SMR and PHR in Catalonia. ICT Services for Integrated Care

Transcription

1 SMR and PHR in Catalonia ICT Services for Integrated Care

2 Shared Medical Record in Catalonia

3 WHY ARE WE DOING IT? 3

4 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 - 85% of primary care centres have the same system (ecap) - Interoperability must be guaranteed

5 Shared Medical Record

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

7 Shared Medical Record The Shared Medical Record virtual space grouping patient s healthcare process documents Publication SMR REPOSITORY CENTRAL REPOSITORY OPTION 1 HEALTH CENTRE 1 INDEX REPOSITORY

8 Shared Medical Record - Definition Information Request SMR REPOSITORY CENTRAL REPOSITORY OPTION 1 SECURITY HEALTH CENTRE 1 INDEX REPOSITORY CLINICAL WORK STATION

9 Shared Medical Record Access control Physicians and nurses : For patients with scheduled care or admitted to the hospital Emergency care Primary Care: When the patient is assigned to this Primary Care professional When is backing the assigned team Other staff : When they have any ongoing care process with the patient

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11 Shared Medical Record Display 1. Web viewer: web environment to view only HC3 information of one patient 2. Integrated Workstation: Integrating data of HC3 in the provider Clinical Workstations (WS) and displaying both EHR and EMR data. Viewer professional Octubre Novembre Desembre Gener Febrer Març Abril Maig Juny Juliol Agost Setembre Octubre Different professionals who have agreed WS Access Maig Juny Juliol Agost Setembre Octubre Novembre Desembre Gener Febrer Març Abril Maig Juny 11

12 An example of data (HC 3) integrated workstation (WS) 12

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14 Image publication 2013 Images > 4 M 2013 Images per day Documents published per year Chronic patients labeled PCC and MACA Average documents published per month Indexed documents Patients with reports

15 Shared Medical Record Look & Feel Name, birth date and PIC Address and phone number Doctor and nurse assigned Reference Primary Care Center

16 Shared Medical Record Summary display

17 Shared Medical Record Shared Medical Record - Reports & Structured Reports

18 Shared Medical Record Structured lab test results

19 Shared Medical Record Image Diagnosis

20 Shared Medical Record Structured Diagnosis

21 Shared Medical Record Structured Diagnosis

22 Shared Medical Record Immunizations

23 Shared Medical Record Integrate Clinical Course 23

24 Shared Medical Record Clinical Risk Groups

25 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

26 Shared Individual Treatment Plan (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

27 Shared Medical Record Next challenges More structured data Laboratory, PA, espirometry, diagnosis, PIIC, breast cancer screening report... More Quality (strutured data allows data mining) More integration with Clinical Workstations Healthcare processes integration Apply clinical alerts and messages Rules to support clinical process Clinical decision support Health and social integration 27

28 Video HC3

29 Personal Health Folther La Meva Salut

30 Definition The Personal Health Folther is a safe digital online space, personal and no transferable, where every citizen of Catalonia, over 18, 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

31 Goals Afavorir la coresponsabilitat i la participació dels ciutadans en els aspectes relacionats amb la seva pròpia salut (gestió de les actuacions preventives i de cura de la seva salut) To have a secure environment for citizens to interact with health system, providers and professionals. 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.

32 Main benefits The Personal Health Folther provides great benefits to the citizen, and also to other actors like health services providers and the administration.

33 Project development 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 ATTENTION O Not customizable elements by citizen. P Customizable elements by citizen Project start 2012 Access for all citizens 2014 Improving access and services

34 Logic Model The Personal Health Folther has access to the information that CatSalut has in its repositories and integrates services for citizens.

35 Shared Medical Record in Catalonia (HCCC) 35

36 Services The Personal Health Folther integrates services/apps to improve the citizen health quality, and to ensure the quality of information, the access security and the efficiency. It is necessary the homologation of health services/apps.

37 News functionalities

38 Access PC and tablet vision Movile vision

39 Personal dates

40 Clinical Information Clinical Reports

41 Diagnostics Active health problem Non active health problem

42 Vaccines Reported from health provider Reported from vaccination book Reported verbally from patient Duplicated

43 Medication: electronic recipe Online: always updated Printable

44 Anticipate wills

45 Formalities

46 My controls

47 Access activities to Personal Health Folther Many users who have accessed Accesses that have been made By health region Total % Lleida 75 6% Camp de Tarragona 94 7% Terres de l'ebre 82 6% Girona % Catalunya Central 74 6% Alt Pirineu i Vall d'aran 40 3% Barcelona % By sex Total % Men % Woman % By age Total % 18 to % 36 to % > % (Assessments from October 6th to October 31th) Access digital certificate Access digital certificate (%) 40% Access with user / pass word Access with user / pass word (%) 60% Acces to users 2,15 Prova pilot d accés a CPS amb usuari i paraula de pas/setembre 2014

48 Access activities to Personal Health Folther Access by tab Total % Clinical Records % Personal Dates % Diagnostics % Medication % HCDSNS Access % Formalities 802 6% Vaccines 683 5% My controls 627 5% Anticipates wills 455 3% Personal Health Folther pilot access with username and password / September 2014

49 Evolution logins Accesses have increased significantly after pilot start 49

50 Health and social integrated care

51 Presentation Objectives 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. Avantatges 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. 51

52 Model exchange factors Legal framework Health and social information sharing Model exchange ICT infrastructure 52

53 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 among 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. 53

54 Health and social information sharing Category HCCC (Shared Medical History of Catalonia) SIAS (Social Service Information System of Barcelona) ID information Name and surname ID card Date of birth Address Telephones Age Name and surname Gender Date of birth ID card or passport Address Telephones Census Services information Supplementary information Health information Needs assessment Intervention 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 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...) Services: Home care services Telecare Food assistance Day care centres Barthel ADL index Lawton-Brody's index Pfeiffer cognitive evaluation test Zarit Burden Interview Social diagnosis Community care Programs/projects Programs/projects 54

55 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-centred 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. 55

56 Technological terms 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 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.

57 Size of the project PILOT Health Departament with HCCC (Shared Medical History of Catalonia) City Council of Barcelona with SIAS (Social Service Information System of Barcelona). WHO IS INVOLVED? Centres, programs and facilities of health and social care, that are property of the City Council of Barcelona and of the Health Department. PLANNING Phase 1 - Basic primary social services Phase 2 - Specific social services 57

58 Thanks!! Oscar Solans Oficina tècnica: