"A Computerized Communication Network for Primary Care Support"

A Computerized Communication Network for Primary Care Support

Ilana Fogelman & Eduardo O. C. Chaves

I. Introduction

The project consists in the establishment of an experimental computer-aided communications network for the interconnection of Primary Care Centers, Health Authorities and Health Care Reference Services in the city of São Paulo.

II. Objectives

1) To improve the flow of communication between peripheric levels and upper levels of the Health System and among the peripheric units themselves.

2) To establish a continuous, far-reaching, flexible and quick channel for the dissemination of medical, technical and operational information to peripheric health delivery units.

3) To establish a computerized data collecting system.

III. Choice of Technology

The chosen technology was videotex, which uses the existing telephone network for transmission of information. This technology requires NO specialized personnel for its operation and it is of lower cost, when compared to other alternatives.

IV. Description

The city of São Paulo is divided in eight health regions, each with its Regional Health Office (ERSA). All ERSAs are under the supervision of the State Secretariat of Health.

Forty videotex terminals (MSX microcomputers emulating videotex terminals) were rented from the local telephone company which also provides storage space for applications development in its host computers.

The terminals were distributed to organs of the State Secretariat of Health in the city of São Paulo (those responsible for health information and epidemiologic surveillance), to the eight Regional Health Offices of São Paulo (covering the whole city), to the main infectious diseases hospital in the State of São Paulo (the Emilio Ribas Hospital), to its supportive laboratory ( the Instituto Adolfo Lutz), to other three reference hospitals and to 23 Primary Care Centers located in two Health Regions of the city.

V. Applications Supported by the Network

The applications supported by the network were developed considering the following videotex's facilities:

-Electronic mail (E-mail);

-Access to data banks;

-Transmission of data from users to host computers.

The main applications tested were the following:

1) Epidemiologic surveillance support:

Infectious diseases are of compulsory notification in Brazil. However, subnotification and slowness in notification have always blocked the attainment of a satisfactory Epidemiologic Surveillance Information System.

The network is a supportive tool to epidemics control for it eases information flow. When a case of infectious disease is identified, pre-formatted questionnaires are electronically filled-up and transmitted by Primary Care Centers. The data is promptly retrieved and analysed by the Center for Epidemiologic Surveillance. This allows the identification of starting epidemics and its geographic distribution, allowing appropriate measures to be carried out immediately.

Cases of infectious diseases are usually hospitalized in Emilio Ribas Hospital. If the case is confirmed the hospital notifies (by E-mail) the ERSA where the patient lives so that the patient's contacts can be followed-up.

2) Dissemination of technical information:

Videotex allows an easy access to technical and scientific information stored in host computers. Informative modules can be easily prepared, expanded and changed.

Modules on AIDS, infectious diseases, immunizations are available for consultation.

Data banks on existing health services and on drug information are being developed.

3) Feed-back of information:

Epidemiological bulletins on the most frequent infectious diseases and their geographic distribution in São Paulo are available and monthly updated, so that users at peripheric levels can check the information they sent and compare their situation with that of neighboring units. It is expected that feed-back of results can motivate data collection.

4) Delivery of results of laboratory tests:

The Emilio Ribas Hospital receives through E-mail the results of bacteriological tests performed in the supportive laboratory.

Primary Care Centers are also connected to a laboratory from which they receive emergency tests results through E-mail.

5) Patient scheduling:

Primary Care Centers schedule outpatient visits to the reference hospitals connected to the network through E-mail.

6) Vaccine supply requisition:

Pre-formatted questionnaires on vaccine inventory inform the ERSAs about the supply of vaccines to be delivered to Primary Care Centers.

7) Drug supply:

Primary Care Centers communicate via E-mail with the drug supplier located in a reference hospital.

VI. Advantages of Videotex

Electronic-mail seems to be a useful alternative to the telephone, which is often insufficient to cope with the necessities of information transmission.

With telephone one has to call every unit to deliver the same information, lines are frequently busy, the person to which the message is destined is often not found, there is no record that contact was made, etc.

Videotex, with its built-in E-mail service, allows the display of information for several users on bulletin boards, allows messages for specific users, permits confirmation of message receival and keeps a record on magnetic media (which can be printed or taped) of all transactions.

Furthermore, updated information can become immediately and easily available to all users.

The time it took to implement the System was quite short (one month), and it started being used for E-mail at the same time that information was being placed in the data-banks.

A two-hour training session was all it took to familiarize the users with the operation of the system.

At the central level, only one person was enough to collect and prepare all the technical information which was presented through a series of menus.

VII. Conclusion

The experience so far has shown that videotex is a viable, low cost alternative to improve communications in the Health System, including the communication that is necessary for notification of cases of infectious diseases, for request of supplies (vaccines,drugs), for dissemination of technical norms and other information that must reach the peripheric levels quickly and which is constantly updated.

The videotex network requires no previous training in computer programming and operation and therefore, can be used by people with no specialized training.

The development of applications is simple and can be done by few people after a short training course.

Last revised: May 02, 2004