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SIGA Sa úde São Paulo City Health Information System July 30, 2010

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.

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SIGA Sa úde São Paulo City Health Information System July 30, 2010

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  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, PhDHealth 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 (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 SaúdeSão 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 São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area. 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 usingfree-software open-code concepts. 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 15 million patients in the database NorthRegion Population: 2,396,940 Southeast Region Population:2,136,977 South Region CenterEast Region Population:2,499,294 Population:2,402,093 Population: 1,244,456

  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 Role-based AccessControl NacionalRegistry Domain Tablesand Vocabularies Hospitals and Healthcare Units Users (Patients) HC Workers Electronic HealthRecord Exams Emergency Primary Care Inpatients Specialties HC Services Management Flow Control Assessment Beds Emergency Billing HealthSurveillance Consultations Exams Authorization Auditing

  13. 2004 -2007 Authorization processing of high-cost, high-complexity procedures Medication Medication at Home 112 thousand prescriptions 2009 745 HC Units 12 M 2009 2 Millionmed/month 5 M in 408 HC units (2009) 2.2 M (2009) 369 thousand (2009) SIGA Saúde Deployment Strategy Health Information 2007 -2011 Adm / Manag. DSS Medical Images HIS Auditing Lab Integrationpilot project in 3 units 2010 EHR Surveillance SpecializedConsultationsScheduling CapturingEncounterInformation Scheduling 15.669.823 2004 National HealthPatient Registry National Health CareProviders Registry HR capacity Infra-structure

  14. axes Patient Flow Organization & Control High Complexity - Hospitals Private Hospital UniversityHospital Public Hospital Reference Electronic Health Record Polyclinic Diagnostic Center Specialties DiagnosticCenter Counter-reference Medium Complexity regionalization Reference PhysicianOffice PrimaryCare Unit PhysicianOffice PhysicianOffice PrimaryCare Unit PrimaryCare Unit Entry Level Primary Care Ensuring Equity and Integrality of Care

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

  16. 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

  17. Opening Screen in 2005

  18. Opening Screen in June, 2008

  19. 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-ComplexityProcedure Order Form

  20. Notifiable Diseases Report

  21. National Health Card RegistrySão Paulo city - SIGA Saúde

  22. High Cost/Complex Procedure (APAC) 2005 -2009Paper X Electronic Source: SMS-SP, Assessoria de Informática, July 2010

  23. 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

  24. 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.

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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. SIGA’s evaluation http://vitalwaveresearch.com/healthit/

  32. SIGA evaluation http://vitalwaveresearch.com/healthit/

  33. SIGA evaluation

  34. 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

  35. http://www.sdmx-hd.org/wiki/expert

  36. 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…

  37. Thanks!! Questions? Heloisa Helena Andreetta Corral hcorral@PREFEITURA.SP.GOV.BR Maria Aparecida Orsini Maria.aparecida@uol.com.br Beatriz de Faria Leão bfleao@gmail.com

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