Problem: Lack of access to specialist diagnostic services in remote communities; limited response capacity of local health system.
Solution highlights: Telemedicine system introduced to improve access to specialist services for remote populations; primary and secondary health centres now collaborate with specialists from tertiary level hospitals on diagnostic services; telemedicine system transmits medical images to specialists; specialists provide diagnostic services to isolated health centres.
Description of practice
In Paraguay, populations living in rural and remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. The local health service delivery networks do not include tertiary hospitals. There were subsequent equity issues between urban and rural populations.
In 2011, WHO/PAHO called attention to the lack of specialized care and EEG exams for people living with epilepsy, leading to lack of treatment of epilepsy in remote communities and socio-economically vulnerable populations. Also the Ministry of Health and Social Wellbeing and PAHO/WHO-PRY consider that cardiovascular diseases, tumors and maternal mortality health are problems of great importance for the country and take into account the lack of electrocardiography, ultrasonography and CT services, not accessible to everyone, especially people living in vulnerable conditions.
In order to improve access of these populations, a telemedicine system was introduced including three different diagnostic services: tomographies, electrocardiographies and ultrasounds. The incorporation of EEG exams (telectroencephalography) is being tested since December 2015, with the introduction of 8 systems in different regional hospitals.
Through the implementation of a software system, health professionals in first and secondary level health centres can now capture images with their medical devises and transmit these images to specialists in tertiary hospitals hundreds of kilometers away. The specialists review the images, write up their diagnosis in a medical report and send it back to the first or second level health centre that contacted them.
The system was put in place in primary and secondary care centres and hospitals in remote areas, where the population had no previous access to diagnostic services. Health professionals were trained on how to realize the exams and the patient information is uploaded into a MoH controlled system that each health professional can access to upload their medical reports and follow up the patient information.
Specialists who participate in the project receive incentives for each diagnostic report sent back to the health service delivery network, allowing the primary health care teams to provide continuity of care to their patients.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
The project is a result of an international collaboration between the Ministry of Health and Social Wellbeing of Paraguay and its Department for Telemedicine, the University of Asunción / Department of Biomedical Engineering at the Research Institute for Health Sciences (IICS-UNA), the University of the Basque Country (UPV/EHU), the Italian Hospital of Buenos Aires and the WHO/PAHO country office in Paraguay.
The response capacity of the local integrated health service delivery networks has been improved by providing access to tertiary level diagnostic services by specialists.
Patient satisfaction studies have shown a high level of satisfaction and a tendency of improved uptake of these services.
The main challenges for the expansion of the system are related to a lack of trained technical assistance, resistance among health personal to accept remote diagnosis, and the low speed internet connection.
- Pedro Lopez