A Mobile System for Primary Care Assistance of Underprivileged Communities

Transcription

1 A Mobile System for Primary Care Assistance of Underprivileged Communities Marco Antonio Gutierrez Heart Institute University of São Paulo Medical School

2 Basic Facts about Brazil Population:190,000,000 States: Federal District Municipalities: 5,563 40% of the population in metropolitan areas

3 The SUS Unified National Health System (SUS) provides free health coverage to all Brazilians Two main governmental policies have been adopted: decentralization focus on primary health care Implementation history of Family Health Program in Brazil, from 1999 to April 2008

4 Healthcare in Brazil Hierarchic structure Physicians, Nurses and Interdisciplinary team Regional, national and university hospitals (e.g. Heart Institute) Physicians, Nurses and Interdisciplinary team District Hospitals Physicians, Nurses and Community Health Agents (CHA) Clinics and Units of Primary Care - Basic Health Units (BHU) - Outpatient Medical Care (AMA)

5 Brazilian National Education and Research Network RedCLARA Rede Nacional de Ensino e Pesquisa (RNP) is a not-for-profit corporation incorporated under the laws of Brazil that interconnects over 350 education and research institutions, helping an estimated public of over a million users, and linking all the Brazilian regional academic networks. Ministry Ministry of of Science and Technology Education Ministry of Health

6 Education and Research Community Metropolitan Area Network A 1Gbps R&E-Ring in each of the 27 state capitals! 12 are already launched! Brasília Belem, State of Para Manaus, State of Amazonas Vitória, State of Espirito Santo Ministry of of Science and Technology Education Ministry of Health

7 List of University Hospitals Telemedicine University Network RUTE 2009 Faculdade de Medicina da UFRR Faculdade de Enfermagem da UNIFAP HU João de Barros Barreto da UFPA HU Betina Ferro de Souza da UFPA HU da Universidade Federal do Maranhão da UFMA Maternidade Escola Assis Chateaubriand da UFC Hospital Universitário Walter Cantídio da UFC Hospital Universitário da UFPI HU Ana Bezerra da UFRN Hospital de Pediatria da UFRN Maternidade Escola Januário Cicco da UFRN HU Onofre Lopes da UFRN Hospital Getúlio Vargas da UFAM Faculdade de Medicina da UFAC Faculdade de Medicina Veterinária da UFT Faculdade de Medicina da UNIR HU Júlio Müller da UFMT Hospital das Clínicas da UFG HU Maria Aparecida Pedrossian da UFMS Hospital das Clínicas da Unicamp Hospital das Clínicas da FMUSP Hospital São Paulo da Unifesp Hospital Unimar HU de São Paulo / LSITEC da USP Instituto Dante Pazzanese Hospital de Clínicas da UFPR HU da UFSC Hospital Universitário da UFSM HU Dr. Muguel Riet Correa Júnior da FURG Hospital Escola da UFPEL Irmandade da Santa Casa de Misericórdia (ISCMPA) Hospital das Clínicas da URGS Instituto de Psiquiatria da UFRJ Instituto de Puer. e Ped. Martagão Gesteira da UFRJ Instituto de Neurologia Deolindo Couto da UFRJ Instituto de Doenças do Tórax da UFRJ Instituto de Ginecologia da UFRJ Hospital Escola São Francisco de Assis da UFRJ Maternidade Escola da UFRJ Clementino Fraga Filho da UFRJ HU Antônio Pedro da UFF Gaffrée e Guinle da UNIRIO Canal Saúde (Fiocruz) HU Pedro Ernesto da UERJ HU Alcides Carneiro da UFCG HU Lauro Wanderley da UFPB Hospital das Clínicas da UFPE HU Profº Alberto Antunes da UFAL Hospital Universitário da UFS Centro Pediátrico Hosannah de Oliveira da UFBA Maternidade Climério de Oliveira da UFBA HU Prof. Edgar Santos da UFBA Hospital Universitário na UnB HU Cassiano Antônio de Moraes da UFES Hospital de Clínicas da UFU Hospital Escola da UFTM Hospital Universitário da UFJF Hospital das Clínicas da UFMG Phase 1 Phase 2 Faculties Telehealth Program

8 University Hospital Connection to a 1Gbps Metropolitan R&E Ring Create a Telehealth Unit with Videoconference Room, Teleconsult, Telediagnosis Participate in Special Interest Groups Demonstrate teleassistance, teleeducation and teleresearch 23 University and Teaching Hospitals on-line broadband + 10 August December until December 2013 Ministry of of Science and Technology Education Ministry of Health

9 Telehealth - Federal University of Minas Gerais - UFMG Minas Telecardio Minas Gerais State Secretary of Health 12hours a day 500 ecg/day (UFMG, UFU, UFTM, UFJF, Montes Claros) More than 300 Municipalities Teleconsultations on line and off line also in some specialties Ministry of of Science and Technology Education Ministry of Health

10 The Primary Care & SUS Policy of primary care: use Family Health as a priority strategy for its organization Family Health Program FHP actions are performed by Primary Care Teams PCTs gather health related data such as: house type, sanitation, number of residents, details about family members, chronic diseases, vaccinations, pregnancies

11 SIAB Brazilian Primary Care Information System (SIAB) Contains basic or primary - care information from all States of the country SIAB data is primarily collected using paperbased forms, filled in by the Community Health Agent (CHA)

12 SIAB forms Form A family registration Form B-GES pregnant women monitoring Form B-HA hypertensive monitoring Form B-DIA diabetics monitoring Form B-TB tuberculosis patients monitoring Form B-HAN hanseniasis patients monitoring Form C (Child Card) - children monitoring Form D tasks performed, procedures and notifications

