It's a good thing that Jose Ignacio Valenzuela, M.D., likes a challenge, because he and his colleagues at Fundación Santa Fe de Bogotá (FSFB) had to overcome plenty of them to create a robust Internet-based health education platform in Colombia.
Despite a lack of funds, skepticism from administrators and very low connectivity rates in many areas of the country, the 29-year-old Valenzuela persevered to create a model for telehealth and medical e-learning in Latin America.
Valenzuela, who has a master's degree in health informatics from City University in London, says education is one of the key missions of FSFB, a private, non-profit hospital and healthcare organization with more than 1,000 employees and an annual budget close to $50 million.
“Because there is a scarcity of health education material available in some parts of Colombia, both for practitioners and the general public, we thought we would experiment with the delivery of health education material over the Internet,” he explains.
Four years ago, FSFB's education division began producing e-learning material for both practitioners and the general population on topics such as the management of diabetes. Executives developed 10 e-learning courses and have put on more than 100 videoconferences for the country's health professionals.
To expand on those offerings, Valenzuela and colleagues sought to create free Web-based physician consultations that might reach patients without direct access to hospitals and specialists.
But Valenzuela, whose title is head of special projects in the education division, knew that creating a teleconsultation system would require convincing FSFB administrators to provide long-term funding, which he realized was an uphill battle.
“We faced skepticism from the directors of the institution about this application of technology in the healthcare field,” Valenzuela admits. “We had to convince them.”
He did so by starting with a small experimental pilot project to show the direct value to patients. Then he sought to engage directors by demonstrating how online communities could help them. For instance, one physician director was having trouble recruiting patients for a research project. Education division staff members built him an online multi-center patient recruitment tool, which proved valuable. They did similar projects for other directors.
Eventually, financial resources were made available that led to the creation of a permanent Center for Virtual Education and eHealth, which is now a strategic arm of FSFB. The center has since received grant funding from the Colombian Institute for the Development of Science and Technology and the International Development Research Centre in Canada. The eHealth team has grown from three people to 15 researchers.
In 2006, the FSFB team used open-source tools to create a Spanish-language, Web-based asynchronous tool they called Dr. Chat. Users enter the Web site and leave medical queries and physicians respond to them via e-mail within days. “At first, we didn't know if it was going to work,” Valenzuela admits. “Our connectivity rates are not the best. But we had more than 800 consultations in the first year. We were very surprised by the interest level.”
Valenzuela and colleagues recently published the results of a study on the usage patterns of Dr. Chat in the Journal of Medical Internet Research. “We saw strong requests for information on sexual and reproductive health,” he notes. “We have the second-highest rate of teen pregnancy in Latin America, so more information on reproductive health and sexually transmitted diseases could have a macro-economic impact.” If there has been any failing in the development of Dr. Chat, it has been due to the difficulty in reaching patients in rural areas, which is one of its goals. A demographic study found that 92 percent of Dr. Chat's early users live in cities. But Valenzuela is hard at work on that problem as well.
“We're working on expanding Dr. Chat to the mobile phone arena, perhaps through SMS (short message service) messaging,” he says. “The penetration of cell phones is very high in Colombia — 70 percent — so we think a major impact can be achieved.”
The potential of Dr. Chat has made Valenzuela and colleagues popular speakers in other Latin American countries where interest in e-health is strong. It also has led to a project in partnership with Argentine researchers on connecting EHRs to doctors' personal digital assistants.
While he is proud of his accomplishments, Valenzuela deflects much of the credit onto others in his organization. “These are not the achievements of one person,” he stresses. “Many people have been involved in making it happen.” He describes being open to other staff members' ideas as among his strengths. “People are always throwing out ideas and you have to discern which are worth pursuing,” Valenzuela says. “You also have to have the people skills to really listen and to care about them as a person.”
Valenzuela says that the field of health informatics is new to Colombia and there are not many people with formal training and experience in the area. He feels lucky that although he is still young, his combination of interests, experience and education has put him in the right place at the right time to be among the healthcare IT pioneers in his country.
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