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_619kb

Summary of EDUS Implementation in Costa Rica

Introduction
EDUS, the Single Digital Health Record, is a comprehensive digital health system promoted in Costa Rica to strengthen universal health coverage and improve health services. Implemented through the Program for Results (PforR), it covers all levels of care, with 99% of health services digitized. Law 9162 established it as a national priority, and it was recognized by the UN for digital transformation.

Background and Expansion
EDUS was designed user-centered, integrating clinical, social, and administrative data. The implementation began in 2008, with full coverage at all care levels achieved within 15 years. Key facilitators included political commitment, strong legal frameworks, and collaboration with institutions like the Costa Rican Electricity Institute. Challenges involved resistance to change, infrastructure issues, and system failures, but strategies like change management and training mitigated them. By 2023, EDUS had over 5.6 million app downloads and was integrated into various health services.

Success Factors

• Political and institutional will with a clear legal framework.
• User-centered design, enhancing value for both patients and providers.
• Local adaptation and decentralization, allowing tailoring to regional needs.
• Change management components, including leader identification and peer training.
• Strong intersectoral collaborations, such as with the College of Physicians and government agencies.

Challenges Encountered

• Infrastructure barriers, like lack of internet and electricity, addressed through targeted infrastructure investments.
• Resistance to change, handled through training, alliances with unions, and gradual adaptation.
• Standardization issues for clinical information and system performance problems, resolved through continuous monitoring and upgrades.
• Cybersecurity threats, like a 2022 attack, managed with immediate response protocols.

Future Plans and Lessons
EDUS is seeking HIMSS certification and evolving towards intelligent health systems, integrating predictive medicine and data analytics for diseases like diabetes. The Institutional Directorate of Innovation and Digital Health will drive further innovations, such as digital predictive models. Lessons learned emphasize the need for decision-maker engagement, strategic planning, change management, healthy competition, and stakeholder collaboration for successful health digitization.

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