Even without EHRs, data collection works

HAVANA–What can U.S. healthcare IT executives learn from one of the poorest countries in the world? A lot about the spirit of saving lives through the use of data collection.

Twenty-three members of the Medical Group Management Association (MGMA) took a trip to Cuba this past December to learn about the small communist nation’s healthcare system. Those who took the trip told Healthcare IT News they were amazed to see what a valiant effort Cuba makes to keep its citizens healthy with so few resources.

Cuba is particularly challenged not only by poverty, but also by the U.S. embargo that blocks imports to that country. Because of this, Cuba has very little medical technology and is handicapped in its ability to provide modern care. But that doesn’t stop the island from making the most of what it has.

Evidence of Cuba’s success shows up in its 4.6 percent infant mortality rate, one of the lowest in the world – lower than the U.S. rate of 6.4 percent.

Cuba has one physician per 170 people – twice as many doctors per capita as the U.S., according to the Association of American Medical Colleges. Eighty percent of Cuba’s physicians are primary care doctors, with only 20 percent trained as specialists. In the U.S., these proportions are reversed.

According to trip delegate Justin Barnes, vice president of government affairs at Greenway Medical Technologies, “There’s no bloat in the Cuban healthcare system. Family doctors manage the entire population.”

The Cuban government has assigned each doctor responsibility for 1,000 patients. Doctors operate out of local neighborhood clinics, with the help of a nurse, a social worker and a statistician. If a patient requires more care than the clinic can provide, that patient is sent to the local Politiclinico, which houses specialty physicians.

Finally, patients who cannot be treated at the Politiclinico are sent to the hospital. “You don’t just walk into an emergency room in Cuba,” Barnes said. “They push everything through a community model.”

Patients are given free healthcare in Cuba. Obviously, this is a socialistic system that the U.S. would never aspire to have, Barnes noted, but what can be taken from this example is how tightly the country has built its medical home model. This is particularly helpful for pre- and post-natal care. The government even provides housing for mothers during and after pregnancy up until a child is one year old, if the woman does not have a safe or healthy environment in which to live.

“The bottom line is that they have implemented a very interesting and successful system that is community-based, ambulatory-focused and that takes great pride in prevention rather than treatment,” Barnes said.

Coupled with this dedication to maternal and infant care is the overall top priority the Cuban government places on healthcare data collection – mainly paper-based, Barnes said.

MGMA trip delegate Paul Jaconette, chief operating officer
at CenCal Health, a California Medicaid management plan, said he was impressed with the annual population health report Cuba produces each year, with data analyses covering topics such as disease morbidity, mortality, diagnoses and influenza.

“Cuba loves data, and they combine the data system-wide and country- wide,” said Jaconette. They really know what their health issues are. Every Cuban doctor has a plan for every person they are responsible for. They know about all of them.”

William F. Jessee, MD, former president of the MGMA and now the senior vice president at Healthcare Strategies, also went on the trip. “I don’t think any of us quite knew what to expect when we went there,” he said. “When you go into a clinic, everything looks like stuff you’d buy at a garage sale.”

“Despite no electronic health records, the Cuban government is doing a pretty good job of keeping family doctors informed,” he said. “The message is this: The key is not the IT per se, it’s the communication and the coordination of care.”

Jessee said Americans should be more receptive to learning about healthcare in other countries. “We have a hard time in this country thinking we can learn anything from another country, let alone a Third World, communist island nation.”