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Panel: Renewal of Primary Health Care and the use of information technology. 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. - PowerPoint PPT Presentation
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SIGA Saúde São Paulo City Health Information System
July 30, 2010
Beatriz de Faria Leao, MD, PhDHealth Informatics Consultant
FUNDAP, São PauloMOH Brazil - TeleHealth Program, Brasilia
JEMBI, South Africa
Panel: Renewal of Primary Health Care and the use of information technology
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
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
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
SIGA Saúde
São Paulo City’s Health
Information SystemSpecial thanks to
Heloisa Helena Andreetta CorralInformatics Advisor SMS-SP
And
Maria Aparecida Orsini, MDDirector Paulistana Mother Program
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 beendeveloped 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 São Paulo City public health care providers
Before SIGA Saúde
• 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
Tiradentes 15
E. Matarazzo 18
Guianases 20
Itaim Paulista 22
Itaquera 31
São Mateus 28
São Miguel 24
Aricanduva 12Ipiranga 29Jabaquara 13Mooca 25Penha 29V Mariana 31V Prudente 36
Southeast Region
North Region
Casa Verde 16Freg/Brasilandia 26Perus 9Pirituba 25Santana 20Tremembe/Jacana 13V Maria/V Guilherme 18
South Region
CenterEast Region
Butantã 27
Lapa 29
Pinheiros 14
Sé 36
Population:2,136,977
Population: 2,396,940
Population:2,499,294
Population:2,402,093Population:
1,244,456
Campo Limpo 29
Cidade Ademar 20
Boi Mirim 34
Parelheiros 9
Socorro 24
Sto Amaro 20
East Region
Volumes per HC Region in the City
15 million patients in the database
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
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
Auditing
Billing
Assessment
HealthSurveillance
HC ServicesManagement
Specialties Inpatients
Exams
Electronic HealthRecord
Primary Care
Emergency
HC Workers
Hospitals and Healthcare Units
Domain Tablesand Vocabularies
Users (Patients)
NacionalRegistry R
ole-based
Access Control
Flow Control
Consultations
Beds
Exams
Emergency
Authorization
SIGA Saúde Conceptual Model
SpecializedConsultations
SchedulingScheduling
Medication
Medication at Home
CapturingEncounter
Information
Lab Integrationpilot project in 3 units 2010
AuditingMedical Images HIS
Adm / Manag. DSS
Health Information
SIGA Saúde Deployment Strategy
EHR Surveillance
Authorization processing of
high-cost, high-complexity
procedures
2004 -
2007
2007 -
2011
National HealthPatient Registry
National Health CareProviders RegistryInfra-structure
HR capacity200415.669.823
112 thousand prescriptions 2009
2 Millionmed/month
745 HC Units
12 M 2009
2.2 M (2009) 5 M in 408 HC units(2009)
369 thousand (2009)
Ensuring Equity and Integrality of Care
Polyclinic DiagnosticCenter Specialties Diagnostic
Center
PhysicianOffice
PrimaryCare Unit
PhysicianOffice
PrimaryCare Unit
PrimaryCare Unit
PrivateHospital
UniversityHospital
PublicHospital
Primary Care
High Complexity - Hospitals
Cou
nter
-ref
eren
ce
Referenceregionalization
Med
ium
Com
plex
ity
PhysicianOffice
Reference
Patient Flow Organization & Control
Elec
tron
ic H
ealth
Rec
ord
Entry Level
axes
SIGA Saúde IT Model
Electronic Health Record
Patient Flow Organization & Mngmnt(Specialties, Beds, Exams)
Management(Surveillance, Auditing
and Billing)
Internet
SP CityDatacenter
SMS-SP
Dept of Health
Access Control
SIGA Saúde: 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
– 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-ComplexityProcedure Order Form
National Health Card RegistrySão Paulo city - SIGA Saúde
Usuários
Cadastrados
Cadastros de Usuários
AtualizadosDIGITADO SIGA 2004 18.074 1.923
Carga Inicial Set-04 2.535.175TOTAL 2004 c/ Carga 2.553.249DIGITADO SIGA 2005 2.130.158 235.717
Cargas 2005 5.227.269TOTAL 2005 c/ Cargas 7.357.427
TOTAL GERAL c/ Cargas 9.910.676 237.640DIGITADO SIGA 2006 2.370.437 753.810
TOTAL GERAL c/ Cargas 12.281.113 991.450DIGITADO SIGA 2007 1.868.745 1.370.810
TOTAL GERAL c/ Cargas 14.149.857 2.362.260TOTAL SIGA 2008 2.765.978 7.387.378
TOTAL GERAL c/ Cargas 16.915.835 9.749.638DIGITADO SIGA 2009 1.685.532 10.532.224
TOTAL c/ Cargas 18.601.368 20.281.862
Cadastro Cartão Nacional de Saúde - CNS - SUS - SIGA
Fonte: Prodam (SIGA) / Junho 2010
High Cost/Complex Procedure (APAC) 2005 -2009Paper X Electronic
Source: SMS-SP, Assessoria de Informática, July 2010
How IT can support MDG4 and 5 goals and really make a difference???
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
Source:http://archive.student.bmj.com/issues/03/04/news/93b.php
Paulistana Mother
• A program created by São 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.
If your name is not in our list, we’re goingkeep calling you….
Source: Diario de São Paulo, July 25th Pg. 53
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
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
ANO 1980 1990 2000 2002 2004 2006 2007 2008COEFICIENTESMORT. INFANTIL GERAL 50,62 30,90 15,80 15,10 13,96 12,86 12,54 11,99
MORT. INF. POS-NEONATAL 25,31 11,87 5,49 4,97 4,73 4,59 4,36 4,00
MORT. NEONATAL TOTAL 25,31 19,03 10,30 10,13 9,23 8,27 8,18 7,98
MORT. NEONATAL PRECOCE 18,29 15,36 7,70 7,27 6,31 5,74 5,46 5,60
MORT. NEONATAL TARDIA 7,03 3,67 2,60 2,86 2,91 2,53 2,72 2,38
MORT. PERINATAL 30,46 23,80 17,41 16,51 14,00 12,60 11,67 12,72
NATIMORTALIDADE 12,40 8,57 9,78 9,31 7,73 6,90 6,24 7,16
TAXA DE NATALIDADE** 28,23 20,71 19,90 17,56 17,19 16,07 15,77 15,89
NASCIDOS VIVOS 239.262 196.985 207.462 185.417 183.883 173.901 171.602 173.799FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE).* Coeficiente por 1.000 nascidos vivos (NV).**Por mil habitantes
EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008.
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
SIGA Saúde: 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
Next Steps for SIGA Saúde
• 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
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
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 Saúde 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…
Thanks!! Questions?
Heloisa Helena Andreetta Corral [email protected]
Maria Aparecida Orsini [email protected]
Beatriz de Faria Leão [email protected]