uni tuss hc

Transcription

uni tuss hc

Parallel Session 1.5 Choosing and using standards for
interoperable information systems
Beatriz de Faria Leao, MD, PhD
Zilics eHealth
Convener WG8 Brazilian ISO TC 215 Mirror Committee ((ABNT- CEE-IS))
Vice-Convener WG8 - ISO TC 215 Health Informatics
Brazil
Introduction
Current HIS challenges
SDO in
SDOs
i B
Brazilil
Using the standards
Summary
PMAC, Bangkok, Jan 2010
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Some Facts about Brazil
6th Largest Economy in the World (2007)
190 million Inhabitants
5th Largest Country in the World, Larger than Continental USA
It is a Country of Huge Contrasts:
• some top quality institutions and
• a very bad income distribution, though improving
67 M Internet users today, some 12 M with broadband access
18% of houses have Internet access
e-Business:
• 5th largest market in e-business
• U$15Bi in e-commerce in 2009
95% of IRS Tax Return Forms on the Web
National Voting System is 100% Electronic
• More than 100 million voters
• Recent national election results in less than 12 hours
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SUS – The Brazilian National Health System
Universal Access
Health is a Right of All (~ 150M individuals rely on SUS)
Full Coverage
Coverage, Free of Charge
All Services and Procedures
SUS principles:
Equity
Universality
Integrality
Funding and Management are Shared Across Levels
Federal, State and Municipal Levels
Private Health Plans for Those Willing to Pay
~ 1,400 HMOs (cover ~ 50M individuals)
ANS (Agência Nacional de Saúde Suplementar) regulates the
sector
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HIS in Brazil
Vertical systems (more than 30 years)
Immunization
Primary Care (Child and maternity care
care, family health program
program,
housing and socio-economical data)
Chronic diseases
Special Programs (TB
(TB, AIDS)
Diseases of Mandatory Notification
Inpatient national database
Outpatient database
• aggregate data 1986 - 2008
• from 2009 on individualized records
High Cost / High Complexity procedures
• MRIs, CT scans, dialyses, hemotherapy, Cardiac
catheterization, stents, pacemakers…
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Health Information Systems in Brazil
Health Information Systems have been used in the Public Sector
since the 1970s
A huge collection of Public Health data is available from the
Department of Health, on www.datasus.gov.br
As in many other places, vertical applications were the focus,
leading to literally more than 250 siloed systems, such as HIV,
Prenatal and Child Care, TB, Diabetes and others
Lack of national standards started to be reverted by two major
projects at the end of the XX Century:
• The National Health Card Project defined unique identifiers
for individuals (including HC workers), and
• The National Registry
g y of HC Organizations
g
and HC workers
registry defined unique identifiers and the relationships
among workers, equipment and organizations
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HC Standards in Use
Currently in use
Diagnosis: ICD-10
Procedures: Brazilian CPT Codes private X public
Medication: several different vocabularies with billing purposes
Recent developments
ATC-Based Medication Codes Brazilian FDA agency (ANVISA)
GMDN (being translated now)
LOINC (translation and mapping Brazilian public CPT codes)
TUSS - Unified Terminology for HC (Brazilian Supplementary
Health Agency) - mapping private and public procedures codes
Under consideration:
• IHTSDO
• dm+d (NHS Dictionary of Medicines and Devices)
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HC Standards in use
Content
Patient ID and Profile
• ISO/TS 22220 - Identification of Subjects of Health Care extended
(ABNT standard- public consultation from Feb 2010)
HC Professional ID and Profile and HC Providers Registry
• Extends ISO/TS 27527 - Provider Identification (ABNT)
Surveillance,, Notification and Investigation
g
Forms
• 42 diagnoses
Primary Care and Family Health Program
• Household conditions
• Child and Maternity Health
• Immunization
• Specific diseases follow-up (diabetes, hypertension, hypertension)
O t ti t dataset
Outpatient
d t
t
Inpatient dataset
High Cost / High Complexity procedures
Archetypes
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HC Standards in use
Interoperability
XML for Messaging with External Systems
HL7 v3.0 (CDA R2) + LOINC for Clinical Lab Integration in Sao
Paulo City
TISS - supplementary health billing, authorization and eligibility
(XML and webservices between HC providers and payers)
• CDA R 2 now being considered for adding clinical content
in supplementary health
13606 - EHR for Minas Gerais State – under a bidding process
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HC Standards in use
Security
National PKI Infrastructure compatible with
• ISO 17090
17090-1
1 - Public Key Infrastructure-1
Infrastructure 1 Framework and
Overview
• ISO 17090-2 - Public Key Infrastructure-2 Certificate Profile
• ISO 17090-3 - Public Key Infrastructure-3 Policy
Management of Certification Authority
Information Security Management in Health using ISO/IEC 27002 ABNT NBR ISO/IEC 27002:2005
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HC Standards in use
Software Certification for EHR systems
• A joint initiative of the Brazilian Federal Medical Council and
