Questions/Answers

“Keep an Eye in Your Appointment” is an IC technological solution, developed by employees of the Municipality for Public Health System(SUS) users. It´s a platform– app and website- that has as major objective to communicate efficiently with patients to amplify access to services. It allows people to know their dates- and confirm their presence- for medical appointments with specialists or for tests prescribed by a primary care physician and scheduled through the National Regulatory System, called SISREGIII, with restricted access.This restriction from SISREGIII regarding schedule communication and confirmation from patients, with its access open only to Health Units professionals, made people need to keep going to the Health Units to enquiry about appointments and tests dates. This caused various problems to users of Public Health System(SUS) in Brazil, such as: absenteeism, long wait in Health Units to get information about scheduling, dissatisfaction, pressure on professionals of Health Units for confirmations, distrust and a widespread feeling of public-sector negligence with the most vulnerable. And it was not different in Jaboatão dos Guararapes. However, this scenario changed in May 2017: the platform implemented allows registered users to know via website or mobile notifications, date, time and place of scheduled appointment or test, avoiding the trips to the Health Units repeatedly.The platform extracts daily from SISREGIII, the codes of users that are entitled to these specialized appointments or tests and sends them mobile notifications, with their appointment details, requesting confirmation. It also offers online access through www.deolhonaconsulta.jaboatao.pe.gov.br, where users may autonomously enter the request code registered in SISREGIII and follow the process.Users of app version, also receive regular information on vaccination campaigns and takes surveys on specific topics, generating rich database for managers. It is a pioneer solution known in Brazil that brought a significant change to SUS users, mostly underprivileged ones.

The platform addresses an issue that interfered on people´s health treatment: difficult access to information made people miss medical appointments. With absenteeism reduced by 7.55 percentage points, use of specialized appointments and tests have increased, proving efficiency in the delivery of services.This transformative tool operates in a context that hindered access to public health services, already available, but not fully used,because of poor access to information. This situation of vulnerability turned into protection, with the use of technology. The app sends important messages and offers surveys, thus providing useful data for BI analysis, aiming its improvements and wider services delivery.

The initiative has contributed to achieving SDGs/Targets #1(1.4), 3(3.1, 3.4, 3.7, 3.8, 3.9-d), 9(9.5-c) and 16(16.5, 16.6).It allows users of health public services free access via website or app, to information regarding scheduled appointments/tests, previously restricted to Health Units professionals, guaranteeing easier access for specialized assistance to the most vulnerable. By registering cancellation requests, it also promotes better coverage of specialized appointments/tests, as the position is automatically available and informed to another patient. Conducting specialized appointments/tests is one of the effective preventive actions for disease monitoring and control, bringing treatment, cure, reducing the risk related to hospital admittance and avoiding death.The initiative favors those who need more than primary care, facing, for instance, high risk pregnancy, mental health or family planning issues.As a disseminator of available data in SISREGIII, which regulates vacancies and priority order in the waiting lists for specialized appointments/tests, the platform ensures safety and equity, avoiding possible bribery and corruption related to appointments/tests vacancies.This communication tool also promotes the strengthening of links between the public sector and citizens allowing the sending of alerts and relevant health information, such as vaccination campaigns, dengue fever virus combating- to the large group registered or a specific group of interest.

The initiative is socially sustainable because it focuses on those who depend on Public Health Services(SUS) totaling 80% of the population in Jaboatão.These are patients who need support from government to face the SUS system bottlenecks, such as the low supply of medical specialists, which lead to long waiting list until the appointment. It is economically sustainable, cheap, simple and effective solution, preventing people from having to pay for transportation on repeated trips to Health Units for information;It is accessible to most vulnerable and generates cost reduction, and environmental benefits avoiding the printing of schedules, previously done in Health Units.

