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 Panel: Renewal of Primary Health Care and the use of information technology
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Presentation VII Conference Global Network Collaborativa Centers
Presentation made at the VIII Conference of the Global Network of the World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery, São Paulo, July 2010
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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
• 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 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 12
Ipiranga 29
Jabaquara 13
Mooca 25
Penha 29
V Mariana 31
V Prudente 36
Southeast Region
North Region
Casa Verde 16
Freg/Brasilandia 26
Perus 9
Pirituba 25
Santana 20
Tremembe/Jacana 13
V 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
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
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
Scheduling
SchedulingMedication
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
• 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 2008COEFICIENTES
• 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