Transforming Care Management in Brazil — A Family Affair
Paulo, Sergio, and Dr. Cid Gusmão share more than a last name. The brothers share a vision for transforming cancer care in Brazil, and beyond. Based in São Paulo, OTAWAhealth and partner oncology clinic, Centro de Combate ao Câncer (CCC), are supported by a multidisciplinary team that has cranked out a suite of digital healthcare management platforms for hospitals, clinics, and medical teams, with a focus on oncology.
“We are a software company, but we are a software company with oncologists, nurses, pharmacists, nutritionists, and psychologists,” says Paulo Gusmão, co-founder and Chief Information Officer at OTAWAhealth. Paulo is the computer scientist of the family, Sergio the economist, and Dr. Cid is an oncologist. They launched OTAWAhealth after years of refining a clinical management system (CMS) that is now revolutionizing cancer care at the CCC, the country’s premier oncology clinic.
Brazil’s two-tiered health-care delivery system, complex regulatory hurdles, and a shortage of human and technical resources are just three of the challenges that affect the implementation of standardized cancer care in the country. That’s what makes OTAWAhealth’s systems so valuable. OTAWAonco, an oncology-specific CMS, and their mobile app, OTAWAcare promote collaboration between clinicians, hospitals, and payers, which in turn helps to simplify the complexity of their healthcare system, eases the strain on limited resources and automates adherence to regulations.
“We are unaware of any other clinical management system that allows physicians to diagnose a patient with such precision.”
At present, OTAWAonco is the backbone of care management at the CCC, and two other clinics in the country access the system via the web to support their care coordination. The brothers envision a future in which OTAWAonco is leveraged by hundreds, if not thousands of other clinics around the globe.
“The system was not built to hold that kind of volume, so we will have to invest in technology, and in people to help us move this from server-based into a web-based technology,” Paulo says. “We are looking for partners in the U.S., where digital health is not just a buzzword, it is a reality. Twenty years from now, I hope to see thousands of physicians using the OTAWAhealth systems, because that will mean millions of cancer patients are receiving the kind of personalized care they need.”
OTAWAhealth’s systems are a magnet for international attention and accolades. In 2009, the clinic received the ONA Acreditado com Excelência, the highest certification in the Brazilian health services industry. The following year, in 2010, the CCC became the first out-of-hospital oncology clinic in the world to receive the Accreditation Canada, one the most prestigious international health certifications. Then in 2014, the CCC finalized the accreditation process with the Joint Commission International, another globally recognized health institution.
For the past eight years, the team has grown and tested the capabilities of OTAWAonco at the CCC, in addition to rolling out OTAWAcare. The mobile app supports assistive care to patients of multidisciplinary teams and has managed the continuum of care for more than 6,000 patients, 49,000 chemotherapies, and 22,000 hospital visits.
The Gusmão brothers have a way of making their software success look easy, but like any great endeavor, OTAWAhealth has taken time to perfect its recipe for revolutionary care management.
“We argue and fight and call each other names, sometimes — or most of the time — but when we leave the workplace, we are family. We go to mom’s for dinner, and catch up on life. You only have one family, and we all understand that,” Paulo says.
Secret’s In the Sauce
In 2007, Paulo led a team of programmers to develop the first iteration of OTAWAonco.
“We needed a system to control cancer treatment. There was no good system to do this. The existing systems focused primarily on the appointments, bills, medicine inventory, and other administrative aspects. Instead, we focused first on the clinical part of the system, and created a very robust electronic medical record for oncology,” Paulo said.
To say that oncology is a complicated area of medicine is an understatement. Creating a robust electronic medical record (EMR) for oncology is like choosing to put together a 10,000-piece puzzle. The variables are innumerable when you take into consideration cancer type, TNM staging and the unique anatomical makeup of each individual’s tumors. In the end, it was this steep barrier to entry that paved the way for new opportunities for the company.
“Oncology incorporates so many disciplines. Since we were able to create such a rich EMR for oncology, everything is there for other specialties. We have a strong EMR ready to incorporate any kind of speciality,” Paulo says.
OTAWAonco includes templates specific to clinical staff, nursing, pharmacy, nutrition, psychology and medical genetics, and provides instant access to medical records of all specialties. In November, the company will be rolling out a major upgrade to the platform that will further incorporate the use of predefined protocols and adherence to TNM staging to better control care management.
“This new version will allow physicians to prescribe treatments based on the exact TNM staging. Being able to associate a protocol with a particular stage of the disease allows for a much more precise and effective treatment,” Paulo said. “We are unaware of any other clinical management system that allows physicians to decide a patient’s clinical pathway with such precision.”
The brothers take a non-linear approach to the ongoing development of OTAWAonco and OTAWAcare and incorporate Design Thinking as a way to solve complex problems. That, and a whole lot of patience. The brothers agree — when working with family, patience is more than a virtue, it’s a necessity.
“We argue and fight and call each other names, sometimes — or most of the time — but when we leave the workplace, we are family. We go to mom’s for dinner, and catch up on life. You only have one family, and we all understand that,” Paulo says.
Trail Boss
In Brazil, the movement to establish universal healthcare — reforma sanitária — was a catalyst for metamorphic social change that eventually led to the country’s Unified Health System (Sistema Único de Saúde, SUS). In 1988, as the European welfare system faced increased scrutiny, Brazil wrote a new constitution which included the framework for their welfare state. The country became a forerunner for universal healthcare in a modernizing world with an emerging economy.
Today, Brazil is something of a trail boss when it comes to implementing new fields of medicine in a unified healthcare system, fields like precision care in oncology. As a developing country working to address public health issues in a value-based marketplace, Brazil’s challenges and how they overcome them are being observed by an international audience eager to learn the lessons that Brazil is learning.
“Everybody in this industry needs the same thing. We have this wonderful technology we created, and put our own money and time into it, and now we are ready to offer this to the world,” Paulo says.
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