Leapfrog Health Innovation in Latin America
Instead of re-inventing the healthcare wheel, or borrowing wholesale from more digitally-advanced systems, entrepreneurs in Latin America are curating the best health solutions and adapting them to their unique environment.
When Argentinian engineer Matías Spanier was diagnosed with a chronic disease, he made the typical rounds to a series of doctors from various specialties. During this process, Spanier realized that some of the doctors requested the exact same diagnostic tests, but almost invariably, the results were stored on paper charts, making it nearly impossible to share with other members of the medical team. That was when he started thinking about how to build a digital health solution that would integrate all the existing information about a patient into one electronic record so that medical teams anywhere could use it.Within the world of health technology, Spanier’s story isn’t particularly unique. Across the globe, from Boston to Beijing, this frustration at a lack of digital health connectedness has led to a health data revolution. But South America, where Spanier is focusing his company’s attention, is at a crossroads, and offers digital health innovators a unique set of challenges and opportunities.
The southern continent wears many of its health challenges on its sleeve. Despite moves towards universal healthcare, access continues to be a challenges. According to the World Economic Forum, approximately 30% of the population in Latin America lack access to health care for financial reasons while 21% face geographical barriers. Few countries in the region meet international standards for the number of available doctors or hospital beds, and when they are available, they’re often concentrated in urban centers. Those who seek to address South America’s healthcare challenges are faced with economic instability — massive inflation and rapid currency devaluation are not easy on a company’s growth.
It’s within this environment that entrepreneurs like Spanier have made their mark. The result has been an ecosystem of startups that have learned to be hyper-adaptable to changing conditions.
“You have to develop a special set of skills in order to survive the turmoil,” he says. “In the US you might have an economic crisis every 70 years or so, while in Argentina it seems like it happens every five to 10 years.”
Political instability poses other challenges, as well, such as the exodus of experienced medical professionals, which results in “brain drain.” But brain drain turns out to be one of the challenges that makes healthcare tech innovations more valuable: the technology can fill gaps and provide more standardized health care when resources are strained.
Innovators in Latin America are also taking advantage of the huge technology gaps between the US and their countries. Currently, Latin America’s digital healthcare infrastructure is rudimentary in comparison, often limited to scheduling appointments and online bill paying. By learning from what has worked in more technologically advanced nations, innovators identify how to fine-tune advancement for Latin America. Instead of reinventing the wheel, they adapt and improve for relevance. Electronic health records (EHRs) is one example: the US market has a multitude of choice, but Latin America healthcare systems are hungry for a breakthrough platform.
“You have to develop a special set of skills in order to survive the turmoil,” he says. “In the US you might have an economic crisis every 70 years or so, while in Argentina it seems like it happens every five to 10 years.”
Furthermore, for these entrepreneurs, the market is wide open, because Latin America has so far been largely ignored by Europe, Asia and North America — and yet its proximity to North America (and convenient sharing of time zones!) make it easy to learn and collaborate.
Emphasis on Interface at Omnia Salud
Based in Argentina, Omnia Salud was co-founded by Spanier, software engineer Alejandro Bologna and physician Maura García Aurelio. The trio developed their eponymous product in constant collaboration with a team of ten people. Trained in cardiology and medical informatics, García found the existing Argentinian systems clunky.
“The current systems are not modern or cloud-based,” says García. “They’re systems from the 1980s.” Omnia Salud provides a way for all members of a patient’s medical team to connect digitally, to have access to the same records and to collaborate. It is cloud-based and can be accessed from any computer with an internet connection — which means that clinics and hospitals save money since they don’t have to build special servers. Argentina’s major cities have excellent connectivity, but even in small towns Omnia Salud is having success with the product. They’re doing trials in small towns all the time, and the country’s internet connectivity is improving steadily.
But the real beauty of the product, says García, is its user interface and user experience. The team refers to the platform as being “physician-centric,” because it was designed first and foremost to assist medical teams.
“The main idea is to add real value,” explains Garcia. “Because data until this moment has not been useful for doctors. Our idea was to create data that’s useful.”
To determine what would be, the founders surveyed medical professionals — doctors, nurses, pharmacists, psychologists, physical therapists — and asked them what kind of electronic system they would like to use, and how they’d like to use it. The result is that Omnia Salud has a user interface tailor-made for each type of professional. So, for example, when a nurse opens Patient X’s record, he sees something different than when Patient X’s physical therapist opens the record. All the patient’s data is in the record — but it’s presented differently according to who’s looking at it.
The data available in every patient record includes everything that would be part of what Omnia Salud calls a patient’s “program,” that is, their procedures, challenges, lab results, notes, X-rays, images and other records of their condition, diagnosis and treatment. The founders are continually making the platform ever more robust by adding new sections to it, such as mental health and gastroenterology. The team is now building a section on fertility, and soon hope to implement a pharmacy module that simplifies prescriptions for the doctors and the patients. A patient portal is in the works for next year. Omnia Salud charges providers a monthly subscription fee to use the product, the fee determined by the size of the setting.
