There is no denying that digitally transforming health is a complex, multifaceted, long, and costly process. Many reports and articles in the international press have spotlighted this difficulty. In 2019, a Boston Consulting Group article stated that as many as 70% of digital transformation projects fail to deliver the expected benefits.1 Another study on large companies in the United States found that only 9% of digital projects are a complete success, while 53% went over budget, 68% were completed late, and only 42% of planned characteristics were functional. 2
It is understandable that the risk of failure, in a sector as sensitive as health care, could keep governments and institutions from fully embracing a digital transformation. In LAC, the challenges span many areas, including gaps in access to equipment and Internet connections, fiscal constraints, limited digital skills, and resistance from health professionals.
However, these challenges do not necessarily doom DT to failure. Instead, the efficacy of DT initiatives is often thwarted by the lack of a comprehensive strategy and sustained commitment from their leaders. The truth is that digital transformation adds value by allowing countries to address, at different stages, the sector’s major challenges as they bolster their health systems. To do so, they need an intentional, holistic, and long term approach that follows the Principles for Digital Development (PDD)s and the 8 Principles for Digital Transformation of Public Health, as well as action in all key areas. The rest of this publication explores each practical aspect of this approach and identifies the specific areas in LAC where digital transformation has enormous potential.
But first, it is important to dispel a few misconceptions that often detract from the success of these initiatives.
More than shiny objects
Terms like “electronic health record systems,” “interoperability engine,” “telehealth,” or “electronic prescription” can give the impression that digital transformation revolves around buying hardware or software. Paradoxically, the most important part of a DT is not digital, per se.
The assumption that buying the “latest” tool or most “cutting-edge” technology will be what transforms the health system is a recipe for failure. A DT is not about keeping processes as they are and launching an “application.” Rather, a successful DT consists of a portfolio of projects and investments in six key dimensions: governance, people and culture, informed health policy, infrastructure, infostructure, and system applications.
Source: ISO/TR 14369.
No straddling the fence
The arithmetic of digital health is simple: a 50% investment does not equate to a 50% outcome. Countries have to go all in. To design and implement a DT well, countries have to realize that its price tag far exceeds that of an information system. The average investment required is estimated to be 3 to 5% of the national health budget.3 In LAC, DT in health are often derailed by a failure to allocate the necessary resources.
If the goal is to achieve long-term solutions, it is crucial to first, increase investments; second, make effective, sustainable, and equitable investments; and, third, implement investments in a coordinated way. Technology can indeed be transformative when implemented properly, provided investments are done right.
Start today, plan for tomorrow
A successful digital transformation also requires a political commitment to launch a participatory and sustained joint creation process involving all relevant health system stakeholders.4 This commitment yields immediate benefits, but to reach its full potential, it must transcend any one government, sector, or administration, for three reasons. First, a radical and authentic transformation of a health system takes more than three, five, or six years. Second, digital transformations by nature require a longer timeline to reach maturity, hence the need for state policies that provide cross administration continuity. However, with leadership and determination, it is possible to reach key short-term milestones that help the digital transformation gain momentum. Finally, the starting point for a DT must be a vision for the future state of the health system cast by all key government and non-government stakeholders of the ecosystem—with an emphasis on citizens—followed by comprehensive and vigorous action by the whole sector. Otherwise, the process will be plagued by constantly shifting directions,plans, teams, funding allocations, and performance indicators that, at best, will incur enormous losses of investment and, at worst, will result in a staggering loss of life and a population with deteriorating health.
Despite the risks and obstacles, misconceptions, and resistance to digital transformation, multiple international experiences demonstrate the singular value of this process in improving the quality and efficiency of public services and in preparing for future crises.
As the region builds back better post-coronavirus, LAC has a historic opportunity to prioritize a redesign of public health to transform the lives of patients, resolve social problems, and achieve a more equitable system. Not just because it can, but because it should.
The next section explores the potential of this process in the region.
References:
1 Patrick Forth et al., “Flipping the Odds of Digital Transformation Success”, BCG, October 29, 2020. https://www.bcg.com/publications/2020/increasing-odds-of-success-in-digital-transformation.
2 The Standish Group International, The Chaos Report, (s.l.: s.n., 1995), 2.
3 International Standards Organization (ISO), “Health informatics – Capacity based eHealth architecture roadmap – Part 2 Architectural components and maturity model,” (Standard, ISO/TR 14639-2, 2014), https://www.iso.org/standard/54903.html.
4 Government, private sector, academia, financial entities and insurers, citizens, and professional associations and unions, among others.