andalusian approach to an integrated healthcare ... · andalusia 87,599 km2 8,492,635 habitants...
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Andalusian approach to an integrated healthcare information system
Francisco José Sánchez Laguna
Andalusian Health Service
Andalusia 87,599 Km2 8,492,635 habitants (657,815 foreigners) >22 M tourists yearly
Geographical situation
100 % public funding
Universal coverage*
Free of charge (pharmacy co-pay)
Integrated care
2 levels:
• Primary care
• Hospital care Spanish Healthcare General Act 1986 National Health System Cohesion and Quality Act 2003 National Public Health Act 2011 RDL 16/2012 NHS sustainability*
Spain: National Health System
• A long-term strategy from 1999
• A single health record number for all citizens in Andalusia
• A shared single electronic health record for every person
• An individual smart card for each person as a key for access
• Structured information
• A regional EHR shared among:
• Primary care
• Hospitals
• Emergencies
• Pharmacies
• Patients (from 2012)
The Digital Strategy of the Public Healthcare System of Andalusia
Healthcare information and management integrated system
8.3 M individual EHR
URG
CEX
Much more than an EHR: a corporate information system
Appointment Prescription
Radiology
Waiting lists
Functional tests
Pathology
Lab tests
Inpatient care
Referrals
Primary care
Hospital admission
Data warehouse
Emergency care
Outpatient care
Healthcare information and management integrated system
Some figures
• More than 1,500 PC centers
• 47 hospitals
• 8.3 M individual EHR
• 95 M appointments / year
• 54 M PC (≈50% electronic means)
• 68 M e-prescriptions / year
• 166 M dispensations
• More than 3.5 M lab requests / year
• Almost 10 M diagnostic images / year
• More than 1,300 M images
• 905 TB of images
Medical office Pharmacy
Intranet of the Official College of
Pharmacists
The system allows the dispensation of the treatment during the time established by
the doctor at any pharmacy
Smart card as a key
Intranet of the Andalusian Public Healthcare System
Instruction sheet for patient Treatment available
on line
ePrescription module: Prescription XXI
48,5
49,650,1
50,5 50,349,9
44,143,6
2004 2005 2006 2007 2008 2009 2010 2011
-14 %
PHC visits (millions)
2,7
25,7
46,6
57,763
70,975,2 77,1 78,6
8491,1
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
PHC visits reduction and prescriptions by active principle
Quality and efficiency
% PPA
> 1 billion € savings since 2001
136 Million € saved/year
6,0
0,0
Before After
22,8
5,4
Before After
% ID error p70 (hours)
-76.32%
4,4
1,6
Before After
1,2
0,1
Before After
Not enough sample Lost reports
Lab test errors and response time (p70) after Lab Test Module (MPA) introduction
Safety and quality
Patient ID Location
What happened Symptoms
Andalusian EHR
Medical history Alergies Conditions Prescriptions
Mobility episode
Stock Medication/material Self assessment
Monitor/defibrilator integration
EHR Mobile
Monitor/defibrilator integration
EHR Mobile
Current health problems
Current allergies and contraindications
Current medication
Primary and specialized care appointments
Clinical reports
Communication
Citizens’ autonomy: new ICT services
Citizens’ access to EHR
mSSPA
Mobile strategy
Integration layer
Registration
Authentication
Support
Information
Monitoring
New development
Clinical information
Personal information
Reports
Open integration model with the EHR
• New apps oriented integration layer
• Abierto a iniciativas de terceros (pymes, ciudadanos, otras instituciones)
