2023-11-09-世界银行-扩大哥斯达黎加初级保健系统中单一数字健康记录的覆盖范围（英）-2023.10-8页_8页_620kb

Summary of the EDUS Expansion in the PHC System in Costa Rica

Core Content

The Single Digital Health Record (EDUS) in Costa Rica represents a significant milestone in the country's health system, serving as a cornerstone for achieving universal health coverage and improving the quality, effectiveness, and efficiency of health services. Implemented through the Program for Results (PforR), the project was completed in just three years, covering all levels of care, including remote and vulnerable areas without electricity or internet connectivity.

EDUS is more than just a digital record; it is a comprehensive repository of clinical, social, and administrative data, enabling interoperability and data-driven decision-making. It includes social determinants of health, such as family demographics and housing conditions, and is integrated with the National Information System and Single Registry of Beneficiaries. The system also supports patient empowerment through mobile applications and web/telephone services for appointments and record access.

Main Objectives

• Strengthen the guarantee of the right to life and health.
• Advance universality in access to quality medical services.
• Reduce equity gaps.
• Promote the interoperability of information within the health system.
• Improve institutional and financial efficiency of the CCSS.

Key Facilitators

• Political and institutional commitment: The project was declared a national priority with a solid legal framework (e.g., Law 9162, Regulation 8954).
• User-centered design: EDUS was developed with the needs of both patients and health professionals in mind, ensuring added value for both groups.
• Local adaptation: Implementation was decentralized, allowing for flexibility and responsiveness to regional needs.
• Change management: A structured approach involving leadership, training, communication, and sustainability helped overcome resistance and ensure smooth adoption.
• Intersectoral collaboration: Partnerships with entities such as the College of Physicians, Costa Rican Electricity Institute (ICE), and Ministry of Science and Technology were crucial.
• Financial support: A dedicated budget ensured the project's development and expansion, with total investment from 2013 to 2017 exceeding 11.4 billion colones (approximately 19.7 million USD).

Challenges and Solutions

• Infrastructure limitations: Many EBAIS centers lacked internet and electricity. Solutions included on-site assessments, customized infrastructure plans, and collaboration with ICE for installations like satellite antennas and solar panels.
• Resistance to change: Health professionals were hesitant due to fear of change and unfamiliarity with technology. Peer-to-peer training and strategic alliances with unions helped reduce resistance.
• Standardization of clinical data: Hospitals used different guidelines for medical emergencies. This was addressed through centralized communication with technical and clinical teams and the adoption of internationally recognized guidelines.
• System failures and slowness: Some EBAISs reported unstable connections and system failures. A "EDUS disconnected" program was introduced to allow temporary data saving when connectivity was lost.
• Cyber-attack in 2022: A major security breach temporarily disrupted the system, but antivirus protocols and server cleaning were applied to restore functionality and ensure data protection.

Future Plans and Gaps

• Intelligent health systems: The future of EDUS includes the integration of predictive medicine, artificial intelligence, genomics, and telemedicine.
• EMRAM certification: The system is being evaluated for certification under the Electronic Medical Record Adoption Model (EMRAM) to move towards paperless hospitals.
• Data science initiatives: Projects like data mining for type 2 diabetes aim to develop predictive models to enable proactive health interventions.
• Continuous improvement: The project emphasizes ongoing evaluation and feedback loops to refine processes and outcomes.

Lessons Learned

• Legal and political support is essential for successful implementation.
• Strategic planning must be user-focused and locally adapted.
• Change management programs help reduce resistance and promote adoption.
• Healthy competition among health areas encourages faster implementation.
• Stakeholder engagement and intersectoral collaboration are vital for long-term success.
• Regular evaluation ensures continuous improvement and alignment with goals.

Conclusion

The EDUS project in Costa Rica is a model for digital health transformation in the public health sector, demonstrating how political will, strategic planning, and technological innovation can lead to universal access and improved health outcomes. The experience highlights the importance of user engagement, local adaptation, and intersectoral partnerships in achieving sustainable and impactful health reforms.