Poor communication has always been a significant issue in public administration.The platform aims at establishing efficient communication to amplify the use of health services by citizens, which represent 80% of the total Municipality population, i.e. 561,137 people.The app version of the platform has been downloaded 87,647 times, and can open free access to a lot more people than the number of downloads:a neighbor, friend or a relative, for instance, totaling 3,804,606 accesses since its implementation in May/2017. Data collected from June to August/2019 show that around 48% of those appointments/tests that have not been offered yet, are being verified through the platform and not by repeated visits to Health Units.The platform provides easy and transparent communication and makes people more aware of their responsibilities as citizens, as for example, when they have the chance to assess the services: the first opportunity the app provides for assessment, is for the patient assess his/her primary care physician. Then, he/she can assess the app itself, enabling the collection of data for re-planning strategies and decision-making.Regarding communicating absences, the total number of confirmation from September/18 to September/19 was 22,534 and cancellations, 993. The spots that come up are immediately transferred to the following patient.

The platform has generated benefits especially for women, who are usually responsible for children's and partner's health and for home chores - as of September 2019, about 75% of registered users are women. By avoiding repeated trips to Health Units, previously necessary in order to know about appointments and tests, women have now more time for household chores and for taking care of their families, what facilitates health promotion at home. The platform also promotes women´s empowerment by promoting access to health education notifications, vaccination campaigns or health services task forces.

The initiative was developed to serve Public Health System(SUS), users of Jaboatão dos Guararapes. It´s the poorest and most vulnerable part of society that suffers from bottlenecks of SUS system, such as long waits for scheduling specialized appointments/tests. Not only did this technological tool change the waiting time for specialized appointments and tests, which is a bottleneck even for private health care users, but it also promoted wellbeing and life quality for SUS patients, thus reducing anxiety, distrust, and frequent dissatisfaction that happened before the initiative's implementation. It also promotes management-relevant information by enabling the evaluation of the Health Care Network(doctors, labs and image clinics), as well as allowing the cancellation of the schedule, which ensures patient replacement, reducing absenteeism. By sending push notifications to registered users with scheduling reminders, it avoids involuntary absences, promoting prevention and treatment for the most vulnerable. The platform also works sending mobile messages regarding vaccination campaigns, health services task forces and educational messages on health promotion. The data generates, such as the average waiting time and demand for a medical specialty or test allows managers search for alternatives, such as care efforts or specific educational actions, reducing the distress and suffering of SUS patients.

The initiative was developed in the first three months of 2017 and implemented in May/2017, based on an initial diagnosis on health services of the Municipality. This first measure was to organize the waiting list for appointments/tests.The organization of this list happened after identifying that the National System SISREGIII waiting list management module was not in use in the Municipality.This module was then implemented for systematizing the waiting list, according to nationally defined protocols in which the priority is the highest necessity degree (risk and waiting time).In January 2017, the SISREGIII waiting list management module was implemented seeking equity, but this alone did not prevent SUS users' comings and goings to get information about the appointments.Therefore, professionals from the Municipality Secretariat of Health developed the technological solution for allowing SUS users access information of schedules made via SISREGIII. The tool development, application and website happened between January and March/2017 and the testing phase took place in April, with definitive implementation in May/2017. There was a widespread dissemination to the SUS population through posters and information in large areas inside the city, aside from interviews in radio, TV's and popular newspapers of the State, internet and social media. Training was also given to the professionals of the Health Units to disseminate the tool among SUS users. Since then, managers have been applying data analysis with BI tool and carrying surveys through the app to make improvements and offer better services. The platform is continuously monitored and is undergoing constant improvements, such as the installation of a consultation terminal for training purposes in 2019 for those who have not downloaded the app yet. Another improvement is a feature that sends a printable version to patients of their confirmation number, eliminating the only needed visit to the Health Unit before their appointment/test happen.

The most difficult obstacles were the short implementation time due to the urgency of the situation, and the financial limitation. The project needed to be simple, fast, and of free download to users. Two healthcare professionals developed the technology solution in the office, using available resources, and presented the budget only for advertising material. With their managers support, the technological tool became available to SUS users in a short time of 5 months, promoting transparency, equity, access to information and enhancing communication.

