I spent part of last week with my friends and colleagues at Hospital Italiano de Buenos Aires (HIBA) in Argentina. The HIBA Department of Health Informatics is truly an international leader in the field, with an internally developed electronic health record (EHR) that serves the needs of the hospital's clinicians, patients, and researchers. HIBA is a large academic medical center in the heart of Buenos Aires and also has a large health maintenance organization (HMO), Plan de Salud, that serves nearly half a million people. It also has a young but growing university.
The HIBA EHR has been in development for over a decade. At a time when the "conventional wisdom" of informatics is to acquire and implement commercial systems, HIBA has built a system tailored to its organization and workflow. Their success is a testament to the vision and leadership of the program's founder, Fernan Gonzalez Bernaldo de Quiros, MD. Dr. Quiros started HIBA's Department of Medical Informatics a decade ago to provide leadership in developing and implement the system, called ITALICA. He has now assumed the role of Vice President for Strategic Planning of HIBA, while Daniel Luna, MD has stepped in to head the department. Now called the Department of Health Informatics, they oversee all aspects of IT at HIBA, including non-clinical applications. An excellent overview of all their work is provided in a Yearbook of Medical Informatics 2009 article: Quiros, F., Luna, D., et al. (2009). Experience in the Development of an In-house Health Information System and the Training Needs of the Human Resources at the Hospital Italiano de Buenos Aires, 147-152, in Geissbuhler, A. and Kulikowski, C., eds. IMIA Yearbook of Medical Informatics 2009. Stuttgart, Germany. Schattauer.
HIBA has also become an international leader in informatics education and training. When the department was established, they also launched a medical informatics residency program. This program has trained the human resources necessary for the success of ITALICA. An emerging leader in the educational program has been Paula Otero, MD.
I first met Dr. Otero in 2004. A year later, she enrolled in the very first offering of the OHSU-AMIA 10x10 course. After the course ended, she proposed to translate the course into Spanish to make it available to a Latin America audience. She and her team successfully translated the course and began offering it across Latin America. While the first version was mostly a direct translation, the course has since diverged from the US-based course to be more specific to health care in Latin America. (For example, very little HIPAA!) For more information, see: Otero, P., Hersh, W., et al. (2010). A medical informatics distance-learning course for Latin America - translation, implementation and evaluation. Methods of Information in Medicine, 49: 310-315.
This initial collaboration set the stage for other collaborative activities. Dr. Otero, Dr. Quiros, and I were involved in the Rockefeller Foundation workshop devoted to building human capacity in health informatics in the developing world in Bellagio, Italy in 2008. We subsequently worked together on the AMIA Global Partnership Program. Dr. Otero has become my Co-Chair in leading the International Medical Informatics Association (IMIA) Working Group on Education.
The crowning achievement of our collaboration was the awarding of a grant from Fogarty International Center of the US National Institutes of Health (NIH). In 2009, we were awarded one of eight grants in Fogarty's Informatics Training for Global Health (ITGH) Program. The stated goal of our project under this funding was to extend our collaboration that had mostly been in clinical informatics into clinical research informatics. HIBA has a strong Institute of Basic Sciences and Experimental Medicine, which includes 31 basic research teams. Many are funded by grants, including some from the NIH.
We proposed in the grant, and have operationalized in the first two-plus years of the project, a plan for short-term, intermediate-term, and long-term training. The short-term training has been focused on clinical researchers, extending the Spanish 10x10 course with modules that teach them how informatics can augment clinical research.
The intermediate training has been more focused on informatics trainees, with a course in clinical research informatics developed by OHSU informatics faculty Judith Logan, MD, MS. This course was taught on-line in OHSU's spring academic quarter to both OHSU and HIBA informatics trainees. Dr. Logan also came on this trip to have an in-person meeting with the HIBA students.
The long-term training has focused on providing postdoctoral fellowship training to HIBA informaticians. At OHSU, we have treated these trainees as if they were fellows on our National Library of Medicine (NLM) training grant. The first two fellows - Damian Borbolla, MD and Vanina Taliercio, MD - have been at OHSU for over a year. A third fellow, Sonia Benitez, MD, will join them later this year. The goal for these trainees is for them to return to Argentina after their training to assume leadership roles in informatics and clinical research.
Dr. Logan and I also had the opportunity to give talks at HIBA (with more details and even an Elluminate recording of the slides and audio). Not only were there about 80 people present in person, another 25 or so listened in via Webcast. Some of the Webcast listeners even asked questions of the speakers. In my talk I provided an overview of the HITECH program for EHR adoption in the US. Dr. Otero translated my slides to Spanish and both the English and Spanish versions, with references, are available on my Web site. An interesting piece of trivia I learned on this trip is that the phrase meaningful use has no direct translation in Spanish. The closest translation is uso significativo. (Which is somewhat ironic, since HIBA is much closer to meaningful use of EHRs than most US hospitals!)
Although we have made substantial progress in our collaboration, the best is yet to come. We will look forward not to our trainees applying their new knowledge and skills to advancing healthcare and clinical research in Argentina, but also to new undertakings, such as a possible jointly developed master's degree.