Digital Health Sustainability and Adaptive Innovation in Different Municipal Contexts: An Experience Report

Abstract

The digital transformation of the Brazilian Unified Health System (SUS) faces critical structural barriers in small municipalities, revealing profound asymmetries between levels of care. In this context, this article presents a qualitative experience report on the implementation of digital health technologies in two municipal contexts of different sizes. The experience was systematized based on the theoretical framework of the systematization of experiences by Oscar Jara Holliday. From this systematization, the empirical data demonstrate that, while Primary Health Care consolidates interoperability and longitudinal monitoring through the Electronic Patient Record (EPR) and mobile devices, the hospital environment suffers from the collapse and discontinuation of electronic records and telemedicine services due to budgetary constraints, low demand, and a scarcity of local technical support. Given this gap, the intensification of collaborative work between the local healthcare team and specialists manifests itself through the phenomenon of adaptive innovation, characterized by the use of commercial messaging applications for sending electrocardiograms and supporting synchronous clinical decision-making. The critical paradox between the operational agility and professional cohesion provided by these informal alternatives versus the severe violations of information security, privacy, cybersecurity, and compliance requirements with the General Data Protection Law (LGPD) is discussed. It is concluded that the advancement of Applied Computing in Healthcare requires the development of resilient, low-cost, ethical, and structured software architectures suited to the reality of limited infrastructure in the Brazilian interior.