Benefits of a long-term e-health strategy

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Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative

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Benefits of a long-term e-health strategy

  1. 1. Leaders in Health IT Symposium - Regional PanelBenefits of a long term e-Health strategy at regional level José L. Rocha General Secretary for Quality and Modernization Regional Health Ministry Andalusia Region - Spain josel.rocha@juntadeandalucia.esQuick facts of Andalusia 8,415,490 Inhabitants 87,597 Km2Regional responsibility on health policy and healthcare since 1984 1,146 Primary Care Centers 47 Public Hospitals (16,281 beds) 9,390.2 M € Healthcare Budget 2011 Andalusia
  2. 2. E-Health: Improving quality of care andreducing health and social care costs 100% Healthy, Community independent living Clinic Chronic Disease Doctors Management Office Assisted Living Quality Skilled Nursing Specialist of life Facility Clinic Community Hospital ICU Graphic from NHS/BT Global Services HOME CARE RESIDENTIAL CARE CLINICAL CARE 0% €1 €10 € 100 € 1,000 € 10,000
  3. 3. Main objective of the Andalusian e-healthstrategy (the DIRAYA project):Integrate all the healthcare information of every patientin a Single Health Record for each citizen
  4. 4. EHR in Andalusia: main features• A long-term Strategy: From 1999• Unique health record number for all citizens of Andalusia• A individual smart card for each person as a key for access• A regional EHR shared among: – Primary care – Pharmacies – Hospitals – Emergencies
  5. 5. Much more than an EHR:A corporate information system Appointment Prescription Referrals Waiting lists Pathology Hospital Lab tests admission Functional Data tests warehouse Radiology Emergency Inpatient care care Primary care Outpatient care
  6. 6. Current extent of the developmentCompletion level Tool Population Cases in 2010▌▌▌▌▌▌▌▌▌▌ Clinical Station 100% 7.9 M Pat / 39.7 M Sheets▌▌▌▌▌▌▌▌▌▌ Appointment 100% 83 Million▌▌▌▌▌▌▌▌▌▌ Referral tool 100% 3 Million│▌▌▌▌▌▌▌▌▌ e-Prescription 99.5% 105 Million │▌▌ Analysis 25% 360,000▌▌▌▌▌▌▌▌▌▌ CS-Hosp. Emergencies 100% 3 Million ▌▌▌▌▌▌▌▌ CS-Outpatients 80% 1.1 Million ▌ CS-Inpatients 10% 916,890 ▌ Admission 10% 60,000▌▌▌▌▌▌▌▌▌▌ Appointment 100% 12 Million │▌▌▌ e-Prescription 33% 99,778 │▌▌ Analysis 25% │▌▌▌▌▌ Radiology 52% 3.4 Million ▌ Out of Hosp. Emergencies 10%
  7. 7. Primary Care appointments after the introductionof e-Prescription 38 Million visits -15.28% saved from 2006 56.522 47.910 Before After 6 months trial with the same cohort of population
  8. 8. e-Prescription % by INN (InternationalNonproprietary Name) and estimated savings 84 77,1 78,6 446.1 Million € 75,2 70,9 saved from 2001 63 57,7 46,6 25,7 2,7 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  9. 9. % of sample id errors and results delivery time (p70)after the introduction of the e-Lab module (MPA) 6 23 -76.32% 5 0 Before After Before After % of id errors p70 time, hours
  10. 10. Cumulative economic performance 900.000.000 800.000.000 700.000.000 600.000.000 500.000.000EUR 400.000.000 300.000.000 200.000.000 100.000.000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Present value of cumulative costs Present value of cumulative benefits
  11. 11. Lessons learnt: warnings/risks•Unrealistic expectations•Technology fascination: e-health as an objective itself•Insufficient IT training of healthcare workers•Underestimate preparation for implementation•Inadequate IT infrastructure•Disappointing short-term results
  12. 12. Lessons learnt: keys for success • Align the EHR development with the regional government’s health strategy, supporting it • Integrate the projects needed for each module into a single project that delivers interoperable all the information • Step by step implementation assuring its use after a carefully designed piloting • Ensure that the project horizon is long enough, so that there is enough time to involve stakeholders and to adapt the system accordingly. • Bottom-up approach: critical role of health care professionals in the design and development. • Strong political support in the long run
  13. 13. Thank you very much!

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