Irene Hartmann
09/28/2020 - 16:59
Clarín.com
Society
At this time we are talking about the malfunction or good functioning of the Argentine Integrated Health Information System (
SISA
), with the intention of giving
meaning
to the 3,500 deaths from coronavirus in the province of Buenos Aires that on Friday appeared "delayed" in the bureaucratic limbo of that platform.
While from the Buenos Aires Ministry of Health they hope that the load will
be corrected by the end of this week
, a renowned Buenos Aires infectologist who asked to protect his name revealed the other side of the issue.
He said that "it is simple: deaths are not recorded in the SISA because nothing really forces them to do so, and
in Argentina
there is no culture of data
."
“The SISA has several flaps.
Of course, the laboratories load the positives or negatives of the Covid-19 swabs, which are a requirement for doctors, social works and eventually coachhouses, that is, for the management of internal information about the patient.
But very few hospitals and clinics
They have
Epidemiology personnel
who are in charge of
'closing' the case by
recording the discharge or death, "he explained.
And he added: "As
the system does not generate any alert or notice that the 'history' is incomplete
, unlike many other systems that do not allow you to continue if you do not complete the above, there are few doctors with the dedication to fill in that data in the SISA, whose purpose is purely statistical. However, they are central data, thinking ahead. Here there is a lack of data culture ".
An expert explained that the system does not issue an alert if the data upload is incomplete and that is why not many discharges or deaths are recorded.
AP Photo
This explanation measures a different side of the information gap of 3,527 deaths "not recorded" in the SISA, as admitted by the province of Buenos Aires on Friday.
This Monday, that figure had dropped a bit: there were
3,306 "pending charges,"
indicated the morning report from the national Ministry of Health.
From the portfolio led by Daniel Gollán, they clarified to this medium that they hope to finish correcting the under-registration by the end of this week.
It depends on the different "
effectors
", they clarified, that is, the establishments that, in fact, upload information to the SISA:
sanatoriums, hospitals and laboratories
.
"We already pass the information on to each health provider, because the SISA is not loaded by the Ministry but by each hospital or clinic.
What we did was pass the entire database to them so that they did not have to do the entire update process and only did the corresponding check and load the deaths in the system.
We ask everyone to have everything resolved this week ”, they pointed out from that ministry.
Buildable model
The doctor who spoke with
Clarín
explained that the system “has
different flaps
in which issues such as personal data of the patient are settled;
the 'event', which could be tuberculosis, HIV or Covid-19, to give a few examples. "
The bed management system in the Province is updated four times a day.
It is one of the tools that was used to update the death toll.
AP Photo
Then, he said, "in the 'Clinic' tab, there is a grid with symptoms to check. All that information is central to the internal exchange that is done about the patient. You enter with a password and you consult what you need to know". However, "if the person was discharged or died, it is an issue that very few agree".
It seems not only expected but almost reasonable for a country like Argentina: few health personnel, poor handling of modern tools, lack of data recording culture ...
The truth is that the margin of error between the different "lanes" for registering deaths (an issue that in this pandemic has revealed both the Buenos Aires authorities and those of the main countries of the world) reached such a point in Buenos Aires that it was decided to "
take the bull by the antlers
" and correct the SISA with
two
other
variables
.
From the Buenos Aires Ministry they shared with
Clarín
a letter where they clarify some details of the new registration procedure.
The chosen variables improve the timing problem.
On the one hand, there is, a) the
Statistical Death Report
(IED), where the Death Certificates signed by doctors are gathered (by law, within
48 hours of death
), which will then go to the Registry minutes Civil;
and on the other, b) the
Bed Management System
(SGC), that is, the survey of “entries” and “exits” -both by “medical discharge” or by “death” - that hospitals are obliged to “ close ”(in this pandemic)
four times a day
: at 9, at 12, at 18 and at 21.
In the shared letter they detailed the drawbacks of a system that, in "normal" days, aims to condense
annual statistical information
, something almost useless at this time of health emergency.
The challenge, then, is "to produce reliable and timely statistics, for which the collection of death records must involve all available sources," the letter clarifies, and referring to the heart of what the consulted medical source warned, it warns: " The load on the system
depends on the medical professional and local epidemiology reference
, who must complete the date, establishment and if the cause of death was related to the Covid-19 disease ".
But they admit: “
This process, in practice, presents deficiencies
in terms of coverage and timeliness of the data load, aspects that are observed
more pronounced in private establishments
.
Although at first the accounting of death cases from Covid-19 came exclusively from the SISA-SNVS, based on active surveillance, the declared deaths from Covid estimate a certain percentage of underreporting, which must be reinforced by starting from other instruments ”.
DD
Look also
Coronavirus in Argentina: after the "whitewash" of Buenos Aires, the other districts say they are up to date with the death toll
They ask to question Daniel Gollan for the 3,500 deaths from coronavirus that had not been counted