Empowering the digital health workforce in Latin America in the context of the COVID-19 pandemic: the Peruvian case.

The COVID-19 pandemic has exposed significant gaps in healthcare access, quality, and the urgent need for enhancing the capacity of digital health human resources, particularly in Latin America. During the pandemic, online courses and telehealth initiatives supported by governmental agencies, the Pan American Health Organization, and other public and private resources, have played a crucial role in meeting training demands. This article discusses the role of capacity building programs in digital health within the context of Latin America, with a specific focus on the Peruvian case. We highlight the development of digital health competencies and related policies, while also describing selected experiences related to capacity building in this field. Additionally, we discuss the pivotal role of collaborative partnerships among institutions and countries, emphasizing the importance of culturally relevant training programs in digital health. These initiatives have the potential to accelerate training and research opportunities in Latin America, drawing on the involvement of government agencies, non-governmental organizations, industry, universities, professional societies, and communities.

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis.

BACKGROUND: The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data. METHODS: In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public). FINDINGS: In Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru. INTERPRETATION: In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection. FUNDING: The Bill & Melinda Gates Foundation.

Interventions to improve outcomes in community-acquired pneumonia.

INTRODUCTION: Community-acquired pneumonia (CAP) is a common infection associated with high morbimortality and a highly deleterious impact on patients' quality of life and functionality. We comprehensively review the factors related to the host, the causative microorganism, the therapeutic approach and the organization of health systems (e.g. setting for care and systems for allocation) that might have an impact on CAP-associated outcomes. Our main aims are to discuss the most controversial points and to provide some recommendations that may guide further research and the management of patients with CAP, in order to improve their outcomes, beyond mortality. AREA COVERED: In this review, we aim to provide a critical account of potential measures to improve outcomes of CAP and the supporting evidence from observational studies and clinical trials. EXPERT OPINION: CAP is associated with high mortality and a highly deleterious impact on patients' quality of life. To improve CAP-associated outcomes, it is important to understand the factors related to the patient, etiology, therapeutics, and the organization of health systems.

Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru.

The COVID-19 pandemic forced the government to rapidly modify its legal framework to adopt telemedicine and promote the implementation of telehealth services to meet the healthcare needs of patients in Peru. In this paper, we aim to review the main changes to the regulatory framework and describe selected initiatives to promote the telehealth framework that emerged in Peru during the COVID-19 pandemic. In addition, we discuss the challenges to integrate telehealth services for strengthening health systems in Peru. The Peruvian telehealth regulatory framework began in 2005, and in subsequent years, laws and regulations were established that sought to progressively implement a national telehealth network. However, mainly local initiatives were deployed. In this sense, significant challenges remain to be addressed, such as infrastructure in healthcare centers, including high-speed Internet connectivity; infostructure of health-information systems, including interoperability with electronic medical records; monitoring and evaluation of the national agenda for the health sector in 2020-2025; expanding the healthcare workforce in terms of digital health; and developing the capacities of healthcare users on health literacy, including digital aspects. In addition, there is enormous potential for telemedicine as a key strategy to deal with the COVID-19 pandemic and to improve access to rural and hard-to-reach areas and populations. There is thus an urgent need to effectively implement an integrated national telehealth system to address sociocultural issues and strengthen the competencies of human resources in telehealth and digital health in Peru.

Strengthening capacities of multidisciplinary professionals to apply data science in public health: Experience of an international graduate diploma program in Peru.

Nowadays it is necessary to strengthen health information systems and data-based solutions. However, there are few graduate training programs in Peru to use tools and methods of data science applied in public health. This article describes the development process and the initial assessment regarding the experience of the participants in an international multidisciplinary diploma in data intelligence for pandemics and epidemics preparedness, which was carried out from January to May 2021. The diploma was structured in 7 modules and 40 Peruvian professionals participated, of which 11 (27.5%) were women, and 16 (40%) came from regions outside of Lima and Callao. We discussed the need to strengthen institutional and health professionals' capacity to adequately manage large volumes of data, information, and knowledge through the application of emerging technologies to optimize data management processes to improve decision-making in health.

The importance of adherence to international standards for depositing open data in public repositories.

There has been an important global interest in Open Science, which include open data and methods, in addition to open access publications. It has been proposed that public availability of raw data increases the value and the possibility of confirmation of scientific findings, in addition to the potential of reducing research waste. Availability of raw data in open repositories facilitates the adequate development of meta-analysis and the cumulative evaluation of evidence for specific topics. In this commentary, we discuss key elements about data sharing in open repositories and we invite researchers around the world to deposit their data in them.

Toward a holistic definition for Information Systems for Health in the age of digital interdependence.

The article's main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.

