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Medical Informatics in Morocco O 190 © 2013 IMIA and Schattauer GmbH Medical Informatics in Morocco O. Bouhaddou1, M. Bennani Othmani2, S. Diouny3 1 Hewlett Packard (HP), San Diego, California, USA 2 Casablanca Medical Informatics Laboratories, School of Medicine, Casablanca, Morocco 3 Chouaib Doukkali University, Faculty of Letters & Human Sciences, El Jadida, Morocco and a recent Institute of Medicine (IOM) Summary Introduction report recommend increased adoption and Objectives: Informatics is an essential tool for helping to The technologies collectively known as meaningful use, improve individual and transform healthcare from a paper-based to a digital sector. health information technology (health IT) population health, inspire trust in health This article explores the state-of-the-art of health informatics in share a common attribute: they enable the IT, empower individuals to use health IT to Morocco. Specifically, it aims to give a general overview of the secure collection and exchange of vast improve their health, and improve the health Moroccan healthcare system, the challenges it is facing, and the amounts of health data about individuals. care system – a rapid learning and advancing efforts undertaken by the informatics community and Moroccan The collection and movement of these data system [2]. government in terms of education, research and practice to will power the health care of the future. It Medical informatics is concerned with reform the country’s health sector. also has the potential to empower individuals the use of information in health care by Methods: Through the experience of establishing Medical and increase transparency; enhance the abil- clinicians. It is at the core, aligning IT with Informatics as a medical specialty in 2008, creating a Moroccan ity to study care delivery and payment sys- business and clinical objectives. Physicians Medical Informatics Association in 2010 and holding a first tems; and ultimately achieve improvements recognize that. As a result, medical infor- national congress took place in April 2012, the authors present in care, efficiency, and population health [1]. matics is becoming a medical specialty their assessment of some important priorities for health infor- North American and Europe have seen providing clinicians with career opportuni- matics in Morocco. real advances in the understanding of dif- ties to teach, do research, and implement IT Results: These Moroccan initiatives are facilitating collaboration ferent types of medical informatics applica- solutions that are used in a meaningful way in education, research, and implementation of clinical informa- tions. The growth of health IT and medical to address today’s healthcare challenges. tion systems. In particular, the stakeholders have recognized the informatics as a discipline are largely due to However, if there are advances in specif- need for a national coordinator office and the development of a advances in information technology in gen- ic communities, they have not yet made a national framework for standards and interoperability. eral, and to the fact that biomedical records general impact. Indeed, these technologies Conclusion: For developing countries like Morocco, new health IT data are now essentially unmanageable by are still under-utilized even in the develop- approaches like mobile health and trans-media health advertis- traditional paper-based methods. In addition, ing countries. For instance, in 2009 in the ing could help optimize scarce resources, improve access to rural health IT has been recognized as an essential US, only 25% of physicians have adopted areas and focus on the most prevalent health problems, optimiz- tool that can help address the major health Electronic Health Records (EHRs), only ing health care access, quality, and cost for Morocco population. challenges most countries face related to 15% of hospitals have implemented a hos- inefficient access, quality, and cost. Gov- pital information system, and only 7% of Keywords ernments everywhere realize the efficiencies patients have accessed their records online Medical informatics, Morocco, mobile health, developing that can be gained and have been making [3, 4]. However, these numbers are drasti- countries significant investments in health IT. Health cally increasing as a result of the significant care reforms are driving the evolution of the health IT stimulus made as part of healthcare Yearb Med Inform 2013:190-6 healthcare system toward a digital, data-driv- reform (‘obamacare’.) en, patient-centered, community-linked, new Health IT is beginning to make an impact model of payment-facilitated healthcare in developing countries also. In Morocco, system. For instance, legislation in the U.S. progress has been registered in the field of has established the Health Insurance Por- medical informatics in the areas of academic tability and Accountability Act (HIPAA), studies, research, and practice over the last the Office of the National Coordinator for several years [5, 6]. For example, a formal health IT (ONC), the Health Information medical informatics laboratory was