An Overview and a Future Perspective in Health Information Systems in Portugal

Introduction

The activity of providing health care is a complex task, which stems from several factors, among which it can be highlighted the complexity of the information flow, particularly in clinical processes, the wide variety and different clinical data formats, the ambiguity of the concepts used, the inherent uncertainty in medical diagnosis, the large structural variability of medical records and the organizational and clinical practice cultures of the different institutions (Rouse & Serban 2014). There are growing needs for information at point of care, intended to be complete, homogeneous, accurate, current and of interest to clinical decision (Bath, 2008). Several studies show that information systems can cause a positive effect on quality of care (Lenz & Reichert, 2007), as well as being presently unquestionable their potential economic benefits (Uslu & Stausberg, 2008). One of the main advantages of using computational systems in the health care activity comes from their ability to provide useful information for decision making to health professionals. Thus, their main purpose is to increment the quality and efficiency of health care delivery. In order to achieve these purposes, Health Information Systems (HIS) must fulfil interoperability standards, quality, security, scalability, reliability and timeliness in data storage and processing terms. One of the main problems in this area is that, the large amounts of data produced by health care organizations (which can be of different types, shapes and nature) are stored in several databases with different management platforms and often differ in the architectural levels, which have been developed over the years, in order to support specific needs of certain services or sectors coexisting in the same organization, which may have a large number of heterogeneous and spread systems (Kitsiou, Matopoulos, Manthou & Vlachopoulou, 2007). On the other hand, a large number of health informatics applications do not share information, and when they do, they do it at a very basic level. When communication between different HIS exists, it is mainly achieved through proprietary integration solutions.

In Portugal, several projects were developed in an effort to implement an Electronic Medical Record (EMR) based on the many repositories of information available, but limitations in the existing HIS have prevented this goal to become a reality in a significant extent. To allow a health professional to view the entire medical history of a patient, he must have access to a significant number of documents, which may be spread over many different systems. To make this practical and useful, the user would view all the information from a single system (EMR) that previously received all the information from several other systems (centralized architecture). Alternatively, a more distributed solution may exist, where the user would access other systems besides the EMR. This EMR would contain a set of pointers to remote systems, which store and present the information related with the patient in the study. This is the solution implemented in Portugal through the Plataforma de Dados da Saúde – PDS (Health Data Platform) (Saude, 2014d).