World Health Organization , Geneva, 10 february, 2014
[youtube]http://youtu.be/D95HTuRkfns[/youtube]
Recebemos esse vídeo do Ministério da Saúde e achamos que valia muito a pena compartilhar a visão do governo e os trabalhos que o mesmo tem realizado no setor de saúde digital. O vídeo traz o discurso do Moacyr Perche, coordenador geral do projeto de gestão do Ministério da Saúde no setor de Informática, sobre o cenário de e-health no Brasil.
Transcrevemos o texto em inglês para ficar mais fácil a leitura e incluímos um link para tradução para português.
Clique e leia a transcrição em português, pelo google translate.
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I am Moacyr Perche, from Brazil, General Coordinator of the Project Management of the Minister of Health, in the Department of Informatics. I want to thank the opportunity to attend this meeting and to greet everyone in the person of Dr. Artur Kioro, Minister of Health and the director of DATASUS, Dr. Augusto Gadelha.
To speak of our experience and to contextualize our Brazil scene in informatics and health, Brazil is the 5th largest country in the world, with 200 million inhabitants, more than 90 million internet users, 140 million with a unique National Health Card processed.
Brazilians are among those who spend the largest amount of hours on the internet in the world. Federal tax forms are available and only filled in electronic way and via the internet. The National voting system is fully electronic and we have the results in 4 hours, for 135 million voters. My country has taken 25 years ago the challenge of applying the SUS, national health system, trying to apply the equality of access, the universality of care and the integrality of care. We believe in universal access. Health is a right of all. Approximately 160 million individuals rely on SUS. Full coverage, free of charge. Today we have about 12.000 patients in homecare and one hundred million people under the care of family health teams (PSF), including all services and procedures. One million hospitalizations by month. The highest number of public heart transplants in the world (90% of the vaccine market is driven by the unique system.)
Funding and management are shared across federal, state and municipal levels, totalizing 5587 managers who raises the complexity of this task.
Regulated by our ANS (National Agency of Supplementary Health), we have private health insurance plans for those who are willing to pay. Approx. 1100 health plan organizations and about 40 million people of individuals covered. Policies for establishing the standards semantic and technical ICD-10, ICD11, Snowmed CT, DICOM, HL7, openEHR started in 2011, after a year of discussion in federal states and municipal levels. We have a portfolio of more than 140 systems with a high degree of fragmentation and compartmentalization of information systems which are many and unscattered, what increases the energy and longevity need for government decisions. Brazil has a long tradition of health information and informatization of controls and indicators, but a little experience of informatization in procedures for assistance and health management, the essence of e-health. And we approved in 2013 the National Policies of Information and Informatization of Health, task who involved over 100 people along the year and improvement in all instances of social control in the country. Since May 2012 DATASUS has been promoting a series of workshops on EHR systems for the system and the country, including the private services.
One important political barrier was the gap of the consensus on the concept of e-health, needing to leave the focus of the operation of the electronic health records for a strategic look, other was the absence of organized societies into this discussion. We face problems implementing standards, because there is need of period of development of systems and the need of capacitation for both, the health professional and the health informatics professional, just like other countries referred.
Another important issue is the legal loophole created: reality is faster than regulations and these new forms of citizen interaction with the services require a bioethics description of these changes who has not yet being performed. One of the most important facilitator for the implementation policies of standards of health data at national and subnational was the document ITU WHO met the national e-health strategies. Several initiatives, academic, public and private are being made that direct this disparition. ITU proposes a simple framework and didactic to facilitate this disparition. At the moment, we are discussing and inseminating the third review of this document seeking the approval of the document in all instances of the system and tracing parallel tactical operations to insure short-term results without derail this strategic vision. The governance of the policies, to maintain the standards of the national level, which is a new activity for health, despite aggregate with all the areas of government, such as industry, trading and banking sector is one of the most important things to concentrate now. It is a priority to establish short-terms results in the field that gives visibility to the efforts and concreteness of the concept of eHealth. Parallel to this discussion, the policies react, for example, we still have a large amount of cities that are integrated in a manual way without international standards to national base of data. Recently we did an integration of this records for the national health card in the city of São Paulo with 15 million records cleansed and deduplicated and in parallel we are developing the deployment of XPDQ and NPI standards. We already have published four services for internal applications of the national health care in processes and adapting the existing applications to interoperate with the standards. Recently we engaged IATE initiative. Our national databases identify professionals and institutions providing health care by immigrating the data to their services and interoperating with internal applications. We have a semantic framework developed with identified services and models approved of demographic information and two clinical models to implement. The summary of tendence and primary care and hospital discharges some of new patients. The citizens now can consult their records regarding deals of health services and professionals who attended, and soon, this clinical contents of your health records.
