that digital transformation encompasse... 9
- Concurrent Session 1 10
- Leadership Forum: Sustainability of Digital Health Transformation – Human Capital and Financing Challenges and Strategies 10
- Facilitated by Carina Cockburn, Country Representative, Trinidad and Tobago, IDB 10
- Session Objectives: 10
- • Review emerging thinking and Jamaica’s approach for building sustainable human capital and support for organizational structures 10
- • Facilitate discussions among leaders around key challenges and possible strategies for sustainable digital health, with a focus on human and financial capital 10
- • Identify opportunities for resource sharing (human resources, knowledge, shared capital investments, alternate financing strategies) 10
- Presentations: 10
- Daniel Doane (IDB) – IS4H Functional Model Overview: A Tool for Developing Sustainable IS4H and Digital Health Operations 10
- • Mr. Doane presented an overview of PAHO/WHO’s IS4H Functional Model including its purpose and how it can be used to help countries effectively sustain digital health transformation. 10
- • Mr. Doane highlighted that the IS4H Functional Model should be used as a tool to assess the status of current functions being performed, identify gaps in functions, and support planning for long-term sustainability. 10
- Dr. Michele Roofe (Jamaica) – IS4H Human Resources and Organizational Structures for Sustainability 10
- • Dr. Roofe’s presentation reviewed Jamaica’s proposed organizational structure and governance model, highlighting the key elements that are required to achieve success. 10
- • Dr. Roofe explained Jamaica’s IS4H Programme Components, including Data and Standards Governance, Clinical Governance, Health Information Management, and Strategic Health ICT. 11
- Discussion: 11
- • Following the presentations, participants completed an online survey where they were asked questions regarding their understanding of the presentations, as well as their thoughts on the sustainability of digital health transformation. 11
- • The discussion focused on challenges related to sustaining digital health transformation, including securing long-term funding, managing competing priorities, and the need for high-level cooperation. 11
- • The online survey prompted a conversation around enablers for sustainable digital health transformation. Many ideas were brought forward, including the importance of establishing strategic partnerships, and developing detailed strategic plans. 11
- Technical Session 1a: Health Information Exchange Architecture – Design and Standards for Interoperability 11
- Facilitated by Pablo Orefice, IDB and Peter Ricketts, PAHO/WHO 11
- Session Objectives: 11
- • Share key considerations and best practices for cybersecurity and business continuity when designing, implementing, and operating digital health infrastructure 11
- • Share country experiences with designing and implementing resilient digital health infrastructure 11
- • Identify opportunities for resource sharing (e.g. knowledge, human resources, infrastructure, etc.) among countries to improve digital health infrastructure 11
- Presentations: 12
- Dr. Keisha Barwise (Jamaica) – Jamaica’s Approach to Health Information Exchange Architecture, Design and Standards for Interoperability 12
- • Dr. Barwise highlighted the use of OpenEHR, FHIR, and various clinical standards that enable interoperability within Jamaica’s HIE. 12
- Dr. Taleya Girvan (Jamaica) – Jamaica’s Approach to implementing SNOMED for Interoperability and Data Analytics 12
- • Dr. Girvan shared Jamaica’s approach to a national implementation of SNOMED, including how it’ll help solve challenges with data interoperability between systems. 12
- Michael Hamilton (The Bahamas) – The Bahamas Approach to Design and Implementation of a National Health Information Exchange 12
- • Mr. Hamilton shared the proposed model for The Bahamas HIE and explained the advantages of implementing a hybrid model versus a centralized or decentralized model. 12
- • Mr. Hamilton explained how a hybrid model offers enhanced EHR and data analytics capabilities as well as simpler deployment of care coordination and population health management tools. 12
- Jesse Bridgelal (Trinidad and Tobago) – Trinidad and Tobago’s Approach to Design and Implementation of a National Health Information Exchange 12
- • Mr. Bridgelal explained the silos that exist across Trinidad and Tobago’s Regional Health Authorities, making it challenging for patients to access care across regions. 12
- • Mr. Bridgelal also highlighted the inherent challenges that arise from data silos, such as fragmented care for patients, increased healthcare costs, and dissatisfaction from healthcare workers. 12
- Juan Carlos Sarabia (Belize) – Belize’s Approach to Design and Implementation of a National Health Information Exchange 12
- • Mr. Sarabia highlighted the key features of Belize’s Clinical Data Exchange Platform (CDEP), including Authentication, Authorization, Audit (AAA), a Data Warehouse, a Registry Service, Master Indices, and a Terminology Service. 13
- Richard Mendes (Suriname) – Suriname’s Approach to Design and Implementation of a National Health Information Exchange 13
- • Mr. Mendes explained the approach and rationale behind Suriname’s HIE platform, including the advantages and disadvantages of a centralized system, centralized data repository, and federated data system. 13
- Discussion: 13
