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Revista de Ciencias Médicas de Pinar del Río

versão On-line ISSN 1561-3194

Resumo

CARRETE FRIOL, Zulaimy Dayami; TELLERIA PRIETO, María del Carmen  e  IGLESIAS ACOSTA, Grisel. Information architecture for the management of psychiatry medical record. Rev Ciencias Médicas [online]. 2021, vol.25, n.5  Epub 01-Out-2021. ISSN 1561-3194.

Introduction:

the psychiatric medical record collects the health report of the patient and his social environment. However; the paper format faces several difficulties, such as its deterioration or loss and, sometimes, with a poor, illegible and incomplete writing that hinders the interpretation of the message, in addition to the fact that it can only contribute passively to decision making. Taking into account this difficulty and the need for psychiatry specialists to be able to know immediately the medical procedures received by the patient, in each episode of his/her illness, it was decided to develop a computer tool for such purposes.

Objective:

to design the information architecture for the management of the psychiatric clinical history at Dr. Isidro de Armas Provincial Psychiatric Hospital.

Methods:

a technological development research was carried out on the information management of the clinical history of the Psychiatric Hospital, following the agile methodology of software development for extreme programming, and applying theoretical and empirical methods for the analysis, review and modeling of the processes to be computerized.

Results:

as a final product, the information architecture for the management of psychiatric medical records was developed, from which the prototype of a computer application was developed, which facilitated the analysis with psychiatric specialists of the proposed functions and of the organization, arrangement and structuring of the medical records information.

Conclusions:

the prototype developed will allow the programmers to implement the computer application that will contribute, in the future, to the development of the process and decision making as a result of the management of the information generated. Having great social impact for the Psychiatric entities where it is implemented, with benefits for both patients and healthcare professionals. The implementation of an Information Technology tool is a strategic decision that can simplify the work, as well as to contribute to the optimization of time, organization, management and security.

Palavras-chave : HEALTH RECORDS, PERSONAL; MEDICAL RECORDS; ELECTRONIC HEALTH RECORDS; PSYCHIATRY; INFORMATION MANAGEMENT.

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