eHealth2009 Conference (Praga). Bernat Soria


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Joining efforts to reach optimal quality and equity. Bernat Soria. eHealth Conference 2009. (Praga, 2009).

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eHealth2009 Conference (Praga). Bernat Soria

  1. 1. The Spanish National Health System Ministry of Health and Consumer Affairs JOINING EFFORTS TO REACH OPTIMAL QUALITY AND EQUITY Bernat Soria, MD, PhD Minister of Health and Consumer Affairs
  2. 2. SPANISH NATIONAL HEALTH SYSTEM UNIVERSAL COVERAGE NATIONAL HEALTH SYSTEM SOCIAL SECURITY Coverage (SINCE 1986) SYSTEM (UNTIL 1986) Insured population All citizens covered Includes Restricted to active immigrants employees and their families 1986 2006 Primary First Primary 13.000 Primary Healthcare Healthcare Healthcare Centres built Centres
  3. 3. SPANISH NATIONAL HEALTH SYSTEM I. Among the best in the world - Ranked 4th among the 19 most developed countries Health Affairs ( Health Affairs 27: 58-71 (2008);) - Ranked 6th among 191 countries British Medical Journal (2001) - Ranked 7th among 191 countries WHO (World Health Report 2000. Health Systems. Improving performance ) II. Number one in the world in organ transplantation FIRST IN THE WORLD IN CADAVERIC ORGAN DONATION. SPAIN, EU-27 AND USA COUNTRIES SPAIN EU-27 USA Population (million inhabitants) 45.2 492.3 303.9 Cadaveric Organ Donor 1,550 8,293 8,089 (Rate –pmp-) (34.4) (16.9) (26.6)
  5. 5. ICT: Information and communication technologies Consultations in Health Centres Hospital activity in laboratory tests National Health System 2007 8 National Health System 2007 9 with ICT with ICT 97% 99.8% no ICT 3% no ICT with ICT no ICT 0.2% with ICT no ICT 8 Information from Region of Valencia and Andalusia has not been 9 Information from Andalusia, Region of Valencia, Galicia and included in the figure Cantabria (TI) has not been included in the figure Source: from data supplied by the regional Departments of Health Source: from data supplied by the regional Departments of Health Patient management system: External hospital consultations Patient management system: Hospital emergencies National Health System 2007 National Health System 2007 10 11 with ICT with ICT 99% 98% no ICT no ICT 2% 1% with ICT no ICT with ICT no ICT 10 Information from Andalusia and Region of Valencia has not been 11 Information from Andalusia and Region of Valencia has not included in the figure been included in the figure
  6. 6. e-HEALTH: ELECTRONIC HEALTH RECORD IN SPAIN JOINING EFFORTS TO REACH THE FUTURE - Digital health records - Personal health card - Electronic prescription
  7. 7. EHR IMPROVEMEMENTS 1998-2008 • All the regions have developed EHR: - 90% primary health care doctors have access to EHR - 14 regions have developed advanced processes of implementation in specialist health care - 95% of electronic prescription in primary health care • The national government has supported this effort with 141 additional millions (2006-2008) • The Ministry of health has developed a central point of exchange and a central database of Personal Health Card with an unique number of identification for each citizen • Electronic prescription: where implemented, 22% unnecessary visits to General Practitioners
  8. 8. CITIZENS AND HEALTHCARE SERVICES. II. HEALTHCARE Digital medical record in health centres and population covered National Health System 2007 100.00% 90.00% 80.00% Population with Health Card 70.00% 60.00% 50.00% 100% 98.8% 40.00% 30.00% 20.00% 10.00% 0.00% Population with Primary care EHR health card software registered at health centres
  9. 9. Implementation of the main information systems linked to the electronic health record7 National Health System 2007 Health Centres Hospitals National Health Service healthcare centres 4% 100% * 3% 8% 12% 15% 16% 90% 38% 80% 70% 60% 50% 97% 96% 92% 88% 85% 84% 40% 62% 30% 20% 10% 0% Picture Hospital Radiology Pathology Primary Single- LAB Archiving Information dose care EHR cal Information Management Pharmacy Anatomy and Systems Systems software Communication systems with ICT no ICT
  10. 10. JOINING EFFORTS WITH THE REGIONS AND THE HEALTH PROFFESSIONALS In developing EHR in each region In Creating an unified database of personal health cards for all the countries In agreeing common clinical guidelines In agreeing common technological standards
  11. 11. EHR: THE CHALLENGE • 4.5 million people receive every year clinical assistance in a different region than the one they come from • We have to develop a project for the whole country to guarantee the access to the clinical information at any place and any time regardless where it has been generated
  13. 13. COLLABORATION IN BUILDING AN UNIFIED PERSONAL HEALTH CARD DATABASE 803410 ANDALUCIA ARAGÓN REGION DE MURCIA CONSEJERIA DE SANIDAD Y CONSUMO S.N.S. SERVICIO MURCIANO DE SALUD 01 803408 FRVR5608149009015 300078991111 743295999X CADUCA 12/ 99 F JAVIER XXXXXXXXX XXXXXXXXXXX . 803411 • With an unique identifier for each person • Developed in collaboration with the 17 regions • Integrated with all the EHR of the Country • Universal coverage (45 million users)
