Faculdade de Medicina da Universidade do Porto

1. Faculdade de Medicina da Universidade do Porto Introdução à Medicina Current State of Informatic Infrastructures in Portuguese health centers and its evolution since 2002 João Alhais; João Gonçalves; João Neves; João Rodrigues; Jorge Ferreira; Jorge Rodrigues; Vanessa Rodrigues Class 12 December 2005

2. Contents • Objectives • Introduction • Material and methods • Greetings

3. Objectives • 1.st- To determine the informatic resources in Portuguese health centers; • 2.nd- To compare the results we will obtain with those from a previous research (2002);

4. Objectives • 3.rd- To analyze the evolution within this 3 year period; • 4.th - To study the utility of the informatic resources on the several health centers;

5. Objectives • 5.th- The role of electronic medical records; • 6.th- To determine the main barriers to the implementation of efficient informatic infrastructures and define ways and strategies to overcome them.

6. Introduction • Problem definition: • Study the current state (existence and accessibility) of the informatic infrastrutures in Portuguese health centres, we’ve based on a study made in 2002. • Comparingthe previous results with those obtained now, we will come to a conclusion on the evolution within this period.

7. Introduction • Background: • In Portugal there are 391 Health centers; • and 1941 health centers extensions; • In the last decades it has been registed a great evolution in the informatic infra- -structures. Cabral, Villaverde, Saúde e doença, em Portugal, Lisboa, ICS, 2002

8. Introduction Study realized in 2002 by S. João Biostatics department

9. Introduction • Low development in the use of the informatic technologies in 2002. • No data is available to the public about the present state of the use of informatic technologies in primary care. Relatório da OCDE; HIT do Observatório Europeu.

10. Introduction http://www.ine.pt Neves

11. Introduction Concepts/Teorical suports: • Medical Informatic • The field of information science concerned with the analysis and dissemination of medical data through the application of computers to various aspects of health care and medicine1 • Applications • design of decision support for practitioners • development of computer tools research • study of the very essence of medicine 2 1 - www.hon.ch/HONselect/Selection_pt/L01.700.html 2 - http://im.med.up.pt/informatica_medica/informatica_medica.html

12. Introduction • SNS – Sistema Nacional de Saúde (NHS - National Health System) • Primary Health Care:medical care access on health centers • IGIF - Instituto de Gestão Informática e Financeira da Saúde (Informatic and financial management Insitute) http://im.med.up.pt/epr/

13. Introduction • SONHO - Sistema de Gestão de Doentes Hospitalares (Management system of hospital patientes) • Integrated system of hospital information. • Having as data management base the Oracle, version 7.3; • Assumes a fundamental role in administrative information on the patient management registration. • Was created in order to satisfy the organization needs of the end of the 80’s and beginnings of 90’s in the NHS. http://www.igif.min-saude.pt/upload/igif/img/Enq-SAM-SAPE.pdf http://www.algebrica.pt/i_s/bo2/data/upimages/Castanheira-Jornadas.pdf

14. Introduction • SINUS - Sistema de Informação para as Unidades de Saúde (Informatic system for Health unities) • Similar system to SONHO, for all primary health care. http://www.igif.min-saude.pt/upload/igif/img/Enq-SAM-SAPE.pdf http://www.algebrica.pt/i_s/bo2/data/upimages/Castanheira-Jornadas.pdf

15. Introduction • SAM - Sistema de Apoio ao Médico (Medical Support system) • System guide to the doctor’s activity, based on the clinical-administrative information processed on SINUS. • Developed on Web technology (graphic interface) and wireless technology. • The health professionals that will have access to this system as well as its manipulation will be only doctors – each doctor will have his own access profile. http://www.igif.min-saude.pt/upload/igif/img/Enq-SAM-SAPE.pdf http://www.algebrica.pt/i_s/bo2/data/upimages/Castanheira-Jornadas.pdf

16. Introduction • EHR - Electronic Health Record • A general term describing computer-based patient record systems. It is sometimes extended to include other functions like entry order for medications and tests, amongst other 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

17. Introduction • Is basically a facility that retrieves patient data from a number of information systems and presents the data in a coherent way to the authorised user; • will become a major support tool in health care delivery; • EPR - Electronic Patient Record • CPR - Computer-based Patient Record • EMR - Electronic Medical Record • CMR - Computerised Medical Record http://im.med.up.pt/epr/

18. Introduction • EHR – Benefits • Easier access to information (ex: allows the simultaneous access from different localizations). • Faster access to information. • Better protection of the information than in the paper system. • Actualized information. http://im.med.up.pt/epr/

19. Introduction • Allows having a clinical process with all the patient clinical information. • Precision in information • Variety on ways of visualizing data. • Decision support. http://im.med.up.pt/epr/

20. Introduction • Possibility of data analysis. • Possibility of clinical information exchange, among speciality and primary care, allowing the existence of shared health care. • More respected regulations. http://im.med.up.pt/epr/

21. Introduction • EHR – Disadvantages • Data introduction initially slower. • Need specific formation from the health professionals. • Dispends on initial resources in training and education. http://im.med.up.pt/epr/

22. Introduction • Requires constant actualization of the knowledge. • Low flexibility on the limits demanded for information access. • Very stricted style of the reports. http://im.med.up.pt/epr/

23. Introduction • The records may be lost if the correct procedure isn't followed. • Sometimes electronic records aren't available, which doesn't happen with paper records. • Security break problems. http://im.med.up.pt/epr/

24. Introduction “Better use of information technology is essential to provide better care at lower cost” BATES et al.,A Proposal for Electronic Medical Records in U.S. Primary Care

25. Material and Methods • 75 health centres: • 50 (out of 352) aleatorily chosen in 2002.1 • 25 (out of 341: 391-50) also aleatorily selected.2 • The inquiries will be made in two stages: • 1st stage: telephonic inquest to the 75 H.C. directors Custoias start 1 - Study realized in 2002 by S. João Biostatics department 2 - http://ine.pt

26. Material and Methods • 2nd stage: letter or fax inquests (to send back anonymously – they include a return envelop) • Informatic system implementation planning strategies. • Difficulties. • Possible ways to overcome them. • The inquiries are much alike those from 2002, in which we’ve based on. • We added 25 extra H.C. with the purpose to validate the study.

27. Flowcharts Custoias

28. Vanessa Iolanda start

29. MeSH Terms • Medical Records; • Primary Health Care;

30. Gantt’s Map Vanessa fim

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