What we didn’t know about Cuba: interview with Prof Rolando Rodriguez

Originally published on the Repositive blog and is reposted with permission.

After a successful two weeks’ visit earlier this year, the Repositive team welcomes back Prof Rolando Rodriguez this week for a further two months.

Prof Rolando Rodriguez is leading the creation of Cuba’s national eHealth infrastructure – as a reference project for the WHO – for the integration of hospital, clinical and molecular information. Rolando has many years of experience in clinical data collection and data standards for clinical applications and is heading the eHealth Implementation Task Force for the Ministry of Public Health.

On 04 February, Rolando gave a talk where he described Cuba’s national eHealth Infrastructure and told us about his approaches to developing a nation-wide infrastructure for sharing clinical data.

In this interview, we summarise the most interesting points that were raised during our conversations in these two weeks that Rolando stayed with Repositive.

Could you please introduce yourself and talk a bit about your background and current activities?

I graduated as a chemist from the University of Havana in 1989, then I stayed at the Protein Research Institute of the University of Osaka doing mass spectrometry of proteins and later on I started working at the EMBL in Heidelberg on protein engineering and rational drug design. At the same time, I was leading a group on molecular design and bioinformatics in Havana at the Centre for Genetic Engineering and Biotechnology. I am currently the Head of the Department of Computational Medicine at the National Institute of Nephrology and a Professor on the Faculty of Physics at the University of Havana, where I am also involved as one of the mentors with the Start-up Incubator. I have been visiting professor in several Universities and Institutes mostly in Europe and I am consultant for ITC systems design with some industrial groups.

I am currently leading the ISO TC215 standard implementation task force and the eHealth project at the Cuban Ministry of Public Health, setting and implementing the standards for a countrywide electronic medical record system and clinical data management protocols.

What are the most interesting facts you want us to know about Cuba?

It is a beautiful and warm place with beautiful and warm people! Cuba is the largest and most populated island of the Caribbean, with almost 12 million inhabitants. Fairly known by making the best cigars in the world, also exports rum, sugar from sugar cane, coffee, cacao and nickel. Tourism industry is large due to Cuba being a very healthy and safe place and having a very mild climate all over the year.

Healthcare and education work very well in Cuba and are major cornerstones of our life. Healthcare is very well organised, and it is totally free. If you cannot get treatment in Cuba specific for your condition, you will be paid to go and get it abroad, but this happens only in very rare cases. More than 50% of the annual budget goes to education, social security and healthcare. Cuban doctors and healthcare professionals are present in 67 countries, giving care and teaching. Cuba has been the first to go to fight the last Ebola outbreak in Africa and in our Medical Universities we have almost 13,000 students from 127 countries.

What is the purpose of setting up eHealth system?

As mentioned above, Cuba actually possesses one of the best healthcare systems in the world*, and transition to eHealth is the natural evolution of any healthcare system: if you want to provide better healthcare you need to move to eHealth.

You also do it to save a lot of money by avoiding the repetition of assays, some of which can be quite expensive, avoiding multiple prescriptions and doing in-house follow ups with mHealth (mobile Health) and a more developed community medicine were doctors can immediately share the current data of the patients. You can really do precision and preventive medicine this way and real-time epidemiology that is a dream of every healthcare system.

With the communication infrastructure that you will set up for eHealth, you can empower patients who could see their latest results online and interact with the doctors. You can also create social networks for patient communities and societies, where they are able to share data and to participate actively in searching for the solution of their health issues. To share data across the country via a nationwide computer cloud for a distributed public health system, turns out to be the most effective solution for all that.

When and how did you start the transition to eHealth? Did you start from scratch or were there examples to follow?

As I said above, the transition to eHealth is a natural development of any healthcare system, it is needed for the improvement. In the current world of IT and Big Data, the healthcare systems are very well defined as some of the largest data providers. Some people may think that in countries like ours, where IT has been applied for hospital management for a while, we have most of the clinical data stored and sorted out. In fact, we are only storing a minute amount of the clinical data that we collect every day!