- • Participants engaged in discussions around challenges that countries are currently experiencing, such as concerns around the acceptance of SNOMED between the private and public sectors, as well as challenges with interoperability and standardization... 13
- • Participants generated ideas on information and resources that leaders need to effectively support designing and planning digital health architecture. Countries spoke about the need for shared infrastructure and a regional interoperability platform,... 13
- • The development of shared policies, legislation, and eMPI requirements were noted as areas that would support countries in strengthening their digital health architecture, alongside collaboration from international partners and leveraging support fr... 13
- Technical Session 1b: Principles, Policies, and Program – The Protection of Personal Health Information in Digital Transformation 14
- Facilitated by Blair Witzel, IDB 14
- Session Objectives: 14
- • Review key principles for the protection of personal health information and identify key components of health information privacy programs (i.e., cross-border data sharing) 14
- • Share country experiences and approach to privacy legislation to support protection of personal health information 14
- • Identify resources and support required to advance health information protection (privacy) in the Caribbean 14
- • Identify enablers and limitations for cross-border data sharing 14
- Presentations: 14
- Blair Witzel (IDB) – Principles for the Protection of Health Information; Developing a Privacy Program 14
- • Mr. Witzel presented on key privacy concepts, including privacy legislation, privacy frameworks, and the key components of a robust privacy program. 14
- • Mr. Witzel’s presentation emphasized that a strong privacy program must include safeguards around accountability, purpose, fair handling, patient rights, and breach response. 14
- Prewien Ramadhin (Suriname) – Overview of Suriname’s Approach to Privacy Legislation 14
- • Mr. Ramadhin shared Suriname’s journey to developing privacy legislation and provided recommendations for other countries to consider when developing legislation. 14
- Jermaine Martin (Jamaica) – Overview of Jamaica’s Approach to Privacy Legislation and Next Steps with Privacy Program Development 14
- • Mr. Martin reviewed the key legislative frameworks in Jamaica, such as the Data Protection Act (2020) and the Personal Health Information Protection (PHIP) Guidelines for Public Sector Organizations. 14
- • Mr. Martin outlined key safeguards in the PHIP Policy Guidelines including policies around managing consent, requests for access, retention and destruction, and data storage and security. 14
- • The presentations were followed by a conversation around aspects that are required to protect personal health information when sharing data across borders, such as for the PH4H initiative. Many enablers were mentioned, such as the importance of a se... 15
- • Participants had meaningful discussions around potential areas for collaboration between countries, such as developing shared training resources and an information exchange policy. 15
- Concurrent Session 2 16
- Leadership Forum: Digital Health Architecture and Strategies for Leaders 16
- Facilitated by Daniel Doane, IDB 16
- Session Objectives: 16
- • Review key concepts related to digital health architecture aimed at senior leaders in Ministries of Health, including the role of health information exchange platforms and key standards 16
- • Highlight the relationship between designing a digital health architecture and digital health transformation strategies, considering such issues as health system strategic objectives (e.g., access, quality improvement, efficiency, etc.), human capit... 16
- • Discuss and brainstorm strategic resources and supports to help countries advance their national digital health architecture 16
- Presentation: 16
- Daniel Doane – Digital Health Architecture and Strategies for Leaders 16
- • Mr. Doane provided an overview on the importance of Digital Health Architecture, and highlighted key concepts such as interoperability, standards, privacy and security, conceptual architecture, technical architecture, and health information exchange. 16
- • Mr. Doane reviewed strategic considerations for leaders around digital health architecture, including clinical and operational workflows that can be enabled, data standards and data sources that can be developed, the fit and sustainability of softwa... 16
- Discussion: 16
- • The Digital House Framework was referenced as participants spoke about challenges with digital health architecture in each of the countries. 16
- • Participants from Jamaica shared challenges around having strong governance to support digital health applications. In The Bahamas, the lack of education around digital literacy poses a challenge and hinders meaningful engagement with stakeholders. ... 17
- • The Pan-American Highway for Digital Health was highlighted as a crucial step towards improving digital health architecture in the region. Emphasis was placed on generating tangible results, such as an interoperability platform and unique ID’s in or... 17
- Technical Session 2a: Data for Decision Making – Data Management and Analytics 17
- Facilitated by Sebastian Bauhoff, IDB 17
- Session Objectives: 17
- • Share experiences and approaches for managing and analyzing health data to support decision-making 17
- • Identify key challenges for data management and analysis 17
- • Identify potential supports, resources, and opportunities for collaboration related to health data management and analysis 17