13 Health Units in São Paulo São Paulo is biggest city in Brazil (~11 million inhabitants) Several Health Care Units spread across the city Health care units include: Hospitals (Hosp) Emergency Services (ES) Specialized Outpatient Ward (Amb-S) Basic Health Units (BHU) STD/AIDS Specialized Units (STD-U) Health Care Units in SP

14 West Region project A project of the University of Sao Paulo Medical School in partnership with the Sao Paulo Municipal Health Secretary Main goal: reorganize the health care provided by SUS in part of the West Region of São Paulo (~400k inhabitants)

15 West Region project Large variability BHU Jaguaré Extremely poor people (Paulo VI) Middle class families (Jaguare) BHU Jardim Abril BHU Vila Dalva Frontier of metropolitan area and country side Metropolitan BHU Boa Vista May include small farms (Paulo VI) BHU Jd São Jorge May include some slums BHU Paulo VI Total of inhabitants

16 Original Data Flow PCT visits the family PCT fills in a set of paper forms data is digitized and sent to SIAB PCT takes the forms to Basic Health Unit

17 Original Data Flow PCT visits the family Low quality data Lack of standardization Safety and confidentiality PCT fills in a set of paper forms issues possibility of losing the paper forms data is digitized and sent to SIAB PCT takes the forms to Basic Health Unit

18 Original Data Flow PCT visits the family PCT fills in a set of paper forms data is digitized and sent to SIAB Long delay for entering into the SIAB (~ 45 days) PCT takes the forms to Basic Health Unit

19 Original Data Flow PCT visits the family PCT fills in a set of paper forms Some houses do not have proper address (slums). Location cannot be provided data is digitized and sent to SIAB PCT takes the forms to Basic Health Unit

20 Goal Overcome the problems described in the current process of primary care data gathering To provide a new data gathering workflow that uses a mobile device connected to a 3G network with a GPS to be used by the PCTs for collecting family data To Incorporate usability concepts To deploy a digital version of the SIAB forms operated via a mobile device To collect georeferenced information and to interoperate with other systems (Siga-Saude, SIAB)

21 New Data Flow PCT visits the family Fills in digital version of form on mobile device Data sent to SIAB

22 New Data Flow PCT visits the family Minimize free hand fields (eg. select from a choice list) Standardize fields at the database Fills in digital version of form on mobile device Data sent to SIAB

23 New Data Flow PCT visits the family Fills in digital version of form on mobile device Decrease time to make data available for health managers Decrease time to identify regional Data sent to SIAB epidemiologic features through queries with maps

24 Three main components: 1. An Application Server, with a database, and two clients: 2. A Web Browser 3. A data gathering device a) GeoHealth-Mobile is the software used by PCT who fills a digital version of one data form in a Smartphone b) GeoHealth-Web is responsible for storing the data from GeoHealth-mobile into the databases and retrieving the data for display at the browser. Solution components

25 GeoHealth-Mobile

26 GeoHealth-Web

27 Data security All Community Health Agents have a username and password GeoHealth mobile does not store any data locally On the completion of data entry, information is immediately sent to GeoHealth-Web In the event of a network signal loss, the software keeps a FIFO (First In First Out) queue, that is emptied as soon as the network connection is restored All data is transmitted on https protocol with xml

28 Current numbers 180 CHAs using the GeoHealth. 6 Health Units About families & people registered ~82 families visited/cha/mo

29 BHU Jaguaré BHU Vila Dalva 8 Km BHU Jd Abril BHU Boa Vista BHU São Jorge BHU Paulo VI 8 Km

30 Stored data gives the possibility to present a comorbidity map (people with more than one disease) Georeferenced comorbidity

31 Georeferenced morbidity Possibility to present in a morbiditymap (people with at least one of a group of diseases) Possibility to present morbidity map (people with at least one of a group of diseases)

32 Some conclusions Most CHAs approved the new system Immediate availability of more precise data for healthcare managers Management tool allows better follow-up of population care productivity measurement and reports TCO: ~USD 0.03/inhabitant/month

33 Creation of indicators Next steps Productivity: reveal effectiveness and efficiency of CHA Data quality: are the data suited for decision making? Clinical indicators: draw attention to clinical issues Prioritize visits based on family risk

34 Lessons Learned with Telemedicine A long debate with civil society is a key step. Social participation is essential, including teachers, students, local health system workers and managers. A nationwide joint effort from federal Ministries, Agencies, Universities and civil society is required. Ministry of of Science and Technology Education Ministry of Health

35 Lessons applied in Brazil Support the Family Health Program Connectivity and ehealth Centers in university and educational hospitals Implement Telehealth procedures (continuous education, second opinion and Teleconsult) into rural and underserved regions International collaboration National coordination Ministry of of Science and Technology Education Ministry of Health

36 Achieved Results Comprehension of the technological opportunity in University and Educational Hospitals Acceptance of ehealth norms Stimulate academy, government and enterprises Broaden discussion on health prevention Enable international collaboration Ministry of of Science and Technology Education Ministry of Health

37 Formative Second Opinion to Familiy Health Teams Promotes on-job training. Evidence-based Health. Adapted to regional needs, and regulated by PHC specialists Strategy to establish a epidemiologic surveillance. Allows the establishment of knowledge stations Ministry of of Science and Technology Education Ministry of Health

38 Amazonia The future has already arrived. It is just not equaly distributed São Paulo Rio de Janeiro Amazonia

39 Marco Antonio Gutierrez Division of Informatics Heart Institute University of São Paulo Medical School Thank you!