The government private sector and the civil society have a key role as facilitating the compliance of these policies of standardization participating to this discussion in several levels of social control in our national health system transforming a government policy in a state policy
We’re glad to share this experience with you and learn with your experience. Specially thanks to the support of PAHO in the name of Dr. Nando Campanella and David Novillo.
Can I ask my colleague David Novillo to say a few things on how to approach the support to e-health and standardization in the region. David.
Thank you. Ladies and Gentleman and colleagues connected through the internet. The region of America is interested in experience hard to be found in countries such as Argentina, Barbados, Brazil, Canada, Chile, Colombia, Mexico, Uruguay and the USA. There are four main actors in implementing the standards at the national and international levels: hospitals, medical academic centers, Telemedicine Networks and Universities. The calculation indicates that 30% of health related expenditure is devoted to manage information and just 5% is devoted to implement a completely interoperable national health system. It sems a great amount of work but it must be done. Lack of governmental coordination and digital agendas constitute one of the most important barriers in the e-health standards and interoperability. There are specific problems in the region of America that result in people lacking adequate health coverage. There is no doubt of interoperability is an equalizing factor in this regard, that facilitates sharing information which helps to partially close the access gap.
In this context, there are 4 elements that need special attention in the area of standards and interoperability. Mainly, (1) the social infrastructure. The region of Americas suffers from major disparities in this regard. For example, 50% of people have access to computers in Uruguay, compared to 10% in El Salvador. The region must strengthen its infrastructure to achieve this level of information among different health organizations and across geographical borders. Reliable networks, Internet access and the availability of electric power are among the components needed. (2) In addition to the social infrastructure, there is a need for policies that provide a legal framework and support the implementation of eHealth standards, as well as providing protection in data of intellectual property rights and security and privacy of information Chile and Uruguay are two examples of countries that are relevant in this aspect. Legal and ethical consideration are also key. It should be possible for different entities to share sensitive information under condition that insure privacy, high levels of security, control access and user identification. In addition of that all, properly trained human resources are needed. It is important to work on standardization, objectives, competences that require curricular changes of health workers in the different countries. In addition to train medical workers, (3) other staff should be trained in e-health policy, development and planning, communication and leadership. Finally and not least,(4) importantly, the participation of the international standards association is essential in order for standards to redesign in accordance with national needs.
In the case of regional office, that the pan-american health organization (PAHO), we have a regional strategy on e-health: The resolution CD51/15 that was approved in 2011 by the members of States of Americas, which priorities include developing National e-Health Policies and sharing data and experience with each others.
In addition to this mandate, PAHO has approved the strategic plan 2014-2019, It’s my honor to be able to share with you that one of priority objectives is to support the countries in establishing national e-health strategies. We are convinced that establishing national policies is the foundation for establishing it in an orderly and efficient way of standards and interoperability. I believe, it still should be added, that this is based on the conclusion of the regional clinic consultation on e-Health data, standards and interoperability. It happens in Peru, in april 2015 with national officials of Barbados, Chile, Colombia, Costa Rica, Jamaica, Mexico and Peru.
And, finally, after the discussion of these two days, I think that we have to put focus on three things. first, we need to communicate better our achievement. Also, we need to finish our humble work, which is also heavy. We need to work together in evidences and reports which can show the benefits of the investment in standards and interoperability for the decision-makers. Thank you so much.
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