In January 2017, there was no technological solution known in Brazil that would promote scheduling communication, follow-up and evaluation of specialized appointments and tests through a mobile app for SUS users. It is therefore a pioneer initiative. The information was also made available through a website and in 2019 and through a sort of ATM in a larger Health Unit. The initiative is pioneer in solving the communication problem between the SUS system, which is extremely closed and restrictive, and its beneficiaries, promoting convenience and equity for patients in the Municipality network, who need specialized appointments and tests.

The initiative is a pioneer and was developed by employees, without references, to solve a bottleneck in the Municipality public health system and to promote wellbeing and life quality to SUS patients. It was developed according to an understanding about an emerging need, through the visible appeal of the Municipality's population who uses SUS, which lacked accurate and systematized information to go along the scheduling of specialized appointments and tests. This initiative relied on the team's expertise, creativity and dedication of knowledgeable and problem-sensitive National Regulatory System staff.

Yes. The initiative was presented and implemented in the surrounding neighbor, the Municipality of Ipojuca.After widespread dissemination in the state press, the Secretary of Health of Ipojuca sought the Municipal Health Secretariat asking for permission to apply the technology in his region, and the Municipality of Jaboatão dos Guararapes granted it. The Municipality of Caruaru, located in the rural area of Pernambuco also contacted the Secretariat of Public Health to understand the project better and subsequently develop something similar for their area. Currently other Brazilian Municipalities have implemented similar technological solutions for the same subject matter. One year after “Keep an Eye in Your Appointment” was awarded by CONASEMS , PAHO-WHO, in July 2018, the Ministry of Health, the federal agency responsible for SUS, launched a similar mobile and electronic service platform, where it is possible to access information about appointments and tests scheduled by users, in primary, mild and highly complex care, regulated by SISREG III.It does not send the confirmations through the app as does the “Keep an Eye in your Appointment”, but it allows access to information to registered users. Health managers have a sense of urgency in implementing similar improvements to assist the most vulnerable population.

The initiative has been transferable. It is simple and effective and totally transferable to any Brazilian Municipality. It also applies to other realities where there are communication bottlenecks between the public sector and its citizens, often due to data caution or security. Given this situation, the tool allows extracting from the official database the data that can and should reach the citizens and makes the information available to them via information technology, promoting equity and life quality for the most vulnerable. It addresses to a national communication problem between the SUS system and its users regarding scheduling specialized appointments and tests. It is cheap, simple and replicable, generating relevant benefits for SUS users, most of the population of Jaboatão dos Guararapes and Brazil.

Very few resources were used, less than U$ 1,000, considering the exchange rate of U$1 to R$4, in communication material and dissemination of the initiative. The human resources involved were two civil servants from the Municipality who are Mechatronics Technicians and have Hospital Management degree with specialization in SUS Regulation, being also responsible for the development and dissemination of information about the app. The Health Secretariat staff provided training for system usability at the city's Health and Polyclinic Units.The tool is hosted on the Jaboatão dos Guararapes City Hall server, using only part of its installed capacity and maintenance staff.

The initiative has low maintenance costs and promotes relevant benefits to SUS users, to most of the Municipality's population aside from adding improvements in the provisions of health services, generating value for the public sector. It allows the evaluation of specialized medical care and the monitoring of indicators for decision making. It is an efficient communication channel for the dissemination of health reports and campaigns, facilitating conclusions that will orient strategic planning. It is constantly improving, being highly adaptable, and provides the perception of health services offered to society for improvement implementation, always targeting the most vulnerable people.

