Bringing the healthcare system closer to the citizen Virtual Care Model (SMR, PHR and integratecare)

Transcription

1 Bringing the healthcare system closer to the citizen Virtual Care Model (SMR, PHR and integratecare) Dr. Oscar Solans Functional Director of SMR and PHR. Ministry of Health of Catalonia Fundació TICSalut

2 Shared Medical Record, Personal Health Record and Health and social integrated care in Catalonia

3 Catalonia Government: Generalitat de Catalunya Area: km 2 Population (2012): Life expectancy (2009): 80,55 yrs Birth rate (2007): 11,68 Gross Mortality rate (2007): 8,28 Infant mortality (2007): 2,70 GDP/Capita (2007): High urban concentration Own language and culture

4 Healthcare Model features Funded by taxes Decentralized to regional autonomies Universal coverage Free access Very wide range of publicly covered services Co-payment in pharmaceutical products Services provided mainly in public facilities

5 Shared Medical Record in Catalonia

6 Why have we developed HC3? 6

7 Catalan Healthcare System Decentralized System Current System - Multi-provider model (>160 providers) integrated into a single public network - Enhances autonomous management of each provider - Providers are free to select their information systems - 90% of primary care centres have the same system (ecap) - Interoperability must be guaranteed

8 Shared Medical Record

9 668 Heath Care Centers connected

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11 Shared Medical Record in Catalonia (HC3) and Personal Health Record (LMS) 11

12 Non radiological image

13 Outstanding visitis in HC3 and PHR 14

14 Preliminary report emergency care in ambulance

15 Telemonitoring differentsdiseasesthrough PHR Height Weight BP

16 Progress notes 17

17 Personal Health Folder La Meva Salut

18 The Personal Health Folder is a safe digital online space, personal and no transferable, where every citizen in Catalonia, can check their health information and other services of the Health Department. It offers information published by centres, but It isn t a simple repository. It is an independent module of HC3 with specific functions exclusively for citizens

19 Goals To have a secure Afavorir la environment coresponsabilitat i la for citizens to participació dels ciutadans interact with en els aspectes relacionats health system, amb la seva pròpia salut providers and (gestió de les actuacions professionals. preventives i de cura de la seva salut) To promote responsibility and participation of citizens in matters of their own health (preventive actions management and self care). To improve the health care quality and coordination between different care lines.

20 Project development services that support the care process INFORMATION SERVICES My Health access Digital ID certificate HC3 Information from the HC3 citizen CAP Information of the citizen from the health centre. My Health access Identification with digital ID certificate or user/password PROCEDURES COMUNICATION EDUCATION CARE O Not customizable elements by citizen. P Customizable elements by citizen Project start 2012 Access for all citizens 2014 Improving access and services

21 Access PC and tablet vision Mobile vision

22 Personal data

23 PHR shows all access in my EHR

24 Clinical Information Clinical Reports

25 Diagnostics Active health problem Non active health problem

26 Clinical information - Vaccines Reported from health provider Reported from vaccination book Reported orally by patient Duplicated

27 Electronic prescription Online: always updated Printable

28 Anticipatory wills

29 Formalities

30 econsultation (Virtual visit)

31 econsultation

32 My Calendar of outstanding visits surgical waiting lists

33 More procedures More controls on own health Connect with your professionals Apps to control my health State 2: functionalities we are extending

34 Health and social integrated care

35 Objectives Advantages Exchange social and Health data The main purpose is to build a framework to improve the interaction between social and health services. This project wants to promote continuity of people attendance, by using information and communication technologies (ICT). It wants to define a model to share information between both services replicable to other entities in Catalonia. Higher quality integrated care. Better communication between health and social professionals. Higher intervention planning. Optimize resources and services. Reduce costs and avoid diagnostics and tests duplication. Promote patients to take more control over their own care. 36

36 Model exchange factors Legal framework Health and social information sharing Model exchange ICT infrastructure 37

37 Legal framework REGULATIONS Law 21/2000, September 29 th, about the rights of information concerning the health and autonomy of the patient, and clinical documentation. Law 44/2003, Novembre 21 th, to regulate profiles of health professions. Law 12/2007, October 11 th, of Social Services and professionals who are involved in the monitoring and evaluation of the citizen. Agreement GOV / 28/2014 of Febraury 25 th, to create the Integrated Health and Social Care Plan (PIAISS), in the Government Plan , to promote, lead and participate in the transformation of the social and health care model to achieve a person-centred integrated care model. AGREEMENT The Framework agreement" has been signed between the Health Department and the City Council of Barcelona concerning the exchange of information between HCCC (Shared Medical History of Catalonia) and Social Service Information System of Barcelona. CONSENT Informed consent to ask the citizen authorization to share their health and social information. PERSONAL IDENTIFICATION NUMBER The Personal Identification Number has been established as the common identifier in health and social systems. 38

