Brazil in all accounts has been categorized as an emerging market. However, is its healthcare market ready for a sustainable information technology transformation yet?
A 21st century goal of a sustainable healthcare IT infrastructure will require crucial IT infrastructural implementations before hospitals and all other stakeholders in a national wide scale can benefit from information technology per say. However, InterSystems Inc., headquartered in Cambridge, MA has implemented its EHR solution, patented as InterSystems TrakCare, in the Federal District of Brasilia, the Capital of Brazil. Different modules were installed such as TrakCare Lab, Clinicals and Patient Administration modules. According to InterSystems Case Study on this EHR implementation, “the Federal District of Brasilia healthcare delivery network that includes 17 hospitals with 4400 beds, plus 61 health centers, polyclinics, diagnostic laboratories, and pharmacies” has realized significant benefits. These benefits include increased monthly revenues, savings of R$18 million per year by its implementation of a web portal for lab results access, and significant drug dispensing savings through the use of TrakCare Pharmacy. Although, this case study fully describes all benefits related to this EHR implementation in the Federal District of Brasilia, it lacks content on the challenges faced by this particular project (s).
Brazil only started with a vision for a national IT infrastructure in the late 1990s, an effort pioneered by the Ministry of Science and Technology. In that same year, an institutional framework was created to develop e-government programs at the federal level. Nevertheless, only in 2004 this effort was materialized by the publication of “e.gov.br—the next Brazilian revolution”, a group effort of 44 specialists.
In the last decade though, Brazil secured a US$350 million funding from the Inter-American Development Bank to overhaul a struggling US$23 billion public health system, “ to expand and improve the delivery of care under the Unified Health System (SUS) through investment in infrastructure rehabilitation and equipment, parallel to the introduction of policy reforms which will improve financial sustainability, equity, efficiency and management of the SUS.” This project funding has been reported as a “primer for the market for information systems that facilitate government goals of decentralization, consolidation and cost control.” Furthermore, the World Bank group (US$300 million) and the Brazilian Federal government (US$100 million) additional funding totaled US$750 million for this project alone. In 2011, the Brazilian Federal Health Department was still debating strategic issues related to the SUS implementation of relational databases and the use of electronic ID Cards throughout the different states and its counties and its information exchanges with the Federal Health Department main servers.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The Brazilian private healthcare IT market potential can be better represented by the inflows of foreign funding during the last two decades and the size of this market. The Latin American health sector is an estimated US$150 billion industry region-wide, and is one of the recipients sectors of these inflows. Due to this significant volume of foreign funding, the health sector is in state of continuous change. Thus, the Brazilian Health IT market potential is enormous however, right now, its immediate needs rests in the 12% of hospitals that have more than 150 beds. Those are hospitals that its management fully understands the role of healthcare informatics and the need to invest in it as part of their strategy to grow and survive within these market changes.
As of 2010, Brazil presented the following market:
| Hospitals | Hospital Numbers | Bed Numbers | Average Number of Beds |
| Public | 2011 | 335482 | 53 |
| Private | 4616 | 80037 | 80 |
| Academic | 174 | 47647 | 309 |
| Total | 6801 | 463166 | 442 |
European companies have been heavily targeting the Brazilian market being the French diagnostic image companies the most well represented. US companies, such as McKesson, Epic and others are not in the market yet. Domestic information technology vendors have developed patient-accounting and resource management systems designed to fit local payer requirements and comply with Federal healthcare regulations. Nevertheless due to a lack of network interface capabilities, any integration and interoperability among other systems is non-existent. Laboratory systems are also outdated and do not carry any network and interoperability capabilities. Radiology, intensive-care, clinical records and diagnostic image management are almost unheard of, or are strictly used in very few facilities. Furthermore, there are many physicians that do not even use computers in their medical practices, that being due to lack of information or just a flat-out refusal to innovate their practice management.
Domestic companies have been protected from foreign competition for many years, however, several years ago the government opened its market to foreign competition and it has been supporting it since then. Realistically, there is a strong need for having the Federal government educated on the great benefits of health IT transformation and lobbied to pass legislation supporting it as it has been done in the US. The physician community ought to also be educated on the intricacies and advantages of health IT and its potential to transform the healthcare environment. Most of the Brazilian physicians are eager to adopt innovation and they would invest on what it’s required to compete and please their patients.
