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
Contents




Objectives
Introduction
Material and methods
Greetings
2
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);
3
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;
4
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.
5
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.
– Comparing the previous results with those
obtained now, we will come to a conclusion
on the evolution within this period.
6
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
7
Introduction
Health Centers (n=48)
Median
Inscribed 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
8
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.
9
Introduction
Health centers
Hospitals
With
internment
Without
internment
Health
centers
extensions
Pharmacy
Medicine
post
Nº
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
Portugal
10
http://www.ine.pt
Neves
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 medicine 1
– Applications



design of decision support for practitioners
development of computer tools research
study of the very essence of medicine 2
11
1 - www.hon.ch/HONselect/Selection_pt/L01.700.html
2 - http://im.med.up.pt/informatica_medica/informatica_medica.html
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)
12
http://im.med.up.pt/epr/
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
13
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
14
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
15
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;
16
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
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/
17
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/
18
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/
19
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/
20
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/
21
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/
22
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/
23
Introduction
“Better use of information
technology is essential to
provide better care at lower
cost”
24
BATES et al.,A Proposal for Electronic Medical Records in U.S. Primary Care
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
1 - Study realized in 2002 by S. João Biostatics department
2 - http://ine.pt
Custoias
start
25
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.
26
Flowcharts
391 Health Centers
(2005)
352 Health
Centers (2002)
Already included
341 Health
Centers
Simple Aleatory Selection
Simple Aleatory Selection
50 Health
Centers
Custoias
25 Health
Centers
Sample of study:
75 Health Centers
27
Articles obtained in the
bibliographical research
n=1076
Articles
excluded for
the review
n=1016
60
articles
Excluded
articles
n=36
Revision through
headings and
abstracts
24
articles
Incompleted
Articles
Articles
excluded for
the content
n=5
Excluded
articles
n=13
Revision through
complete article
n=11
Vanessa
Iolanda start
Used articles in the
introduction of the work
n=6
28
MeSH Terms


Medical Records;
Primary Health Care;
29
Gantt’s Map
Vanessa fim
30
Greetings

We have to thank professor Luís
Azevedo, whose help has been
essencial.
31