Parallel Session 1.5  Choosing and using standards for interoperable information systems Beatriz de Faria Leao, MD, PhD Zi...
Brazil  <ul><li>Introduction </li></ul><ul><li>Current HIS challenges  </li></ul><ul><li>SDOs in Brazil </li></ul><ul><li>...
Some Facts about Brazil <ul><ul><li>6th Largest Economy in the World (2007) </li></ul></ul><ul><ul><li>190 million Inhabit...
SUS – The Brazilian National Health System <ul><li>Universal Access </li></ul><ul><ul><li>Health is a Right of All (~ 150M...
HIS in Brazil <ul><li>Vertical systems (more than 30 years) </li></ul><ul><ul><li>Immunization </li></ul></ul><ul><ul><li>...
Health Information Systems in Brazil <ul><ul><li>Health Information Systems have been used in the Public Sector since the ...
HC Standards in Use <ul><li>Currently in use </li></ul><ul><ul><li>Diagnosis: ICD-10  </li></ul></ul><ul><ul><li>Procedure...
HC Standards in use <ul><li>Content </li></ul><ul><ul><li>Patient ID and Profile  </li></ul></ul><ul><ul><ul><li>ISO/TS 22...
HC Standards in use <ul><li>Interoperability  </li></ul><ul><ul><li>XML for Messaging with External Systems </li></ul></ul...
HC Standards in use <ul><li>Security </li></ul><ul><ul><li>National PKI Infrastructure compatible with </li></ul></ul><ul>...
HC Standards in use <ul><ul><li>Software Certification for EHR systems </li></ul></ul><ul><ul><ul><li>A joint initiative o...
HC Standards used in the software certification process <ul><ul><li>HL7 EHR Functional Model </li></ul></ul><ul><ul><li>IS...
Software Certification Quality   Stamp
Health Informatics and SDOs in Brazil <ul><li>SBIS - Brazilian Health Informatics Association </li></ul><ul><ul><li>Founde...
Brazil ISO TC 215 Health Informatics Mirror Committee  <ul><li>ABNT  </li></ul><ul><ul><li>Created in September 1940 </li>...
How ABNT - Health Informatics TC Works <ul><li>Resources </li></ul><ul><ul><li>Collaboration Tool: Livelink (ABNT/ISO) </l...
ABNT Health Informatics TC - Results <ul><li>Standards published  </li></ul><ul><ul><li>ISO/ABNT TS 18308 - Requirements f...
ABNT Health Informatics TC Results (cont) <ul><ul><li>1st Brazilian Symposium on Health Informatics Standards (July, 2008)...
ISO TR 14639 - eHealth Enterprise Architecture for  Emerging and Developing Countries: TR Structure <ul><li>Part 1: Enviro...
Where the national standards are being used? <ul><li>Brazilian TeleHealth Strategy </li></ul><ul><li>SIGA Sa úde - São Pau...
Brazilian TeleHealth Strategy Brazil Telehealth Program - remote assistance and permanent education Pilot Project: 9 state...
TeleHealth National Project <ul><li>Supports about 3000 Health Family Teams, covering 11M people </li></ul><ul><li>Promote...
 
System operation should be  as simple as the local users
SIGA Saúde – São Paulo City Health Information System <ul><ul><li>SIGA Saúde is São Paulo City Integrated and Distributed ...
Examples of Primary Care Units in São Paulo
SIGA Sa úde -  Dec 2010 <ul><ul><li>14,500,000 registered users  </li></ul></ul><ul><ul><li>1,200,000 primary care appoint...
SIGA ’s evaluation  http:// vitalwaveresearch.com/healthit /
SIGA  evaluation http:// vitalwaveresearch.com/healthit /
SIGA  evaluation
Health Information for better health <ul><li>Brazilian Health Indicators </li></ul><ul><ul><li>Set of demographic, socio-e...
Health Information Use, Dashboards & Indicators www. datasus . gov . br
 
Brazil HIS Challenges <ul><li>Interoperability with local (state/municipal level) systems needs improvement </li></ul><ul>...
Final Remarks <ul><li>It is not enough to have an eHealth Policy document </li></ul><ul><li>It is necessary to implement t...
Summary <ul><ul><li>An existing and active Brazilian Health Informatics Society has been crucial to ABNT-PC-HI success; </...
Come visit us ! <ul><li>ISO TC 215 Health Informatics Plenary Meeting,  May 9 -13 </li></ul><ul><li>HL7 Plenary Meeting, M...
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Parallel Session1 5 Brazil Experience V3

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Presentation at the Parallel Session 1.5
Choosing and using standards for interoperable information systems at the PRINCE MAHIDOL AWARD CONFERENCE 2010, Bangkok, Jan 28-30

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  • current HIS challenges in your country - what standards are needed NOW for what&apos;s being done to meet these challenges (and how this compares to what the standards development organizations have prioritized) - what difference an initiative like ROADS would make, in terms of open access to standards, codesets, and implementation guidance Here&apos;s some additional information about the session that you may wish to take into account, in preparing to lead your breakout group. Before we hand the session over to the breakout groups, we will provide some common ground by sharing with everyone three mini-cases of standards implementation in countries, where having open access to standards might have meant different outcomes. These mini-cases are:
  • On the other hand, the things that are going right - national registries (persons, HC professionals and HC providers) as well as a very nice formatted policy for primary health care, data collected and the health indicators that are nationally used for strategic planning might help. The lab project - difficulties in working and translating vocabularies ( very important issue for non-English speaking countries - how can we help on that? ) - the need for standards but not alone, together with Implementations Manuals, Training and Technical Assistance. I guess then we would note a difference . An example - the identification of subjects of care ISO standard has been customized to our national registry ( we added ethnicity - a demand from the black movement in Brazil) and now the e-government initiative is using it as a basis for all identifications in the country. I guess that helps and avoids duplication of systems. HL7 CDA - although it took a while for the Labs to understand it - is now being implemented by the 6 labs - HL7 Brazil is supporting the initiative and providing technical assistance and training - and this helps to move things forward. I think our difficulties are worth mentioning because perhaps other countries have the same problem and we can thing together in a solution. Thanks again for your input. Beatriz
  • Parallel Session1 5 Brazil Experience V3

    1. 1. Parallel Session 1.5 Choosing and using standards for interoperable information systems Beatriz de Faria Leao, MD, PhD Zilics eHealth Convener WG8 Brazilian ISO TC 215 Mirror Committee (ABNT- CEE-IS) Vice-Convener WG8 - ISO TC 215 Health Informatics
    2. 2. Brazil <ul><li>Introduction </li></ul><ul><li>Current HIS challenges </li></ul><ul><li>SDOs in Brazil </li></ul><ul><li>Using the standards </li></ul><ul><li>Summary </li></ul>
    3. 3. Some Facts about Brazil <ul><ul><li>6th Largest Economy in the World (2007) </li></ul></ul><ul><ul><li>190 million Inhabitants </li></ul></ul><ul><ul><li>5th Largest Country in the World, Larger than Continental USA </li></ul></ul><ul><ul><li>It is a Country of Huge Contrasts: </li></ul></ul><ul><ul><ul><li>some top quality institutions and </li></ul></ul></ul><ul><ul><ul><li>a very bad income distribution, though improving </li></ul></ul></ul><ul><ul><li>67 M Internet users today, some 12 M with broadband access </li></ul></ul><ul><ul><li>18% of houses have Internet access </li></ul></ul><ul><ul><li>e-Business: </li></ul></ul><ul><ul><ul><li>5th largest market in e-business </li></ul></ul></ul><ul><ul><ul><li>U$15Bi in e-commerce in 2009 </li></ul></ul></ul><ul><ul><li>95% of IRS Tax Return Forms on the Web </li></ul></ul><ul><ul><li>National Voting System is 100% Electronic </li></ul></ul><ul><ul><ul><li>More than 100 million voters </li></ul></ul></ul><ul><ul><ul><li>Recent national election results in less than 12 hours </li></ul></ul></ul>
    4. 4. SUS – The Brazilian National Health System <ul><li>Universal Access </li></ul><ul><ul><li>Health is a Right of All (~ 150M individuals rely on SUS) </li></ul></ul><ul><li>Full Coverage, Free of Charge </li></ul><ul><ul><li>All Services and Procedures </li></ul></ul><ul><li>SUS principles: </li></ul><ul><ul><li>Equity </li></ul></ul><ul><ul><li>Universality </li></ul></ul><ul><ul><li>Integrality </li></ul></ul><ul><li>Funding and Management are Shared Across Levels </li></ul><ul><ul><li>Federal, State and Municipal Levels </li></ul></ul><ul><li>Private Health Plans for Those Willing to Pay </li></ul><ul><ul><li>~ 1,400 HMOs (cover ~ 50M individuals) </li></ul></ul><ul><ul><li>ANS (Agência Nacional de Saúde Suplementar) regulates the sector </li></ul></ul>
    5. 5. HIS in Brazil <ul><li>Vertical systems (more than 30 years) </li></ul><ul><ul><li>Immunization </li></ul></ul><ul><ul><li>Primary Care (Child and maternity care, family health program, housing and socio-economical data) </li></ul></ul><ul><ul><li>Chronic diseases </li></ul></ul><ul><ul><li>Special Programs (TB, AIDS) </li></ul></ul><ul><ul><li>Diseases of Mandatory Notification </li></ul></ul><ul><ul><li>Inpatient national database </li></ul></ul><ul><ul><li>Outpatient database </li></ul></ul><ul><ul><ul><li>aggregate data 1986 - 2008 </li></ul></ul></ul><ul><ul><ul><li>from 2009 on individualized records </li></ul></ul></ul><ul><ul><li>High Cost / High Complexity procedures </li></ul></ul><ul><ul><ul><li>MRIs, CT scans, dialyses, hemotherapy, Cardiac catheterization, stents, pacemakers… </li></ul></ul></ul>
    6. 6. Health Information Systems in Brazil <ul><ul><li>Health Information Systems have been used in the Public Sector since the 1970s </li></ul></ul><ul><ul><li>A huge collection of Public Health data is available from the Department of Health, on www.datasus.gov.br </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Lack of national standards started to be reverted by two major projects at the end of the XX Century: </li></ul></ul><ul><ul><ul><li>The National Health Card Project defined unique identifiers for individuals (including HC workers), and </li></ul></ul></ul><ul><ul><ul><li>The National Registry of HC Organizations and HC workers registry defined unique identifiers and the relationships among workers, equipment and organizations </li></ul></ul></ul>
    7. 7. HC Standards in Use <ul><li>Currently in use </li></ul><ul><ul><li>Diagnosis: ICD-10 </li></ul></ul><ul><ul><li>Procedures: Brazilian CPT Codes private X public </li></ul></ul><ul><ul><li>Medication: several different vocabularies with billing purposes </li></ul></ul><ul><li>Recent developments </li></ul><ul><ul><li>ATC-Based Medication Codes Brazilian FDA agency (ANVISA) </li></ul></ul><ul><ul><li>GMDN (being translated now) </li></ul></ul><ul><ul><li>LOINC (translation and mapping Brazilian public CPT codes) </li></ul></ul><ul><ul><li>TUSS - Unified Terminology for HC (Brazilian Supplementary Health Agency) - mapping private and public procedures codes </li></ul></ul><ul><ul><li>Under consideration: </li></ul></ul><ul><ul><ul><li>IHTSDO </li></ul></ul></ul><ul><ul><ul><li>dm+d (NHS Dictionary of Medicines and Devices) </li></ul></ul></ul>