- Presentations: 17
- Sebastian Bauhoff (IDB) – Leveraging Existing Data for Decision-Making and Health Policy 17
- • Mr. Bauhoff presented examples of data, and the potential use cases and policy actions that it can be used to inform. He provided the example of utilizing hospital discharge data to shape policies aimed at improving health outcomes and reducing hosp... 17
- Javan Chavarria (Belize) – Belize’s Approach for Data Quality and Data Analysis Leveraging the BHIS 17
- • Mr. Chavarria provided an overview of the Belize Health Information System (BHIS) and the benefits it provides, such as patient matching, data validation, and resource allocation. It also supports with policy development, reporting, and improves hea... 17
- Dr. Aloysius Koendjbiharie (Suriname) – Suriname HEARTS Initiative 18
- • Dr. Koendjbiharie presented on Suriname’s HEARTS initiative and shared an overview of the implementation journey, which started in 2017. 18
- • Dr. Koendjbiharie explored the development and approval of the clinical pathway for hypertension and shared next steps for the HEARTS initiative, which includes procurement and implementation in a second group of sites. 18
- Dr. Jerry Toelsie (Suriname) – Suriname HEARTS Initiative: Systems for Monitoring 18
- • Dr. Toelsie provided an overview of the data collection tools and systems that are used for the HEARTS initiative. 18
- • Dr. Toelsie explored how data collection tools contribute to improved healthcare, reduction of treatment errors, reduced workloads, and increased efficiencies. 18
- Dr. Jerry Toelsie and Richard Mendes (Suriname) – Suriname’s Digital Death Certificate Platform 18
- • Dr. Toelsie and Mr. Mendes provided an overview of Suriname’s Digital Death Certificate Application and the advantages of the tool, which include standardization and quality of data, accessibility and retrieval, security and privacy, error reduction... 18
- Discussion: 18
- • Participants engaged in discussions around the various systems shared throughout the country presentations as well as the use of data at individual, local, regional, and national levels. 18
- • Countries were interested in learning about the use of Suriname’s Digital Death Certificate within hospitals and the legislation in place to support the initiative. 18
- • Countries highlighted that international partners could help strengthen data management and decision-making capacity by offering support in areas such as policy development, financial aid, political commitment, and the promotion of knowledge and dig... 18
- • Participants discussed how the electronic coding system in Trinidad and Tobago, and the data policy in Barbados could be leveraged as shared resources across the region. 19
- Technical Session 2b: Designing and Building for Digital Health Infrastructure Resilience – Approaches for Cybersecurity and Business Continuity 19
- Facilitated by Peter Ricketts, PAHO/WHO and Mario Casco, IDB 19
- Session Objectives: 19
- • Review frameworks and key considerations for building digital health infrastructure that is resilient in the face of various threats (e.g., cybersecurity attacks, extreme weather events, power failure, connectivity failure, equipment failure etc.) 19
- • Learn about country approaches to digital health infrastructure resilience and share experiences, challenges, and strategies among countries 19
- • Identify opportunities for resource sharing among countries, including knowledge, human resources, and infrastructure resources 19
- Presentations: 19
- Jesse Bridgelal (Trinidad and Tobago) – Re-design of Infrastructure for Resilience and Business Continuity 19
- • Mr. Bridgelal provided an overview of the impact a cybersecurity breach can have on patients, organizations, and industries as a whole. He reviewed the National Institute of Standards and Technology (NIST) Cybersecurity Framework and outlined strate... 19
- Shawn Bolton (Jamaica) – Designing and Building for Digital Health Resilience: Cybersecurity and Business Continuity 19
- • Mr. Bolton presented an overview of Jamaica’s Digital Landscape and highlighted core principles in designing safeguards for security and resilience. 19
- • Mr. Bolton shared a case study from Jamaica’s Ministry of Health and Wellness data breach in 2021 that affected the Jamcovid database. As part of Jamaica’s response to the incident, a public awareness campaign was launched to inform citizens about p... 19
- Louise Bobb (Barbados) – Responding to a Cybersecurity Attack: Response and Lessons Learned 20
- • Ms. Bobb provided a review of the cybersecurity incident at the Queen Elizabeth Hospital in 2022. She shared the state of the ICT environment pre-attack, measures that were taken in response to the attack, and measures that will be taken in the future. 20
- • Ms. Bobb highlighted proposed plans, such as completing an Incident Information Security Risk Assessment, delivering enterprise security awareness training for all staff, and developing a Security Operations Centre (SOC) monitored by an external par... 20
- Ben Toppin (Barbados) – Barbados Approach for Designing Resilient Digital Health Infrastructure 20
- • Mr. Toppin presented on the Fiber Distributed Data Interface (FDDI), a 100Mbit network used for its low failure rate and high data throughput. The FDDI network is based on synthetic fiber cables, which differs from most networks that use copper-base... 20
- Discussion: 20
