Colombian Health care is a two-tier system of private and public services. The private system is divided into groups of 130 (22 in Bogotá) medical insurance providers regulated by the Empresas Promotoras de Salud (EPS). Patients in the private system pay insurance premiums, typically through their employer, to use the medical services of a specified group of medical practitioners and clinics. Whereas Colombia’s private system is governed by the Social Security Institute (SSI) and is funded with federal tax contributions. Patients in the public system are subsidized accordingly to their annual income and may purchase optional insurance to cover any outside expenses.
Constant protests throughout Colombia driven by a Commission for Health Reform demonstrate the need for fair and consistent health care for all citizens. The current demand for reform is the force driving national EMR/EHR adoption in order to ensure patient medical demographic portability between systems.
In 2011 the government of Colombia passed law 1438 that defined goals to restructure the two-tiered [private and public] health care systems to become ubiquitous and available to all citizens. Colombia recognized that electronic health record portability might close the gap between competing health systems. So as of December 31, 2013 single electronic health records became obligatory throughout Colombia. (See: Revista Normas y Calidad No 88).
Colombia is currently at the beginning of system wide implementation and integration of systems that manage electronic health records (EMR’s). However few medical clinics at the primary level are adopting EMR systems and their options appear to be expensive, limited and lacking features. There also appears to be a lack of a regulated matrix or infrastructure to support transference of single medical records or medical data between systems.
Bogota’s Medical Marketplace
A rough estimate determines 1.9 doctors per 1000 patients in Colombia. Therefore, the capital city of Bogotá the 9 million citizens would have access to approximately 17,100 medical doctors. With an estimated 91,200 doctors serving 48 million Colombians nationally.
In Bogotá alone there are 22 EPS insurance groups that consist of a 3-tier hierarchy with the top hospitals and outpatient clinics at the top, followed by a middle class group and several micro groups.
Many practitioners take some of their time to work in “consultorio clinics” which are neighborhood medical offices that offer medical check-ups at substantially reduced rate.
The public hospitals and large private groups employ medical practitioners on a salary.
It is roughly estimated that 50% to 60% of the medical clinics in Bogota do not utilize an EMR to manage their practice.
Current Health Informatics Technology in Colombia
Overall, the medical technology in Colombia is highly advanced. However it appears that the technology is isolated in hospitals, large clinics and outpatient centers with large budgets. An average neighborhood clinic, small general practice or less resource rich medical practice does not use an EMR. It also seems that none of these systems communicate with each other outside of their home group.
Consulting Groups
- Everis is a consulting firm that appears to be working on the interoperability of medical systems in Colombia.
EMR’s or Historia Clinica Electronica (HCE):
- Serapis EHR http://www.serapisehr.net/
- Heon MD http://www.heon.com.co/index.php/lineas-de-producto-2/heon-medical
- Drager Omega
- MedicalApp http://ww.medicalapponline.com
Medical Laboratories and electronic medical services:
- Analizar http://www.analizarlab.com/
- VictrixWeb http://www.vicsoft.com.co/
- Telesalud http://telesalud.ucaldas.edu.co/telesalud/
Medical I.T. Protocols Used in Colombia:
- Picture Archiving and Communication System (PACS) are primarily used in large hospital systems.
- SNOMED CT used in EMR’s for medical translation.
- International Classification of Diseases (ICD-10 & ICD-9) from the WHO as used by SNOMED.
- Health Level 7 (HL7) usage for electronic patient file transfers has recently become a national intuitive in Colombia.
- A foundation has been formed here: http://www.hl7.org.co/nuevo/index.php
Education
- Colombians can achieve a diploma in Shared Electronic Health Records and Interoperability in Healthcare from Universidad del Rosario in Bogotá. http://www.urosario.edu.co/
Resources
http://www.ehealthreporter.com/en/noticia/verNoticia/1425/colombia-the-law-on-the-unique-electronic-health-record-will-come-into-effect-in-2013
http://www.ehealthreporter.com/en/noticia/verNoticia/1947/the-first-diploma-in-shared-electronic-health-records-and-healthcare-interoperability-in-colombia-