News Coverage

Translated from an article in “Healthcare Brazil” magazine – November 2007.

Like so many others documented in the archives of the Brazilian public departments, a project that more closely resembles a script of the movie “Mission Impossible”, becomes a reality, and promises to be the principal example of an information technology (IT) solution and digital integration of the public healthcare system in the country.  The Federal District Government (GDF, Governo do Distrito Federal) not only implemented the Integrated GDF Healthcare System, but also took the first step for the implementation of the larger Healthcare Community of Brazil.

The project, which received investments of R$6 million in systems alone, will interconnect all the healthcare centers, diagnostic laboratories, public pharmacies, and hospitals of the Federal District in addition to “connecting” with programs of the Department of Health, such as Family Health.  With the integration, all of the healthcare units will have access to the electronic health records of patients, and citizens will simply use their health card.  The IT solution will allow the GDF to act intensively in five different areas of service management:  management of medications, laboratory and imaging exams; management of hospital beds; clinical management of patients; and management of invoicing and regulation.

The objective is to modernize, and prevent waste at all levels, in addition to better controlling available resources, optimizing current processes, and supporting policies for restocking the system.  With the program, healthcare managers will be able to access, through the patient health record, information on the epidemiological mapping of the community, plus a through correlation analysis of clinical, administrative, and management data.  The patient will be monitored during all stages of his treatment.  More than 6 thousand points will be available to access electronic health records on the network.

For the Federal District Governor, José Roberto Arruda, the project brings the public health system out of the Stone Age.  “For this to work, a large job needed to be done first.  We invested R$6 million in systems alone, and that much again in equipment and training.  The public healthcare employee who spent twenty years holding a pen and a carbon paper note pad has to be trained to work in the new way, and this is already being done,” he explains.  A large part of the program is already in use, but it should take three years to be completely deployed.  An example of what is already working is the Exam Portal (www.portaldeexamessaude.df.gov.br), launched in the beginning of September, which allows patients to access their test results over the Internet.  Considering only units that are already included in the portal, such as the laboratories of the Base Hospital, the North Wing Regional Hospital, the South Wing Regional Hospital, the Gama Regional Hospital, the Taguatinga Regional Hospital, the Samambais Regional Hospital, and the Central Laboratory itself, the total number of medical exams per year is 5.5 million.  More than eight million procedures are performed in the Federal District each year.

According to José Geraldo Maciel, the Federal District’s Secretary of Health, 20% of exams are lost by users before their medical appointment, resulting in new requests for the same exams.

When they are repeated, 30% of these exams are lost.  The portal will cut these rates to zero, since the entire system is computerized and the user and/or the healthcare professional can access, at any moment and in real time, the patient record and their previous exams.  “The 8.4 million exams that we perform each year cost the system about R$60 million.  This waste represents a minimum annual loss of R$18 million,” Maciel explains.

Patients used to wait 15 to 30 days to receive exam results in the traditional form, even though the exam was ready in the laboratory in less than 24 hours.  In the case of more complex exams, such as for HIV, it used to take about 30 days; now it takes two days for negative results and seven days for positive results.  For the Papanicolaou exam, which used to take 3 to 4 months for the analysis of the result, the forecast is that the result will be obtained in ten days.

Another example given by the secretary is in relation to the purchase of medicine, which costs the Federal District about R$220 million. “About 20% of these resources are lost, and together with them, another R$40 million. Just in these two cases, we are talking about a loss of R$60 million per year,” he states. After implementing the management system in the healthcare centers, it will be possible to halt the distribution of medicine without a doctor’s prescription or the distribution of the same medicine more than once to the same patient in different healthcare centers. By the end of three years, with the entire system computerized, it is hoped that the total savings in all of the areas will reach R$100 million per year, as the Federal District Subsecretary of Health João Luiz Arantes de Freitas predicts.  The management of the hospital beds will also bring about a reduction of costs.  Currently, all of the 257 beds in the ICU of Brasilia (in 17 hospitals, of which 10 are public and 7 are private) are being regulated by the new government project in real time.

The system has already brought savings on the order of R$1 million with the management of ICU beds contracted in the private hospitals.  “Brasilia has around 4 thousand beds in all of the hospitals of the system and the occupation is 2.3 patients per month (in the private initiative this occupation is on average 6.5 patients per month).  We can set as a goal for the end of the governor’s term, to double the occupation of a bed from 2.3 to 4.6 patients per month, effectively building 4 thousand more beds in Brasilia without laying a single brick,” explains José Geraldo Maciel.

The entire project was around the InterSystems TrakCare™ hospital and clinical laboratory management information systems.  The TrakCare system includes capabilities ranging from scheduling appointments at the basic healthcare units, to the complete management of the data of any patient in the community.

According to Fernando Vogt of InterSystems, the implementation of the project represents the breaking of a paradigm that the public system is not able to deploy high technology and management systems. “Some issues will take place quickly.  The health communities will grow at a great speed.  We hope that the Health Ministry sees that it is they who have to be the driver of these initiatives.  This should be a national process,” he says.

HEALTH CITIZEN CARD

One of the most highly anticipated stages of the Health Integration System of the GDF is the deployment of the Health Citizen Card, which began with a pilot project in Gama, one of the seventeen regional hospitals in the whole program.  About 100 thousand inhabitants of the region and users of the public healthcare system will be able to use their health card.  The idea is that the initiative will be extended to the entire population of the Federal District.  The objective is to offer more comfort for the patient, more agility, decisiveness, availability of information, and simultaneous access by diverse service providers.  This is a commitment of Governor Arruda.  I am certain that the Health Ministry will be thrilled with the idea,” explains the Federal District’s health secretary.

According to the Governor, José Roberto Arruda, because the project extends beyond the area of technology to being a government program, it should be supported and encouraged by the Federal Government and the Department of Health, since it should serve as a model for other Brazilian cities and states.  “With this card working, it will signify fewer public jobs, lower operating cost of the system, shorter lines, shorter waiting times, fewer trips, greater efficiency and greater productivity.   In short, better service to the population.”

José Carvalho Noronha, Federal Aide of Health Assistance and Attention (and who represented the Secretary of Health, José Gomes Temporão, at the opening ceremony of the medical exam portal) agreed, and affirmed that the initiative is what the Single Healthcare System (in Portuguese, SUS, Sistema Único de Saúde) plans to adopt in the future.  “We are here designing the structure that will guarantee every Brazilian citizen opportunities related to the care of their health.  And, I am foreseeing, it is a short hop from here to implementing and having a user identification card, the national health card – starting with the Federal District.  We have all the tools designed,” he states.

Noronha also emphasized the importance of the clinical and laboratory tracking of patients, in the long term, in addition to the issues related to regulation.  “We have to manage this according to risk management criteria because we have to administer shortages and leverage the available resources.  When these systems begin to be integrated, they will keep the patient from wasting time, there will be no duplication in the use of resources, and the doctor will also be able to track their patients at any time.”

The initiative, to be overseen by the World Bank (which is analyzing the liberation of resources to the Federal District Government) is estimated to reach 2.5 million inhabitants of the region.