- • Participants engaged in conversations around the tools and resources needed to strengthen cybersecurity and ensure that digital health solutions are resilient. Some ideas included having updated hardware, leveraging subject matter experts, implement... 20
- • Countries shared examples of resources that are available that could be shared among countries. These included clinical strategies from Jamaica, a draft FDDI network framework from Barbados, and national policies and standards. 20
- • Countries identified various areas for collaboration, such as the development of working groups, toolkits, regional standards, and a regional cyber incident response team. 21
- Innovation Event 21
- Facilitated by Mr. Anton Edmunds, Manager of the Caribbean Countries and the Jamaica Country Representative for the IDB, the objective of the Innovation Event was to promote dialogue for an ecosystem approach to digital health in the Caribbean by high... 21
- In his opening remarks, Mr. Edmunds noted that the IDB is a unique organization given that it works across three different sectors – the public sector, the private sector, and the entrepreneurial sector. 21
- The first panelist, Brian Blakely from IDB Invest, spoke on the mission of IDB Invest as the private sector investment arm of the IDB. As a member of the IDB Group, IDB Invest has the same goals for economic growth and social inclusion as the public ... 21
- IDB Lab has recently invested in a Jamaican company called Novamed to build Catalyst, the first health innovation accelerator and incubator in the Caribbean region. Dr. David Walcott of Novamed joined the panel to discuss the impact of this investment... 21
- One of the key themes of the panel discussion was the role of public-private partnerships and the how government can best leverage these arrangements to drive innovation, particularly in the realm of digital health. Dr. Walcott noted that the governme... 21
- Concurrent Session 3 22
- Leadership Forum: Information Systems for Health (IS4H) Governance for Strategy, Coordination, and Standards 22
- Facilitated by Blair Witzel, IDB 22
- Session Objectives: 22
- • Review IS4H framework and benefits 22
- • Share country experiences with IS4H governance 22
- • Identify challenges and brainstorm solutions for strengthening IS4H governance capacity 22
- • Learn about potential approaches to regional and sub-regional governance for the PH4H 22
- Presentations: 22
- Blair Witzel (IDB) – IS4H Governance and Benefits 22
- • Mr. Witzel explained the key aspects of IS4H governance including decision-making, policy, strategy, standards, and legislation. 22
- • Mr. Witzel provided an example of a decision-making structure, highlighting working groups as an important tool for digital health transformation. 22
- Blair Witzel (IDB) – Governance approach for the Pan-American Highway for Digital Health 22
- • Mr. Witzel explained the interrelation between governance mechanisms on a regional and country level for the PH4H initiative. 22
- • Mr. Witzel shared the decision-making structure for the PH4H, including the role of the PH4H Council to support strategic planning, develop policies and standards, and establish priority use cases. 22
- Discussion: 23
- • Participants discussed common challenges related to governance, such as a lack of skilled human resources and the need to streamline working groups and committees to increase efficiency. 23
- • The importance of considering change management in the long-term was raised as an area for improvement among many countries. Participants discussed strategies and solutions to improve efforts in this area. 23
- Technical Session 3a: Digital Health Solutions – Lessons Learned from the Front Lines 23
- Facilitated by Dr. Sergio Miguens, IDB 23
- Session Objectives: 23
- • Share country experiences with implementing digital health solutions. 23
- • Identify key challenges and potential opportunities for sharing knowledge and resources related to the implementation and sustainability of digital health solutions in the Caribbean. 23
- Presentations: 23
- Permanent Secretary Malcolm Watkins (Guyana) – Overview of Guyana’s Digital Strategy 23
- • PS Watkins shared an overview of Guyana’s digital health landscape, including the current state and next steps for various initiatives (e.g., telehealth, EMR implementation, hybrid learning). 23
- • PS Watkins indicated various opportunities for growth to improve Guyana’s digital health landscape, including increasing education and buy-in among stakeholders, improving training and retention among human resources, ensuring reliable connectivity,... 23
- Jesse Chun (Belize) – EHR Implementation in Belize: Experience and Lessons Learned 23
- • Mr. Chun shared the timeline for Belize’s EHR implementation as well as key challenges that were experienced with the country’s previous system. These challenges included limited functionality, information silos and duplication of efforts, manual da... 23
- Dr. Bradley Edwards (Jamaica) – Jamaica’s Approach to Implementing an EHR in Hospitals and Primary Care Clinics 24
- • Dr. Edwards shared staff’s perceptions and experiences with using Jamaica’s EHR and highlighted key statistics. In a survey done with staff, 94% of staff indicated being comfortable with using the EMR, 94% of staff and 100% of doctors voted not to s... 24
- Akanni McDowall (Barbados) – Integrating Lessons from COVID-19 for Future Pandemic Preparedness 24
- • Mr. McDowall highlighted the ways in which Barbados’ Meddata platform supported with the country’s COVID-19 response, such as tracking vaccine uptake, identifying vulnerable populations, managing drug distribution, and tracking healthcare system int... 24
- • Mr. McDowall shared how the system could be leveraged further in future pandemics, such as using surveillance data for patient education and information, and combining data from labs, pharmacies, and tertiary care for comprehensive health monitoring. 24
- Azaad Nazir (Trinidad and Tobago) – EHR Implementation 24
- • Mr. Nazir highlighted the steps taken in one of Trinidad and Tobago’s EHR implementations, from developing a business plan, engaging vendors, training human resources, implementation, and monitoring/evaluation. He emphasized focusing on the issues a... 24
- Michael Hamilton (The Bahamas) – The Bahamas Design and Approach to a Patient Portal 24
- • Mr. Hamilton highlighted The Bahamas’ proposed HIE, as well as the country’s 8 IS4H key priority systems. These systems emphasized the country’s vision to achieve an integrated health system. 24
- • Mr. Hamilton shared the features included in the development of The Bahamas’ Patient Portal, including online appointment booking, prescription management, a messaging feature, and a payment gateway. 25
- Discussion: 25
- • Participants discussed challenges and planned approaches for generating unique patient ID’s. Some countries shared solutions on navigating various use cases with patient ID’s. 25
- • Participants discussed Jamaica’s EHR implementation model and emphasized the importance of involving clinicians and key stakeholders in all stages of the process. 25
- Technical Session 3b: Digital Health Regional Public Good Initiatives in the Caribbean 25
- Facilitated by Elisa Martínez Luaces, IDB 25
- Session Objectives: 25
- • Share information about the Digital Health Regional Public Good initiative in the Caribbean, highlighting their alignment and support with the Pan-American Highway for Digital Health. 25
- • Share CARPHA’s vision for digital health transformation to support pandemic preparedness and response. 25
- • Share information about the role and benefits of RACSEL and how Caribbean countries can become engaged. 25
- • Learn about the upcoming Connectathon in October 2024, how countries can become involved, and how this work supports the PH4H. 25
- Dr. Lisa Indar (CARPHA)– CARPHA’s Vision for Connected Digital Health Surveillance 25
- • Dr. Indar provided an overview of CARPHA’s integrated response to health emergencies, including partnerships with regional and international preparedness and response agencies, the development of regional frameworks for regional health security and ... 25
- • Dr. Indar shared a list of CARPHA’s 15 current surveillance systems and how they contribute to CARPHA’s vision for integrated digital public health surveillance. 26
- Alejandra Piermarini and Carlos Nuñez (RACSEL) – Latin American and Caribbean Digital Health Network 26
- • Representatives from RACSEL provided an overview on the organization, including the role they play in Latin America and the Caribbean, how countries can join, and how being a part of the network will benefit countries. 26
- • Ms. Piermarini and Mr. Nuñez shared information about RACSEL’s Connectathon events and how they enable organizations to perform connectivity and interoperability tests in a controlled environment. 26
- Discussion: 26
- • Countries discussed areas of development for Caribbean countries, including developing harmonized standards, the need for skilled human resources, a more robust infrastructure, reliable connectivity, and seamless clinical processes. 26
- • Participants engaged in discussions around tools and resources that can be supported by international partners. These included funding, networks, technical expertise, and coordination of public health matters. 26
- • To participate in RACSEL and future Connectathons, countries noted that they require adequate networks and IT infrastructure, skilled human resources, and political will. Countries referenced the IS4H Maturity Model Assessment as a tool enabling the... 26
- • To support CARPHA’s vision for digital surveillance and public health across the region, participants noted various required tools and resources, such as DHIS2, support from sectors such as IT and finance, harmonized standards, technical expertise, ... 26
- Plenary Session: Regional IS4H and Digital Health Strategies 27
- PAHO Plan of Action for Strengthening Information Systems for Health 2024-2030 27
- Presented by Marcelo D’Agostino, PAHO/WHO 27
- Mr. D’Agostino introduced the PAHO/WHO Plan of Action for Strengthening Information Systems for Health 2024-2030 and outlined the 4 strategic lines of action: 27
- • Strategic Line of Action 1: Strengthen management and governance of information systems 27
- • Strategic Line of Action 2: Strengthen data management and information technologies 27
- • Strategic Line of Action 3: Strengthen information and knowledge management 27
- • Strategic Line of Action 4: Foster innovation and digital health 27
- Each strategic line of action has correlating indicators. Progress will be tracked periodically through communities of practice for each strategic line of action, with the RELACSIS network serving as the main regional support mechanism for implementat... 27
- Mr. D’Agostino noted that the Governing Bodies of PAHO will be informed on the progress of the Plan of Action through a midterm review in 2027 and a final report in 2031. The plan was approved by PAHO’s Executive Committee in June 2024, and final appr... 27
- Pan-American Highway for Digital Health (PH4H) 28
- Presented by Jennifer Nelson, IDB 28
- Ms. Nelson provided an overview of the Pan-American Highway for Digital Health initiative, explaining its objective and purpose. She highlighted the positive impact that the initiative will have on countries across the LAC region, as well as the advan... 28
- Ms. Nelson emphasized the importance of aligning national strategies with the mission for the PH4H initiative and urged countries to incorporate cross-border information exchange into their legal frameworks. Emphasis was placed on countries shifting f... 28
- Panel Discussion 28
- Facilitated by Dominique Afoon, IDB 28
- Ms. Afoon facilitated a panel discussion with the following participants on a discussion around the Regional Plan of Action and the Pan-American Highway for Digital Health: 28
- • Jennifer Nelson, Senior Health Specialist, IDB 28
- • Dr. Lisa Indar, Interim Executive Director, CARPHA 28
- • Dr. Michele Roofe, Senior Director IS4H, MOHW, Jamaica 28
- • Richard Mendes, Program Director IS4H, MOH, Suriname 28
- • Malcom Watkins, Permanent Secretary, MOH, Guyana 28
- The discussion was centered around the alignment between the two initiatives, how they will work together, and how countries should consider the projects when developing their national IS4H and digital health strategies. Emphasis was placed on using a... 28
- The country representatives on the panel were asked about supports needed from international partners in order for countries to successfully align with the initiatives, as well as considerations for international partners to better support the IS4H an... 29
- Concurrent Session 4 30
- Leadership Forum: Accelerating Digital Health in the Caribbean – Strategies for Sub-Regional Knowledge and Resource Sharing 30
- Facilitated by Nicolette Henry, IDB 30
- Session Objectives: 30
- • Learn about the initiative funded by the USAID and led by the Health Economics Unit, UWI, to establish a Technical Support Facility for Health Information Systems (HIS-TSF) in the Caribbean 30
- • Summarize challenges and opportunities identified in previous leadership forum sessions related to human resource capacity 30
- • Identify concrete mechanisms and possible next steps for sharing knowledge and resources 30
- • Identify supports countries require from international partners 30
- • Identify opportunities for resource sharing (human resources, knowledge, shared capital investments, alternate financing strategies) 30
- • Identify priorities and opportunities for the HIS-TSF from a strategic perspective 30
- Presentation: 30
- Charmaine Metivier (Health Economics Unit, University of the West Indies) – Proposed Approach for a Caribbean Technical Support Facility 30
- • Ms. Metivier highlighted challenges with knowledge and resource sharing among Caribbean countries given that countries are at different levels of development and implementation of their respective health information systems, there are varying levels... 30
- Discussion: 31
- • Participants discussed the funding model for the Technical Support Facility, and learned that it represents a mixed funding model, with grants and service fees for participating countries. 31
- • Participants had conversations around the mutual benefits between the public and private sectors, noting that the TSF would mostly benefit the public sector, and would allow the private sector to leverage it as a service for profit. 31
- Technical Session 4a: Change Management for Digital Health Transformation 31
- Facilitated by Elisa Martínez Luaces, IDB 31
- Session Objectives: 31
- • Inform participants about the IDB Change Management Community of Practice forum 31
- • Share country experiences with stakeholder engagement, communication strategies, and change management for digital health transformation 31
- • Identify shared challenges and brainstorm opportunities for resource sharing (e.g., knowledge, human resources, infrastructure, etc.) among countries to strengthen change management capacity 31
- Presentations: 31
- Elisa Martínez Luaces (IDB) – Overview of IDB Change Management Community of Practice forum 31
- • Ms. Martínez explained that digital transformation is broader than the implementation of a technology and requires robust change management practices in order to be successful. 31
- • Ms. Martínez explained that large-scale change has differing levels of complexity based on the size of the system experiencing the change, whether the change impacts the whole system or a portion of the system, and the way in which the change alters... 31
- • Ms. Martínez shared the IDB Change Management Community of Practice forum and explained how it can be used as a forum to interact with colleagues across the Americas, as well as reference best practices, tools, and operational templates. 32
- Richard Mendes (Suriname) – Approach to Engage Citizens and Private Healthcare Providers in Healthcare Transformation 32
- • Mr. Mendes reviewed Suriname’s IS4H Digital Health Agenda and Roadmap and the strategies to engage different stakeholder groups in digital health transformation. 32
- • Mr. Mendes provided an overview of the 4 strategic objectives encompassed within the Digital Health Agenda, which include improving IT infrastructure and the availability of quality data, generating knowledge from data, transforming healthcare deliv... 32
- Ellerie Seymour (The Bahamas) – The Bahamas Digital Health Transformation Change Management Strategy 32
- • Ms. Seymour explained how The Bahamas models the ADKAR change management methodology and highlighted the country’s use of surveys to gain feedback from key stakeholder groups (e.g., change management survey, patient clinic experience survey, provide... 32
- • Ms. Seymour provided an overview of strategies that are being used to address key challenges with digital health transformation. These strategies include increasing awareness of digital health transformation among citizens and healthcare professiona... 32
- Discussion: 33
- • Countries discussed change management strategies being used within Suriname and The Bahamas, and determined what strategies have been successful as well as pain points that need to be addressed. 33
- • Participants from Trinidad and Tobago discussed the change management approach within the private sector and whether a similar approach could be used within the country’s public sector. 33
- Technical Session 4b: Strategic Procurement of Digital Health Solutions – Best Practices and Lessons Learned 33
- Facilitated by Blair Witzel, IDB 33
- Session Objectives: 33
- • Learn about the IDB’s Digital Health Procurement Guide, including an overview of the guide, highlights of best practices, how the guide can be used, and procurement supports for digital health solutions 33
- • Share approaches and lessons learned on the procurement of digital health solutions from countries 33
- • Identify resources and support required to strengthen country capacity for digital health procurement 33
- Presentations: 33
- Blair Witzel (IDB) – Overview: Digital Health Procurement Guide and Best Practices 33
- • Mr. Witzel provided an overview of factors for successful procurement, including representation from stakeholders, realistic timelines, committed resources, defined needs and goals, and a detailed approach. 33
- • Mr. Witzel shared the key stakeholders required as part of a procurement team (e.g., project team, subject matter experts, leadership, etc.) and referenced the IDB Digital Health Procurement Guide, which countries can use as a tool for procurement. 33
- Deneice Marshall (Barbados)– Developing Requirements for a Robust Health Information System in a Tertiary Care Institution 33
- • Ms. Marshall reviewed key considerations when developing functional, nonfunctional, and service requirements for a HIS. She emphasized the importance of engaging stakeholders and conducting a current state assessment to understand the workflows and ... 33
- Discussion: 34
- • Participants discussed challenges that countries are experiencing with procurement, such as a lack of end-user engagement, difficulty deviating from current processes, and disconnect from leadership when making decisions about system requirements. 34
- • Countries outlined strategies to use when assessing and selecting a vendor. These include assessing the vendor’s capabilities before specifying requirements, undergoing a multi-stage procurement process to refine requirements, and obtaining vendor r... 34
- Plenary Session: Strategic Planning Session 35
- Participants engaged in strategic planning sessions to discuss ideas, key priorities, and needs from countries for the PH4H initiative. There were 3 breakout groups (leadership, IT/digital health, clinical/data) and participants were required to self-... 35
- Leadership Breakout Group 35
- The leadership group outlined a series of potential use cases for the PH4H initiative, and ways in which governments and Ministries would benefit the most from the project. Potential use cases for the PH4H include: 35
- • Understanding and monitoring migration on a national/international level 35
- • Managing health data for disease tracking and policy development 35
- • Generating standardized templates for efficient reporting to different organizations (e.g., WHO) 35
- • Establishing a health information exchange for countries to share and access health data. Participants discussed several use cases for data sharing, including digital vaccine certificates, public health and research, and International Patient Summar... 35
- • Leveraging the platform for procurement, system planning, and health surveillance 35
- • Using the platform for health financing and education (e.g., development of a resource center to share published studies and information) 35
- • Establishing standardized training modules to avoid duplication of effort among countries 35
- • Ensuring compliance with international standards and governance through standardized protocols and benchmarks 35
- In addition to developing use cases, this group discussed governance for the PH4H, and how the initiative will leverage existing protocols and governance bodies that currently exist across the Caribbean. Participants identified the Council for Human a... 36
- Additionally, members noted the possible role of the Caribbean Technical Working Group for Information Systems for Health. Endorsed by CARICOM, the group was established in 2015 as a technical coordinating mechanism for IS4H, with secretariat support ... 36
- Discussions around future directions for the initiative were discussed, such as private sector participation and whether the standards and information could be harmonized with other countries and regions. 36
- IT/Digital Health Breakout Group 36
- The IT/Digital Health group discussed technical priorities for countries to build “on ramps” to the PH4H, as well as the resources and supports required. Participants highlighted various technical priorities, including: 36
