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Brazilian Ministry of Health: National Health Information Exchange Solution Dr. Augusto Cesar Gadelha CIO DATASUS/ Ministry of Health - Brazil Luiz Paulo Ribeiro Manager Middleware Platforms - CDS Kumar Sivaraman Director, Product Strategy Oracle America

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Healthcare system in Brazil Health is a social right under the terms of this constitution 6 th art. Constitution of 1988. (section) 2

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5 th largest country in the world. (7,682,300 Km 2 ) 5 th largest population. (201 million) (2013) 7 th largest economy (GDP 2.2 trillion USD) (2013) Young democracy (Constitution from 1988) Political stability National Federation 5 Regions 26 states + DF (Federal District) 5,569 Cities (Municipalities) 3 Brazil: Facts and Data

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More than 90 million people connected to the Internet 100% of income tax forms are sent via Internet Electronic Voting System: a system with 135 million voters with election results in 4 hours 35 billion electronic bank transactions in 2012 We feel confortable about IT technologies Intense use of social networks by internet users 4 Brazil: Facts and Data

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At the end of 80s, the Constitution of 1988 defined that it is a duty of the State to ensure the health of the population. To comply with this requirement, SUS was created ( Sistema nico de Sade Unified Health System) in order to provide universal healthcare access. DATASUS is the Ministry of Health Department responsible to provide necessary IT resources to the Ministry. 5 Healthcare system in Brazil

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6 About SUS Universal healthcare access The health is a right Health is a right of all and a duty of the State More than 160 million citizens depend on SUS Universal coverage, for free In all services and procedures Principle of SUS: Equality of access Universality of services Integrity in attention Finance and Shared Management By Federal, State and Municipal levels There are private healthcare insurance for those who can afford 1.400+ healthcare insurances that provide coverage for more than 40M people The ANS (National Supplemental Healthcare Agency) is responsible to regulate the health insurance sector.

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7 About SUS: Numbers ServicesCount (2011) Month Average Amount Paid per Year (2011) Procedures Hospital Admissions 11.1 mi0.9 mi R$ 11.2 bi 112 mi High Complex Procedures 717.7 mi 59.8 mi R$ 5.8 bi 3,600 mi Ambulatory 3,524.0 mi 293.7 mi R$ 15.2 bi 3,524 mi Total 4,252.8 mi 354.4 miR$ 32.2 bi ~US$16 bi7,236 mi 1 BRL 2 USD (2011)

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8 About SUS: Numbers Healthcare providers PublicPrivatePhilanthropic SUS Providers 65,33317,3314,812 Non-SUS Providers 168,150

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Objectives To promote correct identification and individualization of health information To provide demographic information to support decision making of healthcare policies To provide access to electronic health record To promote interoperability between health IT systems with the national database (CADSUS). 9 National Healthcare Card It identifies a SUS user (patient), allowing to create a link between the patient, healthcare professionals and providers where the healthcare services actions were taken. (CNS)

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10 National Healthcare Card The five is IdentificationInteroperabilityIntegrationInfrastructureInformation

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 11 Health Resources and Services Administration U.S. Department of Health and Human Services Health information exchange (HIE) is the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient- centered care. What is Health Information Exchange?

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 12 Document Repository Document Registry Document Consumer Patient Identity Manager Document Source Patient Identity Feed ITI-8 ; ITI-44 Provide and Register Document Set ITI-41 Registry Stored Query ITI-18 Retrieve Document Set ITI-43 Register Document Set ITI-42 Patient Demographic Query ITI-21; ITI-47 Patient Identity Source Document Repository Document Source Document Consumer Transaction Flow Cross-Enterprise Document Sharing

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 13 Transaction Flow Document Repository Document Registry Document Consumer Patient Identity Manager Document Source Patient Identity Feed ITI-8 ; ITI-44 Provide and Register Document Set ITI-41 Registry Stored Query ITI-18 Retrieve Document Set ITI-43 Register Document Set ITI-42 Patient Demographic Query ITI-21; ITI-47 Patient Identity Source Oracle Healthcare Data Repository Oracle Health Sciences Information Manager Oracle Healthcare Master Person Index Cross-Enterprise Document Sharing

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 14 Oracle Exalogic / Oracle Weblogic Server Oracle Exadata / Oracle Database Oracle Exalogic / Oracle Weblogic Server Oracle Exadata / Oracle Database Orchestrated Integration Message-based Web Services Java API Health Information Systems Public Health Systems Clinical Information Systems Laboratory Information Systems Diagnostic Imaging Systems Pharmacy Systems Healthcare Portals Other Health Information Systems Standards-Based Integration IHE Profiles IHE Web Services eHealth Exchange Direct/CONNECT Oracle Healthcare Master Person Index Oracle Healthcare Data Repository Oracle Health Sciences Information Manager Oracle Health Sciences Information Gateway Oracle Healthcare Data Model Oracle Healthcare Data Model Oracle Identity and Access Management Oracle SOA Suite for Healthcare Integration Oracle Health Information Exchange

