Andalusian approach to an integrated healthcare IT system

Transcription

1 Andalusian approach to an integrated healthcare IT system Ana M. Carriazo, MD PhD Regional Ministry of Equality, Health and Social Policies Belfast, NI,

2 Andalusia 87,597 Km 2 8,492,635 habitants (657,815 foreigners) >22 M tourists yearly Geographical situation

3 Andalusia: Political context Susana Díaz. President of Government Political Autonomy since 1981 Regional Institutions Parliament Government ( Junta de Andalucía ) Court of Justice (TSJA) Juan Pablo Durán. Speaker of the Parliament Regional Parliament Regional Government Regional Court of Justice Lorenzo del Río. Chief Justice

4 Regional Ministry of Equality, Health and Social Policies Regional Minister of Equality, Health and Social Policies María José Sánchez General Secretary For Economic Planning and Evaluation Deputy Regional Minister Of Equality, Health and Social Policies General Secretary For Social Policies General Secretary For Quality, Innovation and Public Health Martin Blanco Aquilino Alonso Ana M. Rey Josefa Ruiz Andalusian Health Service Agency of Social Services And Dependency José M. Aranda Manuel Martínez

5 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 Act 1986 National Health System Cohesion and Quality Act 2003 National Public Health Act 2011 RDL 16/2012 NHS sustainability*

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7 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 Act 1998 Andalusian Public Health Act 2011

8 Andalusian Public Healthcare System: Main features 1,500 Primary care centers 47 Public Hospitals (16,821 beds) 100,000 Healthcare professionals 8,414 M Health Budget ,800 Pharmacies Servicio Andaluz de Salud Empresas Públicas Sanitarias - EPES - Hospital Costa del Sol - Hospital de Poniente - Alto Guadalquivir - Bajo Guadalquivir Consorcio Público HSJDA Centros Privados Concertados (17 H)

9 Primary Care in Andalusia: Main features GP as a Gatekeeper Capitation: 1 GP/1,400 inhabitants Team of professionals working in a PC Centre Homogeneous territorial distribution Aggregation of PC Centres in Districts Supportive teams at Districts for Public Health purposes: Epidemiologists, Vets, Pharmacists Professionals are civil servants Focus on health promotion and prevention

10 Hospital Care in Andalusia: Main features Hospitals 5 Level I (>1.000 beds) 9 Level II (500-1,000 beds) 20 Level III (<500 beds) 13 CHARE (proximity hosp) Total: 47 Hospitals Hospital Network. Patient referral by levels of complexity Financing based on capitation + level of complexity + foreign patients Professionals are civil servants or salaried % of salaries depends on outcomes (incentives & professional career) Multidisciplinary teams (Clinical Management Units) working by objectives Close coordination between hospitals and primary care districts* * In 12 cases, the Hospital and the Primary Care District are unified as an Integrated Area

11 Public Company for Emergencies Calls received at coordination centers (061 line) Evaluation of each emergency in call centre Assignation of the appropriate resource: - Mobile ICU*, emergency team* or helicopter* - Basic life support team* - Referral to other services - Resolved by phone information or advice Emergency care provided by healthcare professionals (physicians and/or nurses) Specific programs for some chronic diseases such as asthma/copd, hearth insufficiency, coronary disease: delivering faster and better care identifying high-risk patients by a database

12 Social Welfare Services in Andalusia Wide range of types of centres and benefits. More than 3,500 social care centres are under the regulatory framework of the Regional Ministry, including: child care, drug addiction, people with disabilities, elderly people and community social services (roma people, migrants, immigrants). Social services are provided in coordination with local authorities, and close collaboration with the third sector. 1,978 centres are devoted to the elderly (day-care centres, active participation centres and others).

13 Population trends

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15 ehealth Strategy Health Care Information and Management Integrated System 8.3 M individual ehr 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 A individual smart card for each person as a key for access Structured information A regional ehr shared among: Primary care Hospitals Pharmacies Emergencies Patients (from 2012)

16 An integrated information system supporting the quality strategy Patient centred care Continuity Accessibility Quality and efficiency improvement Variability reduction Patient safety Patient Autonomy Alternatives to inpatient care

17 ehealth Strategy accesses/month individuals Citizens access to ehr Pharmacists eprescription-edispensations: /day 156 M eprescriptions/year ehr Primary and Specialised care -XRay studies: 6,4 M M RIS images -170 M PACS images -XRay reports: 4,5 M - Lab tests: 29,5 M - Appointments: 95 M

18 3,5 Million consultation sheets per month 40.6 Million in 2013 Primary healthcare 9500 workstations 100% coverage 3.4 M lab request in Million results 156 Million e-prescription in % in 2013

19 Hospitals Emergencies Outpatient care 1.6 M OC Reports in 2013 Inpatient care: 19 hospitals 96.4% Discharge reports ( ) 76.8 M e-prescriptions in 2013

20 eprescription module: Prescription XXI Smart card as a key The system allows the dispensation of the treatment during the time established by the doctor at any pharmacy Medical office Pharmacy Instruction sheet for patient Treatment available on line Intranet of the Andalusian Public Healthcare System Intranet of the Official College of Pharmacists

21 ehr Mobility Hospital Antecedentes Alergias Problemas de salud Contraindicaciones Medicación activa Enfermedad actual Información paciente Lugar accidente Motivo Síntomas Episodio en movilidad Historia de Salud Digital Sistema Sanitario Público de Andalucía Stock Medicación/Fungibles Autoevaluación

22 Monitor/Defibrilator Integration ehr Mobility

23 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

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26 Telecare service

27 Telehealth service HealthResponds Living will Second Medical Opinion Waiting lists Information Centralized appoint Health card Internet appointment Telephone appointment Electronic Prescription 2013 European Telemedicine Conference Virtual Office

28 Integrating health and social care EEA EET ECA DCCU SMS APP - Cita Previa - Salud 24 horas - Libre elección hospital - Segunda opinión médica - Servicio SMS - Seguimiento de pacientes - Enfermera gestora de casos - Voluntad vital anticipada - Servicio teletraducción TSC SVB Health Report Assessment centre

29 Social Record project: from procedures

30 to a real interoperalbe social record CARTERA DE SERVICIOS SOCIALES E INCLUSIÓN Infancia y Familia Pensiones Personas mayores Discapacidad HISTORI A SOCIAL ÚNICA Dependencia Drogodependencia Juventud Mujer COMPONENTES ESTRUCTURALES PROFESIONAL CIUDADANÍA RECURSOS ES HISTORIA DIGITAL DE SALUD (ehr)

31 Gracias Thanks Thank you Merci Grazie Dzięki Gracias Merci Dzięki Thanks Gracias Thanks Merci Grazie Takk Gracias ευχαριστίες Thanks Merci Thanks Merci Grazie Gracias ευχαριστίες Thanks Gracias Merci Grazie Thanks Gracias Ana M. Carriazo Senior Advisor Regional Ministry of Equality, Health and Social Policies Government of Andalusia Av. Hytasa, Sevilla (España) T: