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Presentation VII Conference Global Network Collaborativa Centers

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Presentation made at the VIII Conference of the Global Network of the World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery, São Paulo, July 2010

Presentation made at the VIII Conference of the Global Network of the World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery, São Paulo, July 2010

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  • Integration wit Sports Seceretary Transit authoriry Full Maternal Health Form for Paulistana Mother and for hemodyalisis pts Social net - Bolsa Familia

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  • 1. SIGA Sa úde São Paulo City Health Information System July 30, 2010 Beatriz de Faria Leao, MD, PhD Health Informatics Consultant FUNDAP, S ã o Paulo MOH Brazil - TeleHealth Program, Brasilia JEMBI, South Africa Panel: Renewal of Primary Health Care and the use of information technology
  • 2. Some Facts about Brazil
    • 5th Largest Economy in the World (2010 )
    • 190 million Inhabitants
    • 5th Largest Country in the World, Larger than Continental USA
    • It is a Country of Huge Contrasts:
      • some top quality institutions and
      • a very bad income distribution, though improving
    • 74 M Internet users today, some 48 M with broadband access
    • 27% of houses have Internet access in 2010 ( http://www.cetic.br/)
    • e-Business:
      • 5th largest market in e-business
      • U$15Bi in e-commerce in 2009
    • 95% of IRS Tax Return Forms on the Web
    • National Voting System is 100% Electronic
      • More than 100 million voters
      • Recent national election results in less than 12 hours
  • 3. SUS – The Brazilian National Health System
    • Universal Access
      • Health is a Right of All (~ 150M individuals rely on SUS)
    • Full Coverage, Free of Charge
      • All Services and Procedures
    • SUS principles:
      • Equity, Universality and Integrality
    • Funding and Management are Shared Across Levels
      • Federal, State and Municipal Levels
    • Private Health Plans for Those Willing to Pay
      • ~ 1,200 HMOs (cover ~ 50M individuals)
      • ANS (Agência Nacional de Saúde Suplementar) regulates the sector
  • 4. Health Information Systems in Brazil
    • Health Information Systems have been used in the Public Sector since the 1970s
    • A huge collection of Public Health data is available from the Department of Health, on www.datasus.gov.br
    • As in many other places, vertical applications were the focus, leading to literally more than 250 siloed systems, such as HIV, Prenatal and Child Care, TB, Diabetes and others
    • Lack of national standards started to be reverted by two major projects at the end of the XX Century:
      • The National Health Card Project defined unique identifiers for individuals (including HC workers), and
      • The National Registry of HC Organizations and HC workers registry defined unique identifiers and the relationships among workers, equipment and organizations
  • 5. SIGA Sa úde São Paulo City’s Health Information System Special thanks to Heloisa Helena Andreetta Corral Informatics Advisor SMS-SP And Maria Aparecida Orsini, MD Director Paulistana Mother Program
  • 6. SIGA Saúde
    • SIGA Saúde is São Paulo City’s Integrated and Distributed System for Managing the Public Healthcare System.
    • The system belongs to São Paulo City, which is willing to share it with other cities, states and countries.
    • SIGA Saúde has been developed using free-software open-code concepts .
