The ricochet of the Coronavirus pandemic was felt in every corner of the globe. With its tragic effects somberly noted, the crisis propelled digital transformations across all industries. In healthcare, we saw wider utilisation of telehealth consultations and remote patient monitoring, the creation of digital COVID-19 vaccination passports, and AI-driven digital triaging and diagnostic tools.
The rapid migration to digital technologies driven by the pandemic will continue into our recovery towards a new norm. In the Caribbean, we must ensure that our health systems catch up with international standards and close some 10+ year gaps in digital health (DH) ‘fundamentals’ such as Electronic Health Records and data collection and interoperability.
DH is an opportunity to utilise technology’s transformative power to address intrinsic flaws and move the region’s healthcare systems into the future to reduce costs and save lives. Global evidence suggests that digital transformation (DT) offers tangible improvements to the public healthcare system, clinical care processes, and health outcomes.
We must first address any ‘digital divides’ made by inequitable access to information and communication technologies (ICT) and the world wide web. Fortunately, nearly all Caribbean countries have upwards of 60% internet penetration rates (Statista, 2022). We do however require upgrading of ICT infrastructure in the region, particularly in rural communities.
The DT of our collective healthcare systems should be heralded by the implementation of Electronic Health Records (EHR), and its benefits are clear. A meta-analysis of 47 studies showed an association between EHR systems and reduced documentation time, higher guideline adherence, fewer medication errors and adverse drug effects. St. Lucia is an example of a leader in the region utilising EHR systems since 2017. Medial Health, a St. Lucian-born, NYC-based EHR startup, has created a streamlined patient-doctor interface to help deliver more efficient healthcare in the Caribbean. Their goal is to provide a solution to optimise and modernise every aspect of healthcare delivery including billing, pharmacies, test results, scheduling and workflow automation.
EHR systems also support the integration of electronic prescriptions which help reduce errors caused by illegible handwriting. Another meta-analysis of 38 studies showed that electronic prescribing strategies reduced medication and dosing errors, and had a significant effect on reducing adverse drug events (RR=0.52). Another trailblazer in the region is Trinidad-based startup, Medl. Medl connects doctors, patients, insurers and pharmaceutical distributors to deliver and manage medication. They aim to solve the problem that 50% of prescriptions are never filled, and to derive side effect data for persons of colour to drastically reduce the cost of drug development.
The ultimate application of EHR involves healthcare data exchange (interoperability) and management systems which will reform the region’s health sector. A health system that is integrated can help reduce costs, better use and manage resources, better monitor notifiable diseases, keep an accurate record of the population disease burden, aid public health research, and strengthen disaster response. Widespread use of EHR in the region will allow Caribbean governments to provide expanded access to quality healthcare services and to reduce, or at least control, the rising costs of healthcare.
As the demographic makeup of the Caribbean shifts towards a larger elderly population, the potential of DH to provide more effective treatment and improved well-being for chronic illnesses cannot be overstated. Using mobile devices, mHealth is an approach to treating non-communicable diseases (NCDs) like heart disease and its risk factor, high blood pressure. It can also be used to encourage behavioural changes required to reduce the risk of developing or exacerbating NCDs like regular physical activity and good nutrition. In 2022, the Jamaica Ministry of Health supported by the IDB, announced a pilot mobile application called JaMoves on the Move as part of an initiative to promote self-monitoring of personal health status. Users can track their blood pressure, blood glucose, weight and physical activity levels, and share their progress with their healthcare provider. The app also supports maintaining healthy targets with feedback on readings and targeted reminders.
As we continue to lay the groundwork, this region has a special opportunity to create health futures that can be sustainable from the outset, incorporating in its design all four action areas mentioned in The Lancet and Financial Times Commission on Governing Health Futures 2030 Report. First, we must acknowledge digital technologies as increasingly important determinants of health and prevent further health inequity. Second, build governance that creates trust in DH by enfranchising patients and vulnerable groups. Third, collect and use health data securely and equitably and promote the public good potential of such data. Finally, foster strong country ownership of DT strategies and clear investment roadmaps to prioritise DH technologies that are most needed.
Caribbean countries are at different stages of DT of their healthcare systems. We require collective, more urgent, and sustained efforts to close the DH gap in the region, capitalising on available vantage points from more digitally matured health systems. Countries must first define their future state vision including all key government and non-government stakeholders, particularly the voices of Caribbean youth, to address our unique health challenges. It is indeed a mammoth task requiring the overhauling of long-established systems and culture. This author’s approach would be to begin DT on a smaller scale and gradually incorporate experience and best practices to tackle the entire system. For example, we can begin transitioning to EHR through national cancer registries and health centres.
In our post-pandemic recovery, the Caribbean has a choice; continue an unsustainable and outdated status quo or strategically move our health systems toward a future state vision. The harsh lessons of the COVID-19 pandemic urge us to translate experiences into action; embark on a digital transformation to create national health systems that are high-quality, efficient, and equitable to improve the spectrum of population health and healthcare delivery in the region.
Dr. Jade Murray is a physician from Trinidad and Tobago with over 3-years’ experience in the public healthcare system. Dr. Murray’s goal is to contribute to the advancement of individual and population health through evidence-based medicine, health education and promotion and utilisation of health technology.