Since 2012, Salud.uy has brought together healthcare system stakeholders to make strategic decisions in the field of medical informatics with a user-centered approach. To this end, they have established various forums for exchange and technical cooperation that have formed and consolidated an interdisciplinary community among all public and private stakeholders, aligned with the national healthcare policies of the Sistema Nacional Integrado de Salud (SNIS). Thanks to this background, Uruguay is facing the pandemic with several healthcare provider information systems available, which interoperate with each other through the private data network (health network) using the government's healthcare platform.
The National Electronic Health Record (HCEN) is one of the cornerstones of the Salud.uy program, playing a crucial role in ensuring the healthcare continuity of Uruguayans. It is based on interoperability, enabling the exchange of clinical information among different healthcare providers, regardless of where the information was generated. It has been in operation since 2016, and four years later, more than 54 million clinical documents are registered on the HCEN health platform, with over 11 million consultations and about 300,000 documents exchanged on the platform. Today, it is linked to the Coronavirus UY App, specifically created for this pandemic, providing information about the progress of suspected or confirmed COVID-19 patients, among other functionalities we will see later.
In summary, the HCEN is an initiative driven by the Salud.uy program, with the primary goal of contributing to the promotion and improvement of healthcare continuity within the Sistema Nacional Integrado de Salud (SNIS) through the use of Information and Communication Technologies (ICTs)
Healthcare continuity is defined as a longitudinal and shared vision of healthcare work involving multiple professionals in different workplaces, acting at different times and under different circumstances but always with the same goal: the user's health. Through HCEN, the clinical information of users within the Uruguayan healthcare system is available and accessible to healthcare teams in a timely, secure, and online manner, regardless of the geographical location and healthcare provider where the user seeks assistance. It is structured on three pillars, based on international health standards from the IHE and HL7 organizations, to organize clinical information:
- Clinical information model
- Data architecture
- Exchange model
These pillars ensure real-time information, ensuring that the healthcare team can make the best decision at the time of diagnosis.
Continuity of care has been a long-standing goal in Uruguay for years; that's why the country was prepared when this global scenario arose. With the emergence of the pandemic, the primary objective was to have a single database containing all suspected or confirmed COVID-19 cases in the population, enabling unified control and monitoring. This objective was quickly achieved while respecting data security, thanks to the interoperability of clinical information.
Coronavirus.UY
As an initial step in centralizing information regarding the population potentially positive for the virus, the National Coronavirus Plan was implemented. This plan not only centralized all official information about COVID-19 for the citizens but also provided various communication channels (phones, chatbots, etc.).
This platform, beyond what we all know as the final user interface (the Coronavirus UY App), has various integration mechanisms, both with healthcare providers (public and private) and with the Ministry of Public Health (MSP), to fulfill its primary functions:
- Allow interoperability with the healthcare providers' own systems.
- Monitoring of potential cases.
- Tracking of positive cases.
- Updating the vaccination status of each individual.
The consolidation and integration into a single system with a centralized case database allow for comprehensive monitoring and ensure appropriate care for clinically probable cases and transmission vectors.
The development and deployment of various control panels (backends or inboxes) for both the MSP and various healthcare providers throughout Uruguay allowed for patient care and clinical follow-up, even in healthcare providers that were not fully digitalized or couldn't integrate automatically.
As of today, Coronavirus.uy has processed over 1,470,153 cases in the clinical inbox, while through all interaction channels (application, chat, phones, etc.), there are approximately 2 million interactions with the National Coronavirus Plan database and about 105,000 data entries (obtained from the interoperability of the National Coronavirus Plan platform with healthcare providers' systems). The Coronavirus UY application, which is its most visible face, acted as a bridge between people and healthcare teams and has been downloaded by more than 600,000 individuals, with approximately 300,000 active users and 200,000 users with exposure alerts enabled.
Furthermore, the Coronavirus UY application adapts to the evolution of society and introduces a new feature for Digital Border Declaration, while the government allows the entry of tourists and Uruguayan residents living abroad into the national territory.
Residential Application
When we thought we had all the tools and the situation was relatively under control, an outbreak occurred in residential care homes for the elderly. Due to the characteristics of the affected population, this outbreak raised significant concerns among authorities and the general public.
Outbreaks are a significant feature of this pandemic and become a major threat, especially when they occur in places like residential care homes. Having information about the healthcare characteristics of these facilities was essential for managing the outbreak, taking proactive measures, and enabling its control.
In response to this need, the Residential Application was created in just 2 days. This application records the healthcare data of the residential care home, as well as that of the staff and residents (patients). When the user registers the data, they also assess whether any person is showing symptoms, and if so, they are referred to the Coronavirus.Uy Database.
1,200 residential care homes, over 3,500 staff members, and 10,000 residents have been registered. This application has evolved, and today, it is considered as a control tool. Beyond the pandemic itself, this is a monitoring process that is here to stay and aims to ensure oversight for the highest quality of care in residential facilities.
Volunteers Application
Collapsed can occur because we've occupied all the available ICU beds, but also because there's not enough healthcare personnel to assist. In this case, a tool for coordinating volunteer healthcare workers to address the healthcare demand across the entire national territory is essential to ensure that healthcare capacity is not lost.
So, as an initiative of the K2BHealth team, the implementation of a centralized system for registering healthcare volunteers emerged.
The aim of this system is to allow individuals who want to work as volunteers to register their willingness, indicating their clinical profile (doctor, nurse, etc.), their availability, and the location where they are available.
On the other hand, healthcare providers also register their demand, specifying the profile they need to cover, as well as the days and hours they require assistance.
Through filters and search engines, the application displays offers to meet the demand, assigning a volunteer. This makes the mechanism for maintaining healthcare quality more effective and efficient during periods of high demand. The registered volunteers included medical students and retirees who, during that period of high demand, handled 17,500 consultations, helping alleviate the heavy workload of the Administration of State Health Services (ASSE) at the peak of cases.
The technological ecosystem of Salud.uy was able to function rapidly to assist during the pandemic thanks to the foundation it was built upon. In this case, the HCEN acted as a robust immune system that allowed us, Uruguayans, to confront a highly contagious disease. These accelerated technological processes, carried out in record time, even though they emerged in the context of a pandemic and urgency, are processes that are here to stay and reinforce new initiatives for centralization, management, and monitoring, which will undoubtedly continue to have positive effects in the future. Mauricio Bauza, HCEN Coordinator at the Agency of Electronic Government and Information and Knowledge Society (AGESIC), stated: 'Today, we can say that we are proud to have contributed our part to these projects and to contribute to positioning Uruguay as an innovative country with a very strong healthcare and technological system.