Belize Health Information Goes Digital: The Tiny Central American Nation of Belize Is Digitizing Its Health Information Systems. Concerns about Privacy Need to Be Set against Benefit to Patients

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Perched on the Caribbean coast and as ethnically and culturally diverse as it is geographically, Belize has launched a cutting-edge web-based health information system. The Belize Health Information System (BHIS), which was inaugurated on 16 September 2008, links the Ministry of Health with the country's public and private hospitals, laboratories and clinics. The system allows data to be made available to authorized users anywhere in the country almost as soon as they are entered in the system. Benefits include the use of alerts and reminders to decision-makers connected to the system, a greater ability to track and monitor infectious disease outbreaks, and country-wide support for such programmes as the prevention of mother-to-child transmission of HIV.

For Ian Smith, one of the founding developers of BHIS, the system not only improves the efficiency of the country's health system, but also encourages a more holistic approach to diagnosis and treatment: "Instead of focusing on a specific disease whenever a patient comes to them, doctors have access to their medical history, allowing them to ask the type of leading questions to provide a thorough check-up," Smith says, noting also that the system encourages participation from birth, establishing a patient ID "from cradle to grave".

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BHIS's official roll-out was in September 2008, but the system's first modules were in fact piloted in 2005 at the Karl Heusner Memorial Hospital, the country's flagship public health institution located in the capital, Belize City. The system has faced many challenges since then, including local bandwidth limitations that obliged the founders to scale down systems designed for developed countries; an erratic grid--electrical surges are commonplace in Belize and could damage the equipment needed to run the system; and the perennial budgetary constraints that limit many public health initiatives.

Smith is keen to stress that the system is not just a server designed to store health information. It is an adaptable system that serves many different users. "The type of information that a director [of a health centre or hospital] may need to make evidence-based decisions is different to the type of information that a maternal-child health nurse needs when they are vaccinating a child. The system is designed to meet these different requirements," he says. The director might require aggregate data for decision-making on such issues as medical supplies and human resources, while a nurse needs individual data such as patient history.

The system, which currently serves two-thirds of Belize's approximate population of 300 000, was financed initially through a loan from the Inter-American Development Bank (IADB) and the Caribbean Development Bank, with technical support received from the Pan American Health Organization (PAHO) and Accesstec of New Brunswick, Canada. In 2006, a grant was received from the Health Metrics Network, a Geneva-based partnership hosted by WHO, committed to facilitating better health information at the country, regional and global levels. That grant first brought the Belize system to Health Metrics Networks attention. The Network subsequently developed guidelines for all countries and, after studying the Belize model, found that it was in line with those recommended guidelines. In May 2008, Belize became the first country in the Americas to be granted priority technical support from Health Metrics Network and that means it will eventually receive financial resources for continued work on BHIS.

But while support has certainly come from outside, BHIS is very much a home-grown phenomenon. "Under the leadership of the Ministry of Health, Belize has pioneered an outstanding example of a national health information system," says Dr Nosa Orobaton, chief of country programmes for Health Metrics Network, while Smith stresses the importance of consultation with the domestic health sector's key participants, including, notably, the director of health services, who is responsible for the delivery of services within the Ministry of Health. …