health information systems in brazil
DESCRIPTION
Health Information Systems in Brazil. Beatriz de Faria Le ão, MD, PhD Claudio Giulliano da Costa, MD, MSc Jussara Macedo Pinho Rötzsch, MD, MSc Lincoln de Assis Moura Jr, MSc, DIC, PhD Marivan Santiago Abrah ão, MD. The Brazilian Delegation. - PowerPoint PPT PresentationTRANSCRIPT
Health Information Systems in Brazil
Beatriz de Faria Leão, MD, PhD
Claudio Giulliano da Costa, MD, MSc
Jussara Macedo Pinho Rötzsch, MD, MSc
Lincoln de Assis Moura Jr, MSc, DIC, PhD
Marivan Santiago Abrahão, MD
2Jan-07
The Brazilian Delegation
Claudio Giulliano A. da Costa - CIO São Paulo City Health Authority, Treasurer Brazilian Health Informatics Association (www.sbis.org.br)
Jussara Macedo P. Rötzsch - General Manager of Standards - National Agency for Supplementary Health (www.ans.gov.br)
Marivan Santiago Abrahão - Brazilian HL7 Chair, Coordinator of the Health Users Group of São Paulo Society of Computers Users
Beatriz de Faria Leão - Consultant Health Informatics, Coordinator Standards and Software Certification Brazilian Health Informatics Association
3Jan-07
Agenda
Brazil - the “soft power” Brazilian Telehealth Program Health Informatics and Standards in Brazil The Brazilian Standard to Exchange Information between
Healthcare Providers and Payers São Paulo City Health Information System: SIGA Saúde The Role of HL7 in Brazil Next Steps
Brazil: “Soft Power”- Emerging Giant
5Jan-07
Some Facts about Brazil
9th Largest Economy in the World 190 million Inhabitants Larger than Continental USA It is a Country of Huge Contrasts:
• some top quality institutions and • a very bad income distribution, though improving
22 million Internet users today, some 5M with broadband access e-business:
• 5th largest market in e-business• U$15Bi in e-commerce in 2005
95% of IRS Tax Return Forms on the Web Voting System is 100% Electronic
• More than 100 million voters• Recent National Election Results in Less than 12
hours
6Jan-07
Brazil – Geo-political Perspective
The largest country in Latin America
The only Portuguese-speaking country in LA (52% of South America speak Portuguese)
The 5th most populated country in the World
The 2nd country in number of Internet hosts in America
7Jan-07
Brazil Strategic Data
Mercosul Gateway: borders with 9 countries (Argentina, Bolivia, Colombia, French Guiana, Guyana, Peru, Surinam, Uruguay, and Venezuela);
World's largest producer of regional jets, 3rd in shoes and soft drinks, 4th in commercial aircraft, 8th in steel, 10th in automobiles;
Largest livestock in the world
Latin America's largest forestry-based industry;
5th world rubber industry, and the 7th-largest paper and pulp industry;
World's 6th-largest market for cosmetics, with annual sales of US$ 9 billion.
A modern and competitive textile complex, with 30,000 companies and annual sales of US$ 21 billion.
22% of the world's arable land surface.
The most advanced banking system and one of the most high-tech telecommunications systems in the world. In Brazil, 99% of tax returns are filed over the internet
The world largest fresh water resource
9Jan-07
Healthcare Challenges in Brazil
Increasing demand for health care (aging, emerging of new diseases, re-emerging of considered overcome diseases)
Skyrocketing healthcare costs (Health Technology) Inefficiency Paper base uncoordinated system, multiple formularies Lack of adequate information to support decision making, quality of
care evaluation and to monitor disease management programs; Lack of common health and healthcare information standards
within the sector Failed attempts of bottom-up standardization
10Jan-07
SUS – The Brazilian Health System
Universal Access Health is a Right of All (~ 145M individuals)
Full Coverage, Free of Charge All Services and Procedures
SUS principles: Equity Universality Integrality
Funding and Management are Shared Federal, State and Municipal Levels
Suplementary Health for Those Wiling to Pay ~ 2,000 HMOs (~ 45M individuals) ANS (Agência Nacional de Saúde Suplementar) Regulates the Sector
11Jan-07
The Brazilian Healthcare Market
Extremely Fragmented Market: ~ U$ 90B/year SUS is the major Payer: ~ 66% in volume and some 50% in $ 190M inhabitants, spread over 5.500 cities Around 7,500 Hospitals and 2,000 Health Plan Operators (HMOs) 70% of Hospitals have less than 80 beds Estimate that only 10% of Hospitals have Information Systems 90% HMOs cover less than 50,000 lives each Only 3% of HMOs cover more than 200,000 each The largest HMO covers less that 4M lives There is no important network of Health Organizations Lack of notion of production chain, added value and best practices National Standards on their way It’s a “Market of Discontent”
Fragmented and Uncoordinated Market
Small and Badly Connected Players!
