Without exception, a digital transformation in health care has to start with a clear vision of what the country’s future health system should look like; in other words, ithe ideal state. This vision is based on questions like: What important challenges does the health system of the future address and what problems does it solve? How does it further the population’s wellbeing and health? How does it perform in emergencies? How is it equipped to continue to evolve?

It seems logical and simple enough: define the destination before setting out. The complicated part, which is commonly overlooked but key to the success of a DT in health, is that this vision has to be based on a consensus between all actors in the system. This is particularly challenging in fragmented health systems like those of LAC, where each party operates in isolation and has its own vision for how the future should be, why it should be that way, and how to get there. This difficulty is commonly exacerbated by communication gaps between the different actors. For example, there is often a lack of communication between the people using the digital tools (medical staff and patients) and those procuring them (IT staff). A prominent physician with broad experience in both medicine and IT summed up the problem well: “For decades, doctors had no idea what they wanted, which is exactly what software developers gave them.”¹ Another common and equally important hurdle is a sudden, radical, or repeated change in this vision. This often happens, for example, in administration changes, when past objectives and processes are usually reconsidered

Fortunately, different industries² and the WHO³ have extensively used methods for addressing this type of problem and helping countries define their ideal future state

The key to this process is broad, transparent, and ongoing engagement from the different players in a country’s digital ecosystem—not just those in the field of health and technology—to reach an agreement about the ideal health system and then define how technology will support it.

A common starting point is reaching an agreement on at least the health system’s main desired characteristics. In LAC today, quality, efficiency, and equity should be at the center of the conversation. Addressing aspects like delivering health care, funding, and the role of citizens can also help build a unified vision. Another important requirement for these discussions is to initially focus on objectives instead of dwelling on obstacles. The vision for an ideal future state should be just that: ideal. In other words, it should be based on goals rather than limitations. This stage of the health system DT is about defining what it is and not how it will come about. Therefore, questions for his participatory process of cocreation include: How do you imagine healthcare services in a better future? What would happen in that ideal scenario?

The IDB has experience implementing this method in different LAC countries and in successfully fostering effective discussion and agreements between stakeholders. This process has four essential ingredients:

• Genuine support from top authorities. Without this support, the process will lose credibility and will not have the participation, dedication, and engagement it needs.
• Broad engagement from the ecosystem. This factor will depend on the tone set at the beginning of the dialogue and on how motivated participants are to make progress toward DT. They have to take a step back from the mentality of everyday problems and immediate challenges to cast an unfettered vision for an ideal future One common exercise is to ask what a front-page headline 10 years from now should say about the country’s digital health achievements.
• Validation and giving feedback to participants. The exercise should end by confirming the shared vision and formally articulating, in writing, the desire of all participants to move towards it

The quote, “the best way to predict the future is to create it,” is attributed to both Abraham Lincoln and Peter Drucker, an acclaimed consultant, professor, and writer considered by many to be the greatest management philosopher of the 20th century. Regardless of who said it, this quote conveys the powerful lesson that the best way to create the future one desires is to actively shape events as they unfold.

Like any process, health system transformations need a goal, a vision that encapsulates hopes, ideals, and the desire to grow and improve, and that gives a sense of purpose. This step in the process of transforming the region’s health system starts with imagining what is possible.