EUROPEAN ASSOCIATION OF SENIOR HOSPITAL PHYSICIANS

EUROPEAN ASSOCIATION OF SENIOR HOSPITAL PHYSICIANS

PATIENT-ORIENTED HOSPITAL CARE IN THE FUTURE João de Deus President

Quality Effectiveness Human Resources Patient Safety

History Mainly of private nature Minimal health care in Mercies Hospitals poor people Religious charities

History 1974 Constitution of 1976: Principle of health citizen s, with the creation of a national universal health care, general and free 1979 - NHS

NHS Primary care Health units Hospital network

Portugal today Hospitals 212 Public 121 Private 91 Primary care health centers - 363

Portugal today Financing Constitution of 2005: Through a national universal health care and general and, given the economic and social conditions of citizens, tendentially free Co-payment (exceptions) Subsystems (Army, Civil servants, bank employees,..) Private health insurances

Did it work?

1960 1970 1980 1990 2000 2005 2010 2013 Infant mortality 77,5 55,5 24,2 12,2 5,8 3,8 3,3 3,1 Life expectancy 63,9 66,7 71,4 74,1 76,7 78,3 79,1 80,8

Mortality rates from ischemic heart disease 800 700 600 500 400 300 200 100 0 France Portugal Spain Netherl Italy Luxemb Greece Switzerl Slovenia Norway Denmark Cyprus Germany Iceland UK Sweden Austria Ireland Poland Bulgaria Finland Czech Rep Romania Hungary Estonia Latvia Slovak Lithuania

Why did it work?

Health expenditure per capita 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Private Public Norway Luxembourg Denmark Netherlands Ireland France Austria Germany Sweden Iceland Switzerland Belgium UK Italy Finland Spain EU Greece Slovenia Portugal Czech Rep Slovak Rep Hungary Poland Lithuania Estonia Latvia Cyprus Romania Bulgaria Turkey

Why did it work? Organization (?) Medical careers Backbone Clinical leadership

Medical careers - Education Training programs (PMA) Length of training Evaluation

Medical Careers Reflect Different Professional Skills And Competencies Defined as a sequence of ascending grades / steps of different knowledge and scientific & technical skills, on the basis of training, courses, and competency public evaluations (CPD).

Medical Student Medical Doctor Pre-graduation 6 years Formal Education 5/7 years Continuous Professional Development Student Trainee / Junior Doctor Assistant (Specialist) Consultant (Graduate Specialist) Senior Physician Remuneration increases accordingly Head of Department

Self regulation

Labour conditions of hospital doctors play a crucial role in patients safety. Poorly paid work, non-specialized doctors doing specialized tasks, cheap manpower in health services, quantity instead of quality indicators only leads to an increasing risk for patients safety.

CONSEQUENCES Desorganization of health departments Hierarchical disruption Loss of interest in training junior doctors End of team work

CONSEQUENCES Less quality in health care Risk for patients safety Destruction of National Health Service Shortage of doctors

CHALLENGES Integration between Primary and Secondary care e-records, e-prescription Waiting time for surgery

Integration between Primary and Secondary care Back to back Health Center Hospital GP / Hospital Doctor

GP FAMILY DOCTOR

Hospital Tertiary Care PACIENT Continuing Care Family Doctor

Integration between Primary and Secondary care GP Patient Hospital Half day work No priorities Waiting time

Integration between Primary and Secondary care Family Doctor IT ALERT System Hospital No working hours lost Priorities Balanced waiting time

Integration between Primary and Secondary care Waitin g time

Integration between Primary and Secondary care Doctor

Integration between Primary and Secondary care Physician who sent the patient Family Health Unit

Integration between Primary and Secondary care Clinical information

Integration between Primary and Secondary care

Integration between Primary and Secondary care Priority Normal (Max. 90 days) High (Max. 60 days) Very high (Max. 30 days)

Integration between Primary and Secondary care Done

e-records, e-prescription

Patient

Clinical Record Prescription New consultation

PDS/PHR Portuguese Health Record The Portuguese Health Record (PHR) constitutes the national health record data sharing facility. This data can be shared between citizens, healthcare professionals and healthcare entities. While some data can be registered on PHR other is accessed via web service technology that links old and new existing applications. This project is supported by the Portuguese Ministry of Health and the Comissão de Acompanhamento para a Informatização Clínica (CAIC), the comission that supports the computerization of clinical records (Dispatch 9725/2013). As well as it is developed by Serviços Partilhados do Ministério da Saúde, EPE (SPMS).

Citizen Portal (Portal do Utente) Official launch: May 2012 MoU Health Sector PDS/PHR - Plataforma de Dados de Saúde / Portuguese Health Record Scope: Personal Health Record area that offers online informative and electronic services to the patient. It aims to strengthen the relationship between citizens and the NHS. Professional Portal (Portal do Profissional) Official launch: June 2012 Scope: Provide professionals with access to patient clinical data stored in servers and records from different institutions and central repositories. Institutional Portal (Portal Institucional) Testing Scope: Provide statistics from anonymised clinical data to central institutions. International Portal (Portal Internacional) Official launch: June 2013 (pilot) Scope: Enable the epsos pilot to serve as electronic patient s summary review for professionals.

Autorizações dadas pelo utente Data sharing is managed and controlled by the citizen through the Citizen Portal. There are three types of authorizations 22-01-2014 SPMS,EPE

Three types of authorizations: Autorizações dadas pelo utente Give the healthcare professionals access to the personal data registered on the Patient Portal: health related habits, allergies, medications, diseases and documents. Give the healthcare professionals access to the personal clinical data existing in other applications from the NHS Give the healthcare professionals from a country participating on epsos access to the patient s summary 22-01-2014 SPMS,EPE

My Health Online booking of consultations for primary and hospital care services of the NHS; Online ordering of chronic medication, within the list of medications authorized by the GP. Check the position on the waiting list for surgery of the NHS and its estimated time. Personal emergency contacts. Authorizations.

PDS Professional Portal RCU2 Patient Summary Acesso autenticado

48 Portuguese Patient Summary 48

New eprescription (PEM@med ) integrated in reall time with the EU guideline based Patient Summary Allergies and adverse reactions Chronical medication Patient Summary Update chronical medication Prescription Update Health Patient Record Alert to Clinical recomendations Prescription alerts Drug Information Historical Prescriptions (with dispense information) Local System: Health Patient Record

Waiting time for surgery SIGIC Reasonable waiting time Surgery check Choose an Institution

Conclusion Control Quality System CPD Better integration between primary and Patients hospital care Reasonable waiting list Priorities IT safety Patient and centered quality of care

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