2015 IEEE 28th International Symposium on Computer-Based Medical Systems
DOI: 10.1109/cbms.2015.72
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A hospital generates daily large amounts of clinical, administrative and financial data. Given this production along with the growing use of technology, many information systems are designed to deal with all this information. The management of hospital data is handled differently in each region of the world, but despite all the social and cultural differences, it is possible to abstract a common concept: the hospital needs, which are used to create a minimum dataset that will allow the comparison of hospital records from different countries. The object of this project is the discharge summary, which is the document responsible for the patient's transition from hospital environment to primary care. This study aims to verify the minimum data required to be contained in the discharge sheet to ensure the continuity of care. For this we analyzed the CPDH's discharge sheet of the Ribeirão Preto Hospital, the ABNT's proposal for use in Brazil, Ireland, Scotland and Australia.