Little Investiment in
Management and IT
12Jan-07
SUS Organization & Financing
State Dept of Health
City City City City City City
LocalManagement
NationalHealth Council
State Health Council
Municipal Health Council
MunicipalHealth Fund
Tri-party &Bi-party
Committees
Tri-party &Bi-party
Committees
National Health Fund
$$$$
Info
rmat
ion
Informatio
n
State Dept of HealthState Dept of HealthState Dept of Health
$$
Dept o Health (Federal Govrnt)
13Jan-07
SUS – Negotiation
City
BigCity
CityCity
City
City
City
State
PPI: Agreed and Integrated Covenant Distribution of Health Resources based on Health Indicators and Benchmarking
PPI: Agreed and Integrated Covenant Distribution of Health Resources based on Health Indicators and Benchmarking
14Jan-07
Patient Flow Control (“Regulation of Care”)
Polyclinics DiagnosticCenter Specialty Center Clinic
PrimaryCare Unit
PrimaryCare Unit
PrimaryCare Unit
PrimaryCare Unit
PrimaryCare Unit
PrivateHospital
UniversityHospital
CharityHospital
Primary Care Primary Care
High Complexity - HospitalsHigh Complexity - Hospitals
coun
ter-
refe
renc
e
referênciaregio
nalizatio
n
Med
ium
Com
plex
ityM
ediu
m C
ompl
exity
PrimaryCare Unit
referência
Patient Flow Control
Ele
ctr
on
ic H
ea
lth
Re
co
rd
Entry Level
Entry Level
axes
15Jan-07
Health Informatics Trends in Brazil
Electronic Health Record Unique Identifier for Patients and HC Workers Know the Patient – Follow Up Treatment Decision Support at Point of Care
Patient Flow Control (Regulation) Operate the Reference – Counter-Reference Model Find Fast and Resolving Pathways Unique Identifiers Health Care Units Management HIS
Conectivity Integrate Clients – In and Outside the Organization HMOs, HC Providers, Clients and Authorities Public x Private Integration
Health System Management Surveillance and Control Strategic and Tactic Decision Support Operation of the Healthcare System
Ministry of Health
Brazilian Telehealth Program
Franciso Eduardo Campos Laboratory of Excellence and Innovation
in e-Health Latin America and Europe
- I Workshop
Belo Horizonte – Minas GeraisNovember 2006
Ministry of Health
Tele-health National Project
Promote the use of technology by the Family Health teams
Decrease the number of patients sent to secondary level
Evaluate different technologies, methodologies and costs Improve quality of primary care Leads to money-saving (preliminary
figures are 100:1)
18Jan-07
Telehealth points in Brazil for 2007
Participation of all Brazilian States
Points of Telehealth
Ministry of Health
Ministry of Health
“FOR DECADES IN A ROW BRAZILIAN’S POLITICAL DECISION HAS BEEN TO
BUILD STEADLY A STRONG UNIVERSAL AND EQUITATIVE HEALTH SYSTEM.
