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
 The basis of many health systems
 Universal service
«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.»
CHAN, M. (2008). "Primary health care – now more than ever." Retrieved 21 October 2009,
from http://www.who.int/dg/speeches/2008/20081014/en/index.html.
Introduction: Background and Rationale
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.»
AMERICAN MEDICAL ASSOCIATION. "Health Information Technology (Health IT)." Retrieved
28 October 2009, from http://www.ama-assn.org/ama/pub/physician-resources/solutionsmanaging-your-practice/health-information-technology.shtml.
Introduction: Background and Rationale
Regional Health Administrations
(ARS)
Health Centre Groups
(ACES)
Community
Health Centres
Introduction: Background and Rationale
Portuguese Northern Region
 Location
 Wide area
Existence
 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)
Research Question and Aims
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.
Participants and Methods
Study Participants
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
Participants and Methods
Study Design
The study is classified as:
 Observational
 Cross-sectional
 Ecologic
Participants and Methods
Contact the Director of
ARS Norte
Interview Dr. Castanheira
- Explain aims and methods
- Ask collaboration and authorization for the study
e-mail
- Ask about the stimulus given by the ARS Norte for the
implementation and usage of basic Health IT in Health Centres
presential interview
Send a pilot survey to
selected director of
community health centre
(Dr. Carlos Martins)
Contact the Executive
Directors
(ACES, Community
Health Centres)
Analyse the gathered data
- Improve the quality and objectivity of the surveys in order to
obtain more relevant and concise information
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
e-mail and telephone
- Gather and process data statistically in order to establish
comparisons and come up with the conclusions of the study
Pilot Survey
 Answered by Dr. Carlos Martins via telephone
 Main goal
Perform relevant adjustments in some of the questions to
make them easier to answer
Final version of the
survey
Main Results
Description of the institution
Type of institution
25%
ACES
Health Centres
75%
Main Results
Equipment and its usage
Percentage of equipments in doctors’ offices and nursing rooms
Doctors’ offices
91-100%
Computers
Nursing rooms
91%-100%
91%
11-20%
81%-90%
9%
0%
90%
20%
40%
60%
80%
100%
10%
0%
20%
40%
60%
91%-100%
Printers
91-100%
100%
0%
Scanners
40%
60%
80%
0%-10%
20%
40%
60%
80%
0%-10%
100%
0%
20%
40%
60%
80%
10%
61%-70%
10%
0%
100%
20%
40%
60%
80%
0%-10%
100%
100%
80%
81%-90%
100%
100%
0%
Photocopiers
20%
80%
100%
100%
0%
20%
40%
60%
80%
0%-10%
100%
100%
0%
20%
40%
60%
80%
100%
Main Results
Equipment and its usage
Frequency of the utilization of computers by health professionals
Health professionals (doctors and nurses)
always use computers in primary health care
Main Results
Equipment and its usage
Percentage of computers that allows the usage of specific applications
90%
90%
80%
82%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
100%
82%
80%
10%
9%
9%
0%
90%
9%
9%
0%
1
0
0
%
100%
100%
90%
90%
80%
100%
91
%
80%
82%
90%
80%
70%
70%
70%
70%
60%
60%
60%
60%
50%
50%
50%
50%
40%
40%
40%
40%
30%
30%
30%
30%
20%
20%
20%
20%
10%
10%
10%
10%
0%
0%
9%
9%
0%
9%
78
%
22
%
0%
91%100%
Patient Health
Record
Administrative
management
Internet
TeleHealth
Video
conference
Other
applications
Main Results
Equipment and its usage
Percentage of computers that allows the usage of specific applications
Other applications:
 Alert P1
 SAPE
 Siars
 SGSR
 Spark





GestCare
SIMA Rastreios
Taonet
Impax
Hígia
Main Results
Usage of the existing information systems
Access to the patient record and its frequency
Doctors
Nurses
Always
Always
64%
91%
Frequently
9%
0%
20%
40%
60%
80%
Sometimes
18%
Without Access
18%
100%
0%
20%
Administratives
Always
40%
60%
80%
100%
Patients
9%
Sometimes
Sometimes
10%
9%
Never
18%
Without Access
Without Access
90%
64%
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
Main Results
Usage of the existing information systems
Access to the patient record and its frequency
Other health professionals
Frequently
9%
Rarely
9%
Without Access
Operational assistants
Social assistants
Psychologists
Nutritionists
82%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Main Results
Usage of the existing information systems
Specific software for the doctors
To make prescriptions
To make health certificates
9%
Existence
100%
91%
91%-100%
91%-100%
64%
91%
81%-90%
Utilization
61%-70%
18%
61%-70%
9%
41%-50%
9%
9%
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
Main Results
Usage of the Internet
Internet access
Doctors’ offices
Nursing rooms
91%-100%
Existence
91-100%
91%
100%
81%-90%
0%
20%
40%
5
60%
80%
100%
39%
4
9%
0%
20%
40%
5
39%
4
39%
60%
80%
100%
60%
80%
100%
33%
Utilization
3
3
6%
1
6%
17%
Don't know
11%
0%
Don't know
20%
40%
60%
80%
100%
11%
0%
20%
40%
Main Results
Usage of the Internet
Purposes of the usage of the Internet
Search
scientific articles
Share data
with other health entities
25%
8%
8%
75%
17%
75%
Use tools
to support clinical practice
92%
Personal use
25%
Other usages
14%
25%
14%
50%
75%
Communicate
with other health professionals
25%
71%
Main Results
Existence and utilization of intranets
Existence of intranets
36%
64%
No
Yes
Main Results
Existence and utilization of intranets
Utilization of intranets
Doctors
Nurses
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
43%
30%
43%
30%
29%
29%
29%
20%
20%
10%
10%
0%
14%
14%
3
1
0%
5
4
3
5
4
Main Results
Support
 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.
Main Results
Training
Doctors, nurses and administratives
all have/had specific training
to work with the hardware and software available
Sufficiency of the training made available
Doctor
Nurses
9%
9%
55%
Administratives
9%
9%
36%
82%
91%
Main Results
Remarks
Hardware
• Scanners
The main
needs
• Establish more efficient links
between applications
• Computers
• General improvement of the
quality and speed of the
devices
• Make network connections
faster
What should
be changed in
terms of usage
Software
• Increase the number of
devices available
(e.g. scanners, screens for the
waiting rooms)
• Faster and more reliable
computer programs
• Make the computers less
vulnerable to threats
(e.g. virus)
• There is technical support
available in case of difficulties
Main Results
Remarks
Human resources
Training 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
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 http://www.arsnorte.minsaude.pt/portal/page/portal/ARSNorte.
 AMERICAN MEDICAL ASSOCIATION. "Health Information Technology (Health
IT)." Retrieved 28 October 2009, from http://www.amaassn.org/ama/pub/physician-resources/solutions-managing-your-practice/healthinformation-technology.shtml.
References
 CHAN, M. (2008). "Primary health care – now more than ever." Retrieved 21
October 2009, from
http://www.who.int/dg/speeches/2008/20081014/en/index.html.
 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