El objetivo principal de este artículo es proponer una nueva definición de los sistemas de información para la salud, que se caracterizan por la identificación y la participación de todas las partes involucradas en un complejo proceso interconectado de recopilación de datos y toma de decisiones en el ámbito de la salud pública en la sociedad de la información. El concepto se desarrolló en un proceso de siete pasos que incluyó el análisis de documentos, sesiones presenciales y virtuales con expertos y una encuesta en línea a profesionales de la salud en general. Esta nueva definición procura ofrecer un criterio holístico, un proceso y un enfoque para la gestión de bases de datos y aplicaciones interoperables que considere desde un punto de vista ético el acceso abierto y gratuito a datos estructurados y no estructurados de diferentes sectores, información estratégica y herramientas de tecnologías de la información y de la comunicación (TIC) para la toma de decisiones en beneficio de la salud pública. También brinda apoyo al seguimiento de los Objetivos de Desarrollo Sostenible y la ejecución del acceso universal a la salud y la cobertura universal de salud, así como la salud en todas las políticas como iniciativa para promover políticas relacionadas con la salud en todos los sectores. El concepto de sistemas de información para la salud implica una evolución desde lo que se consideraba anteriormente sistemas de información de salud hacia un esfuerzo integrado por parte de varios interesados directos que garantiza una mejora en la atención, la formulación de políticas y la toma de decisiones.

O principal objetivo deste artigo é propor uma nova definição para Sistemas de Informação em Saúde, que são caracterizados pela identificação e participação de todas as partes de um processo complexo e interconectado para a coleta de dados e tomada de decisão em saúde pública na sociedade da informação. O conceito foi desenvolvido por um processo de sete passos incluindo análise de documentos, sessões presenciais e virtuais com especialistas e uma pesquisa on-line com profissionais de saúde generalistas. A nova definição busca oferecer uma visão, um processo e uma abordagem holística para gerenciar aplicativos e bases de dados interoperáveis que consideram eticamente o acesso aberto e gratuito a dados estruturados e não estruturados de diferentes setores, informações estratégicas e ferramentas de tecnologia da informação e comunicação (TIC) para tomadas de decisão em prol da saúde pública. Também sustenta o monitoramento dos Objetivos de Desenvolvimento Sustentável e a implementação do acesso universal à saúde e da cobertura universal de saúde, assim como a Saúde em Todas as Políticas como uma abordagem para promover políticas relacionadas à saúde em vários setores. Os Sistemas de Informação em Saúde evoluíram de pré-conceitos dos sistemas de informação de saúde para um esforço integrado e com muitas partes interessadas, assegurando melhor cuidado, formulação de políticas e tomada de decisão.

[Implementation of telemedicine in the Americas: Barriers and facilitatorsBarreiras e facilitadores para a implementação da telemedicina nas Américas]. / Barreras y facilitadores a la implementación de la telemedicina en las Américas.

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.

Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

Evaluación de la confiabilidad de la información sanitaria en español sobre la Covid-19 en Google / Evaluation of the health information reliability in spanish about Covid-19 on Google

Introducción: La pandemia de la COVID-19 ha generado un incremento de la información sobre esta enfermedad, por lo que es fundamental garantizar la credibilidad y confiabilidad de las páginas web que brindan esta información. Objetivo: Evaluar la confiabilidad de la información sanitaria en español sobre la COVID-19 en el motor de búsqueda Google considerando los criterios de la herramienta HONcode. Material y métodos: Estudio observacional de corte transversal. Las páginas web de Google se analizaron en diciembre del 2020 desde Lima-Perú, utilizando 4 términos de búsqueda. Se evaluó la confiabilidad de la información sanitaria de las páginas web mediante la herramienta HONcode (versión 3.1.3). Se clasificaron según la fuente de información y su procedencia. El análisis estadístico se realizó para un nivel de significancia de p<0,05. Resultados: Se evaluaron 200 páginas web en español, el 16,5% poseían certificado HONcode, la mayoría fue de la OMS (33,3%), la principal fuente de información fue "académica-profesional" (30,0%). Además, el 33,0% de las páginas web eran peruanas, siendo mayormente de tipo gubernamental (42,4%), pero ninguna tenía certificado HONcode. Conclusiones: Solo una de cada seis páginas web proporcionaba información sanitaria confiable sobre la COVID-19. Además, se distingue la presencia de las páginas web de la OMS en proveer información sanitaria sobre la COVID-19 en Google. Si bien este estudio destaca las páginas web de organismos internacionales, se requiere fortalecer la comunicación desde las páginas web gubernamentales peruanas.