    São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area. SIGA Saúde is present in 100% (704) of S ão Paulo City public health care providers
  • 7. Before SIGA Sa úde
    • Access to health services was difficult: long waiting lines for specialized procedures and consultations
    • No integration among health care providers
    • No control of medication distribution
    • Very little information for health care management
  • 8. Volumes per HC Region in the City Southeast Region North Region South Region CenterEast Region Population: 2,136,977 Population: 2,396,940 Population: 2,499,294 Population: 2,402,093 Population: 1,244,456 East Region 15 million patients in the database Tiradentes 15 E. Matarazzo 18 Guianases 20 Itaim Paulista 22 Itaquera 31 São Mateus 28 São Miguel 24 Aricanduva 12 Ipiranga 29 Jabaquara 13 Mooca 25 Penha 29 V Mariana 31 V Prudente 36 Casa Verde 16 Freg/Brasilandia 26 Perus 9 Pirituba 25 Santana 20 Tremembe/Jacana 13 V Maria/V Guilherme 18 Butantã 27 Lapa 29 Pinheiros 14 Sé 36 Campo Limpo 29 Cidade Ademar 20 Boi Mirim 34 Parelheiros 9 Socorro 24 Sto Amaro 20
  • 9. Examples of Primary Care Units in São Paulo
  • 10. SIGA Saúde Building Blocks
    • Identifying Patients
        • Based on Unique Nation-Wide Patient Identifier
        • Captures Encounter Data Set
        • On-line Access to Patient Information
    • National Registry of HC Units and Workers
      • Unique Nation-wide Identifiers:
        • Healthcare Workers, Units & Medical Equipment
        • Relationships Among Them
  • 11. SIGA Functionalities
    • Registries: Persons, HC professionals, HC facilities, Families, CHW
    • Scheduling: local and reffered
    • Primary Care: Child and Maternal Health, FHP, Immunizations, Chronic Diseases, Oral Health
    • Specialized Care: Authorization Higgh Cost Complex Procedures
    • Real Time Surveillance
    • Patient flow – referral / counter referral
    • Encounter Information -> mandatory notifications
    • Medication
    • Lab Orders and Results
    • Reports on the BI tool
  • 12. SIGA Saúde Conceptual Model Auditing Billing Assessment Health Surveillance HC Services Management Specialties Inpatients Exams Electronic Health Record Primary Care Emergency HC Workers Hospitals and Healthcare Units Domain Tables and Vocabularies Users (Patients) Nacional Registry R o l e - b a s e d A c c e s s C o n t r o l Flow Control Consultations Beds Exams Emergency Authorization
  • 13. Specialized Consultations Scheduling Scheduling Capturing Encounter Information Lab Integration pilot project in 3 units 2010 Auditing Medical Images HIS Adm / Manag. DSS Health Information SIGA Sa úde Deployment Strategy EHR Surveillance 2007 - 2011 National Health Patient Registry National Health Care Providers Registry Infra-structure HR capacity 2004 15.669.823 Medication Medication at Home Authorization processing of high-cost, high-complexity procedures 2004 - 2007 112 thousand prescriptions 2009 2 Million med/month 745 HC Units 12 M 2009 2.2 M (2009) 5 M in 408 HC units (2009) 369 thousand (2009)
  • 14. Ensuring Equity and Integrality of Care Polyclinic Diagnostic Center Specialties Diagnostic Center Physician Office Primary Care Unit Physician Office Primary Care Unit Primary Care Unit Private Hospital University Hospital Public Hospital Primary Care High Complexity - Hospitals Counter-reference Reference regionalization Medium Complexity Physician Office Reference Patient Flow Organization & Control Electronic Health Record Entry Level axes
  • 15. SIGA Saúde IT Model Electronic Health Record Patient Flow Organization & Mngmnt (Specialties, Beds, Exams) Management (Surveillance, Auditing and Billing) Internet SP City Datacenter SMS-SP Dept of Health Access Control
  • 16. SIGA Sa úde: Project Timeline
    • January 2004 - contract was signed
    • September 2004 - First deployment
    • 2004 - 2007:
        • 700 health care providers connected
        • Medication control and patient scheduling 100% of HC providers
        • Authorizations of high cost / complexity procedures: 100% electronically
        • Special programs data capture such as Paulista Mother
        • Lab results integration under pilot deployment
    • Investment
        • US$ 10M Software
        • US$ 50M Hardware, Connectivity
    • Training
        • 15,000 health professionals trained
  • 17. Opening Screen in 2005
  • 18. Opening Screen in June, 2008
  • 19.  
  • 20.
      • Type of Attendance
      • Special Programs
      • Anamnesis, Physical Exam, History
      • Diagnosis
      • Disabilities
      • Procedures carried-out
      • Requested procedures
      • Medications
      • Course of Action
    Encounter Data Set Work-Related Diseases Communication Form Notifiable Diseases High-Complexity Procedure Order Form
  • 21. Notifiable Diseases Report
  • 22. National Health Card Registry S ão Paulo city - SIGA Saúde
  • 23. High Cost/Complex Procedure (APAC) 2005 -2009 Paper X Electronic Source: SMS-SP, Assessoria de Inform ática, July 2010
  • 24.
