Abstract
BackgroundThe electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries.ObjectiveThe aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services.MethodsThe proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution.ResultsThe eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients’ identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication.ConclusionsThe proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.
Highlights
BackgroundThe care of mental disorders frequently requires a coordination of efforts among different health care professionals, services, and care levels [1]
The proposed platform established an electronic health (eHealth) solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management
It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care. (JMIR Ment Health 2018;5(4):e10129) doi:10.2196/10129
Summary
BackgroundThe care of mental disorders frequently requires a coordination of efforts among different health care professionals, services, and care levels (primary, secondary, and tertiary) [1]. There is a frequent need to integrate the care of mental disorders with the care of nonpsychiatric health problems (such as cardiovascular disorders, diabetes, maternal health, HIV/AIDS, and cancer) for the same people. This type of comorbidity is common, and there is evidence that an adequate management of behavioral problems can positively impact other health conditions [2,3]. The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, in low- and middle-income countries
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