A caderneta de saúde da criança para o cuidado integral à saúde infantil: percepções de profissionais de saúde / The child's health booklet for comprehensive child health care: perceptions of health professionals

A atenção primária e as ações voltadas para a vigilância à saúde da criança constituem a base da organização da atenção à saúde infantil. Das estratégias voltadas para a atenção integral à saúde da criança, a Caderneta de Saúde da Criança (CSC) apresenta-se como instrumento essencial de vigilância infantil, por ser o documento onde são registrados os dados e eventos mais significativos para a saúde infantil e por possibilitar o diálogo entre a família e os diversos profissionais que atendem a criança. Objeto de estudo: a utilização da caderneta de saúde da criança pelos profissionais de saúde para o cuidado integral à saúde infantil. Objetivos: identificar como os profissionais de saúde utilizam a CSC para o acompanhamento e vigilância da saúde infantil; descrever os fatores que interferem na utilização ou não da caderneta pelos profissionais de saúde; discutir a importância da utilização da CSC na perspectiva dos profissionais de saúde, com vistas ao cuidado integral a saúde infantil. Estudo descritivo, de caráter exploratório, abordagem qualitativa. Os dados foram coletados com 24 profissionais de saúde que prestam atendimento à criança em um Centro Municipal de Saúde e em uma Unidade Hospitalar Pediátrica em um município do estado do Rio de Janeiro. Foram realizadas entrevistas semiestruturada e os dados foram avaliados pela técnica de análise de conteúdo temática. Resultados: três categorias teóricas foram definidas: A utilização da Caderneta de Saúde da Criança para o acompanhamento da vigilância infantil; Fatores que interferem na utilização ou não da caderneta pelos profissionais de saúde na perspectiva do cuidado integral à saúde infantil com duas subcategorias: fatores facilitadores para utilização da CSC pelos profissionais e dificuldades enfrentadas pelos profissionais; A importância da utilização da Caderneta de Saúde da Criança para o cuidado integral na perspectiva do profissional. Os dados quanto à utilização é preocupante, pois a ausência e os dados incompletos foram relatados pelos profissionais. Quanto às facilidades e desafios na utilização da CSC para o cuidado integral da criança o estudo apontou facilidades por possibilitar a continuidade no atendimento. E dificuldades enfrentadas pelos profissionais de saúde que estão ligadas, sobretudo, ao não preenchimento de dados, seja por desvalorização pelos profissionais, de algumas informações da própria caderneta, seja pela falta de tempo por sobrecarga de trabalho. A importância que a CSC tem no controle, vigilância, prevenção e promoção à saúde infantil, seja em nível individual ou em uma coletividade, são indiscutíveis. Além de auxiliar os profissionais na observação, notificação e análise da situação de saúde da criança, esta caderneta é um instrumento útil e fundamental para os profissionais desenvolverem tais ações. Os registros na caderneta possibilitam a comunicação entre os profissionais de saúde de diferentes serviços, a articulação entre os membros da equipe e a família e a valorização desse documento devem se intensificar, para que se efetive seu papel fundamental de vigilância do crescimento e desenvolvimento. Conclusão: evidências sobre a subutilização da caderneta foram reveladas pelos profissionais de saúde. O registro completo e correto pelos profissionais das informações sobre o atendimento contribui para o planejamento, acompanhamento e a avaliação das ações desenvolvidas, em diferentes espaços que prestam atendimento à criança, por ser este o principal instrumento para a vigilância infantil no contexto da atenção integral à saúde da criança

The primary care and actions directed to monitoring of the health of children constitute the base of the organization of attention on children´s health. On strategies destined to the integral attention of the Child´s Health Bookle is presented as the essential instrument of children´s monitoring for being the document where it is recorded the data and most significative events to children´s health and make dialogue possible between family and other proffessionals who treat the child. Object of study: the use of the health book of the child by health professionals for the integral care of children. Goals: o identify how health professionals use CSC to monitor and monitor children's health; to describe the factors that interfere in the use or not of the carnet by the health professionals; to discuss the importance of using CSC from the perspective of health professionals, with a view to comprehensive child health care. Descriptive study of exploratory type, qualitative approach. Data was colleted with 24 health proffessionals who provide service to children. At a "Municipal Center of Health" and "Pediatric Hospital Unit" in the state of Rio de Janeiro. Semistructured interviews were made and data were evaluated by technical analysis of subject content. Result: three theorical categories were defined: The use of the Child Health Handbook for the monitoring of child; Factors that interfere in the use or not of the booklet by health professionals from the perspective of integral health care for children with two subcategories: facilitating factors for professionals' use of CSC by professionals and difficulties faced by professionals; The importance of using the Child Health Handbook for comprehensive care from the perspective of the professional. All date regarding the use is worrying due to the absence and incomplete data related by proffessionals. In terms of facilities and challenges on the use of the CSC to fullcare of the child the study indicated facilities for allowing the continuity on the service. And the difficulties faced by health proffessionals that are linked, mainly, to the no filling up of some information of its own CSC, or, by the lack of time due to work overload. The importance CSC has on the control, monitoring, preventive and children´s health promotion, in individual or community levels in unquestionable. Besides helping proffessionals on observation, notification and analysis of the situation of children´s health, this Booklet (CSC) is a useful and fundamental instrument for proffessionals to develop these actions. The records on the booklet al.low communication between health proffessionals of different services, the articulation of members of the team and the family and valorization of the document must be intensified so that its fundamental role of growth and development monitoring can be implemented. Conclusion: Under utilization evidences of the booklet (CSC) were reveald by the health proffessionals. The complete and corrected record of the information about the service made by the proffessionals contributed for the planning, fallow up and the evoluation of the actions developed in the dufferent places that provide child service, by being this the main instrument for child monitoring in the context of full attention to children´s health

