Sistemas de informação em saúde do Brasil e da França: uma abordagem a partir dos referenciais da Ciência da Informação e da área de saúde

Abstract

This work aimed at making an unprecedented comparative analysis of health information systems in Brazil and in France. The choice for the French system was mainly due to the fact that France in many aspects plays a referential role in the international scene and expresses a complex and enfoldingly managed scientific institutional design. In order to carry on the comparison task, the work sought building up a comparative field through a wide work of conceptual systematization in the field of information science as well as a study on considerations that aim at evaluating and set up norms along the experiences on building up information systems for health. The result of this double task was the setting up of reference points for the comparative analysis (ch. 6) which besind a methodological strategy to avoid the mistake that would stem from a direct and simplistic comparison of two scenarios which were built along very particular historical paths and which are framed in such diverse institutional and social contexts. Firstly, the work sought to systematize the literature that reflected how such distinct organizational models were formed based on the incorporation of information technologies, such us the Japanese model that is centered in the quality approach, the reengineering of processes and knowledge management. Information systems were conceptually data-centered typified, user centered and framed within the strategic management. It was sought to understand, beyond the technical dimension, how such concepts of information systems could have different social uses in dialoged or instrumental versions, self-referred or pluralist, of social control or of democratization. Secondly, it developed the historical recovery of the various periods within the building up of information systems for health: analysis of clinical data originated from equipments, administrative areas structural aspects, control of assistance activities and, finally, the incorporation of information technologies in the process of the assistance work itself. Following, studies were developed on the classical and more contemporary considerations on the structure, functions and challenges that are nowadays set up in relation to information systems for health. In order to make the comparison viable, landmarks were established in the health system both in Brazil and in France. A choice was made to present a more detailed picture of the latter so as to offer more adequate knowledge of such experience in Brazil. In the French case, what was sought was to make considerations on how the adaptive transitions operated in the Welfare State and the formation of the European Community interact with the evolution of the information system. On an effort for synthesis, ten analytical reference points for comparison were then built up: strategic character of the information; unique structure for the management of informational resources; decentralization of the system (SIS); planning for the incorporation of information technologies; integration of financial, clinical and administrative information; data base reach; types of information management; policy towards information availability; social participation and regulation of the area. The information systems for health were confronted for each of the reference points both in France and in Brazil. General considerations on questions related to the structuring of information systems for health in the two countries, sought special focus in proposals which show development in the potentials of the structural aspects of the system in Brazil, reacting them towards the overcoming of structural impasse in the building up of the National Health System (Sistema Único de Saúde).