Modelagem e implantação da Plataforma SMS Rio para a autorização de procedimento de alta complexidade/custo

Abstract

The lack of interoperability between the systems and subsystems of the Brazil Unified Health System (SUS) causes a lack of rationality, and submits to the state and city health secretaries the need to promote innovative, creative and transformative use of information technology, in order to improve work processes, as well as control and evaluation. To develop and implement the SMS Rio Platform product for the Authorization of High Complexity / Cost Procedures (APAC) in interoperability between health information and Regulation systems. Validate the system with the Insertion of Elective Surgery, Regulation (SISREG) and the SIGTAP Table; improve the control and evaluation of the production of outpatient ophthalmologic surgeries. It was an exploratory evaluative study carried out “in loco” at Rio de Janeiro Health Municipal Secretary. Three indicators for monitoring the performance of health services were created: 1) Percentage of APAC beyond the 4-month deadline for request by provider, procedure and competence; 2) Quantity of APAC requested per procedure in the month according to the status on the SMS Rio Platform; 3) Quantitative of negatives (APAC not authorized and rejected) by reason and health establishment. The implementation of the modeling allowed analyzing the request for ophthalmic procedures from February to September 2020. In relation to indicator 1, out of a total of 2,554 procedures, 13.8% were out of the request deadline. In indicator 2, 2,099 procedures were requested, of which 85% were authorized, 3.5% are awaiting authorization and 12% were not authorized. Indicator 3 represents the details of the unauthorized quantity, which includes unauthorized and rejected requests that can still be corrected and requested again. The most prevalent negative justification reported by the modeling system now developed was that the SISREG code was invalid (47%). The Platform provided the improvement of the operational process of APAC authorization, and ensured the expansion of management capacity, through more effective mechanisms in the areas of finance, planning, control and evaluation of production. The tool improves administrative governance and control, points out flaws in the process, links the regulation of patient access to the service performed by the performing unit and the requested procedure.