Preenchimento da caderneta de saúde da criança: percepção dos profissionais / Completion of the child health record: perception of professionals

O objetivo deste estudo foi analisar a percepção dos profissionais que atuam na rede básica de saúde sobre o preenchimento da caderneta de saúde da criança. Trata-se de uma pesquisa exploratória de abordagem qualitativa realizada com 20 profissionais de saúde que atuavam diretamente na assistência à criança no município de Cuiabá, Mato Grosso. Para o levantamento dos dados, optou-se pela técnica de entrevista semiestruturada, a qual foi realizada no período de fevereiro a março de 2013. Os dados foram organizados e submetidos à Análise de Conteúdo, modalidade temática. Os profissionais referiram que os dados presentes na caderneta são importantes, sobretudo, para o acompanhamento da saúde da criança, no entanto, o registro desses não está sendo realizado de forma adequada pelos profissionais das maternidades e das unidades básicas de saúde. Para os entrevistados, o registro dos dados na caderneta é de responsabilidade dos membros da equipe de saúde, contudo, houve discordância entre eles quanto à participação da família no preenchimento deste instrumento. A falta ou incompletude do registro dos dados de saúde da criança na caderneta traz prejuízos para o acompanhamento integral de sua saúde e dificulta a avaliação das ações de saúde prestadas.

The objective of this study was to analyze the perception of professionals working in primary health care system on the filling of the Child Health Record. This is an exploratory qualitative study conducted with 20 health professionals who worked directly on child care in the city of Cuiabá, Mato Grosso. To survey data we chose the semi-structured interview technique, carried out from February to March 2013. The data were organized and analyzed through thematic content. Professionals reported that the data present in the child health record are important, especially, for monitoring the health of the child, however, the child health record is not being done properly by professionals from hospitals and basic health units. For respondents, recording data in the child health record is the responsibility of members of the healthcare team, however, there was disagreement among them as to family participation in completing this instrument. The lack or incompleteness of recording data on child health record brings harm to the comprehensive evaluation of their health and complicates the assessment of health provided.

CCR+: Metadata Based Extended Personal Health Record Data Model Interoperable with the ASTM CCR Standard / 대한의료정보학회지

OBJECTIVES: Extension of the standard model while retaining compliance with it is a challenging issue because there is currently no method for semantically or syntactically verifying an extended data model. A metadata-based extended model, named CCR+, was designed and implemented to achieve interoperability between standard and extended models. METHODS: Furthermore, a multilayered validation method was devised to validate the standard and extended models. The American Society for Testing and Materials (ASTM) Community Care Record (CCR) standard was selected to evaluate the CCR+ model; two CCR and one CCR+ XML files were evaluated. RESULTS: In total, 188 metadata were extracted from the ASTM CCR standard; these metadata are semantically interconnected and registered in the metadata registry. An extended-data-model-specific validation file was generated from these metadata. This file can be used in a smartphone application (Health Avatar CCR+) as a part of a multilayered validation. The new CCR+ model was successfully evaluated via a patient-centric exchange scenario involving multiple hospitals, with the results supporting both syntactic and semantic interoperability between the standard CCR and extended, CCR+, model. CONCLUSIONS: A feasible method for delivering an extended model that complies with the standard model is presented herein. There is a great need to extend static standard models such as the ASTM CCR in various domains: the methods presented here represent an important reference for achieving interoperability between standard and extended models.

