The use of digital technologies advances in Brazilian healthcare establishments, but information security remains a challenge, according to the ICT Health Survey 2021

The eighth edition of the survey indicates an increase in the use of electronic systems for patient data records

Healthcare establishments in Brazil are more computerized; however, implementing strategies to enhance the security and protection of stored personal data remains a challenge for the sector. This was one of the conclusions of the ICT Health Survey 2021 by the Brazilian Internet Steering Committee (CGI.br), conducted by the Center for Information and Coordination of Point BR (Cetic.br) of the Brazilian Network Information Center (NIC.br).

The data collected reveals the growth of Internet adoption among public establishments during the period marked by the advancement of COVID-19: 94% of them have computers and Internet, which represents an increase of nine percentage points compared to 2019. Among private establishments, access to both remains universal.

Basic Health Units have used more computers (from 91% in 2019 to 94% in 2021) and the Internet (from 82% to 92% in 2021). Out of approximately 40,600 BHUs, about 2,500 do not have the device and 3,400 lack network access.

“This increase may be related to the greater need for digitalization of information due to the pandemic scenario. As with homes and individuals, this data shows there was a growing demand for digitization during this period,” says Alexandre Barbosa, manager of Cetic.br|NIC.br.

There was a progression in the use of electronic systems for recording patient data—from 82% in 2019 to 88% in 2021. This upward trend occurred in virtually all strata investigated by the survey. In public units, it increased from 74% to 85% between the two years, while in private units, it remained stable, around 91%. In relation to the BHUs, 89% have some type of electronic system.

Regarding the availability of patient information in digital format, growth was also observed compared to the previous edition. In BHUs, the functionalities that recorded the highest increases were: listing all patients by type of diagnosis (from 43% to 60% in 2021), conducting medical prescriptions (from 58% to 75%), and compiling laboratory test results (46% to 62%).

Interoperability between electronic health information systems also advanced during the pandemic. The survey indicates a greater number of establishments with systems that receive or send information to other electronic systems in the health care network, especially in public units (from 25% in 2019 to 43% in 2021), including BHUs (from 28% to 45%).

Information Security
Only one-third of healthcare establishments had a defined policy on information security, with the percentage being lower in public units (21%) compared to private ones (around 40%).

Among security tools, those related to encryption showed the largest increase compared to 2019, such as file and email encryption, present in 52% of establishments (against 41% in 2019). Database encryption advanced from 36% in 2019 to 48% in 2021.

GDPR and use of new technologies
A novelty in this edition is the inclusion of indicators on the measures adopted by healthcare establishments for compliance with the General Data Protection Law (GDPR). According to the results, less than half implemented any of the surveyed measures. Among the most adopted are the provision of channels for service and interaction with data subjects (38% of the total) and the implementation of an internal campaign to raise awareness about the GDPR (32% of the total).

“The GDPR came into effect in August 2020, and the survey data collection took place in the first half of 2021. The results indicate that healthcare establishments still have a way to go in adapting to the new law,” says Barbosa.

The ICT Health survey also investigated, for the first time, the use of new technologies by healthcare establishments that have an IT department or area. A significant portion has been using cloud computing. Among the services analyzed, the most common was cloud email (69%), followed by file storage or cloud database (57%). The results pointed to disparities between public and private establishments regarding the use of cloud software and data storage (17% public and 45% private).

Big Data analysis is adopted by a still reduced number of establishments. Out of a universe of 109,000 assessed, only about 4,200 utilize this resource, with approximately 3,600 being private. For these analyses, data from the establishments themselves are most used, both from registration forms, forms, and medical records (76%) and from smart devices and sensors (69%).

The survey also indicates that 4% of health establishments used Artificial Intelligence, while 3% reported using robotics applications. All these resources are more present in private units. Among geographical regions, the Southeast shows the highest use of AI (6%) and robotics (4%).

Telehealth and online services
In general, telehealth practices grew during the pandemic, as indicated by the ICT Health Survey 2021. They became more present in establishments with teleconsultation (from 15% in 2019 to 26% in 2021), tele-diagnosis (from 12% to 20%), and remote patient monitoring (from 5% to 20%).

For the first time, the survey investigated the implementation of teleconsultation between doctor and patient among health establishments—a mode regulated on an emergency basis due to the advancement of COVID-19. It was observed that this service was offered by 18% of healthcare establishments, 14% of public, and 22% of private ones.

About the Survey
Due to the pandemic scenario and high demand on the sector, the survey methodology was adapted. It was not possible to collect information on the use of ICT among professionals in the field (doctors and nurses). Telephone interviews were conducted between January and August 2021, with 1,524 managers of healthcare establishments located throughout the national territory.

Conducted since 2013, the survey has the support of international organizations such as the Organization for Economic Cooperation and Development (OECD), the Economic Commission for Latin America and the Caribbean (ECLAC), and the United Nations Educational, Scientific and Cultural Organization (UNESCO). Furthermore, the survey is supported by the Ministry of Health and the Department of Informatics of the SUS (Datasus), the National Supplementary Health Agency (ANS), the Brazilian Hospital Services Company (EBSERH), the National Council of Municipal Health Secretariats (CONASEMS), as well as specialists linked to important universities and research institutions.

The unprecedented data was disclosed at an online event, restricted to participants of the XVIII Brazilian Conference on Health Informatics (CBIS 2021), 10th Brazilian Conference on Telemedicine and Telehealth and RNP Forum 2021. On the occasion, the publication of the survey was also launched.

To access the full indicators, visit: https://cetic.br/pt/pesquisa/saude/indicadores/. To check the ICT Health 2021 book, go to: https://cetic.br/pt/pesquisa/saude/publicacoes/.

About Cetic.br
The Regional Center for Studies on the Development of the Information Society, of NIC.br, is responsible for producing indicators and statistics on the availability and use of the Internet in Brazil, disseminating periodic analyses and information on the development of the network in the country. Cetic.br is a Regional Study Center, under the auspices of UNESCO. More information at https://cetic.br/.

About the Brazilian Network Information Center - NIC.br
The Brazilian Network Information Center — NIC.br (https://nic.br/) is a civil, private, non-profit entity that, in addition to implementing the decisions and projects of the Brazilian Internet Steering Committee, has among its duties: coordinating domain name registration — Registro.br (https://registro.br/), studying, responding, and addressing security incidents in Brazil — CERT.br (https://cert.br/), studying and researching network technologies and operations — Ceptro.br (https://ceptro.br/), producing indicators on information and communication technologies — Cetic.br (https://cetic.br/), implementing and operating Internet Exchange Points — IX.br (https://ix.br/), enabling the participation of the Brazilian community in the global development of the Web and supporting public policy formulation — Ceweb.br (https://www.ceweb.br), and hosting the W3C Chapter São Paulo (https://w3c.br/).

About the Brazilian Internet Steering Committee - CGI.br
The Brazilian Internet Steering Committee is responsible for establishing strategic guidelines related to the use and development of the Internet in Brazil, coordinating and integrating all Internet service initiatives in the country, promoting technical quality, innovation, and dissemination of services offered. Based on the principles of multistakeholderism and transparency, CGI.br represents a model of democratic Internet governance, praised internationally, in which all sectors of society participate equally in its decisions. One of its formulations is the 10 Principles for the Internet Governance and Use (https://cgi.br/principios). More information at https://cgi.br/.

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