Norwegian ehealthweek The Andalusian ehealth Strategy
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1 Norwegian ehealthweek 2014 The Andalusian ehealth Strategy
2
3 Andalusia 87,597 Km 2 8,449,985 habitants (526,942 foreigners) 21,8 M tourists yearly Geographical situation
4 Andalusia Population
5 Andalusia: Political context Political Autonomy since 1981 Regional Institutions Parliament Government ( Junta de Andalucía ) Court of Justice (TSJA) Susana Díaz. President of Government Manuel Gracia. Speaker of the Parliament Regional Parliament Regional Government Regional Court of Justice Lorenzo del Río. Chief Justice
6 Regional Ministry of Equity, Health and Social Policies Regional Minister of Equity, Health and Social Policies María José Sánchez General Secretary For Planification and Economic Evaluation General Secretary For Social Policies Deputy Regional Minister Of EquityH and SW General Secretary For Quality, Innovation and Public Heath Director Andalusian Health Service Director Agency of Social Services And Dependency Martín Blanco Ana Rey Aquilino Alonso Josefa Ruiz José Manuel Aranda Manuel Martínez trategic Planning, follow-up and Evaluation, Economic planification, budget, Sociial policies General Coordination, procedures regulatory Innovation, Surveillance Protection Participation. Intersectoriality Healthcare provision Primary care Hospitals Mgmt and Provision Socuial Services And Dependency
7 Spain: National Health System 100 % Public Funding Universal coverage* Free of charge (Pharmacy co-pay) Integrated care 2 levels: Primary Care Specialized Care Spanish Healthcare General Law 1986 National Health System Cohesion and Quality Law 2003 RDL 16/2012 NHS sustainability*
8 Andalusian Public Healthcare System Legal Framework Principles Full Autonomy for Health Policy since 1984 Healthcare Management at regional level Same Principles as national law Some specific driving principles: Public provision of the services Based on cooperation & coordination Stress on: Equity Guarantee of rights Territorial homogeneity Accessibility Transparency Participation Andalusian Health Law 1998 Andalusian Public Health Law 2011
9 Andalusian Public Healthcare System 1,506 Primary health centres (PHC gatekeeper) 47 Public Hospitals (16,821 beds) 94,753 Healthcare professionals (2012) 9,330 M Budget 2012 (6.72% PIB; 1,108 /habitant) In 1984 transfer of the political competencies on health and public healthcare system management
10 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
11 Much more than an ehr: A corporate information system 121 Million e-prescriptions/year 95 Million appointments/year Waiting lists Hospital admission Data warehouse Appointment Prescription Referrals Pathology Lab tests Functional tests Radiology Emergency care Primary care 8.1 Million individual ehr Outpatient care Inpatient care 3.5 Million Rx images/year Health Care Information and Management Integrated System
12 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
13 Users Data Base
14 Hospital level Primary Care level Functional architecture Centro de Salud S M Centro de Salud Centro de Salud Users Data Base Structure MACO Users Data Base Structure MACO Centro de Salud Centro de Salud Centro de Salud External Bus Hospital Hospital Hospital Hospital
15 Media mensual de episodios de URGENCIAS registrados en Diraya Media mensual de episodios de Consultas Externas registrados en Diraya ,716 e-prescrip 96.8 M XRay Images Emergencies: 3.4 Million 280,000 per month Outpatients: 1.5 Million 125,000 per month 19 hospitals 3.5 M inhabitants (43%)
16 Primary Healthcare 3,5 Million consultation sheets per month 41 Million in 2011 Hojas de consulta de AP: Media mensual Million e-prescription in ,000 lab request/month 4.2 Millions results Million XRay reports All PC centres
17 Prescription XXI EHR DIRAYA Dispensation Module PHARMA BDU HSE BDP FARMA Dispensations Health System corporate network INTRANET COF Dispensations Prescriptions Clinic DIRAYA Instructions Sheet for the patient Pharmacy
18 Quality and Safety: Prescription DSS: dosage, alergies, interactions,
19 Safety and Continuity of Care: eprescription module receta XXI and alerts Farmacia The Pharmaceutic can send an alert to the patient s ehr and block a prescription until his doctor verifies it and makes a confirmation or changes the prescription alerts en % 93% Confirmados Reactivados Consulta Official college of Pharmaceutics Intranet Public Health System Intranet The alert appears in the patient s ehr. His doctor can agree with Pharmacy and change the prescription or reactivate the treatment.
