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New Brunswick firm helps reform Belize's health care

A former Central American cycling champion has a new challenge off the track - training to master the Canadian-made information system that's part of a sweeping reform of health care in the country of Belize.

"It's been very, very exciting," says Ian Smith, his lanky frame leaning over the table in the crowded boardroom at Accesstec Inc., a 12-person software development firm in Fredericton. The manager of information systems for the Belize Health Ministry describes learning alongside developers working on a code for the health information system that goes live under his direction on July 14.

He's excited for good reason. The computerized system promises to improve the delivery of health care, help control costs, create local jobs and save as many as 100 lives in the first full year of operation.

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"Half of those lives will be saved by the timeliness of the data transfer," says Dr. Michael Graven, a neonatologist and international expert in bio-informatics who Belize hired to assist with the reforms.

A team of medical personnel, process improvement specialists and software developers spent months researching, analyzing and refining the country's existing, mostly manual procedures.

"There's almost no problem that can't be solved once people understand the components," says Accesstec founder John Rutter who has been working on community development projects in Belize since 1999.

"If you don't know how to control the costs in the system, you put a cap on them," adds his son Tristan, vice-president of business development. (Another son, Nick, is company president.) "The truth is that 80 per cent of your health dollar, and this is almost universal, is spent on people. So the real challenge here is to make evidence-based information available so you know where to point the people."

The key to the Accesstec system is an electronic, cradle-to-grave individual health record supported by enabling legislation. As of next week, it will be available in all but the most remote parts of Belize, a country of about 250,000.

Because of the dated information systems in Belize, there wasn't the usual encumbrance of having to deal with legacy computer systems. "We had the chance to create this process from the beginning to the end," says Norbert Horvath, Accesstec's director of software development.

The system is based on free open-source software such as Java, Tomcat, MySQL and Apache - a feature Accesstec believes helped the tiny East Coast firm beat goliaths such as California-based Oracle Corp. for the contract. The open-source path is being followed by more and more countries wary of being tied to hefty licensing fees for proprietary computer code.

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Development was done in less than 90 days, thanks to a process known as automated testing. A test is written for each program component, and then the actual code is written to pass the test. Mr. Horvath said the move paid off, because the last 10 per cent of a typical software development project eats up 50 per cent of the costs as clients get heavily involved and repeated testing of modifications is required.

"Let's say you jump in and pull out a piece of functionality. All you do [with automated testing]is push a button and re-run the test suite," he says. "You make a change, you push a button and you watch a green bar."

The Accesstec software is designed to manage Belize's new national public health insurance plan, track pharmaceutical prescriptions and inventory, and provide virtually instant actuarial analysis of medical trends.

"If you have a rise in malaria for example at point A, point B and point C, you can triangulate that there's a swamp in the dead centre," Mr. Horvath says. This allows authorities to begin local education and insect control programs immediately to minimize costly outbreaks.

Unlike the usual IT consulting contract, "the overwhelming majority of the functionality that matters is going to be in the client's hands," Mr. Horvath adds.

Mr. Smith says this was a critical selling point: "If we have to rely heavily and constantly on the developers of this application, for a small country like Belize, it's going to run the government dry."

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