Innovation, Technology: The Legacy of INCMNSZ

Q: How do the alliances created by the institute support the improvement of medical practice?

A: The relationships the institute establishes with other entities, such as governments, academia or research institutions, are fundamental. The Salvador Zubirán National Institute of Health Sciences and Nutrition (INCMNSZ) actively participates in international projects that became even more important during the COVID-19 pandemic. We have close relationships with many other actors that allow us to generate better results in medical care, education and research.

Q: How will medical institutions benefit from technology integration?

A: Advances in medicine resemble advances in technology. The institute has focused on incorporating new technologies to keep up to date and fulfill our responsibilities as a national institute. In the past two years and despite the pandemic, the institute was recognized as one of the best highly specialized hospitals in the world by the media and the data platform Statista. This is thanks to the incorporation of technology.

The institute worked for five years to develop a functional electronic clinical record (ECR) adapted to its own needs, which required weekly meetings with the medical, paramedical, nursing, radiology and laboratory staff to build a responsive record. The ECR is now fully functional and the institute avoided having to buy an external ECR that would not necessarily have adapted to INCMNSZ’s needs. Our ECR allows us to generate databases for medical practice, teaching and research and allows patients to schedule appointments, consult lab results and access telemedicine sessions. The institute is developing its own telemedicine platform with full data security and making it accessible to the general population. Telemedicine brings many opportunities but does not replace the doctor-patient relationship. It cannot be used for a first-time consultation and can only be used by selected patients.

During the COVID-19 pandemic, we used these two tools to have the same number of patients online and in person, considerably reducing the saturation of our services. Our tools are available to other institutions and we have created care models that can be applied elsewhere.

Q: The institute developed a ventilator in record time to address the COVID-19 pandemic. How is the institute encouraging these types of R&D projects?

A: Innovation is essential to keep us up to date as a medical center and education and research institution, so we adopt innovative trends that emerge worldwide and also conduct innovation in-house. For that reason, we have created an intellectual property unit. This unit does not aim to generate economic resources but to protect the institute’s research and development.

During the COVID-19 pandemic, we realized that our biomedical engineering department, which is responsible for maintaining over 1,200 pieces of equipment installed in the institution, had the capacity to develop a ventilator. This ventilator was named after Dr. Salvador Zubirán and the year in which it was developed: VSZ-20. The institute is also able to develop many other medical devices, such as laryngoscopes and 3D equipment, alongside universities like UNAM and IPN.

Q: What has been the role of INCMNSZ in the development of National Health Surveys?

A: One of the institute’s objectives is to develop models of care, research and education. INCMNSZ has actively participated in the development of these surveys from the start and they are now run by the National Institute of Public Health (INSP). The surveys are transparent as their information is available to any entity in the country. With this information, each health provider can access reliable data.

Q: How could Mexico achieve universal health access beyond hiring medical professionals to go to rural areas of Mexico?

A: The distribution of doctors across the country is a complex subject that requires an integral approach. Mexico is a heterogeneous country: living in Mexico City is not the same as living in the mountains. Because of that, it needs to create strategies that promote equity and bring uniformity to the country.

Key efforts are being made to strengthen primary care but for these to be effective, the plan must go beyond hiring doctors. A technology-based strategy can help. For example, telemedicine would allow doctors to provide primary care without being next to the patient, making the provision of care more uniform. This would require a small team but what is more important than hiring doctors is the homogenization of health services in an equitable way, which requires a referral and counter-referral system where patients know when, where and how they are going to be treated. These services can actively regularize the provision of care in Mexico and record information about the country's epidemiology, fostering clinical and basic research.

Q: You received recognition from the Coalition for Global Hepatitis Elimination for your work in the field. What led to this recognition?

A: The treatment of hepatitis changed with the development of direct antiviral agents, which allowed doctors to cure hepatitis in 12 weeks. The cost of the drug was approximately US$30,000. We analyzed the reasons behind this treatment’s high cost and called the competent authorities to reduce the sale price to US$2,000. The pharmaceutical industry had already recovered the costs of developing that medicine, so it was possible to find a way for the government to offer the treatment at no cost to anyone in Mexico. This treatment is part of the World Health Organization’s (WHO) strategy to eliminate hepatitis C by 2030. In Mexico, the medication and all laboratory studies involved in the treatment of hepatitis C are free.

David Kershenobich specializes in internal medicine, gastroenterology and hepatology, receiving several awards and distinctions, including the Miguel Otero Research Prize and the Medal Eduardo Liceaga of the General Health Council in Mexico.