With respect to starting from scratch and following examples… There has always been a science of distributing data, so there is no reinventing a wheel here. We took the best approaches from data distribution and processing and applied it to our system. Canada, for example, did the same, and in fact we will have very similar system implementations.

We did not start the eHealth project from scratch, because since computers were introduced in our country, clinicians did extensively use them and the Ministry of Public Health has always been a pioneer on the use of computers and information technology in Cuba.

The Healthcare System Computer Network, Infomed, was founded almost 25 years ago and is the largest private network in Cuba not only on coverage but also on the number of users and content availability, mainly from two very large resources, the Virtual Library on Healthcare and the Virtual University of Medicine.

Infomed also provides free hosting for all the Healthcare Facilities, free e-mail services to almost all healthcare professionals and Internet access at home for all doctors, and it will be extended to all professionals in the field progressively. Last year, the Ministry of Public Health provided 82,000 laptops to be sold to all medical doctors at a minimum fee and is planning to continue this year with the dentistry doctors and later on with all healthcare professionals.

What types of data you collect now and plan to collect in the future? Will you also collect genomic data? Any data sharing plans?

In the long run, we will gather everything that can be gathered, i.e. all data generated from your stay in the hospital. Right now we are still prototyping, so it depends on any given hospital where we test the collection of data.

As far as genomic data is concerned, we have a very interesting genetic admixture in the population of Cuba. Collecting genomic information is something we would like to do but only after eHealth is up and running to some extent, because using genomics without clinical data infrastructure would be meaningless.

Genomics is about the genotype, clinical data is mainly about the phenotype: the expression of the genes and the regulation machinery in a given habitat and development condition subjected to societal pressure. Humans are bio-psycho-social beings and we are very unique. To be able to use genetic data to the full extent we would need to be able to relate it to the clinical behaviour of each individual, if we can do that we can start grouping populations in a very different way we do now and we could hopefully start preventing diseases rather than curing them.

For us there is no rush on sequencing whole genomes now; we have a very good program of genetic counselling, we do genetic tests for newborns for the most important genetic conditions and we maintain a database with all twins. We need to start the collection of clinical data first, and then based on diseases we can slowly start sequencing people. By that time it will also be much cheaper than today! I also believe that if we have clinical data organised we will have a better chance of getting grants to sequence individuals. Having a very consistent eHealth programme is essential.

What are the biggest challenges in setting up eHealth?

Everything is a challenge! Not only for us in Cuba, where we have our own particular challenges having a “first world” healthcare system in a “third world” country, but for any country eHealth is challenging: it is all about development and change.

It involves changing the whole society and infrastructure, it will change the workflows of the healthcare system making it more efficient and easy for doctors and transparent for patients enabling and empowering the whole society. It is about people and about change management.

A big challenge that also takes much time is collecting opinions and suggestions from all stakeholders to achieve a coherent vision of what and how needs to be done.

One of the most important things to remember during this process is remembering that we are all patients. We strive to make everybody look at things from a patient’s perspective, by asking them:

  • What would you like to have when you arrive ill to a hospital or bring a relative for medical care?
  • How would you like to be treated?
  • What would be a logical workflow to take care of you in the fastest and better way?
  • Which data would you like to access and how?
  • What is being done wrong right now?”

What help us make our choice of development via eHealth unique and viable is the monolithic structure of Cuban healthcare system and the commitment of our leaders, you must be providing the best possible healthcare for our people as guaranteed by our Constitution.

We also take care of sharing our experience with other countries and we are collaborating with the eHealth groups on the WHO and PAHO, exchanging vital information and experiences as our eHealth project could be used as a reference, especially for the developing world.

We aim to have one of the best eHealth services on the world, matching indeed our public healthcare system stature and so guaranteeing its further development.

Prof Rolando Rodriguez joins the Repositive team again from now until the 30th of June, to assist in our strategic roadmap and expand our networks and market offerings. We see much value in working with him, and we expect to share more news in the future of his time and work with us.

*Note from the Editor: we are not talking about any ratings here; to learn more about Cuban healthcare you are invited to read this article.

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