    • How IT can support MDG4 and 5 goals and really make a difference???
    Source: http://archive.student.bmj.com/issues/03/04/news/93b.php
    • MDG 5: improve maternal health
    • Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
    • Target 5.B. Achieve, by 2015, universal access to reproductive health
  • 25. Paulistana Mother
    • A program created by S ão Paulo city Health authority in 2006, that extended the SUS maternal Health Program.
    • The Paulistana Mother is an integrated program to assist and monitor ALL pregnant woman of São Paulo city.
  • 26. If your name is not in our list, we ’re going keep calling you…. Source: Diario de S ão Paulo, July 25th Pg. 53
  • 27.
    • Using SIGA Saúde and a BI tool the program:
    • Monitors all pregnancies within the public system,
    • Establishes the referrals to hospitals and emergencies,
      • Hihg risk prenancies ate treated separately by special alerts in the system
    • Guarantees the bed allocation for deliveries
    • Follows-up mother and child till the baby is one year old
    • Recharge of the transport card at each prenatal visit
    • Provides counseling on breast feeding and baby care, and
    • A full layette for the baby at delivery
    Paulistana Mother
  • 28. Paulistana Mother Results
    • Free access to all pregnant women
    • Registration done in any of the 409 primary care units
    • 36 hospitals
    • 25 specialized outpatients clinics
    • 80 thousand pts in the program
    • 10 thousand deliveries / month
    • 74% of pts with 7 or more prenatal consultations
  • 29.  
  • 30. SIGA Saúde: Who else has it? ( June, 2010)
    • São Paulo City
      • 7800 health care providers
      • Focus on Patient Flow, Medication, Paulistana Mother
    • São Paulo State
      • 28 Cities share the system for Hemodialysis and Hemophilia
    • Camaçari, BA
      • Small City near Salvador (Bahia State)
      • 250,000 inhabitants, 32 Primary Care Units
      • Focus on EHR, Medication Dispensing, and Billing
    • Campinas,SP
      • City 100km from São Paulo
      • 1.5 million inhabitants, 50 Primary Care Units
      • Focus on EHR and patient flow
    • 19 municipalities around Campinas -> project planing phase
  • 31. SIGA Sa úde: Advantages of the Architecture
      • Several cities can share servers and services;
      • Simple machines at the point of care;
      • No need for computer personnel at healthcare units;
      • Complexity stays away from the user, under central control;
      • Model can be rolled out to other places;
      • New functionalities can be added easily;
      • SIGA Saúde: Periodic Updates
  • 32. Next Steps for SIGA Sa úde
    • Full EHRS
    • On-line lab reports:
      • 8 labs using LOINC + CDA R2 (HL7 v3) for interoperability
    • Municipal Hospitals IT Project
    • Health Information for the Citizen
      • Empowering the patient
    • Distance Learning
    • TeleHealth
  • 33. SIGA ’s evaluation http://vitalwaveresearch.com/healthit/
  • 34. SIGA evaluation http://vitalwaveresearch.com/healthit/
  • 35. SIGA evaluation
  • 36. Lessons learned
    • DO not underestimate the TRAINNING
    • 30 % is software the rest is PEOPLEWARE.
    • Keep the systems as simple as possible at the point of care
    • Be prepared for the political changes
    • Understand that health information systems are strategic and therefore a state matter
    • Empower users and citizens
    • Use information provided by the systems asap -> BI
  • 37. http://www.sdmx-hd.org/wiki/expert
  • 38. Final Remarks
    • IT can be the tool to promote the quantic jump to offer better health for all
    • Today the recommendation from all big donors and HMN/WHO is to strengthen countries health systems by providing local ownership of an integrated eHealth Architecture, moving away from vertical applications
    • SIGA Sa úde is a proof of concept of this recommendation and can be used in other countries, specially for MDG4 and 5 goals
    • SOUTH TO SOUTH COLLABORATION…
  • 39. Thanks!! Questions? Heloisa Helena Andreetta Corral [email_address] Maria Aparecida Orsini [email_address] Beatriz de Faria Le ão [email_address]