SIGA Sade

So Paulo Citys Health Information System

Beatriz de Faria Leo, MD, PhDbeatriz.leao@zilics.com.br

Lincoln A Moura Jr, MSc, DIC, PhDlincoln.moura@zilics.com.br

Cludio Giulliano Alves da Costa, MDcgcosta@prefeitura.sp.gov.br

2Jun-08

SIGA Sade

SIGA Sade is So Paulo Citys Integrated and Distributed System for

Managing the Public Healthcare System.The system belongs to So Paulo City,

which is willing to share it with other cities, states and countries.

SIGA Sade has beendeveloped using

free-software open-code concepts.

So Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area.Initial Figures:

400 Primary Care Units 60 Polyclinics 160 Hospitals 11M Users 8.5M Emergency T/year 550k Inpatients/year 11M Primary Care C/year

SIGA Sade is present in 100% of So Paulo City public health care providers

3Jun-08

24So Miguel28So Mateus31Itaquera22Itaim Paulista20Guianases18E. Matarazzo15Tiradentes

36V Prudente31V Mariana29Penha25Mooca13Jabaquara

29Ipiranga12Aricanduva

Southeast Region

South Region

18V Maria/V Guilherme13Tremembe/Jacana20Santana25Pirituba9Perus

26Freg/Brasilandia16Casa Verde

South Region

CenterEast Region

36S

14Pinheiros

29Lapa

27Butant

Population:2,136,977

Population: 2,396,940

Population:2,499,294

Population:2,402,093Population: 1,244,456

20Sto Amaro24Socorro9Parelheiros

34Boi Mirim 20Cidade Ademar29Campo Limpo

East RegionVolumes per Region in the City14 million patients

in the database14 million patients

in the database

4Jun-08

Before SIGA Sade

Access to health services was difficult: long waiting lines for specialized procedures and consultations

No integration among health care providers

No control of medication distribution

Very little information for health care management

5Jun-08

SIGA Sade Building BlocksIdentifying Patients

Based on Unique Nation-Wide Patient Identifier Captures Encounter Data Set On-line Access to Patient Information

National Registry of HC Units and Workers Unique Nation-wide Identifiers:

Healthcare Workers, Units & Medical Equipment Relationships Among Them

Concepts, Policies & Norms Health Promotion / Prevention Emphasis on Primary Care Family Health Program National Immunization Program Patient Flow Organization and Control Agreed Reference-Counter-Reference Model Municipalization of Care on a Capitation Basis Automatic Electronic Disease Notification Ability to be Intelligent

6Jun-08

Primary Care Units in So Paulo

7Jun-08

Ensuring Equity and Integrality of Care

Polyclinic DiagnosticCenter SpecialtiesDiagnostic

Center

PhysicianOffice

PrimaryCare Unit

PhysicianOffice

PrimaryCare Unit

PrimaryCare Unit

PrivateHospital

UniversityHospital

PublicHospital

Primary CarePrimary Care

High Complexity - HospitalsHigh Complexity - Hospitals

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Reference

Patient Flow Organization & Control

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Entry LevelEntry Level

axes

8Jun-08

Auditing

Billing

Assessment

HealthSurveillance

HC ServicesManagement

SpecialtiesInpatients

Exams

Electronic HealthRecord

Primary Care

Emergency

HC Workers

Hospitals and Healthcare Units

Domain Tablesand Vocabularies

Users (Patients)

NacionalRegistry R

ole-

based

Access

Control

Role-

based

Access

Control

Flow Control

Consultations

Beds

Exams

Emergency

Authorization

SIGA Sade Conceptual Model

9Jun-08

Regulation of High-Complexity Exams

Regulation Center

Configuration HC ServicesGridLimits

(Amounts & Values)

ClinicalBreadth HC Units

RequestingHC Units

ExecutingHC Units

RegulatingAgents

$$$ fromAgreement

PhysicalLimits

DistributionAccording with

Complexity Level

ExecutionLimits

RequestingLimits

Authorization

GeneralParameters

Polyclinic DiagnosticCenter SpecialtiesDiagnostic

Center

PhysicianOffice

PrimaryCare Unit

PhysicianOffice

PrimaryCare Unit

PrimaryCare Unit

PrivateHospital

UniversityHospital

PublicHospital

PhysicianOffice

Entry LevelEntry Level

Municpio

Municpio

MunicpioMunicpio

Municpio

Municpio

Municpio

Estado

10Jun-08

SIGA Sade IT Model

Electronic Health Record

Patient Flow Organization & Mngmnt(Specialties, Beds, Exams)

Management(Surveillance, Auditing

and Billing)

Internet

SP CityDatacenter

SMS-SP

Dept of Health

Access ControlAccess Control

National HealthPatient Registry

National Health CareProviders RegistryInfra-structure

HR capacity

Authorizationprocessing of

high-cost, high-complexity

procedures

SpecializedConsultations

SchedulingMedication Scheduling

Medication at Home

CapturingEncounter

Information

Lab Integration

AuditingMedicalImages HIS

Adm / Manag. DSS

HealthInformation

SIGA Sade Deployment StrategySIGA Sade Deployment Strategy

EHR Surveillance

2004-

2007

2004

2007-

2010

12Jun-08

Opening Screen in 2005

13Jun-08

Opening Screen in June, 2008

14Jun-08

SIGA Sade: Querying Services Quota

15Jun-08

16Jun-08

Geo-referencing Using Google Earth API

17Jun-08

Type of Attendance Special Programs Anamnesis, Physical Exam, History Diagnosis Disabilities Procedures carried-out Requested procedures Medications Course of Action

Encounter Data Set

Work-RelatedDiseases

Communication Form

Notifiable Diseases

High-ComplexityProcedure Order Form

18Jun-08

Notifiable Diseases Report

19Jun-08

e-Authorization Processing

ElectronicManual / Paper-based

0

5.000

10.000

15.000

20.000

25.000

Jan Fev M ar Abril M ai Jun Jul Ago Set Out Nov Dez Jan Fev M ar Abril M ai Jun Jul Ago Set Out Nov Dez Jan Fev M ar

Evolution of electronic and paper-based ordering and authorization processing of high-cost, high-complexity procedures from January/2005 to March/2007.