SBIS - the Brazilian Health Informatics Association
• From 2004 - 2008 - self declared process, free of charge on
Internet
• From 2009 - systems are audited and receive a Quality
Stamp, according to profiles
Current profiles being assessed for certification:
• Outpatient, TISS
Two software products received the Quality Stamp, so far
Six products are currently being audited
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HC Standards used in the software certification process
HL7 EHR Functional Model
ISO/BR TS 18308 - Requirements for an electronic health record
architecture
ISO/BR TR 20514 - Electronic health record Definition, scope and
context
ISO 21090 Health Care data types - (being translated to
Portuguese)
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Software Certification Quality Stamp
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Health Informatics and SDOs in Brazil
SBIS - Brazilian Health Informatics Association
Founded in 1986
National Conferences every two years
Standards and Certification WG
About 900 members
F
Focus
on academic
d i and
d professional
f
i
l activities
ti iti
HL7 Brazil
Founded 2007
Focus on Training
ISO TC 215 Mirror Committee
Founded Dec 2006
Brazilian TeleHealth Association
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Brazil ISO TC 215 Health Informatics Mirror Committee
ABNT
Created in September 1940
Represents Brazil in International SDOs
Some 120 Technical Committees and growing
TC-Health Informatics
Created in November 2006
An initiative of Ministry of Health and Santa Catarina Federal
University
Initial Focus on TeleHealth
Attracted people from the 20-year-old Brazilian Health Informatics
Society
Became formally a Mirror Committee in March 2007
Some 100 people working at varied levels of effort and
commitment
Relies 100% on Volunteers
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How ABNT - Health Informatics TC Works
Resources
Collaboration Tool: Livelink (ABNT/ISO)
• Livelink has been chosen as the formal and official
communication tool
• Our use of Livelink set up a new paradigm for ABNT
Web conferencing for daily work*
Web-conferencing,
work
• Proven to be very effective
Video-conferencing joining 8 cities, for monthly Plenary Sessions**
• Video-Conferencing was a major innovation at ABNT
–
–
–
–
* Unifesp – São Paulo Federal University
** RNP – National Research Network
** Datasus – National Department of Health IT Division
** RUTE - Brazilian TeleHealth University Network
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ABNT Health Informatics TC - Results
Standards published
ISO/ABNT TS 18308 - Requirements for an electronic health
record architecture
ISO/ABNT TR 20514 - Electronic health record - Definition, scope
and context
ISO/ABNT TR 17119 - Health informatics - Health informatics
profiling framework
Standards being translated
ISO/TS 22220 - Identification of Subjects
j
of Health Care extended
ISO/TS 27527 - Provider Identification
ISO/TS 21667 - Health Indicators
ISO/TR 22221 - Good p
principles
p
and p
practices for a clinical data
warehouse (CDW)
ISO/TS 29585 - Deployment of a Clinical Data Warehouse
ISO/ABNT 27799 - Information Security Mgmt in Health using
ISO/IEC 27002
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ABNT Health Informatics TC Results (cont)
1st Brazilian Symposium on Health Informatics Standards (July, 2008)
• Some 200 participants, 3 international speakers
• Very successful in raising issues and increasing awareness of the
process
• Help raised funds for taking more delegates to Istanbul
NWIP co-led by Brazil
• WG4 – EHR S
Systems
t
C
Certification
tifi ti Process
P
(France
(F
+ Brazil
B il
leadership)
• WG8 – Business Requirements for an integrated eHealth
enterprise architecture for emerging and developing countries
(WHO and Brazil leadership)
Next ISO TC 215 Plenary meeting is in Rio May 9 - 13
Importance to Brazil
Contribute to creating standards that will be useful to us
Learning-teaching experience
Contribute to harmonizing standards
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ISO TR 14639 - eHealth Enterprise Architecture
for Emerging and Developing Countries: TR Structure
Part 1: Environmental Scan
Current international initiatives in the area of eHealth
systems.
P t 2:
Part
2 B
Business
i
R
Requirements
i
t
Framework for identifying business requirements that
define an eHealth enterprise architecture in
economically-constrained countries.
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Where the national standards are being used?
Brazilian TeleHealth Strategy
SIGA Saúde - São Paulo Health Information System
Using Health Information
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Brazilian TeleHealth Strategy
Brazil Telehealth Program - remote assistance
and permanent education
Pilot Project: 9 states and 900 points
www.telessaudebrasil.org.br
Open University of the Brazilian Unified Health
System - provides in-service
in service training for thousands
of health care providers
www.universidadeabertadosus.org.br
Telemedicine University Network - RUTE, initially
connecting 57 University Hospitals in collaborative
research and education across all federal states www.rute.rnp.br
Source:M
Jan2010
PMAC,Macedo,
Bangkok,
Jan 2010
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TeleHealth National Project

