Brazilian Ministry of Health :

1. Brazilian Ministry of Health: National Health Information Exchange Solution Dr. Augusto Cesar Gadelha – CIO – DATASUS/ Ministry of Health - Brazil Luiz Paulo Ribeiro – Manager – Middleware Platforms - CDS Kumar Sivaraman – Director, Product Strategy – Oracle America

2. Healthcare system in Brazil “Health is a social right under the terms of this constitution” – 6th art. Constitution of 1988. (section)

3. Brazil: Facts and Data • 5th largest country in the world. (7,682,300 Km2) • 5th largest population. (201 million) (2013) • 7th largest economy (GDP 2.2 trillion USD) (2013) • “Young” democracy (Constitution from 1988) • Political stability • National Federation • 5 Regions • 26 states + DF (Federal District) • 5,569 Cities (Municipalities)

4. Brazil: Facts and Data • More than 90 million people connected to the Internet • 100% of income tax forms are sent via Internet • Electronic Voting System: a system with 135 million voters with election results in 4 hours • 35 billion electronic bank transactions in 2012 • We feel confortable about IT technologies • Intense use of social networks by internet users

5. Healthcare system in Brazil • At the end of 80’s, the Constitution of 1988 defined that it is a duty of the State to ensure the health of the population. • To comply with this requirement, SUS was created ( Sistema Único de Saúde – Unified Health System) in order to provide universal healthcare access. • DATASUS is the Ministry of Health Departmentresponsible to provide necessary IT resources to the Ministry.

6. About SUS • Universal healthcare access • The health is a right • Health is a right of all and a duty of the State • More than 160 million citizens depend on SUS • Universal coverage, for free • In all services and procedures • Principle of SUS: • Equality of access • Universality of services • Integrity in attention • Finance and Shared Management • By Federal, State and Municipal levels • There are private healthcare insurance for those who can afford • 1.400+ healthcare insurances that provide coverage for more than 40M people • The ANS (National Supplemental Healthcare Agency) is responsible to regulate the health insurance sector.

7. About SUS: Numbers 1 BRL  2 USD (2011)

8. About SUS: Numbers

9. National Healthcare Card It identifies a SUS user (patient), allowing to create a link between the patient, healthcare professionals and providers where the healthcare services actions were taken. Objectives • To promote correct identification and individualization of health information • To provide demographic information to support decision making of healthcare policies • To provide access to electronic health record • To promote interoperability between health IT systems with the national database (CADSUS). (CNS)

10. National Healthcare Card – The five i’s

11. What is Health Information Exchange? “Health information exchange (HIE) is the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care.” Health Resources and Services AdministrationU.S. Department of Health and Human Services

12. Cross-Enterprise Document Sharing Transaction Flow Patient Demographic Query ITI-21; ITI-47 Patient Demographic Query ITI-21; ITI-47 Patient Identity Manager Patient Identity Source Patient Identity Source Patient Identity Feed ITI-8 ; ITI-44 Patient Identity Source Patient Identity Source DocumentConsumer DocumentRegistry DocumentConsumer DocumentConsumer Registry Stored Query ITI-18 Register Document Set ITI-42 DocumentRepository DocumentSource DocumentRepository DocumentSource DocumentRepository DocumentSource Retrieve Document Set ITI-43 Provide and Register Document Set ITI-41

13. Cross-Enterprise Document Sharing Transaction Flow Patient Demographic Query ITI-21; ITI-47 Patient Demographic Query ITI-21; ITI-47 Patient Identity Manager Oracle Healthcare Master Person Index Patient Identity Source Patient Identity Feed ITI-8 ; ITI-44 DocumentConsumer DocumentRegistry Oracle Health Sciences Information Manager Registry Stored Query ITI-18 Register Document Set ITI-42 Oracle Healthcare Data Repository DocumentRepository DocumentSource Retrieve Document Set ITI-43 Provide and Register Document Set ITI-41

14. Oracle Health Information Exchange Health Information Systems Oracle Identity and Access Management Oracle SOA Suite for Healthcare Integration Oracle Healthcare Data Model Oracle Healthcare Master Person Index Orchestrated Integration • Message-based • Web Services • Java API Public Health Systems Oracle Healthcare Data Repository Clinical Information Systems Laboratory Information Systems Oracle Health Sciences Information Manager Diagnostic Imaging Systems Standards-Based Integration • IHE Profiles • IHE Web Services • eHealth Exchange • Direct/CONNECT Pharmacy Systems Oracle Health Sciences Information Gateway HealthcarePortals Oracle Exalogic / Oracle Weblogic Server Oracle Exadata / Oracle Database Other Health Information Systems