20 Quality and Efficiency: e-prescription module usage, % prescriptions by active principle and PHC visits reduction > 1 Billion savings since Million saved /year 46,6 57, ,9 75,2 77,1 78, ,1 Electronic Prescriptions 66,3 89,2 105,2 118,6 % PPA 2,7 25, ,2 1,2 8,9 30,5 48,5 49,6 50,1 50,5 50,3 49,9-14 % Aditional savings: 3.1 Million : printed prescriptionss 3.2 Million : data mangement PHC visits (million) 44,1 43,
21
22 e-lab Tests Module Based on Corporate Catalogue. Compatible with any LIS All analitical parameters are integrated in the ehr Homogeneous and comparable Linked to the clinical context Support to the preanalitical process Regional Tracebility regardless ordering and extraction point Working in 678 Primary Care Centers, served by 27 hospital labs, requests/month (4.2 Millions results) Clinical Catalogue CLC00006 (Pla Colesterol de HDL; c.sust) Unidades, decimales, FC, espécimen, sinónimos Lab A Lab B Lab C Lab D General Catalogue GNC Srm Colesterol de HDL;c.sust(calculado) GNC Srm Colesterol de HDL;c.sust(medido) GNC Srm Colesterol de HDL;c.masa(calculado) GNC Srm Colesterol de HDL;c.masa(medido) Unidad específica, CLC, Muestra, Factor Conversión Primario
23 Safety and Quality: Lab test errors (pre/post) and response time (p70) after Lab Test Module (MPA) introduction % 6,0 4,4 1,2 22,8 1,6 5,4 0,0 0,1 Before After Before After Before After Before After Not enough % ID error Lost report p70, hours sample Data from 27 PHC Districs, 5.2 Million inhabitants
24 Continuity of care, quality and efficiency: Digital retinography, teledermatology, telecare 156 retinógrafos patients retinopathy cases detected 83 PHC centres with teledermatology services
25 Digital Services for citizens Transparency Información on Health Centers Quality and Health Service. Waiting list consultation Acciones proactivas Informarse.es salud Education Information Entertainment Web TV/TDT Móvil SaludResponde Telephone consultation Second medical opinion Living will Individual Card Waiting list Telephone appointment arrangement Health Information Translation service Tobacco quit-line Encuesta al alta telefónica SIDA, Tabaco, gripe... SMS services Health Information Health Advise Fragile outpatients follow-up Link nursery support 061 home follow-up Heat wave campaigns e-administration Living will Individual Card 24 hr salud andalucía Individual health evaluation and informatión
26 Accessibility: Appointment systems in PHC (datos 2011)
27
28 Living Will Second medical opinion Waiting list SaludResponde Information and Services Center Información Appointments Internet appointments Health Card Phone Appointment E-Prescription ( InterS@S ) Oficina Virtual
29 Satisfaction: % de users satisfaction (phone access) Call centre Extension Phone access Satisfaction Institute for Social Studies of Andalusia Spanish Scientific Research Council (CSIC)
30 Citizens autonomy: new ICT services Current Health Problems Citizens access to ehr Current Allergies and Contraindications Current Medication Primary and Specialized care Appointments Clinical reports Health apps Hospital Admissions
31 EUR Cumulative economic performance Present value of cumulative costs Present value of cumulative benefits
32
33 Andalusia Reference Site
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35 Gracias Thanks Merci Grazie Dzięki Gracias Merci Dzięki Thanks Gracias Thanks Merci Grazie Takk Gracias Thanks Merci Grazie Thanks Merci Grazie Gracias Thanks Gracias Merci Grazie Thanks Gracias Thanks Merci José Daniel Soto Alba Head of Information and Comunications Tecnologies Service Regional Ministry of Equity, Health and Social Policies of Andalusia Av. Hytasa, Sevilla (España) T:
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