    8. 8. HC Standards in use <ul><li>Content </li></ul><ul><ul><li>Patient ID and Profile </li></ul></ul><ul><ul><ul><li>ISO/TS 22220 - Identification of Subjects of Health Care extended (ABNT standard- public consultation from Feb 2010) </li></ul></ul></ul><ul><ul><li>HC Professional ID and Profile and HC Providers Registry </li></ul></ul><ul><ul><ul><li>Extends ISO/TS 27527 - Provider Identification (ABNT) </li></ul></ul></ul><ul><ul><li>Surveillance, Notification and Investigation Forms </li></ul></ul><ul><ul><ul><li>42 diagnoses </li></ul></ul></ul><ul><ul><li>Primary Care and Family Health Program </li></ul></ul><ul><ul><ul><li>Household conditions </li></ul></ul></ul><ul><ul><ul><li>Child and Maternity Health </li></ul></ul></ul><ul><ul><ul><li>Immunization </li></ul></ul></ul><ul><ul><ul><li>Specific diseases follow-up (diabetes, hypertension, hypertension) </li></ul></ul></ul><ul><ul><li>Outpatient dataset </li></ul></ul><ul><ul><li>Inpatient dataset </li></ul></ul><ul><ul><li>High Cost / High Complexity procedures </li></ul></ul><ul><ul><li>Archetypes </li></ul></ul>
    9. 9. HC Standards in use <ul><li>Interoperability </li></ul><ul><ul><li>XML for Messaging with External Systems </li></ul></ul><ul><ul><li>HL7 v3.0 (CDA R2) + LOINC for Clinical Lab Integration in Sao Paulo City </li></ul></ul><ul><ul><li>TISS - supplementary health billing, authorization and eligibility (XML and webservices between HC providers and payers) </li></ul></ul><ul><ul><ul><li>CDA R 2 now being considered for adding clinical content in supplementary health </li></ul></ul></ul><ul><ul><li>13606 - EHR for Minas Gerais State – under a bidding process </li></ul></ul>
    10. 10. HC Standards in use <ul><li>Security </li></ul><ul><ul><li>National PKI Infrastructure compatible with </li></ul></ul><ul><ul><ul><li>ISO 17090-1 - Public Key Infrastructure-1 Framework and Overview </li></ul></ul></ul><ul><ul><ul><li>ISO 17090-2 - Public Key Infrastructure-2 Certificate Profile </li></ul></ul></ul><ul><ul><ul><li>ISO 17090-3 - Public Key Infrastructure-3 Policy Management of Certification Authority </li></ul></ul></ul><ul><ul><li>Information Security Management in Health using ISO/IEC 27002 - ABNT NBR ISO/IEC 27002:2005 </li></ul></ul>
    11. 11. HC Standards in use <ul><ul><li>Software Certification for EHR systems </li></ul></ul><ul><ul><ul><li>A joint initiative of the Brazilian Federal Medical Council and SBIS - the Brazilian Health Informatics Association </li></ul></ul></ul><ul><ul><ul><li>From 2004 - 2008 - self declared process, free of charge on Internet </li></ul></ul></ul><ul><ul><ul><li>From 2009 - systems are audited and receive a Quality Stamp, according to profiles </li></ul></ul></ul><ul><ul><li>Current profiles being assessed for certification: </li></ul></ul><ul><ul><ul><li>Outpatient, TISS </li></ul></ul></ul><ul><ul><li>Two software products received the Quality Stamp, so far </li></ul></ul><ul><ul><li>Six products are currently being audited </li></ul></ul>
    12. 12. HC Standards used in the software certification process <ul><ul><li>HL7 EHR Functional Model </li></ul></ul><ul><ul><li>ISO/BR TS 18308 - Requirements for an electronic health record architecture </li></ul></ul><ul><ul><li>ISO/BR TR 20514 - Electronic health record Definition, scope and context </li></ul></ul><ul><ul><li>ISO 21090 Health Care data types - (being translated to Portuguese) </li></ul></ul>