TELE-HEALTH IS PART OF IT”
20Jan-07
Brazilian HC National Standards
Unique HC Identifiers Individual HC providers and professionals
Content and Vocabularies Essential Encounter Dataset Diagnostics (ICD-10), Procedures Immunization Charts Birth and Death National Registries (> 50 years) Notifiable Diseases ( Work related, external causes and
communicable diseases) Hospital Discharge Summaries High Complexity Utilization Reports
21Jan-07
Brazilian HC National Standards
TISS – Private Health Information Exchange Content, Vocabularies and Data Transmission XML based Enforces Data Confidentiality and Privacy Simplifies Data Exchange Between Providers and Payors
Security National PKI infrastructure
Software Certification Brazilian Health Informatics Society +
Federal Medical Council
22Jan-07
Brazilian HC National Standards: National Unique Identifiers:
Individuals (116 million people uniquely identified)
Healthcare providers (153.903 uniquely identified) Includes information on:
– Medical specialties, number of beds, equipments, private and public distribution, complexity level,
– Health professionals (physicians, nurses and administrative personnel)
– 1.5 million healthcare professionals uniquely identified
23Jan-07
Brazilian National Health Providers and Professionals Registry - www.datasus.gov.br/cnes
Private Healthcare Insurance Market
45.408.621beneficiaries
HPOS
1.891active Health Plan
Organizations
600.000 estimated Healthcare providers
Sources; NShA 2005/08 CNES 2005/08
ANSState Regulation
Self-regulation
NHS Healthcare providers
NSHA DATABASE (enroll/disenrollments , services utilization, health care indicators)
Demographics, Vital Statistics, Discharge Summary, Notifiable
Diseases
HMOS TISS - XMLTISS - XML
TISS - the Brazilian standard for HPOs and HC providers communication
26Jan-07
TISS standards: Building the Consensus
August 2004 ANS prepared the first version of TISS standards
August 2004 – January 2005 Meetings with stakeholders (HPO, health providers and managers)
February 2005 a two-month public comment
Oct 26th 2005 Standard was published ANS Rule 114 TISS
February 2006 Creation of the National Health Information Standards Advisory
Committee 21 members representatives of all sides involved and five
subcommittees: steering group, terminology, information structure, messaging, privacy
any modification to the standard only after 12-month period beginning at the date the standard is initially adopted
27Jan-07
TISS standards
Information structure: billing formularies Consultation Hospital Discharge Lab, Medical Images Authorization for High Cost and High Complexity Procedures
Core Health Terminologies and Code Sets (e.g ICD-10)
Messaging: XML schemas and Web services
Privacy: ISO/NBR 17799 and SBIS/CFM Software Certification
Mandatory from May 2007 on
28Jan-07
TISS Transactions
PROVIDERS HPOS
Eligibility and prior Authorization
Claim Generation Service Billing
Claim Status Inquiries
Pre certification and Adjudication
Claims Acceptation
Adjudication
Accounts Receivable
Health care Services Delivery
Claims
Claim Status Inquiry
Patient Info
Claim Status Resp.
Claim PaymentAccounts Payable
29Jan-07
TISS schemas
30Jan-07
TISS Implementation Policy
In order to facilitate TISS compliance, ANS provides: Opensource software prototype to generate the electronic
messages
XML EDI Management software (TISS-NET)
E- learning training
Workshops to interested HPOs and Healthcare providers during
the implementation
31Jan-07
TISS Expected Results
Efficiency and effectiveness Improvement of the health care sector in general
Reduction of administrative costs
Enhancement of healthcare quality
Increase ability to develop quality measures and facilitate
implementation of disease management programs
32Jan-07
TISS: What have we learned so far?
Stakeholders Involvement was a critical success factor
ANS governance and support was a key factor
TISSnet helps implement the standards
COPISS, ANS´s Standards Committee, is now the Forum
where the standard evolves
The market is willing to move to the electronic transactions
The project received a national award for fostering e-business
Alignment with the national e-Health initiative
33Jan-07
TISS Challenges
Change management requirements Staff and resource demands — both for data submissions and in
using the data Completeness and quality of the database Provider limitations (e.g. lack of automation, high staff turnover) Sustainable financing and how to equitably share the burden of
funding the project Implementation timeline Legislation issues – privacy protection legislation
Sao Paulo City Health Dept
Information Technology Coordination
São Paulo is a very large City..
São Paulo is a Cosmopolitan City
São Paulo is a City full of Contrasts
East Region
Tiradentes 15
E. Matarazzo 18
Guianases 20
Itaim Paulista 22
Itaquera 31
São Mateus 28
São Miguel 24
Campo Limpo 29
Cidade Ademar 20
Boi Mirim 34
Parelheiros 9
Socorro 24
Sto Amaro 20
Aricanduva 12
Ipiranga 29
Jabaquara 13
Mooca 25
Penha 29
V Mariana 31
V Prudente 36
Southern 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
Medium-West Region
Butantã 27
Lapa 29
Pinheiros 14
Sé 36
Population: 2.136.977
Population: 2.396.940
Population: 2.499.294
Population: 2.402.093
Population: 1.244.456
10.679.760inhabitants
39Jan-07
9.640.906Primary CareEncounters
11.027.517Medical
Emergencies164.704.060
Medical Procedures
10.347.595SpecializedEncounters
592.992Hospital
Admissions
Health Public Sector Figures for São Paulo City / 2005
Fonte: SIA/SUS - SIH/SUS – CNES/MS 2005
40Jan-07
SIGA Saúde – SP City Information System
SIGA Saúde is São Paulo City’s Integrated and Distributed System for Managing the Public Healthcare
System.
