Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis.

Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. The overall prevalence of alert generated by CDSS was 13% (CI95% 5-24%, p-value <0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85-95%, p-value <0.0001, I^2 = 100%). This systematic review and meta-analysis presents a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.

Ten years of the Citizen's Electronic Health Record e-SUS Primary Healthcare: in search of an electronic Unified Health System.

OBJECTIVE: Contextualize the adherence to the Prontuário Eletrônico do Cidadão (PEC - Citizen's Electronic Health Record) by Brazilian municipalities and the evolution of the electronic strategy of the Unified Health System (e-SUS) for Primary Healthcare (PHC) during its 10 years. METHODS: This descriptive study added information on adherence to the use of medical records extracted from the database of the Secretaria de Atenção Primária à Saúde (SAPS- Primary Healthcare Secretary) of the Federal Government between 2017 and 2022. We analized the number of computerized basic healthcare units that used some electronic medical records, the number of those that used simplified data collection (SDC), and those that implemented the citizen's electronic health record (PEC) in the same period. A descriptive synthesis of the functionalities and modules implemented in the system during its 10 years of development was also carried out. RESULTS: The adherence of Brazilian municipalities to the PEC has grown exponentially in the last five years, going from 8,930 healthcare units in 2017 to 26,091 in 2022. As expected, while the main functionalities and improvements developed in this decade sought to implement new flows and modules of administrative, clinical care, and care management processes and health service administration, improving aspects of usability and technological infrastructure of the application architecture was also crucial for the success of the system. CONCLUSIONS: In 2023, the milestone of a decade will be celebrated since the beginning of health records implementation by Brazilian municipalities, marked by technological and infrastructure challenges and improvements and new functionalities that highlight the technological evolution of the e-SUS PHC system and strategy. Despite many other tools, the PEC is arguably Brazil's leading electronic medical record today, as it has always invested in evolution, updating itself in technological and usability opportunities.

Recruiting health professionals to the COVID-19 response, Brazil.

Problem: The coronavirus disease 2019 (COVID-19) pandemic posed a major workforce challenge to Brazil, which has a large land area and a shortage of health workers in regions distant from the big cities. Approach: The Brazilian health ministry implemented a computerized solution to provide rapid support to states and municipalities to hire health professionals from large urban centres to work in underserved areas during the COVID-19 pandemic. We designed an online system for health professionals to register their willingness to work on the COVID-19 response; the system was launched to the public in April 2020. Local setting: Brazil is a large country with great heterogeneity in access to health care across its different regions. Before the initiative was launched, 5 156 020 health professionals were officially registered with professional councils. However, an estimated 3 200 000, more than 60% of them, were working in the two regions with the highest standard of living. Relevant changes: Up to February 2022, 1 007 138 health professionals had self-registered on the system, providing a sizeable database of professionals from a range of disciplines. Of these, 371 275 professionals were willing to work on the COVID-19 response in remote areas. By 1 February 2022, 157 755 professionals have been trained and deployed to these underserved areas. Lessons learnt: Partnership of the government with professional councils and the use of official communication channels were important strategies to improve registration and ensure the success of the scheme. We predict that the database will assist with future public health campaigns in Brazil.

e-SUS APS strategy: Case of success on Primary Care informatization in Brazil / Estratégia e-SUS APS: Um Caso de sucesso na informatização da Atenção Primária no Brasil / Estrategia e-SUS APS: Caso de éxito de informatización de Atención Primaria en Brasil

Objectives: To present the main actions of the Brazilian government that led to the successful implementation of the strategy for the computerization of Primary Care, e-SUS APS, throughout the whole country, as well as the difficulties in implementing such a national health information system (NHIS). Methods: Report on the experience of implementing an NHIS in Brazilian Primary Care, identifying the actions taken by the government to mitigate the risks and overcome difficulties. Results: The e-SUS Primary Care strategy (e-SUS APS) initiated the restructuring of the health information system at the national level. This action focused on the effective management of information, considered essential to increase the quality of care. This strategy aims to create different realities of technological infrastructure and allow all cities to interconnect with an NHIS across the country. Since e-SUS AB was implemented, more than 3 billion records of Primary Health Care (PHC) from all regions of the country have been received by the government. Today, even cities with weak technological infrastructure are able to transmit their data to NHIS, which manages all information. Conclusion: The implementation of the new strategy for primary care at almost 100% of Brazilian municipalities has been a success due to a number of factors. However, efforts must be maintained to ensure the success of its implementation.

Objetivos: Apresentar as principais ações do governo brasileiro que levaram ao sucesso da implantação da estratégia da informatização da Atenção Primária, e-SUS APS, em todo o país, bem como as dificuldades para se implantar um sistema nacional de informações em saúde (NHIS). Métodos: Relato da experiência da implantação de um NHIS na Atenção Primária brasileira, identificando as ações adotadas pelo governo para mitigar os riscos e superar as suas dificuldades. Resultados: A estratégia e-SUS Atenção Básica (e-SUS APS) iniciou a reestruturação do sistema de informação em saúde em nível nacional. Essa ação se concentrou no gerenciamento eficaz das informações, considerado como essencial para aumentar a qualidade do atendimento. Essa estratégia foi construída com o intuito de criar diferentes realidades de infraestrutura tecnológica e permitir que todas as cidades se interconectem com um NHIS em todo o país. Desde que o e-SUS APS foi implantado, mais de 3 bilhões de registros de atenção primária à saúde (APS) de todas as regiões do país, foram recebidos pelo governo. Hoje, mesmo cidades com fraca infraestrutura tecnológica são capazes de transmitir seus dados ao NHIS, que gerencia todas as informações. Conclusão: A implantação da nova estratégia para atenção primária em quase 100% do território brasileiro vem sendo um sucesso devido a uma série de fatores. No entanto, os esforços devem ser mantidos para garantir o sucesso de sua implementação.

Objetivos: Presentar las principales acciones del gobierno brasileño que llevaron a la implementación exitosa de la estrategia de informatización de atención primaria, e-SUS APS, en todo el país, así como las dificultades para implementar un sistema nacional de información de salud (NHIS). Métodos: Informe sobre la experiencia de implementar un NHIS en Atención Primaria brasileña, identificando las acciones tomadas por el gobierno para mitigar riesgos y superar sus dificultades. Resultados: La estrategia de atención primaria de e-SUS (e-SUS APS) inició la reestructuración del sistema de información de salud a nivel nacional. Esta acción se centró en el manejo efectivo de la información, considerada esencial para aumentar la calidad de la atención. Esta estrategia fue construida con el objetivo de crear diferentes realidades de infraestructura tecnológica y permitir que todas las ciudades se interconecten con un NHIS en todo el país. Desde que se implementó el e-SUS APS, el gobierno ha recibido más de 3 mil millones de registros de atención primaria de salud (APS) de todas las regiones del país. Hoy, incluso las ciudades con infraestructura tecnológica débil pueden transmitir sus datos a NHIS, que administra toda la información. Conclusión: La implementación de la nueva estrategia de atención primaria en casi 100% del territorio brasileño ha sido un éxito debido a una serie de factores. Sin embargo, se deben mantener los esfuerzos para garantizar el éxito de su implementación.

Dashboard and a Model of Predictive Analysis for Cerebrovascular Diseases in Primary Health Care.

Cerebrovascular and hypertensive diseases are among the leading causes of death in the world. This study was developed in two stages: the development of a dashboard with specific reports of cerebrovascular diseases and applied a preliminary predictive analysis model for cerebrovascular diseases. The results demonstrate the abitity to predict a citizen's chance acquiring a cerebrovascular disease.