    13. 13. Software Certification Quality Stamp
    14. 14. Health Informatics and SDOs in Brazil <ul><li>SBIS - Brazilian Health Informatics Association </li></ul><ul><ul><li>Founded in 1986 </li></ul></ul><ul><ul><li>National Conferences every two years </li></ul></ul><ul><ul><li>Standards and Certification WG </li></ul></ul><ul><ul><li>About 900 members </li></ul></ul><ul><ul><li>Focus on academic and professional activities </li></ul></ul><ul><li>HL7 Brazil </li></ul><ul><ul><li>Founded 2007 </li></ul></ul><ul><ul><li>Focus on Training </li></ul></ul><ul><li>ISO TC 215 Mirror Committee </li></ul><ul><ul><li>Founded Dec 2006 </li></ul></ul><ul><li>Brazilian TeleHealth Association </li></ul>
    15. 15. Brazil ISO TC 215 Health Informatics Mirror Committee <ul><li>ABNT </li></ul><ul><ul><li>Created in September 1940 </li></ul></ul><ul><ul><li>Represents Brazil in International SDOs </li></ul></ul><ul><ul><li>Some 120 Technical Committees and growing </li></ul></ul><ul><li>TC-Health Informatics </li></ul><ul><ul><li>Created in November 2006 </li></ul></ul><ul><ul><li>An initiative of Ministry of Health and Santa Catarina Federal University </li></ul></ul><ul><ul><li>Initial Focus on TeleHealth </li></ul></ul><ul><ul><li>Attracted people from the 20-year-old Brazilian Health Informatics Society </li></ul></ul><ul><ul><li>Became formally a Mirror Committee in March 2007 </li></ul></ul><ul><ul><li>Some 100 people working at varied levels of effort and commitment </li></ul></ul><ul><ul><li>Relies 100% on Volunteers </li></ul></ul>
    16. 16. How ABNT - Health Informatics TC Works <ul><li>Resources </li></ul><ul><ul><li>Collaboration Tool: Livelink (ABNT/ISO) </li></ul></ul><ul><ul><ul><li>Livelink has been chosen as the formal and official communication tool </li></ul></ul></ul><ul><ul><ul><li>Our use of Livelink set up a new paradigm for ABNT </li></ul></ul></ul><ul><ul><li>Web-conferencing, for daily work* </li></ul></ul><ul><ul><ul><li>Proven to be very effective </li></ul></ul></ul><ul><ul><li>Video-conferencing joining 8 cities, for monthly Plenary Sessions** </li></ul></ul><ul><ul><ul><li>Video-Conferencing was a major innovation at ABNT </li></ul></ul></ul><ul><ul><ul><ul><li>* Unifesp – São Paulo Federal University </li></ul></ul></ul></ul><ul><ul><ul><ul><li>** RNP – National Research Network </li></ul></ul></ul></ul><ul><ul><ul><ul><li>** Datasus – National Department of Health IT Division </li></ul></ul></ul></ul><ul><ul><ul><ul><li>** RUTE - Brazilian TeleHealth University Network </li></ul></ul></ul></ul>
    17. 17. ABNT Health Informatics TC - Results <ul><li>Standards published </li></ul><ul><ul><li>ISO/ABNT TS 18308 - Requirements for an electronic health record architecture </li></ul></ul><ul><ul><li>ISO/ABNT TR 20514 - Electronic health record - Definition, scope and context </li></ul></ul><ul><ul><li>ISO/ABNT TR 17119 - Health informatics - Health informatics profiling framework </li></ul></ul><ul><li>Standards being translated </li></ul><ul><ul><li>ISO/TS 22220 - Identification of Subjects of Health Care extended </li></ul></ul><ul><ul><li>ISO/TS 27527 - Provider Identification </li></ul></ul><ul><ul><li>ISO/TS 21667 - Health Indicators </li></ul></ul><ul><ul><li>ISO/TR 22221 - Good principles and practices for a clinical data warehouse (CDW) </li></ul></ul><ul><ul><li>ISO/TS 29585 - Deployment of a Clinical Data Warehouse </li></ul></ul><ul><ul><li>ISO/ABNT 27799 - Information Security Mgmt in Health using ISO/IEC 27002 </li></ul></ul>
