Technology evaluation of a USA-Mexico health information system for epidemiological surveillance of Mexican migrant workers.

From 1994 through 1996, federal, state, and nongovernmental organizations in Mexico and in the United States of America developed and piloted a Binational Health Information System for Epidemiological Surveillance of Mexican migrant workers. The system allowed data exchange for epidemiological surveillance between the state of Guanajuato in Mexico and the Commonwealth (state) of Pennsylvania in the United States, for case detection, prevention, and treatment, through shared contact investigation and case management of communicable diseases. The target population consisted of migrant workers traveling between Guanajuato and Pennsylvania to work mainly in the mushroom industry, and their sexual partners in their Mexican communities of origin. Computerized migrant health information modules were set up in Guanajuato and in Pennsylvania. Patient information and epidemiological surveillance data were encrypted and communicated electronically between the modules, using the WONDER communications system of the U.S. Centers for Disease Control and Prevention. Evaluation of the Guanajuato-Pennsylvania Binational Health Information System showed that major barriers to binational epidemiological surveillance and control are: a) lack of communication binationally; b) interrupted medical care due to migration; c) inconsistent diagnosis and treatment criteria between the two countries; d) lack of referral clinical records from one country to the other; and e) deficient legal regulations concerning binational clinical data transfer. To our knowledge, this is the first project that has successfully demonstrated the technological feasibility of a binational disease control system linking a state in the interior of one country with a state in the interior of another country, rather than just states in the border region. The project also advanced the understanding of health service organizational issues that facilitate or hinder communication, outreach, disease prevention, and organization of health care services for migrant workers in both Mexico and the United States. Despite the unprecedented success and potential bilateral benefits demonstrated by this project, serious structural and organizational deficits in the public health systems of both countries must be addressed before epidemiological surveillance can be achieved binationally.

Utilization of health services along the Arizona-Sonora border: the providers' perspective.

Under the proposed North American Free Trade Agreement between Mexico, Canada, and the United States, issues of health policy and health care delivery will have to be addressed. People at the U.S.-Mexico border have been using health care providers on either side of the border for many years. Studying how the movement of patients has been taking place, and how it has affected health care providers' practices, is the first step towards the understanding and organization of health care services for the border region. This paper reports on the results of a health care provider survey conducted between 1987 and 1989 in Arizona and Sonora border towns. The paper includes information on the characteristics of border health care providers (98 residing on the U.S. side of the border and 249 on the Mexican side) and the demographics and diagnosis of patients who engage in border crossing behavior. The opinions of health care providers about why patients from the neighboring country come to their offices; the existing communication system between providers in both nations; and some of the problems that result from attending patients residing in the neighboring nation are also reported. Results from the survey demonstrate that although the border constitutes a region in itself, health services at the border are not structured to recognize this regional orientation. Improved communication between health care providers on both sides of the border, the establishment of health care protocols with quality assurance programs, and suitable health care financing mechanisms are some of the issues that require immediate attention if the health care delivery system at the border is to function more efficiently and to the satisfaction of health care providers and consumers.