shared clinical history of catalonia-ignasi garcia-milà, fundació ticsalut
DESCRIPTION
TRANSCRIPT
Regional EHR and PHR in Catalonia
ICT Services for Integrated Care
TicSalut: Technology, Innovation & Health
Founded in 2006, TicSalut Foundation is an agency within the Ministry of Health that works to promote the development and use of ICT in the health and social care domain, acts as a trends, innovations and emerging initiatives observatory, and provides services for the standardisation and accreditation of products.
Current SystemThe Catalan healthcare model is a multi-provider one integrated in a unique public network.
It enhances the autonomous management of each provider.
Providers are free to select their information systems; however 85% of the primary care centres have the same system (eCAP)
Interoperability among systems must be guaranteed.
Decentralized SystemCatalan Healthcare System
Catalan Healthcare System
The history of the Catalan healthcare system, made it highly fragmented at a healthcare supply level: Around 80% of the specialized
care and around the 20% of the primary care is provided by suppliers not belonging to the Department of Health
Inexistent common Information System for all the healthcare suppliers due to the healthcare system diversification
ICT’s Strategic component of the Healthcare System
Insurance Services
US
ER
CATALAN HEALTHCARE
SERVICECONTRACTED PROVIDERS
100%
DEPARTMENT OF HEALTH: Draws up Health Plan and Transfers economic resources Plans
Governance
20%Supplementa
ry Private Insurers
CATALAN INSTITUTE OF
HEALTH
Private Centres
20%
70%
10%
The Shared Medical Record is a virtual space to group together the documents about patient’s healthcare process.
CENTRAL REPOSITORY
HEALTH CENTER
REPOSITORY
SECURITY
CLINICAL WORK STATION
Shared Medical Record - Definition
1st level
2nd level
3rd level
Citizens’ information
Hospitals
Primary care centers
Patient information at health central
registries
Central insurance registry
Healthcare centres
Primary care centres
Centres with reports and documents to share
DatabaseHealthcare authority
Shared Medical Record – Data Sources
Primary healthcare
− Diagnosis− Healthcare reports− Immunizations
Specialized care, socio-sanitary care and mental health
− Discharge report− Emergency reports− Specialized outpatient
clinic reports
Diagnosis procedures− Pathology and laboratory
reports− Radiological image− Imaging diagnosis reports− Other diagnosis tests
reports− Interventions
Healthcare Centres Information
Health Department Information
Medical Activity DB− Diagnosis− Procedures
Prescribed / Dispensed drugs
− Electronic prescription
Advanced directives− Advanced directives
registry
Shared Medical Record – Available information
94% of centres in Catalonia are connected to the SMR
Shared Medical Record – Deployment
Hospitals Primary Care Socio-Sanitary Care
Mental Health0
50
100
150
200
250
300
350
400
450
500
97%
98%
91%
84%
Healthcare centres connected to SMR
• 132.546Professional accesses per month
• 1.895.692Average documents published per month
2010 2011 2012
8.340.88613.842.58
017.182.92
0Documents published per year (not
cumulative)
• 80.715.058Indexed documents
• 6.704.591Patients with reports
Shared Medical Record – Documents available
2013
23.097.493
Shared Medical Record – Look & Feel
Shared Medical Record - Reports & Structured Reports
Shared Medical Record – Image Diagnosis
Shared Medical Record – Structured Diagnosis
Shared Medical Record – Active prescriptions
EHR Evolution - iSalut
New Model Communications platform standards compliant, using iSalut as a network of information services.
Actual modelDifferent connections between providers, SMR as a repository to share information.
Advanced Analytics
Interoperability model and business rules
Integrated clinical process management model
Information management
PersonalHealth
Channel
With platforms to integrate health and social care.
a virtual space where the Health Department stores and
delivers to all the Catalan citizens, online relevant
information of their health status in order to engage
citizens in their own health care.
Shared Medical Record for Professionals
Personal Health Channel for Citizens
ICT tools to offer quality
care to citizens
Personal Health Channel is...
Citizenidentification and
certification
ACCESS PHF
Customizable itemsP
INTERACT
No customizable items
O
ACCESS INFORMATION
Secondary Care Medical
Repository
Primary Care Centre
Repository
SELF-CONTROL
Diabetes, COPD and Sintrom
OTHERS
Expert patient
Contact professionals, entities, etc.
MANAGEMENT
PREVENTION
Physical and mental exercise
Through the Personal Health Channel you can…
PHC - Access
PHC – Data access log & unauthorised access claim
PHC: Clinical reports
Search by:- Report type- Centre- Date
Report search results:- Report type- Diagnosis- Service- Health Centre- Date
PHC: Diagnosis control
Active health problemNon active health problem
PHC: ePrescription – Available and printable medication and chronic treatment
Online: always updated
Printable
PHC: Vaccination – Reports vaccines supplied
Reported from health providerReported from vaccination book Reported verbally from patientDuplicated
PHC: My controls
Telemonitoring - Controlling of diabetic disease- Preventive medicine (SISO)
PHC – Interoperability framework
Communication HL7 messages to exchange patient informationIdentification Ensure system identification and data exchange Ensure single-sign-onPortability Defines interoperable data Defines the used terminology by the accredited system Data transfer under user requestPublication Requirements to show content inside or through the PHS Alarm messages
Catalonia mHealth Ecosystem
mHealth services R&D
Usage of clinical information in a mobility situation‐ Out of my healthcare system‐ Access to information‐ Return information‐ Treatment management‐ Emergency clinical information easily accessible
Disease management with mobile devices‐ Chronic condition CHF‐ Data management by patient‐ Supervision by clinician‐ New sensors possible
Using a Pre Commercial Procurement process‐ Market pull
