There are various examples from human history of technological projects that transformed our societies—electricity, the telegraph, the personal computer, the internet, cell phones, etc. As diverse as these advances were, they repeatedly featured four basic elements: a vision for what was to be accomplished, ¹ a starting point (an understanding of how things functioned before the change), ² a set of capacities (or the conditions and resources needed to make it a reality),³ and a plan for how to achieve those capacities. Digitally transforming health is no different.

Once there is a vision for the ideal state of the health system—a state which will bring value to all system stakeholders and to the country as a whole—and an understanding of the current situation as the starting point, the next step is to build a path and obtain the capacities and resources needed to get from one point to the other.

Welcome home

To define the path itself and inform objectives as the transformation unfolds, a well-defined approach is key. With this in mind, the IDB developed an exercise for creating digital health roadmaps. For practical purposes, it uses the metaphor of a “digital house.” ⁴ The digital house shows the actions and products needed to build a solid DT with good foundations that bring together the different aspects and perspectives of the approach. The digital house is built from the six key dimensions described above: governance, people and culture, informed health policy and practice, infrastructure, infostructure, and applications and digital services for the sector.

It also includes of the 8 key principles for digital transformation of the health sector, which cover topics like universal Internet access, including and mainstreaming human rights, cooperating on artificial intelligence, information security, interoperability, and the sustainability of systems, among others.

To build the house, the first step is to identify factors critical to success. What has to happen, and what do we need to have during the processes of bringing about the desired future? For example, if the house has a kitchen, the water, electricity, and drains need to be installed before the furniture.

Likewise, if we want to be able to exchange medical information between health providers, we first have to have standardized terminology and Internet access so medical information can be shared and understood by the health information systems and the healthcare teams themselves.

Here again it is crucial that the broad group of actors and stakeholders that created the vision for the future of the country’s health system participate in defining these essential factors. Additionally, the interrelationships between each critical element need to be understood and addressed. To return to the kitchen example, we first have to install the plumbing and electricity before putting in the tiling and furniture.

This house-building exercise will establish the interrelationships between actions, the timeline for implementing the DT, and the process of deploying it. The next step in the exercise is to divide the course of action into phases to start budgeting and sourcing funds for the different tasks.

This exercise shows which gains can be achieved rapidly and which tasks need to be tackled right away but will take time to bear fruit. The final product should include the portfolio of projects needed to digitally transform health, with the time it will take to implement each and the interrelationships between them. Many of these projects may be outside of the sector, but the exercise, if done well, helps identify each one and keep those responsible informed about how their actions will affect the delivery of quality and efficient healthcare services.

When building the DT’s pathway to the future, it is important to understand that the process has to be iterative and leave room for changes as the context evolves, time passes, and goals and objectives are met.

The house metaphor helps us understand each element of the DT as an essential component that has to be taken into account. This exercise makes it more difficult to, for example, skip over or minimize aspects related to people, like user-centric design and change management. It also puts healthcare processes at the center of the discussion to avoid giving projects a purely technological focus.

The next chapter explores each dimension in detail, but first we have to make sure there are early and substantial victories along the way.

Victories along the path to DT

In some respects, DT initiatives are an ongoing process. Rather than a single trajectory, they are a shift towards perpetual transformation to harness the benefits of current and future technologies. However, they can and should lead to both immediate and long-term victories. A DT must have holistic vision, which takes time to bring about and implement, but it also can and should yield significant short-term accomplishments and results.

On the path to a new digital ecosystem, initial steps can be just as important and significant as the end products or system launches. One example is Uruguay’s Connectathon, ⁵ an ïnteroperability martathon” that brought together the country’s top officials, hospitals, healthcare centers, and software companies to demonstrate that it really is possible to share data using standards that protect patient privacy. Chile, as part of its general Digital Hospital strategy, made important strides on the rural digital hospital⁶ to resolve a specific access problem and reduce wait times in the remotest parts of the country, supporting technicians and connecting them with physicians in Santiago’s central offices to provide better care and address health issues remotely. Meanwhile, Project ECHO and the Jamaica Moves app have seen significant and specific progress in the project’s first stages in Jamaica⁷.

The speed at which products can be developed depends on several factors unique to each context. The experiences of many LAC countries, especially since the pandemic, have proven that a swift response that creates key functionalities is possible. The challenge, and responsibility, is to generate sustainable actions, in favorable context, that do not require heavy spending or complex rearrangements in the future. These actions therefore have to fit into an overall vision of the health system.

Two examples of initiatives that were quickly rolled out to citizens and that aligned with countries’ DT roadmaps are the launch of the Coronavirus UY app for the health emergency in Uruguay and Argentina’s digital COVID-19 vaccination credential. It is thus possible to fully leverage synergies, infrastructure, and services that are already available to quickly offer new, high-quality services.

All DT will have milestones, spaces for communicating and publicizing progress, subsidiary products, and even substantial products over the short, medium, and long term. The key? As the saying goes, keep your eyes on the stars (or in this case, the vision for the future of the country’s health system) and your feet on the ground. It is also crucial to measure and share progress, and failures, throughout the process, and switch directions when necessary.