Transcript SIGA Saúde São Paulo City`s Health Information System

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
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 System
Special thanks to
Heloisa Helena Andreetta Corral
Informatics Advisor SMS-SP
And
Maria Aparecida Orsini, MD
Director Paulistana Mother Program
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.
SIGA
Saúde is present in 100% (704) of
The system belongs to São Paulo
City, which
willing to
share
it with health care providers
SãoisPaulo
City
public
other cities, states and countries.
SIGA Saúde has been
developed using
free-software open-code concepts.
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
Volumes per HC Region in the City
East Region
North Region
Casa Verde
16
Freg/Brasilandia
26
15 million patients
in the database
9
Perus
Tiradentes
15
E. Matarazzo
18
Guianases
20
Itaim
Paulista
22
Itaquera
31
Pirituba
25
São Mateus
28
Santana
20
São Miguel
24
Tremembe/Jacana
13
V Maria/V
Guilherme
18
Population:
2,136,977
Population:
2,396,940
Southeast Region
South Region
Campo Limpo
CenterEast Region
29
Cidade
Ademar
20
Boi Mirim
34
Aricanduva
12
Ipiranga
29
Jabaquara
13
Mooca
25
Butantã
27
Lapa
29
Socorro
24
Penha
29
Pinheiros
14
Sto Amaro
20
V Mariana
31
Sé
36
Population:
1,244,456
Parelheiros
Population:
2,402,093
9
Population: 36
V Prudente
2,499,294
Examples of Primary Care
Units in São Paulo
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
SIGA Saúde Conceptual Model
Nacional
Registry
Hospitals and
Healthcare Units
Domain Tables
and Vocabularies
HC Workers
Users (Patients)
Electronic Health
Record
Exams
Emergency
Primary
Care
Specialties
Beds
Consultations
Assessment
Emergency
Exams
Authorization
A
c
c
e
s
s
Inpatients
HC Services
Management
Flow Control
Billing
Health
Surveillance
R
o
l
e
b
a
s
e
d
Auditing
C
o
n
t
r
o
l
SIGA Saúde Deployment Strategy
Health
Information
Adm / Manag. DSS
2007
2011
Medical
Images
Lab Integration
pilot project in 3 units 2010
HIS
Auditing
EHR
Surveillance
Medication at Home
Authorization
processing of
2004
high-cost,
- high-complexity
2007
procedures
369 thousand
(2009)
2004
HR capacity
Infra-structure
112 thousand
prescriptions 2009
Medication
2 Million
med/month
Specialized
Scheduling Consultations
Scheduling
745 HC
Units
2.2 M (2009)
12 M
2009
15.669.823
National Health
Patient Registry
Capturing
Encounter
Information
5 M in
408 HC
units
(2009)
National Health Care
Providers Registry
Ensuring Equity and Integrality of Care
axes
Patient Flow Organization & Control
Polyclinic
Physician
Office
University
Hospital
Public
Hospital
Diagnostic
Center
Primary
Care Unit
Entry Level
Specialties
Physician
Office
Physician
Office
Primary Care
Diagnostic
Center
Primary
Care Unit
Primary
Care Unit
Medium Complexity
Private
Hospital
Counter-reference
Electronic Health Record
High Complexity - Hospitals
SIGA Saúde IT Model
Management
SMS-SP
(Surveillance, Auditing
and Billing)
Dept of
Health
Internet
Patient Flow
Organization & Mngmnt
(Specialties, Beds, Exams)
Electronic Health Record
SP City
Datacenter
Access Control
SIGA Saúde: Project Timeline
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•
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•
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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
Opening Screen in 2005
Opening Screen in June, 2008
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
Notifiable Diseases Report
National Health Card Registry
São Paulo city - SIGA Saúde
Cadastro Cartão Nacional de Saúde - CNS - SUS - SIGA
Usuários
DIGITADO SIGA 2004
Carga Inicial Set-04
TOTAL 2004 c/ Carga
DIGITADO SIGA 2005
Cargas 2005
TOTAL 2005 c/ Cargas
TOTAL GERAL c/ Cargas
DIGITADO SIGA 2006
TOTAL GERAL c/ Cargas
DIGITADO SIGA 2007
TOTAL GERAL c/ Cargas
TOTAL SIGA 2008
TOTAL GERAL c/ Cargas
DIGITADO SIGA 2009
TOTAL c/ Cargas
Cadastrados
18.074
2.535.175
2.553.249
2.130.158
5.227.269
7.357.427
9.910.676
2.370.437
12.281.113
1.868.745
14.149.857
2.765.978
16.915.835
1.685.532
18.601.368
Cadastros de
Usuários
Atualizados
1.923
235.717
237.640
753.810
991.450
1.370.810
2.362.260
7.387.378
9.749.638
10.532.224
20.281.862
Fonte: Prodam (SIGA) / Junho 2010
High Cost/Complex Procedure (APAC) 2005 -2009
Paper X Electronic
Source: SMS-SP, Assessoria de Informática, July 2010
MDG 5: improve
maternal health
•Target 5.A. Reduce by
three quarters, between
1990 and 2015, the
maternal mortality ratio
Source:
http://archive.student.bmj.com/issues/03/04/news/93b.php
•Target 5.B. Achieve, by
2015, universal access
to reproductive health
How IT can support MDG4 and 5 goals
and really make a difference???
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 going
keep calling you….
Source: Diario de São Paulo, July 25th Pg. 53
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
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
EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008.
ANO
1980
1990
2000
2002
2004
2006
2007
2008
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
183.883
173.901
171.602
173.799
NASCIDOS VIVOS
239.262 196.985 207.462 185.417
FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE).
* Coeficiente por 1.000 nascidos vivos (NV).
**Por mil habitantes
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
SIGA’s
evaluation
http://vitalwaveresearch.com/healthit/
SIGA evaluation
http://vitalwaveresearch.com/healthit/
SIGA evaluation
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
http://www.sdmx-hd.org/wiki/expert
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]