Persisting Barriers to the Adoption of Telemedicine in Latin America After the COVID-19 Pandemic (Part 2)

November 20, 2023

By Daniela Chueke

Although the COVID-19 pandemic played an important role in the adoption of telemedicine and telehealth across Latin America, certain barriers needed to be addressed to effectively implement remote solutions focused on patient care. Health systems in Brazil, Chile, Mexico, and Colombia – the countries that have made the greatest strides in telemedicine in the region – continue to work to ensure that this modality of care is implemented and widely accepted.

Lessons Learned: Have Barriers Been Overcome?

As Juan Pablo Uribe, Global Director for Health, Nutrition, and Population at the World Bank, noted, “The pandemic has shown that health systems need to be well funded and able to deal with shocks and surges.” In this respect, we concur with his reading that many countries in Latin America and the Caribbean did implement effective and innovative measures, including the expansion of remote health and telemedicine services during the pandemic. They increased the use of data in decision-making processes and established new public–private partnerships that expanded access to healthcare during peaks in the pandemic. These innovations can be harnessed and utilized to push forward a series of broader and more lasting reforms to achieve greater resilience in the health sector. In the field of telemedicine and telehealth, the lessons learned left some promising upsides.

Plenty of experiences implemented – with many documented

These may serve as a foundation and reference to guide current or future processes toward sustainability and cost-effectiveness. Knowledge can come from internal or external sources, by developing or acquiring it. This is never the product of the activity of one organization working in isolation.

Open-source solutions

To lower the costs of developing solutions, and to promote interoperability among them (the ability to dialogue with each other, exchanging data such as patients’ electronic medical records), open-source solutions that are free and cloud-based are being used more and more by telemedicine and e-health developers. The advantages of free software over proprietary software are reduced dependence on vendors of proprietary code, access to more tools, the ability to test software before buying or renting (demos), support from a community of users, access to the code, and the ability to adapt it to the medical center’s needs, no excessive or useless features, installation of necessary features only, more security and faster troubleshooting, and application updates.
One example of a solution that is open-source and free for countries is the Pan American Health Organization’s development of a digital platform to bring telehealth services to remote populations in Latin America and the Caribbean, making telemedicine the “new normal” for medical staff and for patients with chronic diseases, also known as NCDs or non-communicable diseases.
Open-source software or free software does not mean that everything is free (implementation of this type of application is complex and expensive). However, it is still usually cheaper than proprietary software as there are no initial or recurring license costs.

Greater cooperation and collaboration between the institutions and professionals involved in the implementation, whether results are positive or negative

The lessons learned through collaborative work are a great legacy of the pandemic. Teamwork, cooperation among institutions in flexible models, and the possibilities of virtual work make the exchange and distribution of knowledge a priority.
Assistance, interconsultations among professionals, and virtual-format medical training began to be viewed as a permanent complementary option for health services to offer. They also need to be supported by laws, budgets, regulations, and professional association ethics codes, and to become part of individual and clinical health care decisions.

The Communication of Medical Knowledge

Technology has made it possible to discover and connect people with the technical knowledge to make institutional improvements. While technology is no replacement for the value of tacit knowledge exchanged through direct human contact, it does help people locate the knowledge they need and network with each other. Telemedicine facilitates the seeking of second opinions, remote training for specialists, continuous medical training, case presentations, and many other instances of communicating and exchanging medical knowledge.

Patients became more active in managing their health

It has become increasingly possible for patients to assume a more active role in their own health stewardship, and thus avoid the treatment disruptions caused by social-distancing measures. Also, the patient’s involvement has become essential to be able to evaluate what our user population is like, what resources they have, and what communication channels they normally use, making patient empowerment part of the new normal.

Formation of Interdisciplinary Teams and Collaborative Work

The creation of a permanent space for exchange is essential to influence high-level decisions between public or private health sector institutions, professional associations, health professionals, scientific associations and societies, and civil society.

Advances in regulatory frameworks

The laws and regulations governing the practice and use of telemedicine vary in each Latin American country. According to the Inter-American Development Bank (IDB) study cited in Part 1 of this article, only 13 of the countries studied have regulations in force that specifically relate to the use of telemedicine.

Current Regulations per Country

Lastly, each country currently has different regulations in effect as part of their efforts to implement telemedicine and telehealth. In Argentina, before the pandemic, National Mental Health Act No. 26,657 already recognized telemedicine as a valid tool in mental health care. Argentina’s Ministry of Health has also issued specific resolutions to regulate telemedicine in the country. There is also Act 27.706 of 2020, establishing the Unified Federal Program for Computerization and Digitalization of Medical Records of the Argentine Republic, Act 27.553, and Decree 98/2023 of 2023, establishing new regulations on Digital Medical Prescriptions and Telecare.

In Brazil, telemedicine is regulated by the Federal Council of Medicine (CFM by its initials in Portuguese). In 2018, CFM Resolution No. 2.227 was issued, setting out the ethical and technical standards for practicing telemedicine. During the pandemic, the country regulated the use of chat and video calls as channels for medical consultation. Regarding the use of WhatsApp, during COVID, Act 13.989 on Telemedicine authorized the use of telemedicine for the duration of the crisis caused by the coronavirus (SARS-CoV-2).

In Chile, Act No. 20.584 regulates the rights and duties of patients and establishes rules for telemedicine. The Ministry of Health has also issued regulations and technical guides for the implementation of telemedicine there. In Colombia, Act No. 1438 of 2011 and Decree No. 538 of 2015 establish the rules for telemedicine implementation. In addition, the Ministry of Health and Social Protection has issued specific guides and guidelines for practicing telemedicine in the country.

Finally, in Mexico, the General Health Council issued Official Mexican Standard NOM-024-SSA3-2019 in 2020, regulating the use of information and communication technologies to provide health services. The standard includes provisions for telemedicine and teleconsultation.

Next Steps

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Daniela Chueke Perles

Daniela Chueke Perles is a journalist specializing in health and healthcare. She covers Latin American healthcare market news for GHI, reporting on sector trends in the region's countries and interviewing doctors, healthcare leaders, government members, providers, suppliers, laboratories, pharmacists, innovators and other players in the healthcare system.