  14. 14. AGREED SCOPE AND CONTENT Scope: To provide professionals and citizens with access to any clinical datasets that are relevant for healthcare (including diagnostic imaging) Patient Summary Electronic documents: Primary healthcare reports Emergencyde Urgencias Informes Room Reports Discharge & Sp. y Consulta Informes Alta Surgery rep. Nursing Care reports Lab tests Imaging Imagen Other tests Otras pruebas
  15. 15. HOW? Professional Consensus (37 Professional Citizens and Technical Associations) Agreement on the contents of the e-documents Work Groups: Group 1 C. Discharge Report Consultation Report Group 2 Emergency Room Report Group 3 Summarised Medical Record Primary Health Care Report Group 4 ARS Group 5 Lab Tests Report Group 6 Imaging Tests Report Imaging Attributes Group 7 Nursing Care Report
  16. 16. No Central Data Base but Exchange Data System Healthcare Intranet SNS Central node Regional Healthcar e Intranet Regional Node Healthcar e Healthcar e Healthcar e Healthcar e Healthca re Healthc are Healthcare
  17. 17. Online patient referrals to specialized care: implementation and use National Health System 2007 Healthcare centres with Annual patient referrals online patient referral arranged online* systems 36% 67% Health centres 33% 9,283,836 without online patient referral 64% systems 2,256 health centres with online patient referral systems Online referrals Healthcare centres with online referral systems Traditional referrals Healthcare centres without online referral systems Source: from data supplied by the regional Departments of Health
  18. 18. 60 Million Centralized Appointments in 2007 (data from one region of 8 million inhabitants) Web Centralized BDU appointment Back Office Telephone CEIS Users eMail Presential Data Warehouse Others channels
  19. 19. OUTCOME: Improve effectiveness in primary care Provides users with access to pharmaceutical facilities thus making it unnecessary for patients in poor health to go in person Simplifies and speeds up authorization of prescriptions Increases time devoted to patients. 22% LESS OF UNNECESARY VISITS….22% MORE OF AVAILABLE TIME OF GPs Entire treatment prescribed by specialists Possibility of better support for correct prescription Significant promotion of Pharmaceutical Assistance Reduction of management expenses and billing of prescriptions. Improved follow-up and control of rational use of drugs (RUD) Correct assignment of responsibility in RUD among levels Greater control in alerts and pharmacovigilance programs
  20. 20. Breast Cancer ( results of the comprehensive approach) Health area of 1.2 million people 2003 2005 1st visit after GP referral, average time • 8.2 days 3.4 days • Mammogram delay after request, average time 37 days 8 days • Pathology diagnostic report after biopsy 5 days Same day • Surgical average time after diagnosis 37 days 16 days 1st visit in less than 1 week after GP referral • 60,6% 92,8% • Surgery in less than 1 month after pathology 63,44% 96,29% • Conservative surgery 30% 62% • Request for mammograms, percentage from 2003 --- -24% • Global Patient Satisfaction 85.01% 93.3%
  21. 21. 2008 marks a new era in legal and policy framework for EU Cooperation on eHealth • Proposal for a European Directive on patients’ rights in cross-border healthcare • Commission Recommendation on cross-border interoperability of electronic health record systems • Commission Communication on telemedicine for advanced home care and chronic diseases • eHealth Standardisation Mandate 403
  22. 22. epSOS – a highly political project • Member State obligation to deliver the best possible medical treatment – at home or when travelling • Introducing a new dimension in national healthcare systems • Main political objectives: – support patient mobility nationally and in the EU – ensure that patient safety is guaranteed – increase efficiency and cost-effectiveness in cross-border care
  23. 23. CONCLUSSIONS The EHR is being implemented in each of the 17 regions (90% Primary Care) It has been created a national database with more than 40 million users We are implementing through a collaborative effort EHR for the whole country (starting on March 2009 with 10 regions representing more than 60% of the Spanish population)
  24. 24. The epSOS Project Team • The Project Team consists of 27 beneficiaries from 12 member states: – 9 National Ministries of Health – 16 National/regional Competence Centers Including 100+ Contributors – IHE-Europe representing ICT industry team – Empirica responsible for administrative management
  25. 25. Reminder - From Strategies to Services • Provide concrete cross border services that ensure safe, secure and efficient medical treatment for citizens when travelling across Europe • Focus on services close to the patient: – European Patient Summary – ePrescribing across the EU • Build on existing National eHealth Projects and use experiences and knowledge from all Member States
  26. 26. TO MOVE THE AGENDA FORWARD THE NATIONAL AGREEMENT FOR HEALTHCARE (TO BE SIGNED IN JUNE 2009) • Involving the 17 Regions • Involving all the Political Parties TOPICS OF THE AGREEMENT • Human Resources Policy • Common Services • Sustainability of the Health Budget • Health Policies • Quality and Innovation • Prevention of Addictive Drugs Consumption
  27. 27. NHS SPAIN Barcelona 2010, 15-18 march