Sometimes life hangs by a thread. "I thought my life would not continue," says Rodolfo Machin, a retired resident from the Uruguayan department of Canelones, just north of Montevideo. On the night of January 7, Rodolfo went to the emergency room at the Santa Lucía Hospital intuiting that he was dying, after feeling a sharp pain in his chest.

This was not the first time that Rodolfo visited an emergency room in recent months looking for a cure to his feeling of general tiredness, lack of appetite and insomnia, which condemned him to spend sleepless nights. In November, a doctor had diagnosed pneumonia, and Rodolfo had been taking antibiotics for weeks that were not having the expected effect.

"The last time my doctor auscultated me three times and told me 'I can barely feel a little noise, and you're fine'. But every day I felt worse," says Rodolfo. "I could not do it anymore. I walked a few steps and I felt a weight in my chest, and I could not breathe. I told my wife, that today was Monday so let’s go to the ER and see Dr. Felipe Pérez."

Dr. Felipe Pérez, after examining Rodolfo had the chance to do something that was unthinkable just a few months ago: he sat at a computer and was able to check all of Rodolfo’s medical history. While Rodolfo had been treated for pneumonia, his record also reflected suffering a chronic arrhythmia, which helped Dr. Pérez choose the correct treatment.     

"Rodolfo has a cardiac pathology, an arrhythmia, and had a moment of decompensation of his disease," says Dr. Pérez. "Initially the treatment worked, but thanks to the electronic medical record, I was able to look at certain data that I did not know —treatments that had been done— and allowed me to treat him a better way."

Dr. Perez can now can consult electronically, and within minutes, receive the entire medical history of their patients, from previous appointments to exams, lab work, surgeries and prescriptions taken.

"With the electronic medical record we can get to know certain aspects of the person's health that, sometimes, we can not intuit or know in advance, and that will allow us to treat them better," says Dr. Pérez. "If we make a comparison, for example, we used to suffer a lot from the story written on paper that patients brought us, which took us a long time to understand. Often the letter was unintelligible, and understanding what other colleagues did was impossible. But now digitalization has changed it all."

Another problem that ER physicians experienced in the Uruguayan public health system was accessing information. Before having the patient's medical record electronically, doctors only received the information that the patient, directly, provided at the time of the consultation. As a result, doctors requested tests that could have been preventable, and they took longer to reach a diagnosis, which could have been fatal in cases like Rodolfo's.

"The electronic medical record is an effective modification to the management of emergency health services," explains Roberto Fernández, a leading specialist in state modernization at the Inter-American Development Bank (IDB). Through funds donated by the Japanese Special Fund, the IDB supported the Administration of State Health Services (ASSE) to implement electronic medical records in 58 health centers distributed throughout the country. ASSE serves 37% of all Uruguayans and its role as a health provider is key, especially for the most vulnerable population: more than 62% of its patients belong to the quintile of the population with the lowest income.

Up to date, 3,347,175 Uruguayans have at least one document saved in the Electronic Medical Records System.

In its first stages, the project included connecting and implementing a software called GeoSalud, developed by Uruguayan company Geocom. ER physicians were also trained by IT staff to enter data correctly over consultations, studies, treatments, x-rays and laboratory tests.

The software also improved the quality of patient care in emergencies, through process reengineering. "Triage system was implemented. Patients when they arrive at the emergency door, are interviewed by health technicians and depending on the severity of their case, the care they should receive is classified as "very urgent," "urgent," and "not very urgent," says Roberto. "Thus, the entire management is computerized. From the moment they are classified as 1, 2, 3, the doctor knows who is on the waiting list and in what order it should be treated."
 
The project has been so successful that the IDB is supporting the digitization expansion of the entire health sector in Uruguay through a series of loans, still in execution. In this phase, all health providers are included, including insurers and private ones, in order to create a National Electronic Clinical Record. This data bank is expected to include most clinical data of 80% of the population in electronic form by 2020.

Is expected that the digitalization of the health sector contributes to have more happy endings like Rodolfo. Dr. Pérez, after identifying that the true condition of his patient was the arrhythmia, decided to transfer him immediately by ambulance to the Hospital de Canelones. Under the supervision of a cardiologist, he was admitted for nine days. The doctor recommended changing his diet, and to date he has lost eight kilos.

"I'm sleeping now, while I didn’t for two months," he says, relieved. "I'm getting stronger, thank God. And with what medicine provides, I’ll feel much better and wanting to move forward."

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