One day. Nine hours. A large classroom. Seven speakers. More than fifty spectators. One common theme: Healthcare Information Systems.
With the objective of stimulating debate between professionals involved in medical informatics, the Faculty of Public Health at the Universidad Nacional de Entre Ríos (FIUNER) organized the Second Conference on Healthcare Information Systems in Oro Verde. Coincidentally or otherwise, the event coincided with World Bioengineering Day: June 30.
The educational institution, which pioneered the teaching of courses in Bioengineering and Bioinformatics in South America, gathered together doctors, nurses, technicians, informaticians, public officials and students.
Recurring themes? Interoperability and the fragmentation of healthcare systems on both national and provincial levels.
Presentation of the Argentina Health Information System (SISA)
The first speaker was the electronics engineer Mariano Soratti, Director of the SISA project at the Ministerio de Salud de la Nación.
“SISA is a unique health record that registers a pattern of people, health facilities and services from different federal regions that are incorporated into the platform,” the head of the program explained after emphasizing that they aren’t developing a single electronic health record or a hospital administration system.
The system started development eight years ago and today it interoperates with 26 platforms: REFES, REFEPS, REDOS, REMEDIAR, NomiVac, RESAM, and SUMAR, among others.
“Interoperability is no longer something that can be avoided, it is essential that we develop it. Understanding that other information systems exist is important when developing a federal system like SISA,” Soratti said.
Currently the Federal Registry of Establishments has more than 22 thousand institutions registered, while the Registry of Professionals has 800 thousand professionals registered. The pattern of citizens has 20 million files – and this could potentially rise to 40 million.
Soratti revealed that a Perinatal Informatics System (SIP) is being developed and will be incorporated into the SISA, and that they are also working on a cooperation framework for the National Registry of People.
Apart from his presentation of the project, Soratti made a firm statement calling for more commitment from the public sector: “Governments rightly require reliable, useful information, however they generally don’t invest very much to achieve it.” In addition, he said that Argentina must give priority to public technology departments and that today’s needs won’t wait for the necessary organization to take place. “An undesirable phenomenon is occurring: the fragmentation of the health system,” he warned.
To finish, he offered a recommendation to developers of healthcare information systems: “Don’t lose control of your project. Out-sourcing is fine, but the knowledge must remain within the organization,” he advised.
Experiences in the application of standards to achieve interoperability
The next person to speak was Diego Kaminker, co-chair of the Education Work Group at HL7 Argentina. His presentation focused on interoperability and the development of standards.
The speaker began by explaining that interoperability is a process by which two different informatics systems connect with each other and understand the information they are receiving. But to achieve this, he said, a format code is required so that the shared information is legible.
“At HL7 we promote interoperability to save on time and errors,” he noted. He then invited the audience to incorporate the technology, downloading the standards for free from the web page. To strengthen his invitation, he listed the healthcare institutions that use HL7 in Argentina: Hospital Italiano de Buenos Aires, Hospital Alemán, Hospital Garrahan, and the Hospital El Cruce, among others.
Legal aspects of data handling in the health sector
Marcelo Temperini, a lawyer specializing in Informatics Law, who has received a CONICET grant to study informatics crimes and Cybercrime, attended the conference by teleconference from Santa Fe.
To begin, he described National Law N° 25.326 on Protection of Personal Data. “Patient information is a good protected by law and so it must be stored in a way allows for the exercise of the right to access by the owner,” he said.
Later, seeking to warn those who handle sensitive information, he listed the most common informatics crimes that occur today: these include phishing, a method by which a criminal clones a web site to steal its user data. Focusing on this problem, he encouraged the collection of personal data if and only if there is a real purpose to it. “In healthcare, data dealing is a business,” he said.
To finish, he reminded the audience that the registration of personal data in files, registries or data banks that lack security measures is a crime.
Experience with the implementation of a national health information system
The informatician Sebastián Marró, a member of the NGO GNU Solidario, presented GNU Health, a hospital and healthcare management system.
“GNU Health is free software for healthcare professionals, healthcare institutions and governments,” he said. This system covers the functionality of the electronic health record, hospital management and health information systems via four functional areas, each with its respective modules:
1. Person level: demography, socio-economics, lifestyle
2. Patient level: evaluations, genetics, prescriptions, history, surgeries
3. Health center level: hospitalizations, finances, billing, laboratory, stock
4. Ministry of health level: epidemiology, OLAP, reports
As an example, Marró mentioned Jamaica, a country that decided to implement the GNU nationally at over 300 health centers. To finish, he agreed with Solatti’s statements, saying: “Health informatics projects should be implemented by the public sector, not delegated to private companies.”
Implementation of GNU Health at the Hospital Lister in Seguí
Luis Alejandro Ferreyra, Director of the Hospital Lister – located in Seguí in Entre Ríos – announced that the institution covers a fifty kilometer radius and has used the GNU Health system for three years.
“When I took up my role, I decided to digitalize all the health records and no-one from the Ministry came to say anything, either positive or negative,” he said.
According to Ferreyra, the hospital needed to have more control over activities and patients. “There are problems that can be mitigated. You don’t need to be a genius to do simple things such as digitalizing medical records so that everyone who fulfills a role within the health center can get the information they need, which is the most valuable thing there is in healthcare,” he declared.
The director implemented GNU Health in three stages, each in with the respective staff training:
1. Installation and conditioning of the necessary infrastructure and software (appointment administration, patient, laboratory, radiology, nursing and health record modules).
2. Pharmacy management, prescription of medications and admittances.
3. Conjugation of data from the first two stages to incorporate management of the institution’s statistics.
Ferreyra only experienced two instances of resistance to the new management system: two older nurses had never used a computer and some doctors took a while to join the program. “The system is very flexible and easy to use and the hospital staff adapted incredibly quickly,” he said.
To finish, he commented that at the Hospital Lister a new health record is set up every 81 minutes. “The electronic health record is much safer and facilitated my every day activity. Now, in just fifteen minutes I can check every day what was entered into every health record at my hospital.”
Experiences in the development of software for the health sector
Erika Von Der Thursen, representing the Informatics Sector at the Ministry of Health of Santa Fe, presented the Primary Care System (SICAP).
Via this platform, developed by the public body, a family health record is created for every patient in Santa Fe, scheduled appointments are made and records are taken of facilities, vaccinations and laboratories, in addition to other administrative and care activities.
Von Der Thursen said that SICAP is an essential requirement for integrating the entire provincial healthcare system and democratizing it. “The initiative to develop it arose from the fragmentation of the system and the independence of each of the healthcare organizations with regard to the others,” she explained.
Von Der Thursen stated that after the tool was implemented the record of statistics, considerations of medical practices and analysis of working processes all increased. “The system offered a new dimension to the situation, which previously had been fragmented but is now integrated.”
Bioengineering and Health Information Systems
Pablo Escobar, a bioengineer from UNER and teacher and researcher at the Universidad Nacional del Centro de la Provincia de Buenos Aires, focused on the work being done by engineers at healthcare organizations, describing his work and everyday routine.
“Healthcare institutions know nothing about OC or IT problems but they need everything to work,” he said. He also emphasized the need to integrate information systems and end the fragmentation between healthcare actors.
