São Paulo City Health Information System: Four-Year Assessment

São Paulo is the seventh largest city in the world, with 10.3 million people in the city and some 18 million in the Metropolitan Area. In order to deliver proper health care and organize patient flow São Paulo has an integrated public health system in operation since 2005. The system is based on national unique identifiers registries for persons, HC workers and HC providers and implements the Brazilian National Health Systems (SUS) rules. São Paulo adopted the Internet and thin-clients for connecting health units to the city’s datacenter. SIGA Saúde captures an essential data set from Primary Care with extensions for the family health program (FHP), prenatal, child care and immunization. Patient flow management offers resource optimization, via intelligent scheduling of specialized consultations and procedures as well as intelligent bed assignment. It gives life to the referral and counter-referral model, based on real time budget allocation and resource availability. Currently, the system is used by all 803 public health units in São Paulo city and holds the data of 14.5 million people, processing 55,000 schedule requests daily, and attending 2 million prescriptions a month. The system uses a multi-tiered Java-based platform-independent architecture. Traceability has allowed calling back all patients who received medication with problems. Resources have been optimized: reports show there is no shortage of equipment for CT, for instance. Identifying patients and keeping a basic ambulatory EHR have saved lives. Recently, a pregnant teenager was rushed into the hospital in critical conditions (eclampsia). The system alerted the FHP team of her absence from a scheduled prenatal consultation and they visited her home. Fortunately, she and her child were saved. São Paulo City has given away the source code free of charge to other cities in Brazil that now also use the system.