Digital transformation

Since its inception, the Unified Health System (SUS) has faced the challenge of integrating a continental country with profound regional inequalities into a public, universal, and equitable system. Information and Communication Technologies (ICTs) have emerged, along this journey, as strategic tools to ensure continuity of care, improve management, and democratize access. But this path has been built step by step, over decades.

In the 1990s, Brazil began structuring a set of national health information systems. It was during this period that two important systems emerged: one focused on birth surveillance and another that organized primary care data.

Outpatient and hospital information systems were also consolidated, with an emphasis on billing and payment control and administrative data. This marked the beginning of a data culture still centered on the logic of service production, with little coordination between the different points of the network.

In the 2000s, the private sector, with greater resources, rapidly advanced in implementing comprehensive hospital management systems, which included electronic medical records. In the public sector, the emergence of the SUS Card represented a pioneering attempt to identify citizens in the system, aiming to qualify information and develop care pathways.

Despite its technical and operational limitations, the SUS Card already established a fundamental guideline: the centrality of the individual. Computerization, however, was still incipient and uneven, concentrated in large centers and limited to disconnected local systems. The lack of infrastructure and the shortage of IT professionals were major challenges. This decade sowed the seeds of debate about personal data protection.

It was in the 2010s that the country made significant progress in the field of ICTs in healthcare. The implementation of the Citizen's Electronic Health Record (PEC) in Primary Health Care (PHC) represented a qualitative leap in the collection, organization, and use of clinical and administrative information. For the first time, it was possible to longitudinally record the care provided to patients. In 2013, the national strategy gained momentum, with federal incentives and growing municipal participation.

From then on, the digitalization of services began to consolidate itself as a public policy. The creation of the National Health Data Network (RNDS) set in motion the ambition of an interoperable, secure system with public governance and respect for privacy. It was no longer just a matter of computerization; it was also necessary to integrate, share, and generate health intelligence.

The 2020s were marked by the consolidation of the RNDS (National Health System) as a national repository of health data. The COVID-19 pandemic, with its devastating effects, accelerated the adoption of digital tools: Conecte SUS (Connect SUS) became a showcase for accessing vaccination, laboratory, and healthcare data, strengthening transparency and empowering citizens by providing access to health information in the palm of their hand. Simultaneously, telehealth initiatives expanded, essential for ensuring care in remote regions and in contexts of restricted mobility.

Robust, advanced-level interoperability experiences have emerged in places like Recife and at Ebserh's federal university hospitals, demonstrating that data can, in fact, "talk" to each other across different services, breaking the logic of islands of information.

The SUS (Brazilian Unified Health System) is beginning to embrace Artificial Intelligence in healthcare, leveraging real-time data for surveillance, planning, and strategic management. Furthermore, AI has been incorporated into the National Health Information and Informatics Policy, opening up a new range of possibilities for healthcare. The creation of the Digital Health and Information Secretariat within the Ministry of Health and the launch of the SUS Digital Program solidify this transformation agenda.

ICTs are much more than technical tools. They express concepts of care, management models, and political disputes over the system's direction.

It is now up to SUS managers to continue the digital transformation journey, expanding access, improving the quality of care, and ensuring that technology is a powerful ally in promoting health for all Brazilians.

Published in issue no. 1375 of CartaCapital , on August 20, 2025.

This text appears in the print edition of CartaCapital under the title 'Digital Transformation'