    18. 18. ABNT Health Informatics TC Results (cont) <ul><ul><li>1st Brazilian Symposium on Health Informatics Standards (July, 2008) </li></ul></ul><ul><ul><ul><li>Some 200 participants, 3 international speakers </li></ul></ul></ul><ul><ul><ul><li>Very successful in raising issues and increasing awareness of the process </li></ul></ul></ul><ul><ul><ul><li>Help raised funds for taking more delegates to Istanbul </li></ul></ul></ul><ul><ul><li>NWIP co-led by Brazil </li></ul></ul><ul><ul><ul><li>WG4 – EHR Systems Certification Process (France + Brazil leadership) </li></ul></ul></ul><ul><ul><ul><li>WG8 – Business Requirements for an integrated eHealth enterprise architecture for emerging and developing countries (WHO and Brazil leadership) </li></ul></ul></ul><ul><ul><li>Next ISO TC 215 Plenary meeting is in Rio May 9 - 13 </li></ul></ul><ul><li>Importance to Brazil </li></ul><ul><ul><li>Contribute to creating standards that will be useful to us </li></ul></ul><ul><ul><li>Learning-teaching experience </li></ul></ul><ul><ul><li>Contribute to harmonizing standards </li></ul></ul>
    19. 19. ISO TR 14639 - eHealth Enterprise Architecture for Emerging and Developing Countries: TR Structure <ul><li>Part 1: Environmental Scan </li></ul><ul><li>Current international initiatives in the area of eHealth systems. </li></ul><ul><li>Part 2: Business Requirements </li></ul><ul><li>Framework for identifying business requirements that define an eHealth enterprise architecture in economically-constrained countries . </li></ul>
    20. 20. Where the national standards are being used? <ul><li>Brazilian TeleHealth Strategy </li></ul><ul><li>SIGA Sa úde - São Paulo Health Information System </li></ul><ul><li>Using Health Information </li></ul>
    21. 21. Brazilian TeleHealth Strategy Brazil Telehealth Program - remote assistance and permanent education Pilot Project: 9 states and 900 points www.telessaudebrasil.org.br Open University of the Brazilian Unified Health System - provides in-service training for thousands of health care providers www.universidadeabertadosus.org.br Telemedicine University Network - RUTE, initially connecting 57 University Hospitals in collaborative research and education across all federal states - www.rute.rnp.br Source:M Macedo, Jan2010
    22. 22. TeleHealth National Project <ul><li>Supports about 3000 Health Family Teams, covering 11M people </li></ul><ul><li>Promote the use of technology by the Family Health teams </li></ul><ul><li>Decrease the number of patients sent to secondary level </li></ul><ul><li>Evaluate different technologies, methodologies and costs </li></ul><ul><li>Improve quality of primary care </li></ul><ul><li>Leads to money-saving (preliminary figures are 100:1)‏ </li></ul>Source: Ana Estela Haddad, Bellagio, August, 2008
    23. 24. System operation should be as simple as the local users
    24. 25. SIGA Saúde – São Paulo City Health Information System <ul><ul><li>SIGA Saúde is São Paulo City Integrated and Distributed System for Managing the Public Healthcare System. </li></ul></ul><ul><ul><li>Its history began in 2003/2004 when it was conceived and development started. </li></ul></ul><ul><ul><li>The system belongs to São Paulo City and given to other cities in Brazil </li></ul></ul><ul><ul><li>SIGA Saúde has been developed using free-software & open-code concepts. </li></ul></ul>
    25. 26. Examples of Primary Care Units in São Paulo
    26. 27. SIGA Sa úde - Dec 2010 <ul><ul><li>14,500,000 registered users </li></ul></ul><ul><ul><li>1,200,000 primary care appointments scheduled / month </li></ul></ul><ul><ul><li>200,000 specialized care consultations scheduled / month </li></ul></ul><ul><ul><li>2,200,000 medical prescriptions attended over the counter / month </li></ul></ul><ul><ul><li>40,000 authorizations of high cost & complexity procedures / month </li></ul></ul><ul><ul><li>30% reduction in waiting time for specialized consultations & procedures </li></ul></ul><ul><ul><li>Medication available at local pharmacies - supply chain control </li></ul></ul><ul><ul><li>15,000 people trained on the system </li></ul></ul>
