faculdade de medicina da universidade do porto

Current State of Current State of Informatic Infrastructures Informatic Infrastructures in Portuguese health in Portuguese health centers and its evolution centers and its evolution since 2002since 2002

Faculdade de Medicina da Universidade do Porto

Introdução à Medicina

December 2005

João Alhais; João Gonçalves; João Neves; João Rodrigues; João Alhais; João Gonçalves; João Neves; João Rodrigues; Jorge Ferreira; Jorge Rodrigues; Vanessa RodriguesJorge Ferreira; Jorge Rodrigues; Vanessa Rodrigues

Class 12

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ContentsContents

ObjectivesObjectives IntroductionIntroduction Material and methodsMaterial and methods GreetingsGreetings

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ObjectivesObjectives

1.1.stst - To determine the informatic - To determine the informatic resources in Portuguese health resources in Portuguese health centers;centers;

2.2.ndnd - To compare the results we will - To compare the results we will obtain with those from a previous obtain with those from a previous research (2002); research (2002);

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3.3.rdrd - To analyze the evolution - To analyze the evolution within this 3 year period; within this 3 year period;

4.4.thth - To study the utility of the - To study the utility of the informatic resources on the informatic resources on the several health centers; several health centers;

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5.5.thth - The role of electronic - The role of electronic medical records;medical records;

6.6.thth - To determine the main - To determine the main

barriers to the implementation of barriers to the implementation of efficient informatic infrastructures efficient informatic infrastructures and define ways and strategies to and define ways and strategies to overcome them. overcome them.


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IntroductionIntroduction

Problem definition:Problem definition:– SStudy the current state (existence and tudy the current state (existence and

accessibility) of accessibility) of the informatic the informatic infrastrutures infrastrutures in Portuguese health in Portuguese health centres, centres, wwe’ve based on a study made in e’ve based on a study made in 2002.2002.

– ComparingComparing the previous results with the previous results with those obtained now, we will come to a those obtained now, we will come to a conclusion on the evolution within this conclusion on the evolution within this period.period.

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BackgroundBackground::

– In Portugal there are 391 Health In Portugal there are 391 Health centers;centers;

– and 19and 19441 health centers extensions;1 health centers extensions;– In the last decades it has been In the last decades it has been

registed a great evolution in the registed a great evolution in the informatic infra- -structuresinformatic infra- -structures. .

Cabral, Villaverde, Saúde e doença, em Portugal, Lisboa, ICS, 2002


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Health Centers (n=48) MedianInscribed Patients 13000

Doctors 8

Computers 8

Computers with Internet connection 1

Computers used for Booking purposes 5

Computers with Computerized Patient Records 0

Study realized in 2002 by S. João Biostatics department


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Low development in the use of Low development in the use of the informatic technologies in the informatic technologies in 2002.2002.

No data is available No data is available to the public to the public about the present state of the use about the present state of the use ooff informatic technologies in informatic technologies in primary care.primary care.

Relatório da OCDE; HIT do Observatório Europeu.


1010

Hospitals

Health centersHealth centers

extensions

Pharmacy

Medicine post

With internmen

t

Without internmen

t

NºPortugal 217 76 315 1941 2566 331

North 64 21 103 445 757 55

Center 55 14 95 776 655 126

Lisbon 63 2 52 173 718 13

Alentejo 11 16 43 340 244 99

Algarve 8 7 9 68 104 8

Azores 8 13 4 102 46 19

Madeira 8 3 9 37 42 11


http://www.ine.pt Neves

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Concepts/Teorical suports:Concepts/Teorical suports:


Medical InformaticMedical Informatic– The field of information science concerned The field of information science concerned

with the analysis and dissemination of with the analysis and dissemination of medical data through the application of medical data through the application of computers to various aspects of health care computers to various aspects of health care and medicineand medicine 11

