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Public health

Patient at the other end of the line

Smartphone tested for collecting field data to feed online medical records

Mobile phone screen with the GeoHealth system: patients’ medical data can easily be entered

Since February of 2010, some of the agents at a healthcare center on the outskirts of the city of São Paulo have been going into the field to collect data on the local population carrying a powerful ally in their pocket: a smart mobile phone,  linked to the Web via the 3G data network, with a little keyboard for writing, GPS and activation by using a touch-sensitive screen. With this little device in hand, the family health teams of the Paulo VI Basic Healthcare Unit (UBS) in the vicinity of the Raposo Tavares highway, on the outskirts of São Paulo city’s western region, can set aside their pen and paper and record straight into the smartphone all the data pertaining to each home visited and its inhabitants. The phone runs an application developed by the West Region Project of the Medical School of the University of São Paulo (FMUSP). Provisionally named GeoHealth, this software includes an electronic medical records form. If the street where the person lives has no formal name, which is not unheard of, there is no problem. The device’s GPS always records the geographic coordinates of the records that the healthcare agents create for each individual. Once the visit has been completed, the UBS team saves the form and transmits it directly to the project’s database from the person’s home, with the aid of the little phone. In just a few seconds, the medical profile of a Paulo VI family is in a FMUSP computer.

Using smartphones to feed the embryo of a future set of medical records online is part of a series of initiatives designed to reorganize and humanize the care provided by the Single Healthcare System (SUS) in an area in the West of the São Paulo state capital, in the micro-region that comprises the districts of Butantã and Jaguaré, where some 420 thousand people live. This is the chief aim of the West Region Project, which also engages in scientific research and teaches medicine. In October 2008, FMUSP signed a management agreement with São Paulo city’s Municipal Health Bureau and, through this project, took over the management of the primary structure at the healthcare centers, walk-in clinics and emergency rooms in these two districts (see article in Pesquisa Fapesp issue 164). In this part of the city, which is turning into a laboratory for new SUS practices, the implementation of the project is being conducted gradually. For the time being, five of the region’s 14 UBSs are already under the management of the project team. At the Paulo VI unit, the FMUSP researchers decided to tackle one of the public healthcare system’s weaknesses: the poor quality of medical information about the patients who resort to SUS. “An efficient database will allow the integrated system to work better”, states Sandra Grisi, president of the steering council at the West Region Project. “Like the patient, information must also run through the system”.

According to Alexandra Brentani, the project’s executive director, the lack of data on the population that lives in the area covered by a UBS or by a healthcare center in the city of São Paulo is currently substantial. When there are family healthcare teams that regularly visit the homes in the region, all the information collected is written down on a paper form. The problem is that sometimes this information is lost along the way, neither being digitized nor going into computer systems. “Even when the data are entered into Siab [the Basic Care Information System of the Ministry of Health] they are not permanent”, comments the FMUSP manager, an expert in healthcare resources management. “After one month they are deleted”. To solve this problem, the West Region team looked for an alternative way for the community agents themselves to feed the medical information database directly from the field, with no intermediaries. Giving them a laptop was one possibility, but the risk of theft in the streets was high. This left smartphones, which are more discreet, but can handle the job. “People already know how to use mobile phones and with just a minimum of training they manage to fill out the electronic form”, says Marco Antonio Gutierrez, the project’s IT coordinator.

Automatic saving
The next step was to determine what kind of device would be most appropriate for testing with the work of the family healthcare teams. The researchers chose mobile phones that run on Google’s Android operating system and created a data collection software program, GeoHealth, which runs on the said platform. Access to the programming that makes Android run is totally open and free of charge, making application developers’ work easier. This allows GeoHealth to be easily integrated into the mobile phone and enables it to be user-friendly. Except for the person’s name, GeoHealth requires very little keying in of data. Writing on a smartphone’s tiny keypad is uncomfortable. Therefore, the West Region team created a form which can be completed by the user simply touching the device’s screen. Practically all the information about the home and its inhabitants’ health history can be entered into this form. In the tests carried out at UBS Paulo VI, the healthcare agents are using five devices (three provided by Motorola and two provided by LG, both of them firms that established a partnering agreement with the project) and they are transmitting the data via TIM’s 3G network, which is also supporting the initiative. “If there is no network signal in the area where the agent is, GeoHealth automatically saves all the data in the smartphone’s memory”, says João Henrique Gonçalves de Sá, a systems analyst working on the West Region project. “As soon as the device finds the signal, the form is automatically transmitted to our database”.

With the help of the mobile phones, which are blocked in terms of regular phone calls, the records of some 150 families that live in the area covered by UBS Paulo VI, totaling about 700 people, have been entered into the system created by FMUSP. As all the data are geo-referenced, one can see on the Google maps system the health status of the inhabitants in any given home, as well as the more general medical status of all the homes in the region. These tools should be immensely valuable for epidemiological studies in the future, especially once the project’s database acquires more data and includes information about the inhabitants served by the other UBSs in Butantã and Jaguaré. When anybody wants to know where the cases of pregnant women with dengue fever can be found in a district, for instance, they will be able to research this in the database to find an answer. “We also took care to design a system that can be totally integrated with the Ministry of Health database, including the medical records form that Siab uses”, comments Alexandra. Even though smartphones are not a cheap item to add to the equipment that SUS supplies to its agents, the FMUSP researchers believe that in the long run they will pay for themselves, becoming the basis of a more efficient medical data collection system.