The document summarizes healthcare in Andalusia, Spain. It discusses (1) the role of information and communication technologies (ICT) in Andalusia's public healthcare system, including the development of a single electronic health record for citizens; (2) strategies for managing chronic conditions using ICT; and (3) the Living Lab Salud Andalusia initiative which aims to foster innovative ICT projects through collaboration between stakeholders. The implementation of ICT is shown to improve quality, efficiency and patient outcomes in Andalusia.

1. RICHARD
International workshop
E-Health business models for
chronic conditions – the case
of Andalusia (Spain)
Ana M. CARRIAZO
Senior Advisor
Regional Ministry of Health and Social Welfare
Andalusian Governmente, Espagne
anam.carriazo@juntadeandalucia.es

2. Overview
• Healthcare in Andalusia and
the role of ICT
• Strategies on chronic
conditions in Andalusia
• Living Lab Salud Andalusia
• Economic issues

3. Andalusia
87,597 Km2
8,415,490 habitants (526,942 foreigners)
21,781,273 tourists during 2011
Political situation
• Political autonomy since 1981
• Regional Parliament, Regional Government and Regional Court of Justice
• 1984: Transfer of political competencies on health and public healthcare
system management
Andalusian Public Healthcare System
1,506 Primary healthcare centres – 100% coverage
47 Public Hospitals (16,821 beds) – 93% all inpatient beds
102,000 Healthcare professionals
9.33 B € Budget 2012 (6.72% PIB; 1,108 €/habitant)

4. The Digital Strategy of the Public Healthcare
System of Andalusia
• A long-term Strategy: From 1999
• A single health record number for all citizens of Andalusia
• A single electronic Health Record for every person
• A individual smart card for each person as a key for access
• Unified access to all services and levels of care
• Structured information
• A regional eHR shared among:
• Primary care
• Pharmacies
• Hospitals
• Emergencies

5. Much more than an eHR:
A corporate information system
121 Million
e-prescriptions/year
Appointment Prescription
Referrals
98 Million Waiting lists Pathology
appointments/year
Hospital Lab tests
admission
Functional
Data tests
warehouse
Radiology
Emergency Inpatient care
care
Primary Outpatient
care care
3.5 Million
8.1 Million Rx images/year
individual eHR
Health Care Information and
Management Integrated System

6. An integrated information system
supporting the modernization strategy
Patient centred care
Continuity
Accessibility
Quality and efficiency improvement
Variability reduction
Patient safety
Patient Autonomy
Alternatives to inpatient care

7. Functional architecture
Centro de Centro de
Salud Salud
S M
Primary Care level
Centro de
Salud Centro de
Users Data Base Users Data Base Salud
Structure Structure
MACO MACO
Centro de
Salud Centro de
Salud
External Bus
Hospital level
Hospital Hospital Hospital Hospital

8. 350.000
Media mensual de episodios de URGENCIAS registrados en Diraya Media mensual de episodios de Consultas Externas registrados en Diraya
140.000
300.000
250.000
120.000
551,716 e-Prescrip
200.000
100.000
80.000
96.8 M XRay Images
150.000
60.000
100.000
40.000
50.000
19 hospitals
20.000
0
0
2007 2008 2009 2010 2011
2007 2008 2009 2010 2011
3.5 M inhabitants
Emergencies: 3.4 Million Outpatients: 1.5 Million (43%)
280,000 per month 125,000 per month

9. Primary
Healthcare
3,5 Million consultation sheets per month
41 Million in de consulta de AP: Media mensual
Hojas 2011 142,000 lab request/month
4.2 Millions results
4.000.000
3.501.972
3.500.000 3.304.527
3.147.407
3.000.000 2.829.601
2.500.000
2.124.024 118.6 Million e-prescription in 2011
2.000.000
1.500.000 1.315.629
1.000.000 790.517
500.000
0
2005 2006 2007 2008 2009 2010 2011
3 Million
XRay reports
All PC centres

10. Quality and Efficiency:
e-Prescription module usage, % prescriptions by active principle
and PHC visits reduction
91,1
84
78,6
> 1 Billion € savings 70,9
75,2 77,1
since 2001 63
57,7
136 Million € saved /year
46,6
118,6
25,7
105,2
Electronic 89,2
Prescriptions 2,7
% PPA
66,3 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
30,5 50,5 50,3
50,1 49,9
49,6
1,2
8,9 48,5 -14 %
0,2
2004 2005 2006 2007 2008 2009 2010 2011
44,1
43,6
Aditional savings:
3.1 Million €: printed prescriptionss PHC visits
3.2 Million €: data mangement (million)
2004 2005 2006 2007 2008 2009 2010 2011

11. Safety and Quality:
Lab test errors (pre/post) and response time (p70) after Lab Test
Module (MPA) introduction
-76.32%
4,4 22,8
6,0 1,2
1,6
5,4
0,1
0,0
Antes Después Antes Después Antes Después Antes Después
Not enough Lost report
% ID error p70, hours
sample
Data from 27 PHC Districs, 5.2 Million inhabitants

12. Satisfaction:
% de users’ satisfaction (phone access)
Call centre Extension
100
90
80
70
60
50 Phone access
Satisfaction
40
30
20
10
0
00
01
02
03
04
05
06
07
08
09
10
11
20
20
20
20
20
20
20
20
20
20
20
20
Institute for Social Studies of Andalusia
Spanish Scientific Research Council (CSIC)