– ApplicationsApplications design of decision support for practitionersdesign of decision support for practitioners development of computer tools researchdevelopment of computer tools research study of the very essence of medicine study of the very essence of medicine 22 1 - www.hon.ch/HONselect/Selection_pt/L01.700.html

2 - http://im.med.up.pt/informatica_medica/informatica_medica.html

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– SNS – SNS – Sistema Nacional de Saúde (NHS - Sistema Nacional de Saúde (NHS - National Health System) National Health System)

– Primary Health CarePrimary Health Care:: medical care medical care access on health centersaccess on health centers

– IGIFIGIF - Instituto de Gestão Informática e - Instituto de Gestão Informática e Financeira da Saúde (Informatic and Financeira da Saúde (Informatic and financial management Insitute)financial management Insitute)


http://im.med.up.pt/epr/

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SONHO - Sistema de Gestão de Doentes SONHO - Sistema de Gestão de Doentes Hospitalares (Management system of Hospitalares (Management system of hospital patientes)hospital patientes)

– Integrated system of hospital information.Integrated system of hospital information.– Having as data management base the Oracle, version Having as data management base the Oracle, version

7.3;7.3;– Assumes a fundamental role in administrative Assumes a fundamental role in administrative

information on the patient management registration.information on the patient management registration.– Was created in order to satisfy the organization Was created in order to satisfy the organization

needs of the end of the 80’s and beginnings of 90’s in needs of the end of the 80’s and beginnings of 90’s in the NHS.the NHS.


http://www.igif.min-saude.pt/upload/igif/img/Enq-SAM-SAPE.pdfhttp://www.algebrica.pt/i_s/bo2/data/upimages/Castanheira-Jornadas.pdf

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SINUS SINUS - Sistema de Informação para as - Sistema de Informação para as Unidades de Saúde (Informatic system Unidades de Saúde (Informatic system for Health unities)for Health unities)

– Similar system to SONHO, for all Similar system to SONHO, for all primary health care.primary health care.



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SAM - Sistema de Apoio ao Médico SAM - Sistema de Apoio ao Médico (Medical Support system)(Medical Support system)– System guide to the doctor’s activity, based System guide to the doctor’s activity, based

on the clinical-administrative information on the clinical-administrative information processed on SINUS.processed on SINUS.

– Developed on Web technology (graphic Developed on Web technology (graphic interface) and wireless technology.interface) and wireless technology.

– The health professionals that will have access The health professionals that will have access to this system as well as its manipulation will to this system as well as its manipulation will be only doctors – each doctor will have his be only doctors – each doctor will have his own access profile.own access profile.



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– EHR - Electronic Health RecordEHR - Electronic Health Record A general term describing computer-A general term describing computer-

based patient record systems. It is based patient record systems. It is sometimes extended to include other sometimes extended to include other functions like entry order for functions like entry order for medications and tests, amongst other medications and tests, amongst other common functions;common functions;

http://im.med.up.pt/epr/David W. Bates, MD et al. A Proposal for Electronic Medical Records in U.S. Primary Care. JAMIA. Jan / Feb 2003

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Is basically a facility that retrieves patient Is basically a facility that retrieves patient data from a number of information data from a number of information systems and presents the data in a systems and presents the data in a coherent way to the authorised user;coherent way to the authorised user;



– will become a major support tool will become a major support tool in health care deliveryin health care delivery;; EPR - Electronic Patient Record EPR - Electronic Patient Record CPR - Computer-based Patient Record CPR - Computer-based Patient Record EMR - Electronic Medical Record EMR - Electronic Medical Record CMR - Computerised Medical Record CMR - Computerised Medical Record

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EHR – Benefits EHR – Benefits

– Easier access to information (ex: allows Easier access to information (ex: allows the simultaneous access from different the simultaneous access from different localizations). localizations).

– Faster access to information. Faster access to information. – Better protection of the information than Better protection of the information than

in the paper system. in the paper system. – Actualized information.Actualized information.