    27. 28. SIGA ’s evaluation http:// vitalwaveresearch.com/healthit /
    28. 29. SIGA evaluation http:// vitalwaveresearch.com/healthit /
    29. 30. SIGA evaluation
    30. 31. Health Information for better health <ul><li>Brazilian Health Indicators </li></ul><ul><ul><li>Set of demographic, socio-economic, morbidity and risks factors, mortality, HC resources, HC coverage </li></ul></ul><ul><li>Primary Care Pact Indicators </li></ul><ul><ul><li>Child Care </li></ul></ul><ul><ul><li>Maternity and Woman Health </li></ul></ul><ul><ul><li>Hypertension, Diabetes, TB, Hansen ’s disease </li></ul></ul><ul><ul><li>Oral Health </li></ul></ul><ul><ul><li>Family Health Program coverage </li></ul></ul><ul><li>All data is available on Internet </li></ul><ul><ul><li>Queries online back to the seventies </li></ul></ul>
    31. 32. Health Information Use, Dashboards & Indicators www. datasus . gov . br
    32. 34. Brazil HIS Challenges <ul><li>Interoperability with local (state/municipal level) systems needs improvement </li></ul><ul><ul><li>Locally defined interfaces - txt based for the national unique identifiers for persons </li></ul></ul><ul><ul><li>Web services for the national HC providers /professionals </li></ul></ul><ul><ul><ul><li>Locally defined WSDL </li></ul></ul></ul><ul><ul><ul><li>Under tests with SIGA Sa úde - São Paulo City health System </li></ul></ul></ul><ul><li>Terminologies </li></ul><ul><ul><li>Lack of proper clinical vocabularies -> payment approach </li></ul></ul><ul><ul><li>Translation and maintenance of clinical vocabularies </li></ul></ul><ul><ul><ul><li>LOINC (two years and is not ready) </li></ul></ul></ul>
    33. 35. Final Remarks <ul><li>It is not enough to have an eHealth Policy document </li></ul><ul><li>It is necessary to implement the policy </li></ul><ul><ul><li>Proper organizational arrangements are critical </li></ul></ul><ul><ul><li>Continuity across governments </li></ul></ul><ul><ul><li>Financing </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><li>ABNT TC is pushing the use of IS in the country </li></ul>
    34. 36. Summary <ul><ul><li>An existing and active Brazilian Health Informatics Society has been crucial to ABNT-PC-HI success; </li></ul></ul><ul><ul><li>All work has been 100% voluntary, resources are required for hiring technical and administrative staff; </li></ul></ul><ul><ul><li>Developing and emerging countries should be part of the ISO TC 215 SDO </li></ul></ul><ul><ul><li>Standards themselves should be made freely available under some circumstances to promote their use; </li></ul></ul><ul><ul><li>SDO harmonization is vital to reduce redundancy; </li></ul></ul><ul><ul><li>South to South collaboration! </li></ul></ul><ul><ul><li>Organizations such as WHO (in our field) can play a role in adhering themselves to standards and inducing governments to do so by: </li></ul></ul><ul><ul><ul><li>Providing training on HI standards </li></ul></ul></ul><ul><ul><ul><li>Promoting free access to key standards </li></ul></ul></ul><ul><ul><ul><li>Comissioning roadmaps and tools that implement standards (software components -> strengthening of the local expertise) </li></ul></ul></ul>
    35. 37. Come visit us ! <ul><li>ISO TC 215 Health Informatics Plenary Meeting, May 9 -13 </li></ul><ul><li>HL7 Plenary Meeting, May 14 - 22 </li></ul><ul><li>Windsor Barra Hotel, Rio de Janeiro, Brazil </li></ul>Thank you! [email_address] Come visit us in May!!

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