cre- Technology for Economic and Clinical ated in 1997 at the School of Medicine of Health Act (HITECH) Act, and Meaningful Casablanca-Morocco, stimulated by several Use [1]. The recommendations from ONC health IT projects initiated in the 1980s in IMIA Yearbook of Medical Informatics 2013 191 Medical Informatics in Morocco Rabat School of Medicine. In the laboratory are located in every district, and services There are also health care facilities that in Casablanca, a first position for a clinician rendered are free of charge. are not equipped or only partially functional, resident in medical informatics was created. The private health sector is a profit-mak- and there is an under-use of almost the entire In 2001, the first Assistant Professor position ing sector that is principally attended by health care system (average occupation rate in medical informatics was created at the people with sufficient income or those who is 56%). More than seven in ten Moroccans same school. In 2008, medical informatics have health insurance. It caters for the needs (71%) do not have access to a formal health was recognized as a medical specialty. There of 16% of the population covered by health care provider. The average number of med- are now several medical doctors doing their insurance [7]. ical consultations per year is 0.6 contacts residency in medical informatics. In 2009, For the most part, clinicians learn and per person in urban areas and 0.4 contacts the Moroccan Medical informatics Associ- practice in French in Morocco. in rural areas. Recourse to health care is ation (SMIMS) was created. In April 2012, strongly linked to the distance that must be the first national conference in medical covered to reach the health care center with informatics (CNIM12) was organized. 1.1 Quality and Access to the closer the center, the greater the average Developing countries can learn from number of consultations per inhabitant. the advances made in medical informatics Healthcare Services Morocco has a high prevalence of spe- around the world and adapt to their local The Moroccan healthcare system has been cific health problems, in particular in gas- situations or leapfrog them. We hope this instrumental in the improvement of the tro-intestinal diseases, respiratory diseases, paper will help promote medical informatics health standards in independent Morocco. hematology disorders. Certain infectious and as a new field of interest in Morocco. In a first For example, the infant mortality rate fell parasitic diseases are still prevalent like tu- section, our article gives an overview of the considerably between 1962 and 2004, from berculosis, certain perinatal conditions, and Moroccan health care system with a summa- 118 to 40 deaths per 1000 live births, while HIV and other sexually transmitted diseases. ry of the challenges it faces and the current from 1972 to 2004, the maternal mortality The Moroccan health care system is address- informatics efforts in education, research, rate fell from 631 to 227 deaths per 100 000 ing these challenges and improvements are and practice. Section two introduces the births. However, this apparent improvement noticeable, especially over the last decade. SMIMS and the CNIM12. In section three, is tempered by significant urban–rural we discuss challenges and opportunities for disparities. For example, life expectancy medical informatics in Morocco. In partic- at birth is higher in urban than in rural ular, how can Morocco leverage stronger areas. The infant mortality rate recorded in 1.2 Health Care Cost national and international collaborations rural areas is twice that of urban areas and Despite the fact that the financing of the and translate them into effective education, the maternal mortality rate is 30% higher health care system in Morocco increased research, and applications objectives of in rural areas, both infant mortality and to a global expenditure of 4.3 billion US health IT that benefit Moroccan citizens and maternal mortality constitute a major chal- Dollars at the end of 2008, namely 5.6% of the population as a whole. lenge for the Moroccan health care system. the Gross Domestic Product (GDP), it con- By 1999, over 93% of the children up to tinues to lag behind most of the countries in one year of age were vaccinated against the region. In 2001, Lebanon allocated the tuberculosis, 87% were protected against equivalent of 12.2% of its GDP to fund its Diphtheria, Pertussis, Tetanus, and Polio. health system, 9.5% in the case of Jordan and 1 Moroccan Health Care Infant mortality rates have decreased to 36 6.4% for that of Tunisia. Morocco’s national deaths out of 1000 live births. Life expec- healthcare system spends more than 33.6% System tancy has increased from 48 years in 1967 of its monetary resources on buying medi- The Moroccan health system includes to 71.8 years in 2008. Close to 82% of the cine and medical goods. Health promotion a public and private sector, and is cur- population has access to safe drinking water check-ups and external consultations total rently undergoing a number of reforms, and 75% has adequate sanitation.
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