It belongs to the Brazilian Dept of Health and SP City
SIGA Saúde has been developed using open-source free-software concepts.
São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area.
Basic Figures: 400 Primary Care Units 60 Policlinics 160 Hospitals 11M Users 8.5M Emergency T/year 550k Inpatients/year 11M Primary Care C/year
41Jan-07
SIGA Saúde Essentials
National HC User Identification (Cartão SUS) Identifies Patient Uniquely, according to the National Standard
National Registry of Workers & Providers Unique ID Relationships
Patient Flow Control Quote Distribution According to PPI and FPO Controls Flow Related to Specialties, Ancillary Exams and Procedures, and
In-patient Admission and Emergency
Ambulatory Electronic Health Record Integrates and Distributes the Essential Dataset Embodies Intelligence
(such as mandatory notification of diseases)
Role-based Integrated Access Control System Access Authorization based on User Profile Single Sign-On
System is on-line, 100% open, based on Internet ArchitectureSystem is on-line, 100% open, based on Internet Architecture
43Jan-07
SIGA Saúde – Schematics
Ambulatory Electronic Health Record
(Primary, Specialties, High Complexity)
Patient FlowControl
(Consultations, Procedures, Beds)
Heath Care
Management(Surveillance, Audit and Billing)
Internet
SMS-SP
Dept of Health
Secure AccessSecure AccessDatacenter
44Jan-07
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
45Jan-07
SIGA Saúde now
372 using the system via Internet (85% of all Primary Care units) 11,878,294 individuals are registered (uniquely identified) 12,000+ medical appointments daily 20,000 on-line authorizations for high cost procedures per month Two Units Using the Electronic Health Record module (pilot
project)
46Jan-07
Manual vs Electronic High-Cost Procedure Orders
Electronic Manual / Paper-based
47Jan-07
Our current challenges
Improve internet connectivity of health basic units
More investment in development and infrastructure
Integration with the National Health Information system
Partnership with other cities and, perhaps, countries
Wish List:
Hospital Information System
Orders/Observations Lab (using HL7!!!)
48Jan-07
Integration Model of System
ElectronicHealthRecord
(SIGA System)
HospitalInformation SystemW
ebservices
LabSystems*
PACS(Medical Images)
NationalInformation
Systems
HL7
* Only six months to implementWhat do we need ?• Education in HL7 (orders/obs)• Translation LOINC
HL7
HL7
49Jan-07
Java One 2005 Video
50Jan-07
Conclusion
SUS is Modeled and Based on a Recognised Model Deployment of SUS is not homogeneous throughout the Country Dire need for Information Systems Dept of Health Systems are very Fragmented Dissociation between Dept of Health Policies and Practices
National Standards Fastly Improving National Health Card, Essential Dataset, CNES and TISS are very recent
Internet-based Information Systems Gain Acceptance Safety, Privacy and Confidentiality are Deemed Essential Some Trend to Use Open and Free Software Trend to Create Comunities that Share SW Development
Interoperability is Recognized as Essential Integration with Existing Systems (XML / HL7)
Trend to Integrate SUS and the Private Health System Watch Out for TISS!!
HL7 Role in Brazil
Main IssuesFoster international Collaboration
Harmonize HL7 to Brazilian HC Standards
Understand and Discuss Policy and Bylaw
Organize Local Meetings
Promote HL7 Training
Establish liasons with: Brazilian Tele-health Committee ANS - National Agency for Supplementary Health SBIS - Brazilian Health Informatics Association
Priorities for HL7 in Brazil
Lab integration
Hospital Discharge
Compliance with TISS
Compliance with the national HC standards for the public
sector
Training and Education
www.hl7brazil.org
55Jan-07
Amazon’s pirarucu and the pink dolphin
Obrigada!
Thank you!
Hope to welcome you there!
Danke schön, bis Köln!