Introduction: The COVID-19 pandemic has generated an increase in information about this disease, so it is essential to ensure the credibility and reliability of the web pages that provide this information. Objective: To evaluate the reliability of health information in Spanish on COVID-19 in the Google search engine considering the criteria of the HONcode tool. Material and methods: Observational cross-sectional study. Google web pages were analyzed in December 2020 from Lima-Peru, using 4 search terms. The reliability of the health information on the web pages was assessed using the HONcode tool (version 3.1.3). They were classified according to the source of information and its provenance. Statistical analysis was performed for a significance level of p<0.05. Results: 200 web pages in Spanish were evaluated, 16.5% were HONcode certified, most of them were from the WHO (33.3%), the main source of information was "academic-professional" (30.0%). In addition, 33.0% of the web pages were Peruvian, being mostly governmental (42.4%), but none had HONcode certificate. Conclusions: Only one out of six web pages provided reliable health information on COVID-19. In addition, the presence of WHO web pages in providing health information about COVID-19 on Google stands out. Although this study highlights the web pages of international organizations, there is a need to strengthen communication from Peruvian governmental web pages.

COVID-19 reveals the urgent need to strengthen nursing informatics competencies: a view from Peru.

The COVID-19 pandemic requires an urgent action to transform health-care delivery and to promote research and capacity-building nursing programs. Specifically, many countries at the global level have described nursing informatics as an essential competence for nurse professionals. In Peru, nursing personnel represents the largest health workforce group and nursing informatics is still emerging, but the field appear to hold much promise. In this sense, the Peruvian Ministry of Health (MoH) defined in 2020 the core nursing competences, which included a technology and innovation domain. The competence established to apply scientifically based technology and innovation to improve the processes or health service resources. The minimum competencies established by the MoH were as follows: to carry out innovations in processes or resources in their different professional performance areas, to creatively adapt technology in different areas of professional performance, to make rational and ethical use of health technologies with focus on new developments that will be evaluated and applied critically, and to manage information and communication technologies, and health information systems, with emphasis on telehealth (i.e. telemedicine, telecare management, tele-education, and tele-training). Besides the nursing competences defined by the MoH is a good starting point, this special contribution discusses the urgent need to strengthen nursing informatics competencies in Peru.

Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru.

Public-private partnerships (PPP) represent an alternative model of health management focused on improving the quality of health services, particularly in emerging countries. To date, a systematic method to improve the perceived quality of health services by healthcare users in Peru has not been established. The purpose of this study was to evaluate the quality of health services in two PPP hospitals in Peru using the Kano model. A prospective cross-sectional descriptive observational study was carried out through a health service satisfaction survey using the Kano model methodology, measuring six categories of attributes. A total of 250 users of the health services were surveyed in the two PPP hospitals, located in Lima and Callao, using non-probability convenience sampling. Of the 31 attributes evaluated by the patients, 27 (81%) were classified as having a one-dimensional-type attribute, 3 (10%) were reported as mandatory, and 1 (3%) was considered as inverse. These results suggest that the presence of most of the attributes evaluated was relevant to maintaining the level of user satisfaction and that the absence of these attributes generated dissatisfaction in the users. The results showed that the users' evaluation of health services was multidimensional-namely, their evaluation was focused not only on the interaction space between the patient and medical personnel but also addressed other interaction services.

Barreras y facilitadores a la implementación de la telemedicina en las Américas / Barriers and facilitators to the implementation of the telemedicine in the Americas

Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psico-sociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras

Programas de capacitación para el fortalecimiento de capacidades en informática en enfermería: una perspectiva peruana

RESUMEN El personal de enfermería tiene el gran desafío de aprovechar los nuevos recursos tecnológicos para llevar a cabo su trabajo de manera más eficiente y efectiva. La informática en enfermería se ha descrito como una competencia esencial para los profesionales de enfermería en varios países. En Perú, el personal de enfermería es predominantemente femenino y representa la mayor fuerza de trabajo en el sistema de salud. Este artículo analiza los desafíos para los programas de capacitación para el desarrollo de capacidades en informática en enfermería en el Perú. En general, la literatura publicada sobre los programas de capacitación en informática en enfermería en el Perú es escasa. Solo una de cada cuatro universidades peruanas ofrece cursos relacionados con informática en salud en los programas académicos de pregrado en enfermería. En el 2020, el Ministerio de Salud del Perú definió las competencias básicas de enfermería para gestionar las tecnologías de información y comunicación, y los sistemas de información de salud, incluida la telemedicina. Sin embargo, la informática en enfermería aún no se ha extendido ampliamente en el Perú debido a desafíos organizacionales, de recursos, y factores culturales y socio-técnicos. Además, las pandemias, como el COVID-19, requieren una acción urgente para transformar la prestación de atención de la salud, para expandir los programas e iniciativas de teleenfermería y la educación a distancia en el Perú. Es esencial promover programas de investigación y desarrollo de capacidades en informática en enfermería en el Perú y fomentar redes de colaboración global entre instituciones públicas y privadas.

