"User-friendly Videotex"

User-friendly Videotex

Ilana Fogelman & Eduardo O. C. Chaves

I. Introduction

For most people, informatics in health is associated with sophisticated computer systems running in ultra-modern hospital installations. It need not be so. The term "informatics" has quite a broad meaning, and the term "health", perhaps, an even broader one.

In this article we will discuss one form of health informatics which requires a rather simple infrastructure at the user's end. The technology utilized for this application - Videotex - starts out, as far as the user is concerned, with equipment which is largely available in developed and in most developing countries: a telephone and a television set. (See Box).

A Videotex-based communications network has been in operation in the health system of the city of Sao Paulo since December 1987. The project, which has been carried out by the Secretariat of Health for the State of Sao Paulo, consists of a large scale introduction of information technology, from the central to the peripheric levels of the health system, to allow fast and dynamic dissemination and exchange of information among people never before exposed to computer technology.

Specifically, the network was proposed as a means to enhance communication and interaction among all levels of the health system, to provide information feedback to data collectors, to improve data collection itself and to increase the access of health workers to technical and scientific information.

Videotex was the chosen technology due to its extreme user-friendliness (requiring no specialized manpower for its utilization) and its relative low cost (when compared to alternatives).

II. The Project

An initial eight-month pilot experiment, involving 40 health units, preceded the current expansion of the project. There are, presently, 100 Videotex terminals installed in health units in the city of Sao Paulo. Terminals should be installed in the interior of the state in the near future. The terminals (inexpensive MSX-compatible microcomputers emulating Videotex terminals) were rented from the local state telephone company and distributed to 18 divisions of Secretariat at the central level, to all regional administrative offices in the city of Sao Paulo, to 58 primary care centers, to hospitals, and to laboratories and supply units.

At the central level, the coordinating team is composed of only four people (two physicians and two Videotex technicians).

Videotex's user-friendliness has been a key issue in the expansion of the system, since new, non-specialized users are trained to operate the system in a two-hour session. The trained users, in turn, tutor other colleagues.

When connecting to the system, users can acess the electronic mail service (E-mail), transmit collected data or consult information in the Secretariat's data bases.

E-mail has been offered to users as an alternative to the regular telephone and mail systems. It has been utilized for general intercommunication and for specific applications, such as the reporting of cases of infectious diseases, the transmission of laboratory test results, the request of supplies, the scheduling of consultations in referral hospitals, and others.

Primary care centers and regional administrative offices utilize E-mail to exchange data among themselves and to easily contact upper levels of the health system requesting, for example, statistical information related to their region, clarifying doubts on technical and administrative issues, checking receipt of forwarded information, requesting material and even complaining when their demands are not answered!

E-mail has also contributed to the epidemiologic surveillance system of the city: central agencies and surveillance teams in regional administrative offices are readily informed of the hospitalization of patients with communicable diseases in reference hospitals, allowing control measures to be timely triggered at the central, regional and peripheric levels. The timely dispatch of these warnings used to be extremely difficult due to the obstacles imposed by previously insufficient and inefficient communication means.

Videotex also supports data collection by allowing the easy implementation of pre-formatted questionnaires in the system. Primary care centers have utilized this feature to send their weekly reports on infectious diseases via telephone lines, allowing the immediate receipt of data by regional and central agencies. Users only have to select the appropriate questionnaire from a menu and fill it out via keyboard.

The reports on communicable diseases received by the central level are organized in a series of "feedback bulletins" in one of the Secretariat's data-bases. These bulletins become readily available to any user with access to a Videotex terminal, even outside the Health Secretariat. Epidemiologic data are displayed in tables, histograms and maps. Detailed information on any disease can be obtained, as well as the number of cases reported in each region and neighborhood of the city. Further "feedback bulletins" on statistical and demographic information are also displayed.

Other sections of the Secretariat's data bases offer technical information on particular diseases, on starting epidemics, on surveillance and immunization procedures. Abstracts of medical journals, calendar of events, service referral information, new legislation, and pedagogical "self-evaluation programs" are also available.

III. Discussion

The expansion of the project has been supported by a basic element: users' demand. There has been a general agreement among users regarding the present and potential benefits of the system. This fact, as well as the easy mastering of the technology's operation and the reasonably low cost of adding a user to the system (the equipment rents for approximately 15 dollars a month and the utilization of the telephone line is comparatively inexpensive in Brazil), have led to a rapid expansion of the network.

E-mail has been the most utilized feature of the system. It has become an effective tool in the improvement of communication in the health system, enhancing vertical and horizontal information flows and promoting institutional and interpersonal exchanges.

By speeding up the information flow, by overcoming communication bottlenecks imposed by insufficient and always busy telephone lines, by allowing an immediate forwarding of written messages and by transmitting information independently of the presence of a receiving party at the destination point, Videotex has improved interaction among distant elements and levels of the health system.

E-mail allows information to be sent to specific users, being protected by passwords, or to be displayed in bulletin boards, when of general interest. Bureaucratic tasks can be simplified, since a message can be automatically forwarded to one or several receiving parties.

E-mail and other applications of the network do not have, of course, to be implemented through Videotex technology. Other technologies might even offer more sophisticated services. But in a country like Brazil, where scarce financial and specialized human resources are an obstacle towards the extensive computerization of the health system, Videotex does play a major role in the viability of a large scale communications network. Its low implementation and operation costs (when compared to alternatives), its user-friendliness (requiring no specialized manpower for its operation) and its easy and rapid expansion (regarding number of users and applications) are all essential elements in the establishment of such a network.

All in all, Videotex is a viable alternative for the introduction of information technology in the health system of countries with a medium level of technological development.

BOX

Videotex is a communications technology derived from the combination of telephone, television and computers. Users need only their telephone lines and a Videotex terminal (which can be a television set, a microcomputer or a stand-alone Videotex terminal) to access information stored in other computers. The technology allows a two-way transmission of text and graphics over the telephone lines. Although the most common direction of the information flow is from a central computer to terminals, Videotex does support data collection via keyboard, that is, the transmission of data from users to a central computer.

Telephone lines have been used for quite some time, especially by commercial enterprises, to transmit data between computers located at geographically distant locations. The innovation brought by Videotex is in the use of the same telephone lines to allow the general public to access information it needs or wants, or to allow people to communicate among themselves, using their own TV sets as display units and small and cheap keyboards as data entry units.

Videotex was originally conceived for non-technical users. Because of this, user-friendliness is one of its major features. It has achieved its greatest development in France, where more than three million terminals have already been installed. It was introduced in Brazil in 1985 by a regional telephone company, being still in itsinitial growth phase.

Last revised: May 02, 2004