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 15 Supported IHE Profiles Patient Identifier Cross Referencing (PIX) Patient Identifier Cross Referencing (PIX) V3 Patient Demographics Query (PDQ) Patient Demographics Query (PDQ) v3 Cross-Enterprise Document Sharing (XDS.b Document Registry) Cross-Enterprise Document Sharing (XDS.b Document Repository) Multi-Patient Queries (MPQ) Document Metadata Subscription (DSUB) Cross-Community Access (XCA) Cross-Community Patient Discovery (XCPD) Patient Administration Management (PAM Patient Identity Management PIM) Patient Administration Management (PAM Patient Encounter Management PEM) XAD-Patient Identity Change Management (XPID) Consistent Time (CT) Audit Trail and Node Authentication (ATNA) Oracle Health Information Exchange Supported IHE Profiles

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Copyright 2014 Oracle and/or its affiliates. All rights reserved. | 16 Oracle HIE provides person de-identification, document indexing and national repository services Person Index - to de-deduplicate multiple person identities and cross-reference all identifiers Document Index - provides access to participating individuals records from a range of repositories Document Repository - for storing health records and terminology services Solutions Oracle Health Sciences Information Manager Oracle Healthcare Data Repository Oracle Healthcare Master Person Index Oracle Identity Management Oracle WebLogic Suite Oracle SOA Suite Oracle Database Results National infrastructure for e-health records to realize one patient one health record goal Information available at point of care in support of key clinical decisions that can avoid delays in treatment Improve quality of healthcare, lower costs of services, and promote effective health policies Oracle HIE Nationwide Implementations

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OHMPI allows CADSUS to support multiple source systems, identify duplicates, and merge/unmerge records Full history of transactions Use of Oracle Text for phonetic search Hosted in Oracle Exadata and Exalogic platform Use of Oracle SOA products for integration 17 CADSUS Cadastro Nacional de Usurios do SUS Platform responsible to promote interoperability and access to National Healthcare Card database.

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CADSUS Web is a web system that provide easy access to patient information It is available to any SUS healthcare provider to locate and add new patients The solution is design to assist those providers that dont have IT resources to maintain patient records CADSUS Service leverages OHMPI for patient identification 18 CADSUS Cadastro Nacional de Usurios do SUS Platform responsible to promote interoperability and access to National Healthcare Card database.

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19 CADSUS 5.0

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20 CADSUS Integrations General Vision Service Bus for Healthcare CADSUS SCPA SINASC SIM CNES SISRCA SIA, SIH, BPA, APAC SAMU Farmcia Popular HORUS RES e-SUS Hospitalar e-SUS ABSISREG Others systems SIM

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21 CADSUS Interoperability Model Interoperability standards are regulated by an official directive: MS 2.073/2011 Web Services and Security: SOAP and WS-* Document Coding: XML Document Registry and Repository: XDS.b Patient Identification: IHE PIXv3 and PDQv3 Terminologies Lab Coding: LOINC (Logical Obs. Identifiers, Names and Code) Clinical Terms: SNOMED Image coding: DICOM International Standards

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22 National EHR Information and Business models Interoperability architecture (Service bus): deployed 2012 Citizens Health Portal (PHR): deployed 2013 Security and Privacy policy (and enabling tools) Technical architecture and infrastructure Governance

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23 National EHR - Interoperability

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24 How to store data from this message

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25 to this MoH MPI model ?

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26 IHE Profile on CADSUS PIXv3/ PDQv3 The PIX and PDQ built using OHMPI IHE Profile framework It maps the MoH MPI model to IHE Model The PIXManager and PDQSupplier web services interface were published to service bus in less than 3 weeks Use of OHMPI plugins for customized merge logic and CNS number generation Oracle Service Bus compositions for reuse and orchestration with OHMPI IHE Profile

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27 CADSUS IHE PIX/PDQ Solution Design

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28 PIX Feed Flow

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Oracle Healthcare Master Person Index Oracle Exadata Oracle Exalogic Oracle WebLogic Server Oracle JVM JRockit Oracle Access Manager Oracle Virtual Directory Oracle Data Integration Oracle SOA Suite Oracle Service Bus Oracle BPM Suite Oracle HTTP Server Oracle API Gateway Oracle Enterprise Manager Grid Control 12c Oracle Enterprise Repository Oracle Service Registry Oracle Virtual Machine Oracle Linux Oracle BIEE Oracle Identity Manager Oracle Traffic Director 29 Deployed Oracle Products

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Main Challenges Clear e-Health consensus and policies still in development Need to commit Healthcare Professionals and Providers (program is, so far, IT driven!) Complex governance system; Regional and economical diversity; Diversity of technical solutions (in use and in development); Limitations in connectivity and ICT infrastructure (specially outside large and medium urban areas); Lack of required expertise; Bureaucracies at public sector administrative processes Quick wins vs. strategic developments balance 30 Brazilian National e-Health Strategy

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31 Q&A

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Thank you! Augusto Cesar Gadelha CIO DATASUS/SGEP/MS - augusto.gadelha@saude.gov.braugusto.gadelha@saude.gov.br Luiz Paulo Ribeiro Manager Middleware Plaforms - luiz.ribeiro@cds.com.brluiz.ribeiro@cds.com.br Kumar Sivaraman Director, Product Strategy Oracle America - kumar.sivaraman@oracle.comkumar.sivaraman@oracle.com