ehealth in Spain: A Strategy for a Decentralised National Health Service

Transcription

1 ehealth in Spain: A Strategy for a Decentralised National Health Service Juan Fernando Muñoz Chief Information Officer (CIO) Ministry of Health, Social Services and Equality

2 ICT as an Element for Transformation TABLE OF CONTENTS: Health Care in Spain: The Need for Appropriate Information Governance in the NHS Model of ehealth Governance/Cooperation in the Spanish NHS Strategy Agreements Architecture Results: ehealth Services today and their capacity to transform The near future Conclusions -2-

3 The Health Care in Spain Health care in Spain is highly decentralized, being the (17) Regions the responsible of their citizen s health. The Ministry keeps responsibility of coordination to assure equality (citizens should be attended in all the territory with the same rights).the decentralisation of competences and services, and the growing mobility of citizens make it necessary for services providers (Regions) to collaborate beyond the boundaries of their competences to provide quality services focused on patient safety In that scope and with 3 co-official languages plus Spanish, the need to interoperate in order to share information between the Regions has been felt as an important need and it has been a priority from the beginning (decentralization finalized: 2002) -3-

4 Oh!, so you are also implementing ehealth? Governance Mikael Erlandsson

5 STRATEGY: From Information Islands to Hospital Region B Hospital Region A Health Centre Region C -5-

6 STRATEGY: From Information Islands to SERVICIES Health GP B Hospital A Health Care C Other Agents Patients CRM ERP DB -6-

7 Organisational Agreements National Government agreement 2005, developed in tree Plans: Sanidad en Línea I, II, III , , Plans are organised around a framework agreement between the MoH and the MoI and with the Regions The first two plans set forth a co-funding framework of 242 million provided by the National government (MoI and MoH) and an other similar amount provided by the regional authorities Investments are made to boost the regional projects (95%) and the central switching point operated by the MoH (5%) Objectives of the agreements: interoperable SERVICES: Health Card (ID), eprescription (ep), electronic Health Records (EHR), Appointments over the Internet, Telemedicine and Training Situation: all regional authorities (17) have signed and renewed -7-

8 Cooperation Model: Architecture General Diagram on How it Works Ministry of Health NHS Partners NHS service bus Interchange server Level of interchange Services Dispatcher XML Parser Web Server Asynchronous Notifications Web Server XML Adapter XML Parser DB Server NOTIFIC. Synchronous DB Server Services by application National ID DB National EHR eprescription Management of of Chronic patients Applications Population ID Electronic Health Records eprescription Others -8-

9 Individual Health Cards ANDALUCIA ARAGÓN ASTURIAS PLPL T /06 NOMBRE APELLIDO APELLIDO REGION DE MURCIA CONSEJERIA DE SANIDAD Y CONSUMO S.N.S. SERVICIO MURCIANO DE SALUD FRVR X CADUCA 12/ 99 F. JAVIER XXXXXXXXX XXXXXXXXXXX -9-

10 Individual Health Card 1 National DB Ministry Health (MoH) Server Applications Message Interchange Switching Point NHS Pop. Inf. Service WEB Services XML WEB applications FTP, , Physical Device... Web Server Web Server 6 4 Healthcare Intranet 5 Notifications Asynchronous Synchronous 2 3 Web Server Other NHS Partners Social Security Mutual Societies Ministry Justice Regional Health Service Interchange Server HEALTH CARD Regional DB Users Administrators 7 Card Users -10-

11 NHS Health Card - Additions December 2002 December 2002 December 2007 November 2011 July 2007 December 2002 December 2002 August 2010 December 2002 December 2002 December 2002 December 2002 December 2008 December 2002 December 2002 July 2008 December 2005 December

12 Electronic Health Records Query the e-health Records of all Reg. Authorities NHS 2006/ Implemented Under implementation Pilot Planned Not planned Source: Own research based on NHS Health Services data. -12-

13 National Electronic Health Records SERVICES For professionals Access to a patient's data sets (including PS) and images when the patient requests healthcare For citizens Access to all their health data sets Access to Audit data (who has access my data?) Possibility of deciding which of their reports can be hidden -13-

14 National Electronic Health Records Regional Authority A MoH Regional Authority B Query Refs Viewing of Health Health Records Records Query Refs User query List of references Health Record References Viewing of Health Health Records Records Query Refs MSSSI Connection Request for Ref Health records sent Central Switching Point Pt.. Request for Ref Health records sent MSSSI Connection HL7 SNOMED Clinical HL7 Clinical Repository Repository HL7 Conversion? Viewing of Health Health Records Records LOG -14-

15 National Electronic Health Records 12 Regions are interchanging information 20 million Patients have their clinical information potentially available in other regions Use monthly: 3 M. consultations by professionals through the Central Node and by citizens -15-

16 epsos: Patients with Patient Summary FR AT CH IT ES PS PT -16-

17 eprescription Implementation of eprescription at NHS health centres 2006/ Implemented Under implementation Pilot Planned Not planned Source: Own research based on NHS Health Services data. Sept % Prescriptions were computerized 61.0% Dispensations were electronic (without paper) -17-

18 eprescription: Communication between Partners Ministry of Health Ministerio de Sanidad y Consumo Servidor Aplicaciones Nivel de Intercambio Distribuidor de Servicios XML Parser NOTIFIC. Servidor BBDD Servicios por Aplicativo Servidor Web Regional AgenteSNS Authorities Servidor Intercambio Healthcare Intranet Regional AgenteSNS Authorities Servidor Web Servidor Intercambio XML Adapter XML Parser Aplicativos Servidor BBDD Población Fondo Cohesión Receta Electrónica Otros Servidor Web XML Adapter XML Parser Aplicativos Población Servidor BBDD Población Fondo Cohesión Receta Electrónica Otros Fondo Cohesión Receta Electrónica Otros Web Server Application Server Database Server Web Server Application Server Database Server Reg. Auth. Intranet Internet College of Pharmacists Health Centres Primary healthcare Specialised healthcare Certification by Colleges Prescription Dispensation Pharmacies Certification Colleges Doctor Patient Pharmacist -18-

19 Aid in the Decision-Making process Clinical Users Secure Access Authentication Security Auditing Clinical Portal Integration of Processes and Knowledge Patient Classif. Clinical Docs Problems Case Mgmt Clinical Sorting... Management of Chronic Patients Operated by MoH at Central Node Integration of Information Message Interchange Module Clinical Data Repository National Electronic Health Records Existing Systems PCIS PACS Laboratory Radiology... HIS Existing Systems -19-

20 The Future SHARED SERVICES Mature: Phase 1 Under development: Phase 2 National ID interoperable DB National Electronic Health Records eprescription/ edispensation Management of Chronic Diseases Central Procurement MANAGEMENT OF PROFESSIONALS REMOTE SORTING REMOTE CARE REMOTE DIAGNOSES DEPENDENCY MANAGEMENT MOBILE APPLICATIONS -20-

21 CONCLUSIONS This Model, incorporating a powerful central switching point allows for the addition of the services required by the NHS to ensure its sustainability and evolution By applying technology, this Model enables the NHS to be integrated, whilst maintaining independence with regard to the Partners' organisation, platforms and applications, thereby turning a weakness into a strength in our decentralized NHS This Model allows for the development of shared solutions driven by the MoH to move forward less developed Regions, with in-house solutions implemented by more developed Regions in each area -21-

22 THANK YOU VERY MUCH FOR YOUR ATTENTION! Juan Fernando Muñoz Chief Information Officer (CIO) Ministry of Health, Social Services and Equality -22-