15. Oracle Health Information Exchange Supported IHE Profiles

16. Oracle HIE – Nationwide Implementations • Oracle HIE provides person de-identification, document indexing and national repository services • Person Index - to de-deduplicate multiple person identities and cross-reference all identifiers • Document Index - provides access to participating individual’s records from a range of repositories • Document Repository - for storing health records and terminology services • Solutions • Oracle Health Sciences Information Manager • Oracle HealthcareData Repository • Oracle Healthcare Master Person Index • Oracle Identity Management • Oracle WebLogic Suite • Oracle SOA Suite • Oracle Database • Results • National infrastructure for e-health records to realize “one patient one health record” goal • Information available at point of care in support of key clinical decisions that can avoid delays in treatment • Improvequality of healthcare, lowercosts of services, and promote effective healthpolicies

17. CADSUS – Cadastro Nacional de Usuários do SUS Platform responsible to promote interoperability and access to National Healthcare Card database. • OHMPI allows CADSUS to support multiple source systems, identify duplicates, and merge/unmerge records • Full history of transactions • Use of Oracle Text for phonetic search • Hosted in Oracle Exadata and Exalogic platform • Use of Oracle SOA products for integration

18. CADSUS – Cadastro Nacional de Usuários do SUS Platform responsible to promote interoperability and access to National Healthcare Card database. • CADSUS Web is a web system that provide easy access to patient information • It is available to any SUS’ healthcare provider to locate and add new patients • The solution is design to assist those providers that don’t have IT resources to maintain patient records • CADSUS Service leverages OHMPI for patient identification

19. CADSUS 5.0

20. CADSUS – Integrations General Vision

21. CADSUS Interoperability Model International Standards • Interoperability standards are regulated by an official directive: MS 2.073/2011 • Web Services and Security: SOAP and WS-* • Document Coding: XML • Document Registry and Repository: XDS.b • Patient Identification: IHE – PIXv3 and PDQv3 • Terminologies • Lab Coding: LOINC (Logical Obs. Identifiers, Names and Code) • Clinical Terms: SNOMED • Image coding: DICOM

22. National EHR - Interoperability

23. How to store data from this message …

24. … to this MoH MPI model ?

25. IHE Profile on CADSUS – PIXv3/ PDQv3 • The PIX and PDQ built using OHMPI IHE Profile framework • It maps the MoH MPI model to IHE Model • The PIXManager and PDQSupplier web services interface were published to service bus in less than 3 weeks • Use of OHMPI plugins for customized merge logic and CNS number generation • Oracle Service Bus compositions for reuse and orchestration with OHMPI IHE Profile

26. CADSUS IHE – PIX/PDQ Solution Design

27. PIX Feed Flow

28. Deployed Oracle Products • Oracle Healthcare Master Person Index • Oracle Exadata • Oracle Exalogic • Oracle WebLogic Server • Oracle JVM JRockit • Oracle Access Manager • Oracle Virtual Directory • Oracle Data Integration • Oracle SOA Suite • Oracle Service Bus • Oracle BPM Suite • Oracle HTTP Server • Oracle API Gateway • Oracle Enterprise Manager Grid Control 12c • Oracle Enterprise Repository • Oracle Service Registry • Oracle Virtual Machine • Oracle Linux • Oracle BIEE • Oracle Identity Manager • Oracle Traffic Director

29. Brazilian National e-Health Strategy • Main Challenges • Clear e-Health consensus and policies stillin development • Need to commit Healthcare Professionals and Providers (program is, so far, IT driven!) • Complex governance system; • Regional and economical diversity; • Diversity of technical solutions (in use and in development); • Limitations in connectivity and ICT infrastructure (specially outside large and medium urban areas); • Lack of required expertise; • Bureaucracies at public sector administrative processes • Quick wins vs. strategic developments balance

30. Q&A

31. Thank you! Augusto Cesar Gadelha – CIO – DATASUS/SGEP/MS - augusto.gadelha@saude.gov.br Luiz Paulo Ribeiro – Manager – Middleware Plaforms - luiz.ribeiro@cds.com.br Kumar Sivaraman – Director, Product Strategy – Oracle America - kumar.sivaraman@oracle.com