Orders/month

20Jun-08

SIGA Sade Figures for May, 2008

14,301,383 registered users 1,017,463 primary care scheduling / month 189,393 specialized care consultations / month 1,738,807 medical prescriptions attended over the counter / month 35,000 authorizations of high cost & complexity procedures / month 30% reduction in the waiting time for specialized consultations &

procedures Medication available at local pharmacies - supply chain control

21Jun-08

SIGA Sade: Who Is Using the System (June, 2008)

So Paulo City 700 health care providers Focus on Patient Flow

So Paulo State 28 Cities share the system for Hemodialysis and Hemophilia

Camaari, BA Small City near Salvador (Bahia State) 250,000 inhabitants, 32 Primary Care Units Focus on EHR, Medication Dispensing, and Billing

Campinas,SP City 100km from So Paulo 1.5 million inhabitants, 50 Primary Care Units Focus on EHR and patient flow

22Jun-08

SIGA Sade: Project TimelineJanuary 2004 - contract was signedSeptember 2004 - First deployment 2004 - 2007:

700 heath care providers connected Medication control and patient scheduling 100% of HC providers Authorizations of high cost / complexity procedues: 100% electronically Special programs data capture So Paulo city women/child program Lab results integration under development

Investment US$ 10M Software US$ 50M Hardware, Connectivity

Training 15,000 health professionals trained

23Jun-08

Very Tight Initial Schedule

Quick development vs. high quality in a short time (~ 4 months)

Jan Feb Mar Apr Oct NovMay Sep DecJun Jan FebJul MarAug2004 2005

Contract Signed

New FeaturesDevelopment

First Use Cases Specified

Team Assembled

Deployment

Despite the odds, the system was delivered on time

24Jun-08

SIGA Sade Development Strategy: Key Issues

Well-defined software development process Component-driven software development Well-defined project guidelines and coding standards Continuous integration Strong project managementKnowledge sharing

25Jun-08

SIGA Sade Technical Strategies

Use of open standards and open source paradigmsBased on Java / Java EEThree Tiers

presentation, business and persistence

Linux Web basedThin Clients at the point-of-careDatabase independence

26Jun-08

SIGA Sade Technical Strategies

HTML

Session Faades

Entity Beans Service Classes and SLS Beans Utility Classes

Database

WEB ContainerApplication Server

EJB Container

27Jun-08

SIGA Sade Project ManagementWell-defined issues tracking process, using a web-based tool for managing all project tasks;All project members had real time visibility of what was going on in the project;When new tasks were created, delays happened or tasks were finished, an email was automatically generated informing the person responsible for the task;This technique gave us important metrics that helped to keep the project within schedule and improved the communication among the team members.

28Jun-08

SIGA Sade Project Management

29Jun-08

SIGA Sade Proven BenefitsPatient Flow Organization & Control

Supports the Reference-Counter-Reference Model Finds the Shortest & Most Resolving Way Through the HC System Manages & Operate the Whole Health System Identifies all HC Units, Workers & Their Relationships Uniquely Understands and Qualify the Demands

Connecting the Health System Connects Internal & External Units & Functions Reduces Costs & Increases Productivity HL7 v3.0 Project to Connect Accredited Labs to SIGA Sade

The Electronic Health Record Identifies each Individual / Patient Uniquely Knows the Patients Clinical History Helps Healthcare Workers do their Job (Decision Support)

Still Many Things to Do Hospital Information Systems + Full EHR Further Improve the Clinical Content with Archetypes

30Jun-08

SIGA Sade: Advantages of the Architecture

Several cities can share servers and services; Simple machines at the point of care; No need for computer personnel at healthcare units; Complexity stays away from the user, under central control; Model can be rolled out to other places; New functionalities can be added easily; SIGA Sade: Periodic Updates

31Jun-08

Next Steps for SIGA Sade

Full EHRSOn-line lab reports:

8 labs using LOINC + HL7 v3 content + Brazilian national schemasfor interoperability

operational in Sep 2008

Municipal Hospitals IT Project Health Information for the Citizen

Empowering the patient

Distance LearningTeleHealth

32Jun-08

From Archetypes to the EHR System

BP Archetype

Items of Interest

Automatically creates screens and data structures

Open Software

Archetype processing Engine

33Jun-08

From Archetypes to the EHR System

Archetypes

EHRS Screens and Forms

34Jun-08

Thanks!! Questions?

Cludio G A Costa, MD CIO So Paulo City Dept of Health Phone #: +55 11 3218-4244cgcosta@prefeitura.sp.gov.br

Beatriz de Faria Leo, MD, PhDAv. Eng. Luis Carlos Berrini, 962 cj 6104571000 So Paulo, SP, BrazilPhone #: +55 11 8114-1617 Fax #: +55 11 3055-1590 Beatriz.leao@zilics.com.br