Information Technology in primary health care: still a long way to go? Carlos Barbosa, Carlos Ferreira, Cláudia Santos, Diogo Pereira, Inês Grenha, Joana Ferreira, José Costa, Maria Silva, Paulo Ribeiro, Pedro Sousa, Ricardo Coelho, Tiago Oliveira 2010

Introduction: Background and Rationale «Primary health care is a people-centred approach to health that makes prevention as important as cure, offering an upstream attack on threats to health (...) [in an] efficient, fair, and cost-effective way (...) [producing] better outcomes (...) with higher user satisfaction.» Primary health care  The basis of many health systems  Universal service CHAN, M. (2008). "Primary health care – now more than ever." Retrieved 21 October 2009, from

Information Technology (IT)  Computerization of primary health care: a priority task  Interest for the scientific community «Health information technology (Health IT) encompasses a wide range of products and systems, including software, hardware and infrastructure, that are used to support the collection, storage and exchange of patient data throughout the clinical practice of medicine.» Introduction: Background and Rationale AMERICAN MEDICAL ASSOCIATION. "Health Information Technology (Health IT)." Retrieved 28 October 2009, from managing-your-practice/health-information-technology.shtml. managing-your-practice/health-information-technology.shtml

Health Centre Groups (ACES) Introduction: Background and Rationale Community Health Centres Regional Health Administrations (ARS)

Portuguese Northern Region  Location  Wide area Introduction: Background and RationaleExistence  Have IT devices (e. g. computers, printers), appropriate software and networks in: Doctor’s office Nursing rooms Utilization  Direct application of IT in primary health care  Research: Diagnosis and prognosis Protocols (e. g. contingency plans)

Which Information Technologies exist in the primary health care service and how are they used? Research Question and Aims

The study has the following aims:  estimate the existence of Health IT in the primary health care system and its usage in the Health Centre Groups (ACES) and Community Health Centers;  estimate the incentive or training programs made available by the ARS Norte or another institution to its health professionals;  establish a comparison between the deployment of Health IT in the primary health care services in the Portuguese Northern Region and the results of related studies developed in Portugal and foreign countries. Research Question and Aims

Study Participants Participants and Methods Dr. Castanheira Executive Directors of the ACES and Community Health Centres More knowledge about the situation in general More information about their respective health centres and about the professionals who work there Know what is being done regarding IT in primary health care

Study Design The study is classified as:  Observational  Cross-sectional  Ecologic Participants and Methods

- Explain aims and methods - Ask collaboration and authorization for the study - Improve the quality and objectivity of the surveys in order to obtain more relevant and concise information Contact the Director of ARS Norte - Gather and process data statistically in order to establish comparisons and come up with the conclusions of the study Interview Dr. Castanheira Send a pilot survey to selected director of community health centre (Dr. Carlos Martins) Analyse the gathered data presential interview telephone - Ask about the stimulus given by the ARS Norte for the implementation and usage of basic Health IT in Health Centres and telephone -Inform about the authorization from ARS Norte and explain aims - Ask collaboration for the study - Send the final surveys and obtain the required information for the development of the study Contact the Executive Directors (ACES, Community Health Centres)

 Answered by Dr. Carlos Martins via telephone  Main goal Perform relevant adjustments in some of the questions to make them easier to answer Pilot Survey Final version of the survey

Main Results Description of the institution Type of institution

Equipment and its usage Main Results Percentage of equipments in doctors’ offices and nursing rooms Doctors’ officesNursing rooms Computers Printers Scanners Photocopiers

Equipment and its usage Main Results Frequency of the utilization of computers by health professionals Health professionals (doctors and nurses) always use computers in primary health care

Patient Health Record Administrative management InternetTeleHealth Video conference Other applications Equipment and its usage Main Results Percentage of computers that allows the usage of specific applications

Main Results Equipment and its usage Other applications:  Alert P1  SAPE  Siars  SGSR  Spark Percentage of computers that allows the usage of specific applications  GestCare  SIMA Rastreios  Taonet  Impax  Hígia

