SMR and PHR in Catalonia ICT Services for Integrated Care
Shared Medical Record in Catalonia
WHY ARE WE DOING IT? 3
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
Shared Medical Record
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
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
Shared Medical Record - Definition Information Request SMR REPOSITORY CENTRAL REPOSITORY OPTION 1 SECURITY HEALTH CENTRE 1 INDEX REPOSITORY CLINICAL WORK STATION
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
10
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 300.000 250.000 200.000 251.796 234.035 219.079 207.102 217.315 187.827 195.738 204.913 197.564 173.054 167.687157.299 170.389 150.000 100.000 50.000 0 2013 - Octubre 2013 - Novembre 2013 - Desembre 2014 - Gener 2014 - Febrer 2014 - Març2014 - Abril2014 - Maig2014 - Juny 2014 - Juliol2014 - Agost 2014 - Setembre 2014 - Octubre Different professionals who have agreed WS Access 20.096 1.600.000 1.521.075 1.400.000 1.200.000 1.223.958 1.000.000 800.000 600.000 587.754 507.737 400.000 200.000 0 13 31 162 8.438 6.249 25.182 103.101 122.301 160.850138.843 2013 - Maig 2013 - Juny 2013 - Juliol 2013 - Agost 2013 - Setembre 2013 - Octubre 2013 - Novembre 2013 - Desembre 2014 - Gener 2014 - Febrer 2014 - Març 2014 - Abril 2014 - Maig 2014 - Juny 11
An example of data (HC 3) integrated workstation (WS) 12
13
23.097.493 Image publication 2013 Images > 4 M 2013 Images per day 11.000 Documents published per year Chronic patients labeled 108.000 PCC and MACA Average documents published per month Indexed documents Patients with reports 2.119.605 92.262.770 6.704.591
Shared Medical Record Look & Feel Name, birth date and PIC Address and phone number Doctor and nurse assigned Reference Primary Care Center
Shared Medical Record Summary display
Shared Medical Record Shared Medical Record - Reports & Structured Reports
Shared Medical Record Structured lab test results
Shared Medical Record Image Diagnosis
Shared Medical Record Structured Diagnosis
Shared Medical Record Structured Diagnosis
Shared Medical Record Immunizations
Shared Medical Record Integrate Clinical Course 23
Shared Medical Record Clinical Risk Groups
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
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
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
Video HC3
Personal Health Folther Cat @Salut La Meva Salut
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
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.
Main benefits The Personal Health Folther provides great benefits to the citizen, and also to other actors like health services providers and the administration.
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. 2009 Project start 2012 Access for all citizens 2014 Improving access and services
Logic Model The Personal Health Folther has access to the information that CatSalut has in its repositories and integrates services for citizens.
Shared Medical Record in Catalonia (HCCC) 35
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.
News functionalities
Access http://lamevasalut.gencat.cat PC and tablet vision Movile vision
Personal dates
Clinical Information Clinical Reports
Diagnostics Active health problem Non active health problem
Vaccines Reported from health provider Reported from vaccination book Reported verbally from patient Duplicated
Medication: electronic recipe Online: always updated Printable
Anticipate wills
Formalities
My controls
Access activities to Personal Health Folther Many users who have accessed Accesses that have been made 1.223 2.631 By health region Total % Lleida 75 6% Camp de Tarragona 94 7% Terres de l'ebre 82 6% Girona 194 15% Catalunya Central 74 6% Alt Pirineu i Vall d'aran 40 3% Barcelona 664 54% By sex Total % Men 571 47% Woman 652 53% By age Total % 18 to 35 206 17% 36 to 50 495 4% > 50 522 43% (Assessments from October 6th to October 31th) Access digital certificate 1.024 Access digital certificate (%) 40% Access with user / pass word 1.607 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
Access activities to Personal Health Folther Access by tab Total % Clinical Records 3581 27% Personal Dates 2342 18% Diagnostics 1904 14% Medication 1014 8% HCDSNS Access 1032 8% 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
Evolution logins Accesses have increased significantly after pilot start 49
Health and social integrated care
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
Model exchange factors Legal framework Health and social information sharing Model exchange ICT infrastructure 52
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 2013-2016, 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
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 E-mail 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
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
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.
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
Thanks!! Oscar Solans osolansf@gencat.cat Oficina tècnica: oficina.isalut@gencat.cat