38 Category ID information Services information Supplementar y information Health information Needs assessment Intervention Community care Health and social information sharing HCCC (Shared Medical History of Catalonia) Name and surname ID card Date of birth Address Telephones Age Professionals (general practitioner, nurse) Health centre, palliative care, home care, nursing homes... Health factors (diagnostic) Chronically ill categorization Very ill categorization Barthel ADL index Lawton-Brody's index Pfeiffer cognitive evaluation test Zarit Burden Interview Social risk factors (Health at home - Salut a Casa) Individual health intervention plan Individual Treatment Previous medical discharge (24-48 ours before) Medical discharge documents A&E documents EMS (emergency medical services )documents Programs/projects SIAS (Social Service Information System of Barcelona) Name and surname Gender Date of birth ID card or passport Address Telephones Census Professional (social worker) Social services centre Economic information: pharmaceutical copayment Legal incapacity: process, date, guardian Disability: recognized level, kind of disability, disable scale. Dependent people: recognized level. Risk alert (coronary heart disease, fall s...) Barthel ADL index Lawton-Brody's index Pfeiffer cognitive evaluation test Zarit Burden Interview Services: Home care services Telecare Food assistance Day care centres Social diagnosis Programs/projects 39

39 ICT infrastructure The project wants to build a framework to improve the interaction between social and health services, by using information and communication technologies (ICT). Moreover It focuses on person-centered care. This model exchange take the health technical model as a reference. Web Services are used for providing structured information and to make easier the integration of the workstations in the health and social centers. The health professionals can view social information requested of a citizen. The social professionals can view health information requested of a citizen. 40

40 A Web Service is a method of communication between two electronic devices over a network. This will be the way to share information between HCCC (Shared Medical History of Catalonia) and SIAS (Social Service Information System of Barcelona). Health Departament Information System Technological terms Social Service Information System Send informed consent and check Security Informed consent will be signed by the citizen. The health or social professional will send the document to the common repository. Each professional can check if the citizen has signed this consent. Common repository Informed consent will be custodied in a common repository. It will be validated by both systems. It will do periodic checks.

41 Thanks!! Oscar Solans Oficina tècnica:

42 Health professionals can use two methods look up information in the HC3 Professional viewer HC3 Integrated into any health information system

43 Consultation data Access Viewer Professional Access of data Integrated in Workstation Different professionals who have accessed Setembre Different medical records consulted Setembre

44 Shared Medical Record Summary display

45 Structured documents

46 Shared Medical Record - Structured lab test results

47 Shared Medical Record Image Diagnosis

48 Shared Medical Record Structured Diagnosis

49 Shared Medical Record Active prescriptions

50 Shared Medical Record - Immunizations

51 Shared Medical Record Clinical Risk Groups

52 Shared Medical Record Patient complexity profiling PCC: Complex Chronic Patient - HC3 stratification with Clinical Risk Groups (CRGs) - Publish label/mark in HC3 - Label visible on all screens

53 Key Information Summary (PIIC) Health problems/diagnosis Active Medication Allergies Instructions for in cases of crisis or exacerbation Advanced Care Planning Resources and services used Multidimensional assessment Carer whom decisions are delegated Additional information of interest

54 % Completion of Key Information Summary (PI Area Instructions for in cases of crisis Carer whom decisions are delegated Entity provider Area Entity provider PC center

55 Image publication 2014 Images > 5 M Documents published per year Chronic patients labeled MACA PCC Average documents published per month Indexed documents Patients with reports More than 140millions clinical records available

56 Accés LMS Entorn PRE de LMS: ROEZ uss: T pass: video_lms1 Para econsulta Cip: GALO DNI: V Contrasenya: prova_lms_3 57

57 HC3/i.SISS.CAT Interoperability project to facilitate integration between different information systems for healthcare providers and social services promoting continuity of care and management of healthcare and social processes

58 Current statistics 59

59 Lace i-siss.cat the Catalan Health System interact with the information systems that make the real map of Catalonia clinical systems Expanding the information available to the public through its PHF Professionals clínics Departament de Salut / CatSalut Pacients Gestor de processos Feeding the data model HC3 to provide health professionals with the necessary tools to perform better tracking of patien Estacions de treball clíniques Providing interoperability between different systems of health care providers through the definition of standards

60 Oficina tècnica: 61

61 Shared Medical Record Available information Healthcare Centers Information Primary healthcare Diagnosis Healthcare reports Immunizations Chronic patients labels Progress notes Outstanding visits Specialized care, longterm care center and mental health Discharge report Emergency reports Specialized outpatient clinic reports Outstanding visits Health Department Information Diagnosis procedures Pathology and laboratory reports Radiology image and non radiologic image Imaging diagnosis reports Other diagnosis tests reports Interventions Medical Activity DB Diagnosis Procedures Prescribed / Dispensed drugs Electronic prescription Anticipatory wills Anticipatory wills registry

62 63

63 Usability data By health region Access digital certificate (%) Access with user / pass word (%) 34% 66% Acces to users 3,04 By device By sex Home 43% Dona 57% PC 85% Mòbil 11% Tablet 4% By age % % % % % 65 9% Prova pilot d accés a LMS amb usuari i paraula de pas

64 SNOMED CT Example: ConceptId Hierarchy relationships DescriptionIds

65 Demo LMS Entorn PRE de LMS: ROEZ uss: T pass: video_lms1 Para econsulta Cip: GALO DNI: V Contrasenya: prova_lms_3 66

66 Demo HC3 ROEZ CASA CELO

67 Features incorporated this year econsultation International vaccines Online booking Change of doctor Telemonitoring Mobile integrated agenda

68 My controls

69 New services in HC3 Publication of no radiological image (HC3) Outstanding visits of different care centers (HC3 and PHR) Preliminary report of emergency care in ambulance (HC3) strutured clinical variables (HC3 and PHR) Publication of clinical progress notes (HC3)