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

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

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

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

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

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

7. 7 Background: 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 Introduction

8. 8 Health Centers (n=48)Median Inscribed Patients13000 Doctors8 Computers8 Computers with Internet connection1 Computers used for Booking purposes5 Computers with Computerized Patient Records0 Study realized in 2002 by S. João Biostatics department Introduction

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

10. 10 Hospitals Health centers Health centers extensions Pharmacy Medicine post With internment Without internment Nº Portugal 2177631519412566331 North 642110344575755 Center 551495776655126 Lisbon 6325217371813 Alentejo 11164334024499 Algarve 879681048 Azores 81341024619 Madeira 839374211 Introduction http://www.ine.pthttp://www.ine.pt Neves

11. 11 Concepts/Teorical suports: Introduction Medical Informatic 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 medicine 1 –Applications design of decision support for practitioners design of decision support for practitioners development of computer tools research development of computer tools research study of the very essence of medicine 2 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. 12 –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) Introduction http://im.med.up.pt/epr/

13. 13 SONHO - Sistema de Gestão de Doentes Hospitalares (Management system of hospital patientes) 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 80s and beginnings of 90s in the NHS. Introduction 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. 14 SINUS - Sistema de Informação para as Unidades de Saúde (Informatic system for Health unities) SINUS - Sistema de Informação para as Unidades de Saúde (Informatic system for Health unities) –Similar system to SONHO, for all primary health care. Introduction 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. 15 SAM - Sistema de Apoio ao Médico (Medical Support system) SAM - Sistema de Apoio ao Médico (Medical Support system) –System guide to the doctors 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 Introduction

16. 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; 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. 17 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; 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; http://im.med.up.pt/epr/ Introduction –will become a major support tool in 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

18. 18 EHR – Benefits 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/ Introduction

19. 19 –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/ Introduction

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

21. 21 EHR – Disadvantages 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/ Introduction

22. 22 –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/ Introduction

23. 23 –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. Introduction http://im.med.up.pt/epr/

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

25. 25 Material and Methods 75 health centres: 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: The inquiries will be made in two stages: –1 st stage: telephonic inquest to the 75 H.C. directors 1 - Study realized in 2002 by S. João Biostatics department 2 - http://ine.pt Custoias start

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

27. 27 Flowcharts Custoias

28. 28 Vanessa Iolanda start

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

30. 30 Gantts Map Gantts Map Vanessa fim

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