ABSTRACT Nursing personnel has to face the great challenge of taking advantage of new technological resources to carry out their work in a more efficient and effective way. Nursing informatics has been described as an essential competence for nurse professionals in several countries. In Peru, nursing personnel is predominantly female and represents the largest workforce group in the healthcare system. This article discusses the challenges for capacity-building training programs in nursing informatics in Peru. In general, the published literature on nursing informatics training programs in Peru is rather scarce. Only one out of four Peruvian universities offer courses related to health informatics in undergraduate nursing academic programs. In 2020, the Peruvian Ministry of Health defined the core nursing competences to manage information and communication technologies, and health information systems, including telemedicine. However, nursing informatics has not yet been sufficiently developed in Peru due to organizational, material, cultural and sociotechnical challenges. Moreover, pandemics such as COVID-19 require urgent action to transform health care delivery, to expand telenursing and distance learning nursing programs and initiatives in Peru. Therefore, it is essential to promote research and capacity-building programs in nursing informatics in Peru and foster global collaborative networks between public and private institutions.

RESUMO O pessoal de enfermagem tem o grande desafio de aproveitar novos recursos tecnológicos para realizar seu trabalho de maneira mais eficiente e eficaz. A informática em enfermagem tem sido descrita como uma competência essencial para profissionais de enfermagem em vários países. No Peru, o pessoal de enfermagem é predominantemente feminino e representa o maior grupo de força de trabalho no sistema de saúde. Este artigo discute os desafios dos programas de treinamento de capacitação em informática em enfermagem no Peru. Em geral, a literatura publicada sobre os programas de treinamento em informática em enfermagem no Peru é escassa. Apenas uma de cada quatro universidades peruanas oferece cursos relacionados à informática em saúde em programas académicos de graduação em enfermagem. Em 2020, o Ministério da Saúde do Peru definiu as principais competências de enfermagem no gerenciamento de tecnologias da informação e comunicação e sistemas de informação em saúde, incluindo a telemedicina. No entanto, a informática em enfermagem ainda não foi desenvolvida amplamente no Peru devido a desafios organizacionais, físicos, e fatores culturais e sociotécnicos. Além disso, pandemias como a COVID-19 exigem uma ação urgente para transformar a prestação de serviços de saúde, para expandir os programas e iniciativas de telenfermagem e o ensino a distância no Peru. É essencial promover programas de pesquisa e desenvolvimento de capacidades em informática em enfermagem no Peru e promover redes globais de colaboração entre instituições públicas e privadas.

[Artificial intelligence and innovation to optimize the tuberculosis diagnostic process]. / Inteligencia artificial e innovación para optimizar el proceso de diagnóstico de la tuberculosis.

Tuberculosis remains an urgent issue on the urban health agenda, especially in low- and middle-income countries. There is a need to develop and implement innovative and effective solutions in the tuberculosis diagnostic process. In this article, We describe the importance of artificial intelligence as a strategy to address tuberculosis control, particularly by providing timely diagnosis. Besides technological factors, the role of socio-technical, cultural and organizational factors is emphasized. The eRx tool involving deep learning algorithms and specifically the use of convolutional neural networks is presented as a case study. eRx is a promising artificial intelligence-based tool for the diagnosis of tuberculosis; which comprises a variety of innovative techniques involving remote X-ray analysis for suspected tuberculosis cases. Innovations based on artificial intelligence tools can optimize the diagnostic process for tuberculosis and other communicable diseases.

La tuberculosis sigue siendo un tema urgente en la agenda de la salud urbana, especialmente en países de medianos y bajos ingresos. Existe la necesidad de desarrollar e implementar soluciones innovadoras y efectivas en el proceso de diagnóstico de la tuberculosis. En este artículo, se describe la importancia de la inteligencia artificial como una estrategia para enfrentar la tuberculosis, mediante un diagnóstico oportuno. Además de los factores tecnológicos, se enfatiza el rol de los factores sociotécnicos, culturales y organizacionales. Se presenta como caso la herramienta eRx que involucra algoritmos de aprendizaje profundo y, en específico, el uso de redes neuronales convolucionales. eRx es una herramienta prometedora basada en inteligencia artificial para el diagnóstico de tuberculosis que comprende una variedad de técnicas innovadoras que implican el análisis remoto de rayos X para casos sospechosos de tuberculosis. Las innovaciones basadas en herramientas de inteligencia artificial pueden optimizar el proceso de diagnóstico de la tuberculosis y de otras enfermedades transmisibles.