“The main idea is to add real value,” explains Garcia. “Because data until this moment has not been useful for doctors. Our idea was to create data that’s useful.”
So far the feedback has been very good, and Omnia Salud is being used in more than 80 clinics with 100,000 patient records.
“We’re planning to expand to other countries,” says García, “Chile, Peru, even Mexico.”
Standardizing Care with OTAWA
OTAWAhealth is the brainchild of three brothers, Cid, Sergio and Paulo Gusmão, who run Centro de Combate ao Câncer (CCC), one of the top cancer clinics in Brazil. Cid is the doctor, Paulo is the IT guy and chief information officer and Sergio is the finance expert and chief executive officer.
Like García in Argentina, they were also inspired to build a digital platform to improve their healthcare system — and they knew that the product needed to start with the physicians instead of with the billing and scheduling components, which is what the previous generation of portals focused on. Their insight led to two products, OTAWAonco, which focuses on cancer care, and OTAWAcare, which facilitates collaboration among all parties involved in the health care delivery of a patient.
Message Paulo and Matías on StartUp Health HQ, or email otawa@startuphealth.com | omniasalud@startuphealth.com.
The brothers chose oncology to start building their app, because cancer care is well standardized around the world. Regardless of which country they’re in, oncologists use the international classification of diseases (ICD) to identify the type of cancer. A breast cancer patient will have the same code whether she’s in Brazil, the US or China; lung cancer has a different code, as does liver cancer, and so on.
Paired with that is another globally recognized standard for classifying cancer, the TNM classification of malignant tumors. “T” describes the tumor, “N” indicates the nearby lymph nodes and “M” refers to malignancy. As with the ICD, each tumor gets assigned a specific code composed of letters and numbers. The physician enters the ICD and the TNM, or staging, of the cancer for each patient into OTAWAonco, where those codes determine the treatment protocol for the patient. From that point on, any attending medical team can easily tap into the global body of knowledge about the best ways to treat that particular combination of ICD and TNM.
“It’s important to do this,” says Sergio Gusmão, “because a new doctor who’s just graduated will use our system and will be able to treat patients using the knowledge of more sophisticated doctors. Once a protocol is determined, only that protocol can be used.”
So that doctor, whether a rookie or a seasoned professional, is only able to see information about the globally accepted best treatment for the patient. This is critical, Gusmão explains, because one protocol for one stage of cancer could benefit the patient, while the same protocol might harm a patient at a different stage.
“This product prevents human error,” he says.
Like Omnia Salud, OTAWAonco and OTAWAcare were born with the goal to make care more effective.
“We started with the real client: the doctor, the nurse, the nutritionist, the pharmacist. They tell us what they need,” says Gusmão.
The product is so helpful that, five years ago, a psychologist at CCC approached the team and asked to have a psychology section added to the product. “She told us it transforms the way she works,” says Gusmão. The brothers added a psychology section.
Since 2010, the mobile app, OTAWAcare, has been used in the treatment of more than 6,000 patients, and OTAWAonco is used at the CCC to manage all aspects of care delivery.
“We started with the real client: the doctor, the nurse, the nutritionist, the pharmacist. They tell us what they need,” says Gusmão.
Expanding Services and Breadth
Although they are some of the largest solutions, by no means are OTAWAhealth and Omnia Salud the only physician-centered health tech products in Latin America. The trend seems widespread: expanding beyond — way beyond — the traditional patient portal that assists with appointments and billing, and offer health care value to both the medical team and the patient. MedCloud, headquartered in Brazil, is a digital solution that offers support in the field of radiology by storing images, test results and other data. It even offers support to patients by allowing them to listen to the voice of a radiologist explaining test results.
Argentina-based FutureDocs, offers a product called ConsultorioMovil — free to doctors and patients — that helps to manage chronic disease, especially in the fields of dermatology, neurology, rheumatology, diabetes and ophthalmology. What started with “pill reminder” apps has become more robust, offering information and tools that help patients achieve better adherence, which translates to better outcomes.
It seems that entrepreneurs such as Spanier, García and the Gusmão brothers have figured out how to turn the challenges of Latin America into opportunities. They observe what’s happening — and what is successful — in more technologically advanced regions, and then they adapt. They identify needs specific to Latin America, such as resource gaps and rudimentary tech, and they innovate. They anticipate and ride out economic stability by staying flexible. In the end, this cohort of engineers and medical professionals are developing products that fill a gap, make medical data useful and provide better healthcare delivery — and posting impressive growth while doing so.
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