Smart Information System for Gachon University Gil Hospital / 대한의료정보학회지

OBJECTIVES: In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. METHODS: This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. RESULTS: The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. CONCLUSIONS: Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

History and Trends of "Personal Health Record" Research in PubMed / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to review history and trends of personal health record research in PubMed and to provide accurate understanding and categorical analysis of expert opinions. METHODS: For the search strategy, PubMed was queried for 'personal health record, personal record, and PHR' in the title and abstract fields. Those containing different definitions of the word were removed by one-by-one analysis from the results, 695 articles. In the end, total of 229 articles were analyzed in this research. RESULTS: The results show that the changes in terms over the years and the shift to patient centeredness and mixed usage. And we identified history and trend of PHR research in some category that the number of publications by year, topic, methodologies and target diseases. Also from analysis of MeSH terms, we can show the focal interest in regards the PHR boundaries and related subjects. CONCLUSIONS: For PHRs to be efficiently used by general public, initial understanding of the history and trends of PHR research may be helpful. Simultaneously, accurate understanding and categorical analysis of expert opinions that can lead to the development and growth of PHRs will be valuable to their adoption and expansion.

Development of a Personal Health Record System Based on USB Flash Drive and Web Service / 대한의료정보학회지

OBJECTIVE: The development of information communication technology (ICT) and the demand for managing the healthy lives of individuals are accelerating the informatization of the health and medical field. Considering this environment and the needs of the individual, this paper has designed and developed a web and mobile storage device-based personal health record (PHR) system that individuals can manage by themselves anywhere, anytime, whether on-line or off-line. Based on the experience of implementing the system, its development method, results, and relevant technical issues are described. SYSTEM DESIGN AND DESCRIPTION: This system is implemented to manage PHR, including vital signs and ingested/consumed calories for a lifetime by connecting a PHR-integrated web server to each hospital's information system, and the PHR programs installed in the individual's PC or USB flash memory drive. To achieve this, an interface module, web server system, and PHR viewer program for individuals are developed. RESULTS: When it is off-line, the PHR program is operated to inquire the data saved in the DB, and the self-measured information can be inputted. When it is on-line, it calls the web service function to inquire the medical information, including hospital visit history, prescription history, diagnosis result, image inspection result and medical treatment result. CONCLUSION: This system connects home and mobile healthcare to hospitals but minimizes information leakage because the data is not accumulated. By loading a plug & play, PHR viewer to an easy-to-carry mobile storage device, the systems supports a sustainable health management.

A Future of Medical Information System: Establishment of Hospital-oriented Personal Health Record

Personal Health Record (PHR) has recently been drawing attention due to the an ever-increasing interests of ubiquitous healthcare. Diverse approaches have been proposed to implement PHR at home and abroad. In this review, we propose a hospital-oriented PHR system for the future direction of medical information system. If a hospital-oriented PHR system is implemented, hospitals can increase the quality of medical care by providing personalized medical services to the individual patients and the reliability of health records in PHR can be significantly improved. For this purpose, we first investigate the definition of PHR and then address diverse issues to be tackled prior to implementation of the hospital-oriented PHR system.

A Survey of Health Consumers' Attitude of Personnel Health Management Service Using PHR / 대한의료정보학회지

OBJECTIVE: This study was conducted to investigate public opinion regarding personal health management service using Personal Health Record (PHR) in Korea. Specifically, the relationships between consumer's demographic characteristics, need for health information, consumer's benefit and concern, type of health information, type of management and security of patient information using PHR and attitude to PHR were explored. METHODS: A survey was conducted, using questionnaire developed by the study team based on literature review. Structured questionnaires were completed through a telephone survey for 715 consumers. RESULTS: A key finding was the significant difference for customer's attitude towards using PHR by customer's characteristics. Regarding factors affecting attitudes of customers with higher concern about their health, considering authorization level to access their private information and using reliable method to certificate were more likely to prefer PHR system positively. CONCLUSION: Public opinion is reflected in policy of health information. Meeting consumers' needs sufficiently, the goal of health information service to improve consumers' accessibility to and satisfaction will archive successfully.

A Development of Prototype Personal Health Record System based on Continuity of Care Document / 대한의료정보학회지

OBJECTIVE: We have developed a prototype Personal Health Record (PHR) system that can replace traditional paper-based personal health diary with structured clinical details for healthcare. Because numerous disparate electronic versions of medical record systems are found unable to share medical information among hospitals, pharmacies and clinicians, the proposed PHR system can be used to facilitate patient care. METHODS: The PHR system has been implemented on a flash memory (USB drive) that is found to be compact, light weight, cost-effective and sufficient enough to handle a large amount of clinical data. International communication standard HL7 has recommended Continuity of Care Document (CCD) that can provide complete and accurate summary of an individual health and medical history. Care documents stored in USB can also support alerts, reminders, self-management, and stakeholder communication in a standardized manner. RESULTS: The proposed PHR system consists of modules that help collect distributed patient information from multiple sources to generate individual care document (CCD) as personal health record. The preliminary experiment has demonstrated an acceptable performance. That is, the PHR is found to integrate and share various clinical data such as medications, procedures, patient demographics from admission system, test results from LIS, DICOM images from PACS, bio.signals from patient monitors. Especially, the PHR system was tested by connecting to standardized monitoring device (Mediana device) to collect ECG data. The PHR system had received 3410 HL7 messages for 1 hour, then generate CCD document.