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– Allows having a clinical process with Allows having a clinical process with all the patient clinical information.all the patient clinical information.

– Precision in informationPrecision in information– Variety on ways of visualizing data. Variety on ways of visualizing data. – Decision support. Decision support.



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– Possibility of data analysis. Possibility of data analysis. – Possibility of clinical information Possibility of clinical information

exchange, among speciality and exchange, among speciality and primary care, allowing the existence primary care, allowing the existence of shared health care. of shared health care.

– More respected regulations.More respected regulations.



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EHR – DisadvantagesEHR – Disadvantages

– Data Data introduction initiallyintroduction initially slower. slower.– Need Need specific formationspecific formation from the from the

health professionals. health professionals. – Dispends on initial resources in Dispends on initial resources in

training and education. training and education.



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– Requires constant actualization of Requires constant actualization of the knowledge. the knowledge.

– Low flexibility on the limits Low flexibility on the limits demanded for information access.demanded for information access.

– Very stricted style of the reports.Very stricted style of the reports.



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– The records may be lost if the The records may be lost if the correct procedure isn't followed.correct procedure isn't followed.

– Sometimes electronic records aren't Sometimes electronic records aren't available, which doesn't happen with available, which doesn't happen with paper records. paper records.

– Security break problems. Security break problems.



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“ “Better use of Better use of information technology is information technology is essential to provide essential to provide better care at lower better care at lower cost”cost”


BATES et al.,A Proposal for Electronic Medical Records in U.S. Primary Care

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Material and MethodsMaterial and Methods

75 health centres:75 health centres:– 50 (out of 352) aleatorily chosen in 50 (out of 352) aleatorily chosen in

2002.2002.11

– 25 (out of 341: 391-50) also 25 (out of 341: 391-50) also aleatorily selected.aleatorily selected.22

The inquiries will be made in two The inquiries will be made in two stages:stages:– 11stst stage: telephonic inquest to the stage: telephonic inquest to the

75 H.C. directors75 H.C. directors1 - Study realized in 2002 by S. João Biostatics department2 - http://ine.pt

Custoias start

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– 22ndnd stage: letter stage: letter or fax or fax inquests (to inquests (to send back anonymously – they send back anonymously – they include a return envelop)include a return envelop)

Informatic system implementation planning Informatic system implementation planning strategies.strategies.

Difficulties.Difficulties. Possible ways to overcome them.Possible ways to overcome them.

The inquiries are much alike those from The inquiries are much alike those from 2002, in which we’ve based on.2002, in which we’ve based on.

We added 25 extra H.C. with the We added 25 extra H.C. with the purpose purpose to validateto validate the study. the study.

Material and MethodsMaterial and Methods

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352 Health Centers (2002)

391 Health Centers (2005)

50 Health Centers

Simple Aleatory Selection

25 Health Centers

Already included341 Health

Centers

Simple Aleatory Selection

Sample of study: 75 Health Centers

FlowchartsFlowcharts

Custoias

2828

Articles obtained in the bibliographical research

n=1076

Articles excluded for the review

n=1016

Revision through headings and

abstracts

Excluded articles

n=36

60 articles

24 articles

Revision through complete article

n=11

Incompleted Articles

Excluded articles

n=13

Articles excluded for the content

n=5

Used articles in the introduction of the work

n=6

Vanessa Iolanda start

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MeSH TermsMeSH Terms

Medical Records;Medical Records; Primary Health Care; Primary Health Care;

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Gantt’s MaGantt’s Mapp

Vanessa fim

3131

GreetingsGreetings

We have to thank professor Luís We have to thank professor Luís Azevedo, whose help has been Azevedo, whose help has been essencial. essencial.

faculdade de medicina da universidade do porto

Documents

sade informatic

health centers extensionsin

health centersand

informatic resources

informatic infrastrutures

portuguese health centres

portuguese health centers2

use of informatic technologies