Yes

Externally, the initiative was evaluated and awarded at the 33rd National Congress of Municipal Health Secretariats, in 2017, as the best successful experience in the Unified Public Health System (SUS) in the Northeast, offered by the National Council of Municipal Health Secretariats - CONASEMS and Pan American Health Organization / World Health Organization (PAHO / WHO).It is internally evaluated by the development team, through reports from the Google Play platform, and the system's own database, tracking the total of downloads, hits and user ratings for usability. Health management evaluates the tool by the absenteeism indicator.

The indicators that evaluate the initiative are: number of accesses (via web and application), confirmations and cancellations made through the system, absenteeism, application evaluation on the Google Play platform, users who were attended by the Health Care Network (general practitioners specialists, and accredited labs) who have evaluated the services, app downloads per year. The indicators are monitored monthly and at the end of each year a consolidated evaluation report is made to present to management. Data is extracted from “Keep an Eye in your Appointment” system and from Google Play platform reports.

After two years of the initiative's implementation it is possible to state that information and communication technologies can and should be used in the public sector to promote benefits to the most vulnerable audience. The Unified Health System (SUS) bottlenecks must be faced with creativity and low investment through free and widely available technological tools, promoting value to the public service and life quality to SUS patients. After “Keep an Eye in your Appointment” implementation there was an absenteeism reduction of 7.5 percentage points, reducing the index to the lowest level of evaluation, 27.2% in September 2019, against 34.7% in September 2017. This achievement represents more people attending specialized medical appointments and tests, promoting prevention and the optimization of Municipality health resources. To increase access to information for more SUS users, it was observed a need to work with SMS messages, reaching those who have not download the app, which is being developed for implementation in 2019. The value of the new communication channel was also observed for specific health issues, promoting the dissemination of good practice and general and specific campaigns to a large number of citizens.

The initiative works horizontally, serving many sectors of Municipality health management. It promotes changes in various stages of services to SUS users. Starting with the medical service provided by the primary care physician in Health Units - responsible for filling requests with referrals to specialist doctors and tests. The app allows the patient assess him/her. It also allows the patient to assess the service of the app itself. Another important feature is that it promotes the evaluation of other indicators, such as average waiting time and number of requests for medical specialty and tests, thus supporting decision-making for improvement of the delivery of services. It allows integration with other areas of the Municipality, communicating users when there are joint-venture actions, for instance.

In order to develop the technological solution, the Municipality health employees started from the routine field observation in the Health Units. They involved the Health Regulation team to understand and suggest changes in the control process and responses to the requests for specialized appointments and tests, previously fragile in the Municipality. They researched the free tools available in the SUS regulation system and supported the implementation of the SISREGIII waiting list module, which allows regulation respecting the protocols defined in health care, the requests and offers for specialized appointments and tests in the health network of the Municipality. After this stage, they identified the communication gap between SISREGIII and the SUS beneficiaries and proposed the alternative that met the low cost and fast implementation, as it was known of the great dissatisfaction of patients and the financial limitation of the system area. The Communication Department cooperated with the logo, design and communication material. In 5 months, “Keep an Eye in your Appointment” modules for the mobile app and website were implemented, and the evaluation process was initiated through the suggestion registration from users, and fast improvement implementation, a characteristic of the current information and communication technological tools.

It is of utmost importance to train and involve people. The team of Health Units were essential in the implementation of the new communication technology, as they are the main information channel with SUS users, targeted by the initiative. It is necessary to have security and empathy to have users downloading to the tool, ensuring digital inclusion and consolidating the new communication channel that aims only to promote life quality and health to SUS users. It is possible to solve weaknesses of the Brazilian public health system(SUS) with innovation and few resources, in a sustainable way, seeking to make the SUS users the protagonist of the system and promoting life quality and equity. Because it is versatile and easily adaptable, the initiative allows constant improvements, which can be implemented during its operation, such as the demands for health reports, registration updates, surveys, direct scheduling data availability in the application, among others. One of the improvements to be made available in 2019 will be the sending of a text message, like “SMS,” notifying users who do not have an application installed on their mobile phone, explaining the information about the scheduling made via SISREGIII and other communications from the health area.