Supports about 3000 Health
Family Teams, covering 11M
people

Promote
P
t the
th use off technology
t h l
by the Family Health teams

Decrease the number of
patients sent to secondary
level

Evaluate different
technologies methodologies
technologies,
and costs

Improve quality of primary care

Leads
L
d tto money-saving
i
(preliminary
figures are 100:1)
PMAC,
Bangkok,
Jan 2010Bellagio, August, 2008
Source:
Ana
Estela Haddad,
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SIGA Saúde – São Paulo City Health Information System
SIGA Saúde is São Paulo City
Integrated and Distributed System for Managing the Public
Healthcare System.
Its history began in 2003/2004 when it was conceived and
development started.
The system belongs to São Paulo City and given to other cities in
Brazil
SIGA Saúde has been developed using
free-software & open-code concepts.
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Examples of Primary Care Units in São Paulo
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SIGA Saúde - Dec 2010
14,500,000 registered users
1,200,000 primary care appointments scheduled / month
200,000 specialized care consultations scheduled / month
2,200,000 medical prescriptions attended over the counter / month
40 000 authorizations
40,000
th i ti
off hi
high
h costt & complexity
l it procedures
d
/ month
th
30% reduction in waiting time for specialized consultations &
procedures
Medication available at local pharmacies - supply chain control
15,000 p
people
p trained on the system
y
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SIGA’s evaluation
http://vitalwaveresearch.com/healthit/
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SIGA evaluation
http://vitalwaveresearch.com/healthit/
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SIGA evaluation
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Health Information for better health
Brazilian Health Indicators
Set of demographic, socio-economic, morbidity and risks factors,
mortality, HC resources, HC coverage
Primary Care Pact Indicators
Child Care
Maternity and Woman Health
Hypertension, Diabetes, TB, Hansen’s disease
Oral Health
Family Health Program coverage
All data is available on Internet
Queries online back to the seventies
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Health Information Use, Dashboards & Indicators
www.datasus.gov.br
g
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Brazil HIS Challenges
Interoperability with local (state/municipal level) systems
needs improvement
Locally defined interfaces - txt based for the national unique
identifiers for persons
Web services for the national HC providers /professionals
• Locally defined WSDL
• Under tests with SIGA Saúde - São Paulo City health
System
Terminologies
Lack of proper clinical vocabularies -> payment approach
Translation and maintenance of clinical vocabularies
• LOINC (two years and is not ready)
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Final Remarks
It is not enough to have an eHealth Policy document
It is necessary to implement the policy
Proper organizational
P
i i
l arrangements are critical
ii l
Continuity across governments
Financing
Training
ABNT TC is pushing the use of IS in the country
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Summary
An existing and active Brazilian Health Informatics Society has been
crucial to ABNT-PC-HI success;
All work has been 100% voluntary, resources are required for hiring
technical and administrative staff;
Developing and emerging countries should be part of the ISO TC 215 SDO
Standards themselves should be made freely available under some
circumstances to promote their use;
SDO harmonization is vital to reduce redundancy;
South to South collaboration!
Organizations such as WHO (in our field) can play a role in adhering
themselves to standards and inducing governments to do so by:
• Providing
g training
g on HI standards
• Promoting free access to key standards
• Comissioning roadmaps and tools that implement standards
(software components -> strengthening of the local expertise)
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Come visit us in May!!
Come visit us !
ISO TC 215 Health
Informatics Plenary
M ti
Meeting,
M
May 9 -13
13
HL7 Plenary Meeting,
M 14 - 22
May
Windsor Barra Hotel, Rio de
Janeiro Brazil
Janeiro,
Thank you!
[email protected]
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