SIGA Saúde São Paulo City Health Information System

Transcription

1 Panel: Renewal of Primary Health Care and the use of information technology SIGA Saúde São Paulo City Health Information System July 30, 2010 Beatriz de Faria Leao, MD, PhD Health Informatics Consultant FUNDAP, São Paulo MOH Brazil - TeleHealth Program, Brasilia JEMBI, South Africa

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 ( e-business: 5th largest market in e-business U$15Bi in e-commerce in % 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 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 Saúde 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 São Paulo City public health care providers

7 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

8 Volumes per HC Region in the City East Region North Region Casa Verde 16 Freg/Brasilandia 26 Perus 9 Pirituba 25 Santana 20 Tremembe/Jacana 13 V Maria/V Guilherme 18 Population: 2,136,977 CenterEast Region Butantã 27 Lapa 29 Pinheiros 14 Sé 36 Population: 1,244, million patients in the database South Region Campo Limpo 29 Cidade Ademar 20 Boi Mirim 34 Parelheiros 9 Socorro 24 Sto Amaro 20 Population: 2,402,093 Tiradentes 15 E. Matarazzo 18 Guianases 20 Itaim Paulista 22 Itaquera 31 São Mateus 28 São Miguel 24 Population: 2,396,940 Southeast Region Aricanduva 12 Ipiranga 29 Jabaquara 13 Mooca 25 Penha 29 V Mariana 31 Population: 2,499,294 V Prudente 36

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 Hospitals and Healthcare Units Emergency Consultations Beds Primary Care Flow Control Exams Nacional Registry Emergency HC Workers Electronic Health Record Specialties HC Services Management Authorization Domain Tables and Vocabularies Inpatients Health Surveillance Users (Patients) Exams Assessment Billing Auditing R o l e - b a s e d A c c e s s C o n t r o l

13 SIGA Saúde Deployment Strategy Adm / Manag. DSS Health Information Medical Images HIS Auditing Lab Integration pilot project in 3 units 2010 EHR Surveillance Medication at Home Authorization processing of high-cost, high-complexity procedures 369 thousand (2009) HR capacity Infra-structure Medication 2 Million med/month 112 thousand prescriptions National Health Patient Registry Scheduling 745 HC Units 12 M 2009 Specialized Consultations Scheduling National Health Care Providers Registry Capturing Encounter Information 2.2 M (2009) 5 M in 408 HC units (2009)

14 Ensuring Equity and Integrality of Care axes Patient Flow Organization & Control High Complexity - Hospitals Electronic Health Record Counter-reference Polyclinic Private Hospital Diagnostic Center University Hospital Specialties Public Hospital Diagnostic Center Medium Complexity Physician Office Primary Care Unit Physician Office Physician Office Primary Care Unit Primary Care Unit Entry Level Primary Care

15 SIGA Saúde IT Model SMS-SP Management (Surveillance, Auditing and Billing) Dept of Health Internet Patient Flow Organization & Mngmnt (Specialties, Beds, Exams) Electronic Health Record SP City Datacenter Access Control

16 SIGA Saúde: Project Timeline January contract was signed September First deployment : 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

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20 Encounter Data Set Type of Attendance Special Programs Anamnesis, Physical Exam, History Diagnosis Disabilities Procedures carried-out Requested procedures Medications Course of Action Work-Related Diseases Communication Form Notifiable Diseases High-Complexity Procedure Order Form

21 Notifiable Diseases Report

22 National Health Card Registry São Paulo city - SIGA Saúde Cadastro Cartão Nacional de Saúde - CNS - SUS - SIGA Usuários Cadastros de Usuários Cadastrados Atualizados DIGITADO SIGA Carga Inicial Set TOTAL 2004 c/ Carga DIGITADO SIGA Cargas TOTAL 2005 c/ Cargas TOTAL GERAL c/ Cargas DIGITADO SIGA TOTAL GERAL c/ Cargas DIGITADO SIGA TOTAL GERAL c/ Cargas TOTAL SIGA TOTAL GERAL c/ Cargas DIGITADO SIGA TOTAL c/ Cargas Fonte: Prodam (SIGA) / Junho 2010

23 High Cost/Complex Procedure (APAC) Paper X Electronic Source: SMS-SP, Assessoria de Informática, July 2010

24 MDG 5: improve maternal health Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Source: Target 5.B. Achieve, by 2015, universal access to reproductive health How IT can support MDG4 and 5 goals and really make a difference???

25 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.

26 If your name is not in our list, we re going keep calling you. Source: Diario de São Paulo, July 25th Pg. 53

27 Paulistana Mother 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

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 EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A ANO COEFICIENTES MORT. 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 FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE). * Coeficiente por nascidos vivos (NV). **Por mil habitantes

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 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

32 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

33 SIGA s evaluation

34 SIGA evaluation

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

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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 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

39 Thanks!! Questions? Heloisa Helena Andreetta Corral Maria Aparecida Orsini Beatriz de Faria Leão