- • Robust architecture and infrastructure to facilitate data exchange 36
- • Common standards and regulations 36
- • Master Patient Index (MPI) 36
- • Consensus on software requirements 36
- Participants discussed the importance of ensuring successful data exchange among countries given that each country is at a different level of development of implementation of their HIS. Leveraging the PH4H to facilitate digital vaccination certificate... 36
- Clinical/Data Breakout Group 37
- The clinical/data group discussed priorities for cross-border sharing in the PH4H, as well as the required resources and supports. Various data elements and sets of information were identified as clinical data priorities for cross-border data sharing: 37
- • Demographic information 37
- • Country of origin data 37
- • Medical/vaccination history 37
- • Patient consent (for clinical, data sharing, and public health purposes) 37
- • Patient history, imaging, and lab data 37
- • Allergies 37
- • Hospital or clinic visit/encounter information 37
- • Referrals 37
- • Contact information 37
- • Health care professional registry 37
- This data would enable continuity of care, referrals, and more accurate monitoring of public health trends across the region. To facilitate the exchange of clinical data among countries, participants identified various resources and supports that will... 37
- Closing Plenary 38
- Mr. Marcelo D’Agostino delivered the closing remarks on behalf of PAHO/WHO, highlighting the leadership demonstrated by Caribbean countries since the launch of the IS4H Strategic Framework in Kingston, Jamaica in 2016, and ongoing efforts under the re... 38
- Dr. Pablo Ibarrarán closed the conference by sharing some of the key themes that emerged from the event. He emphasized the importance that Caribbean countries have placed on strengthening healthcare and the health system in the region through informa... 38
- Conclusions and Recommendations 39
- Caribbean Connect played a critical role in propelling countries forward in their digital health transformation journeys and fostered a sense of solidarity and collaboration across the region. 39
- A key highlight was the introduction of the PH4H initiative, which garnered strong support from senior leaders across the region. Extensive discussions focused on the various use cases for the PH4H and its potential to facilitate seamless data exchang... 39
- Strategic Planning and Governance 39
- • Create a Community of Practice to enhance collaboration among Caribbean countries 39
- • Develop governance structures that enable data sharing and cooperation across the region 39
- • Leverage existing Caribbean sub-regional strategic frameworks to define priorities and areas for collaboration such as the Caribbean Cooperation in Health (CARICOM) and the Plan of Action for Strengthening Information Systems for Health (PAHO/WHO) 39
- • Engage CARICOM through the Council for Human and Social Development (COSHOD) as a strategic forum and potential governance structure for identifying and supporting common strategic priorities for the PH4H 39
- • Leverage the Caribbean Technical Working Group (TWG) in Information Systems for Health which is endorsed by CARICOM and facilitated by PAHO/WHO as a technical coordinating mechanism for PH4H in the Caribbean 39
- Legal and Regulatory Frameworks 39
- • Develop an international Information Exchange Policy to govern operations across the region 39
- • Develop shared legislation and policy guidelines across the region to strengthen the capacity to protect personal health information 39
- • Leverage existing sub-regional and regional data sharing agreements where possible to accelerate cross-border health data exchange, and identify where new or augmented agreements or legal frameworks are required 39
- Sustainability and Long-Term Investment 40
- • Establish data embassies to protect against cyber threats 40
- • Share regional data from IS4H Maturity Model Assessments among countries 40
- Human Capital Development 40
- • Develop a repository of shared training resources for Caribbean countries 40
- • Establish subject matter experts within various domains across the region by completing an inventory of skills and strengths 40
- • Leverage the Health Information Technical Support Facility (HIS-TSF), currently being developed by the Health Economics Unit, University of the West Indies and supported by USAID, to develop human capital through training, mentorship and by making e... 40
- Regional Collaboration and Resource Sharing 40
- • Establish a regional Cyber Incident Response Team (CIRT) 40
- • Identify digital disaster response team leads across the region 40
- • Establish a Caribbean Digital Health Union to centralize health data management 40
- • Develop templates to support the procurement of digital health tools across the region 40
- • Leverage the PH4H initiative to develop standardized clinical documents, including vaccine certificates, patient summaries, and clinical reports 40
- • Leverage the HIS-TSF to develop and share technical resources and artefacts (e.g. reference architectures, policy templates, standards templates, etc.) 40
- Partnerships 40
- • Engage in global digital initiatives, such as the WHO’s Global Digital Health Certification Network (GDHCN) to increase interoperability and cohesion on a global scale 40
- Appendix 41
- Caribbean Connect Agenda 41
- PH4H Document 45
- PH4H Flyer 52