13. Cumulative economic performance
900.000.000
800.000.000
700.000.000
600.000.000
500.000.000
EUR
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

14. Contribution of ICT to health systems sustainability
Health and social care costs
100%
Healthy, Community
independent living Clinic Traditional
Health IT
Chronic Disease Doctor's
Management Office focus
Assisted Living
Quality
of life Skilled Nursing Specialist
Facility Clinic
Community
Hospital
ICU
Graphic from NHS/BT Global Services
0%
HOME CARE RESIDENTIAL CARE CLINICAL CARE
€1 €10 € 100 € 1,000 € 10,000

15. Finantial crisis impact on health systems
Perhaps at no other time in the last decade has the need to extract
the best potential benefits out of stretched resources been so
urgent. With public sector budget across Europe being stringently
monitored and often curtailed, health care is no exception. In fact,
in quite a few countries, and especially those subject to
international loan agreements, the health sector is one of the
areas targeted not only for more immediate cost savings but also
for long-term re-structuring and efficiency gains

16. Exhibit 4. Health Care Costs Concentrated in Sick Few—
Sickest 10 Percent Account for 65 Percent of Expenses
Distribution of health expenditures for the U.S. population,
by magnitude of expenditure, 2009
Annual mean
expenditure
1%
5% 22%
10% $90,061
50%
$40,682
50% 65%
$26,767
97%
$7,978
Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.

17. http://www.commonwealthfund.org/Publications/Fund-
Reports/2012/Apr/Performance-Improvement-Imperative.aspx

18. http://www.juntadeandalucia.es/servicios/planes/detalle/14546.html

19. http://www.patientsorganizations.org/attach.pl/1539/1453/GHPS%20NCD%20Report.pdf

20. ICT Role in chronic patients’ management
Health and social care costs
100%
Healthy, Community
independent living Clinic New areas of
development
Chronic Disease Doctor's
Management Office
Assisted Living
Quality
of life Skilled Nursing Specialist
Facility Clinic
Community
Hospital
ICU
Graphic from NHS/BT Global Services
0%
HOME CARE RESIDENTIAL CARE CLINICAL CARE
€1 €10 € 100 € 1,000 € 10,000

21. Continuity of care, quality and efficiency:
Digital retinography, teledermatology, telecare…
156 retinógrafos
215.000 patients
20.000 retinopathy
cases detected 83 PHC centres with
teledermatology
services

22. Citizens’ autonomy: new ICT services
Current Health
Problems
Current Allergies
Citizens’ access to eHR and
Contraindications
Current
Medication
Primary and
Specialized care
Appointments
Clinical reports
2 M inhabitants
(23.6%)
Hospital
Admissions

23. “Facilitate the design and
development of innovative
projects focused on real
solutions for detected needs”
Andalusian Public Health System

24. Different projects with
Great number of similar elements …
innovative initiatives in but managed and
the health sector executed in a separate
way
Barriers from portotype to
solutions
Solutions without scalability
or isolated (lack of
interoperability)
Good examples of
collaboration between Efforts were redundant
health and technology and little reutilization
sectors

25. Living Lab Salud Andalucía
• Framework Agreement (noviembre 2008)
• User oriented projects
• Developed in collaboration
• Replicability and sustainables
• Baseline for new and better
projects

26. How is this achieved?
Open Innovation Administrations
Community Universities
Companies
Users
99 members
currently
Management body

27. How is this achieved?
Users have the
leading role in the Priority interest
innovation process areas
Participative
innovation
scenarios
National and
European activity
(ENoLL)

28. Advantages of these innovation
scenarios
• Fast deployment and validation in specific areas
• Common framework for integration and interoperability of
different projects
• Efficiency in the innovative process
Eliminate main barriers for
wide deployment of
projects

29. Services catalogue
ACCESO A INFORMACIÓN
DE INTERÉS
DIFUSIÓN
CORPORATIVA
OFICINA DE INNOVACIÓN
TRANSFERENCIA DE
ESCENARIOS DE TECNOLOGÍA
RELACIONES Y ALIANZAS INNOVACIÓN PARTICIPATIVA
GENERACIÓN
PILOTAJE COMERC. DE
DE IDEAS/ DEFINICIÓN DESARROLLO
DE PRODUCTO/
IDENT. DE PROYECTOS DE PROYECTOS
PROTOTIPOS SERVICIO
NECESIDADES
VIGILANCIA TECNOLÓGICA ASESORAMIENTO EN
CONTRATACIÓN
PÚBLICA

30. LLSA projects
• Main interest areas:
 Innovative processes in health
 Interoperability
 Telemedicine and telecare
 New ways of relationship with citizens
 Decision support systems
 Training and professional collaboration scenarios
• Detailed info at
http://livinglabsalud.es/proyectos

31. LLSA Scenarios
Common use
technology
platforms
Real
healthcare
settings

33. http://livinglabsalud.es

34. Gracias Thanks Merci Grazie Dzięki Gracias Merci
Dzięki Thanks Gracias Thanks Merci Grazie Dzięki
Gracias Thanks Merci Grazie Thanks Merci
Grazie Gracias Thanks Gracias Merci
Grazie Thanks Gracias Thanks Merci
Ana M. Carriazo
Senior Advisor
General Secretariat for Quality and Innovation
Regional Ministry of Health and Social Welfare of Andalusia
Av. Hytasa, 14
41071 Sevilla (España)
T: +34955048138
anam.carriazo@juntadeandalucia.es
www.juntadeandalucia.es/salud