Main Results Usage of the existing information systems Access to the patient record and its frequency DoctorsNurses AdministrativesPatients

Access to the patient record and its frequency Main Results Usage of the existing information systems Other health professionals  Operational assistants  Social assistants  Psychologists  Nutritionists

Specific software for the doctors Main Results Usage of the existing information systems To make prescriptionsTo make health certificates Existence Utilization

Usage of the Internet Main Results Internet access Doctors’ officesNursing rooms Existence Utilization

Usage of the Internet Main Results Purposes of the usage of the Internet Search scientific articles Share data with other health entities Communicate with other health professionals Use tools to support clinical practice Personal useOther usages

Existence and utilization of intranets Main Results Existence of intranets

Main Results Existence and utilization of intranets Utilization of intranets DoctorsNurses

Support Main Results  ARS Norte is the institution that supports the most, in terms of financial and material support (hardware and software)  One of the respondents referred support by Universidade do Minho, showing a possible active role of external institutions in the improvement of primary health care services.

Training Main Results Doctors, nurses and administratives all have/had specific training to work with the hardware and software available Sufficiency of the training made available DoctorNursesAdministratives

Main Results HardwareSoftware The main needs Scanners Computers General improvement of the quality and speed of the devices Establish more efficient links between applications Faster and more reliable computer programs What should be changed in terms of usage Make network connections faster Increase the number of devices available (e.g. scanners, screens for the waiting rooms) Make the computers less vulnerable to threats (e.g. virus) There is technical support available in case of difficulties Remarks

Main Results Human resourcesTraining for the staff Different realities in the various health centres/ACES: Need for a computing professional to provide help to solve the hardware and software issues which happen daily In certain health centres, less than one computer specialist per 300 users Improve the teams which give support More time for training (due to the high complexity of certain applications) Make training and support available whenever necessary Remarks

Comparison with Other Studies Adoption of information technology in primary care physician offices in New Zealand and Denmark  Study divided into five parts  Each part refers to a different aspect of the comparison between New Zealand and Denmark Legend for the results. 1 = <20% of primary care physicians 2 = 20-40% of primary care physicians 3 = 40-60% of primary care physicians 4 = 60-80% of primary care physicians 5 = >80% of primary care physicians

Comparison with Other Studies Adoption of information technology in primary care physician offices in New Zealand and Denmark Main results

Comparison with Other Studies Adoption of information technology in primary care physician offices in New Zealand and Denmark Main results

Comparison with Other Studies Adoption of information technology in primary care physician offices in New Zealand and Denmark Main results

Discussion  Need for improvements in the computer equipments available  Reduced existence and utilization of TeleHealth and videoconference in primary health care  High levels of existence and utilization of health record software and specific software for prescriptions and health certificates  Deployment of platforms which promote a nearer connection between health services  Various realities in terms of availability of technical help for the use of computer tools in primary health care, despite the support given by ARS Norte

Checkpoint Already achieved  Surveys sent to all directors of community health centers and ACES  Statistical analysis made with initial results  Questions for the interview with Dr. Castanheira are made  Comparison with other study  Initial discussion of the results obtained What must be done  Continue to analyze the data that comes up with time  Interview with Dr.Castanheira (held by an agenda conflict)  Final discussion of the results

References  ADMINISTRAÇÃO REGIONAL DE SAÚDE DO NORTE. Retrieved 17th October 2009, from saude.pt/portal/page/portal/ARSNorte. saude.pt/portal/page/portal/ARSNorte  AMERICAN MEDICAL ASSOCIATION. "Health Information Technology (Health IT)." Retrieved 28 October 2009, from assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health- information-technology.shtml.

References  CHAN, M. (2008). "Primary health care – now more than ever." Retrieved 21 October 2009, from  CORREIA R, A. F., FREITAS A, COSTA-PEREIRA A (2002). "State of Electronic Health Records in Portugal." TEHRE.  D. PROTTI et al. (2008) “Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 5: final comparisons” Informatics in Primary Care. 17(1): 17-22