Submitted by Maike Costa (maiksebas@gmail.com) on 2017-03-14T14:56:25Z No. of bitstreams: 1 arquivototal.pdf: 2575793 bytes, checksum: fb59e16c014996b7933557b60e120266 (MD5) / Made available in DSpace on 2017-03-14T14:56:25Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2575793 bytes, checksum: fb59e16c014996b7933557b60e120266 (MD5) Previous issue date: 2015-12-15 / Introduction: Mobile applicative (apps) development is a relatively new phenomenon that is increasing rapidly due to the popularity and portability of smartphones. The idea to use apps to screening oral conditions is still a novelty. Purpose: The aim of this study was to develop a mobile applicative focusing oral cancer screening. Methods: The app content comprised questions about oral cancer profile and short videos of oral examination. The development of this app was performed by a team formed by technology of information professionals and oral pathologists. The app development process was made following the steps: 1) reality and risk factors study, observing the real conditions of collection of data 2) development phase, with implementation of the needs observed in the field study and 3) field test, when the implementation passed by some refinement or even redraw. The app was developed using Android system (4.4.2 version), with JAVA language and focused sociodemographic data, risk factors for oral cancer, tobacco and alcohol uses, solar exposition and other contributing factors such unprotect oral sex, oral pain and prosthesis use. Afterwards, we obtained data of survey of a high risk population for oral cancer and evaluated the sensitivity/specificity/ accuracy and predictive values of clinical oral diagnosis between two blinded trained examiners, who used movies and data from the app, and in loco oral examination as gold standard. This trainning process with examiners was divided in theorical and practical approaches during 8 hours. Results: On reality and risk factors study, we percept the need of clarification of some questions about use of prosthesis as well to establish better conditions to make movies on external light. We modified the initial version and performed the followed to field test with good comprehension and adequacy. On survey/ concordance analysis, we evaluated 55 high risk individuals for oral cancer. Of them, 31% presented homogeneous/heterogeneous white lesions with possible potential of malignancy. Regarding clinical diagnosis by examiners using videos, when compared with the gold standard, the sensitivity was between 82% and 100% (average 91%), specificity between 81% and 100% (average 90.5%) and accuracy from 87.27% to 95.54% (average 90.90%), and considering found lesions. Evaluating the examiner with better concordance with gold standard for risk lesions, the kappa value between than was 0.597. Conclusion: Mobile app with videos and data collection could be an interesting alternative to oral examination and physical formularies filling on oral cancer surveys. / Introdução: Os aplicativos móveis (apps) de desenvolvimento é um fenômeno relativamente novo que está aumentando rapidamente, devido à popularidade e portabilidade dos smartphones. A ideia de usar aplicativos para triagem de condições bucais ainda é uma novidade. Objetivo: Desenvolver um aplicativo móvel para uso em triagem de câncer bucal. Métodos: O desenvolvimento deste app foi realizado por uma equipe formada por profissionais da tecnologia em informação e patologistas bucais. O processo de desenvolvimento de aplicativo foi feito seguindo as etapas: 1) estudo dos fatores de risco e realidades, observando as condições reais de coleta de dados 2) fase de desenvolvimento, com a implementação das necessidades observadas no estudo de campo e 3) teste de campo, quando a implementação passou por alguns refinamentos ou mesmo redesenho. O app foi desenvolvido usando o sistema operacional Android (versão 4.4.2), com a linguagem JAVA e abrangeu dados sócio demográficos, fatores de risco para o câncer bucal, como histórico de tabagismo, etilismo e exposição solar, além de outros fatores contribuintes, como sexo oral desprotegido, sintomatologia dolorosa em boca e uso de prótese dentária. O mesmo foi utilizado por cirurgiões dentistas da atenção básica. Posteriormente, foram obtidos dados de pesquisa com uma população de alto risco para câncer bucal e avaliou a sensibilidade / especificidade / valores preditivos de diagnóstico bucal clínico entre dois examinadores treinados, que usavam filmes e dados do aplicativo, e em exame bucal in loco como o padrão ouro. Esse treinamento com os examinadores se deu em 8 horas de duração, dividido em teoria e prática. Resultados: No estudo de fatores de risco e realidades, percebeu-se a necessidade de clarificação de algumas questões sobre o uso de prótese, bem como para estabelecer melhores condições de fazer filmes em luz externa. Modificou-se a versão inicial e executou-se a seguir para teste de campo com boa compreensão e adequação. Na análise de pesquisa/ concordâncias foram avaliados 55 indivíduos de alto risco para o câncer bucal. Destes, 31% apresentaram lesões brancas homogêneas/heterogêneos com possível potencial de malignidade. Quanto ao diagnóstico clínico por examinadores usando vídeos, quando comparado com o padrão-ouro, a sensibilidade foi entre 82% e 100% (média 91%), especificidade entre 81% e 100% (média 90,5%), e acurácia entre 87,27% e 95,54% (média 90,90%), considerando as lesões encontradas. Avaliando o examinador que apresentou melhor concordância com o padrão ouro para lesões de risco o os valor de Kappa entre eles foi de 0,597. Conclusão: O app móvel com vídeos e coleta de dados pode ser uma alternativa interessante para o exame bucal e preenchimento de formulários em pesquisas de câncer de boca.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of Technology / Research on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.

A presente tese de Doutorado trata de investigar a aplicação da mineração de texto, para a construção de uma terminologia que atenda aos preceitos estipulados pela normalização, nacional e internacional, referente à constituição de um Registro Eletrônico em Saúde (RES). As normas internacionais estudadas pelo presente trabalho foram as seguintes: ISO 13606-1 e ISO TS 17117. O padrão internacional ISO 13606-1 especifica os modelos de referência para a construção de arquétipos que são a estrutura-base do RES. A especificação técnica ISO 17117 estipula a formatação de terminologias controladas para o âmbito da informática em saúde. Localmente, o trabalho analisou o relatório técnico ABNT/ISO TR 20514 que dá a definição, o escopo e o contexto para o RES e o relatório técnico ABNT/ISO TR 12309 que visa a garantir o desenvolvimento de terminologias padronizadas para a área da saúde. Vários trabalhos científicos demonstram que, para a construção do RES baseado em arquétipos, pesquisadores utilizam terminologias de mercado como o SNOMED CT e SNOMED RT. No caso do Brasil, não existe uma terminologia oficialmente desenvolvida regionalmente ou traduzida para o português do Brasil que suporte a criação de modelos de referência. Essa situação dificulta a implantação das normas nacional e internacional de padronização, citadas anteriormente. Nesse ambiente, a tese aqui apresentada construiu uma ontologia no domínio da especialidade de Radiologia e Diagnóstico por Imagem, tendo como base a aplicação de métodos de mineração de texto para compor uma terminologia eficiente e eficaz que atendesse às lacunas demonstradas. A aplicação de método de mineração de texto foi realizada em uma amostra de 2.566.358 de sujeitos-laudos, consistindo em sujeitos-laudos dos exames de Ressonância Magnética, Raios-X, Tomografia Computadorizada e Ultrassonografia de regiões anatômicas humanas. Com base nessa extração, foi construída uma ontologia contendo 5.859 termos-indivíduos, 20.994 axiomas e 15.084 axiomas lógicos. Essa ontologia foi desenvolvida utilizando o software Prótége em linguagem OWL. A partir da formalização da ontologia (terminologia), foram construídos Archetype Definition Language (ADL), para o componente INSTRUCTION para exame de imagem, e ADL para o componente COMPOSITION de Tomografia Computadorizada de Coluna Cervical, Ressonância Magnética de Cervical e Torácica e Ressonância Magnética de Carótida. O trabalho mostrou a aplicabilidade da mineração de texto para a geração de uma terminologia que desse suporte à criação de ADL, conforme preconizado na normativa da área de informática em saúde. / This Doctoral Thesis aim to investigate the application of text mining for the construction of a terminology that meets the procedures laid down for standardization, national and international, regarding the establishment of an Electronic Health Record (RES). International standards studied in this work were ISO 13606-1 and ISO TS 17117. The ISO 13606-1 international standard specifies the reference models for the construction of archetypes, which is the basis of the RES structure. The technical specification ISO 17117 provides the formatting of controlled terminology for the scope of health informatics. Locally, the paper analyzed the technical ABNT / ISO TR 20514 report, which gives the definition, scope and context for the RES and technical ABNT / ISO TR 12309 report aimed at ensuring the development of standardized terminology for the health sector. Several scientific studies have shown that for the construction of RES based on archetypes, researchers use market terminology such as SNOMED CT and SNOMED RT. In Brazil, there is no terminology officially developed regionally or translated into Portuguese-Brazilian who support the creation of reference models. This situation impedes the deployment of national and international standards of standardization mentioned above. In this environment, the thesis presented here built an ontology in the field of specialty of Radiology and Diagnostic Imaging based on the application of text mining methods to make efficient and effective terminology that meets the demonstrated shortcomings. The application of text mining method was performed on a sample of 2,566,358 of subject-report, consisting of subject-reports of examinations MRI, X-ray, CT and ultrasound of human anatomical regions. Based on this extraction was built an ontology containing 5,859 individuals terms, axioms 20,994 and 15,084 logical axioms. This ontology was developed using Protégé OWL language software. From the formalization of the ontology (terminology) were built Archetype Definition Language (ADL) for INSTRUCTION component for imaging examination, and ADL for COMPOSITION component of CT cervical spine, MRI Cervical and Thoracic and MRI Carotid. The study showed the applicability of text mining to generate terminology that supported the creation of ADL as recommended by rules in the IT sector in health.

Orientador: Ana Silvia Sartori Barraviera Seabra Ferreira / Resumo: As deficiências relacionadas às Anotações de Enfermagem mostram a fragilidade da assistência prestada. Os erros cometidos nos registros de Enfermagem na assistência ao paciente causam impactos negativos para as instituições de saúde, tanto no cuidado direto ao paciente, como no setor financeiro. Essas ações levam as glosas hospitalares, que é o não pagamento das prestações de serviços realizados. O objetivo deste trabalho foi desenvolver um software-protótipo para o registro eletrônico das Anotações de Enfermagem. A metodologia utilizada aplicou a realização de uma revisão integrativa de literatura com o objeto de estudo, as Anotações de Enfermagem, e para desenvolvimento do protótipo se utilizou a engenharia de software, contemplando as fases de definição, desenvolvimento e avaliação. A construção do software ocorreu por meio do Microsoft Visual Studio®, que possui um ambiente de desenvolvimento integrado, com programação orientada a objetos, utilizando principalmente a linguagem de programação C# (C SHARP). O software construído foi norteado por deficiências identificadas acerca das inconformidades dos registros. Os resultados apresentados envolveram o desenvolvimento do programa, os layouts das telas do software contemplando as principais necessidades encontradas na literatura sobre déficits das Anotações de Enfermagem. O software-protótipo englobou a necessidade de ser um programa de fácil manipulação, intuitivo e que atendesse aos requisitos do Conselho de Classe, tendo ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The deficiencies related to the Nursing Notes show the fragility of the assistance provided. The errors made in the nursing records in patient care cause negative impacts for health institutions, both in direct patient care and in the financial sector. These actions lead to hospital disallowances, which is the non-payment of services rendered. The objective of this work was to develop a prototype software for the electronic registration of Nursing Notes. The methodology used applied an integrative literature review with the object of study, the Nursing Notes, and for the development of the prototype, software engineering was used, covering the phases of definition, development and evaluation. The software was built using Microsoft Visual Studio®, which has an integrated development environment, with object-oriented programming, using mainly the C # programming language (C SHARP). The software built was guided by deficiencies identified about the nonconformities of the records. The results presented involved the development of the program, the layouts of the software screens contemplating the main needs found in the literature on deficits in Nursing Notes. The prototype software encompassed the need to be a program that is easy to handle, intuitive and that meets the requirements of the Class Council, based on the Guide for recommendations for registering Nursing in the patient's record and other COFEN Nursing documents. / Mestre

No description available.

Context: Computerized clinical decision support systems (CCDSSs) give practitioners patient-specific care advice and are considered an important increment to electronic clinical documentation and order entry systems. Despite decades of research on CCDSS, results from rigorous clinical evaluations remain mixed and systems vary greatly in design and implementation. Objective: To identify factors differentiating CCDSSs that improve the process of care or patient outcomes from those that do not. Data Sources: We searched major bibliographic databases and scanned reference lists for eligible articles up to January 2010. Study selection: 162 eligible comparisons from randomized controlled trials of CCDSS to non-CCDSS care. We deemed successful those systems that improved either 50% of reported process of care outcomes or 50% of patient outcomes. We extracted system characteristics hypothesized to impact patient care and tested them for association with system effectiveness in logistic models. Results: Our primary analysis showed that CCDSSs presented in electronic health records or order entry systems were less likely to be effective than their counterparts (OR, 0.37; 95% CI, 0.17 to 0.80). Systems more likely to succeed than their counterparts provided advice for patients in addition to practitioners (OR, 2.77; 95% CI, 1.07 to 7.17), required from practitioners a reason to override advice (OR, 11.23; 95% CI, 1.98 to 63.72), or were evaluated by their developers (OR, 4.35; 95% CI, 1.66 to 11.44). These findings remained consistent across different statistical methods, sensitivity analyses, and adjustment for other potentially important factors. Conclusions: We identified several factors that may partially explain why some systems succeed and others fail. Primary studies should investigate the impact and optimal implementation of advice provided to patients and practitioners and advice that requires reasons to be overridden. Researchers should also address the reasons for failure of advice presented within charting and order entry systems. / Master of Science (MSc)

Information and communication technologies can be used to deliver healthcare services and improve the healthcare system. Any electronic healthcare system whose usage results in the efficient and enhanced quality of healthcare is an eHealth system and can be beneficial for medical enterprises. Despite the advantages that eHealth systems offer, medical enterprises are often reluctant to abandon their paper-based systems and embrace eHealth solutions. Through a review of existing eHealth literature, this study identified generic technologies used within South African medical enterprises. Fourteen (14) technologies, that represent a basket of eHealth systems for supporting the business management, professional clinical informatics, patient information storage and consumer health informatics functional areas, were identified. The study then aimed to determine the state of adoption of these technologies as well as the factors influencing adoption. The technological, organisational and environmental (TOE) factors that contributed to the current state of adoption were identified through a review of existing TOE literature. A model that explores the effects of these pre-determined TOE factors on the propensity to adopt eHealth was developed and tested. A cross-sectional, quantitative study was carried out and survey data was collected from a sample of 130 medical enterprises in South Africa. Data was collected using a structured questionnaire. Correlation analysis was used to test the model’s hypotheses and hierarchical regression was used to test the overall TOE model. By using the TOE framework, the study has provided a theoretical contribution and addressed a gap in the literature into the barriers and determinants of the adoption of information and communication technologies (ICTs) in healthcare. The results of the study show that South African medical enterprises use systems that range from simple electronic fund transfer systems to more complex electronic record and clinical decision support systems. Of the 14 technologies that were identified, business information systems such as medical aid claims submission systems and electronic record systems for patient and fee related information were the most adopted while a steady, but continued increase in the adoption of clinical health information systems was observed. Specifically, the study reveals that electronic fund transfer systems are the most adopted systems while ePrescription systems are the least used. Furthermore, the study shows that in addition to the enterprises’ operating period, perceived benefits, IT infrastructure, senior clinician involvement, resource commitment and external pressure are correlated with the propensity to adopt while system complexity is a barrier to technology adoption.

O Prontuário Eletrônico do Paciente (PEP) é atualmente um dos principais temas de pesquisa e desenvolvimento no âmbito da Informática em Saúde. No entanto, no Brasil e em odontologia, poucos são os estudos publicados. Frente às deficiências apresentadas no fluxo das informações clínicas nos prontuários baseados em papel e visando o aperfeiçoamento deste fluxo para benefício do paciente e da própria instituição, nos propusemos a desenvolver um prontuário eletrônico direcionado ao atendimento odontológico de pacientes portadores de necessidades especiais do Centro de Atendimento a Pacientes Especiais da Faculdade de Odontologia da USP. Para tanto foi utilizada a metodologia de desenvolvimento denominada ?modelagem orientada ao objeto?. O software foi desenvolvido em conjunto com o Centro de Tecnologia XML do Instituto de Pesquisas Tecnológicas de São Paulo. Uma vez terminado, o software foi submetido ao processo de obtenção de registro na Agência USP de Inovações. / The Electronic Patient Record (EPR) is currently one of the main subjects of research and development in the scope of Health Informatics. In Dentistry, however, few are the published studies in Brazil. Facing deficiencies presented in the clinical information flow in paper based patient record and aiming to improve this flow for both patient and institution benefit, we proposed to develop a electronic patient record system suited to Dentistry attendance of patients with special needs of the Special Care Dentistry Center of University of São Paulo. For such task, it was utilized the ?Object-oriented modeling? software development methodology. The software was developed with the Center of Technology XML of the Institute of Technological Research of São Paulo. Once finished, it was submitted to patent attainment at the University of São Paulo Innovations Agency.

O Prontuário Eletrônico do Paciente (PEP) é atualmente um dos principais temas de pesquisa e desenvolvimento no âmbito da Informática em Saúde. No entanto, no Brasil e em odontologia, poucos são os estudos publicados. Frente às deficiências apresentadas no fluxo das informações clínicas nos prontuários baseados em papel e visando o aperfeiçoamento deste fluxo para benefício do paciente e da própria instituição, nos propusemos a desenvolver um prontuário eletrônico direcionado ao atendimento odontológico de pacientes portadores de necessidades especiais do Centro de Atendimento a Pacientes Especiais da Faculdade de Odontologia da USP. Para tanto foi utilizada a metodologia de desenvolvimento denominada ?modelagem orientada ao objeto?. O software foi desenvolvido em conjunto com o Centro de Tecnologia XML do Instituto de Pesquisas Tecnológicas de São Paulo. Uma vez terminado, o software foi submetido ao processo de obtenção de registro na Agência USP de Inovações. / The Electronic Patient Record (EPR) is currently one of the main subjects of research and development in the scope of Health Informatics. In Dentistry, however, few are the published studies in Brazil. Facing deficiencies presented in the clinical information flow in paper based patient record and aiming to improve this flow for both patient and institution benefit, we proposed to develop a electronic patient record system suited to Dentistry attendance of patients with special needs of the Special Care Dentistry Center of University of São Paulo. For such task, it was utilized the ?Object-oriented modeling? software development methodology. The software was developed with the Center of Technology XML of the Institute of Technological Research of São Paulo. Once finished, it was submitted to patent attainment at the University of São Paulo Innovations Agency.

A saúde mental é uma das áreas que envolve mais atenção, visto que as ações tomadas dentro da rede não podem ser reduzidas a sistemas fechados, sem comunicação com outros sistemas, mas a sistemas abertos, heterogêneos e articulados. Dessa maneira, torna-se necessário a busca de novas possibilidades para a realização do trabalho contínuo e articulado entre os diferentes níveis da rede de atenção em saúde mental. Diante deste contexto, o principal objetivo deste projeto é desenvolver e implantar um sistema de informação em saúde para gestão de pacientes que permite realizar o monitoramento do fluxo de pacientes com transtornos mentais. Para tal, o projeto contempla o desenvolvimento de um sistema web utilizando as tecnologias web PHP, HTML, JavaScript e CSS, Sistema Gerenciador de Banco de Dados MySQL e servidor web Apache. Um sistema baseado na arquitetura web, denominado SISAM 13, que permite acompanhar as consultas, solicitações de internação, internações e o movimento de pacientes na rede pública de saúde mental do Departamento Regional de Saúde XIII (DRS XIII), fornecendo relatórios de gestão, foi criado e implementado. Inicialmente, o sistema foi implantando como piloto e, após de 90 dias, entrou em funcionamento definitivo. De novembro de 2012 até outubro de 2014, foram cadastrados 4271 pacientes, 480 profissionais, 1483 agendamentos de consultas, 5938 solicitações de internação e 3239 internações. Evidenciou-se que a maioria dos municípios de procedência da solicitação de internação fazem parte do DRS XIII, confirmando a adequação da regionalização. Verificou-se que a alta proporção de solicitações provenientes dos serviços especializados em saúde mental mostrou a dificuldade de estabilização de pacientes com transtornos mentais por essas unidades, evidenciando a falta de organização desses serviços e a falta articulação com os demais serviços da rede. O sobrecarregamento da rede do DRS XIII pode ser justificado pelo alto tempo de espera por atendimento, e a redução do giro leito, prejudicando o fluxo de pacientes. A maioria da população atendida nos serviços de internação foi masculina, entre 20 a 39 anos, com diagnóstico de transtornos relacionados ao uso de substância(s) psicoativa(s) e internação com duração maior ou igual a 31 dias. O maior tempo de permanência pelas internações compulsórias em comparação com as internações voluntárias e involuntárias, ocasiona em redução no giro leito, refletindo para toda rede de saúde mental. A alta proporção de contrarreferências para serviços especializados em saúde mental pode contribuir para a continuidade do tratamento, todavia, verificou-se que apenas 54,92% das altas foram contrarreferencias. A baixa utilização da funcionalidade de consultas em conjunto com o número de ações de usuários com permissão de solicitadores menor que o de prestadores, sugere o aperfeiçoamento e/ou inclusão de funcionalidades no sistema para os serviços extra-hospitalares. O aumento de 13,16% do número total de ações de um ano para outro pode ser explicado pela incorporação do sistema no processo diário de trabalho, visto que os usuários do sistema foram vistos e reconhecidos como parte integrante na construção do sistema, permitindo o engajamento dos mesmos na sua utilização e melhoria. / Mental health is one of the areas that involves more attention, since the actions taken within the services network cannot be reduced to closed systems without communication with other systems, but with open, heterogeneous and articulated ones. Thus, a search for new possibilities for the realization of continuous and articulated work between different levels of mental health care network is necessary. Given this context, the main objective of this project is to develop and deploy a web based health information system for patient management in order to perform the monitoring of the flow of patients with mental disorders. To this end, the project will include the use of web technologies such as PHP, HTML, JavaScript and CSS, Database Management System MySQL, and Apache web server. A web based system called SISAM 13, that allows appointments, requests for hospitalizations, hospitalizations and the movement of patients in the public mental health network, providing management reports, was created. Initially, the system was implemented as a pilot, and after 90 days, it came into definitive operation. From November 2012 to October 2014, the system registered 4271 patients, 480 professionals, 1483 schedules appointments, 5938 request for hospitalizations and 3239 hospitalizations. Most origin municipalities of the requests was part of the Regional Health Department XIII (RHD XIII), confirming the adequacy of regionalization. It was found that the high proportion of requests from the mental health specialized services, showed the difficulty of stabilizing patients with mental disorders by these units, showing the lack of organization and coordination with other network services. The network overloading can be justified by the high waiting time for hospitalization, and the bed turnover decrease, damaging the network patients flow. It was shown that the majority of the population treated in hospital admissions was male, between 20 to 39 years, diagnosed with disorders related to the use of psychoactive(s) substance(s) use and length of stay more than or equal to 31 days. The longer length of stay by the compulsory admissions compared with voluntary and involuntary admissions, causes reduction in the bed turnover, reflecting on the entire mental health network. The high proportion of counter references to mental health specialist services can contribute to the continuity of care, however, it was found that only 54,92% of the discharges were counter referenced. The low level use of the appointments features along with the low number of user actions by requesters, suggests the improvement and / or inclusion of features in the system for outpatient services. The increase of 13,16% in the total number of actions from one year to another can be explained by the incorporation of the system in the daily working process, since users of the system were seen and recognized as an integral part in the system development, allowing their engagement in its use and improvement.