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SMR and PHR in Catalonia
ICT Services for Integrated Care
Shared Medical Record
in Catalonia
WHY ARE WE DOING IT?
3
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
Decentralized System Catalan Healthcare System
Shared Medical Record
Primary healthcare
− Diagnosis − Healthcare reports − Immunizations − Chronic patients
labels
Specialized care, long-
term 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
Healthcare Centers Information
Health Department Information
Medical Activity DB − Diagnosis − Procedures
Prescribed / Dispensed drugs
− Electronic prescription
Advanced directives − Advanced directives
registry
Shared Medical Record – Available information
CENTRAL
REPOSITORY
HEALTH
CENTRE 1
REPOSITORY
INDEX
REPOSITORY
SMR
OPTION 1
The Shared Medical Record virtual space grouping
patient’s healthcare process documents
Shared Medical Record
Publication
CENTRAL
REPOSITORY
HEALTH
CENTRE 1
REPOSITORY
SECURITY
CLINICAL WORK
STATION
INDEX
REPOSITORY
SMR
OPTION 1
Shared Medical Record - Definition
Information Request
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
Shared Medical Record – Access control
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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.
Shared Medical Record – Display
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13 31 162 8.438 6.249 25.182 103.101 122.301 160.850 138.843
507.737 587.754
1.223.958
1.521.075
0
200.000
400.000
600.000
800.000
1.000.000
1.200.000
1.400.000
1.600.000
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
WS Access
Different professionals who
have agreed
20.096
173.054167.687157.299
187.827195.738219.079
207.102217.315204.913
234.035
170.389197.564
251.796
0
50.000
100.000
150.000
200.000
250.000
300.000
2013 -Octubre
2013 -Novembre
2013 -Desembre
2014 -Gener
2014 -Febrer
2014 - Març2014 - Abril2014 - Maig2014 - Juny 2014 - Juliol2014 - Agost 2014 -Setembre
2014 -Octubre
Viewer professional
An example of data (HC·3) integrated
workstation (WS)
12
13
Documents published
per year
23.097.493
• 2.119.605 Average documents published per month
• 92.262.770 Indexed documents
• 6.704.591 Patients with reports
2013 Images > 4 M
2013 Images per day 11.000
Image publication
Chronic patients labeled
108.000 PCC and MACA
Shared Medical Record – Look & Feel
Name, birth date and PIC
Doctor and nurse assigned
Address and phone number
Reference Primary Care Center
Shared Medical Record – Summary display
Shared Medical Record - Reports & Structured Reports
Shared Medical Record
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
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Shared Medical Record –
Clinical Risk Groups
Shared Medical Record –
Patient complexity profiling
- HC3 stratification with Clinical Risk Groups (CRGs) - Publish label/mark in HC3 - Label visible on all screens
PCC: Complex Chronic Patient
“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
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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 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.
To have a secure environment for citizens
to interact with health system, providers and
professionals.
Main benefits
The “Personal Health Folther ” provides great benefits to the citizen, and
also to other actors like health services providers and the administration.
Not customizable elements by citizen.
HC3 Information from the HC3 citizen
CAP
Information of the citizen from the health centre.
O
INFORMATION
Project development
PROCEDURES
SERVICES
P
Customizable elements by citizen.
COMUNICATION
EDUCATION
ATTENTION
Identification with digital ID certificate or user/password
My Health access
Digital ID certificate
My Health access
2014 Improving access and services 2012 Access for all citizens 2009 Project start
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)
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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
http://lamevasalut.gencat.cat
Access
PC and tablet vision Movile vision
Personal dates
Clinical Information – Clinical Reports
Diagnostics
Active health
problem
Non active
health problem
Reported from health provider
Reported from vaccination book
Reported verbally from patient
Duplicated
Vaccines
Medication: electronic recipe
Online: always updated
Printable
Anticipate wills
Formalities
My controls
Access activities to “Personal Health Folther”
Prova pilot d’accés a CPS amb usuari i paraula de pas/setembre 2014
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%
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
Many users who have accessed
1.223
Accesses that have been
made 2.631
(Assessments from October 6th to October 31th)
Personal Health Folther pilot access with username and password / September 2014
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%
Access activities to “Personal Health Folther”
Evolution logins
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Accesses have increased significantly after pilot start
Health and social integrated care
Presentation
• Objectives
• Avantatges
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The main purpose is to build a framework to improve the interaction between
social and health services.
It wants to define a model to share information between both services replicable
to other entities in Catalonia.
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.
This project wants to promote continuity of people attendance, by using
information and communication technologies (ICT).
Model exchange factors
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Legal framework
Health and social information sharing
Model exchange
ICT infrastructure
Legal framework
REGULATIONS
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
Law 12/2007, October 11th, of Social Services and professionals who are involved in the
monitoring and evaluation of the citizen.
Law 21/2000, September 29th, about the rights of information concerning the health and
autonomy of the patient, and clinical documentation.
Law 44/2003, Novembre 21th, to regulate profiles of health professions.
Agreement GOV / 28/2014 of Febraury 25th, 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.
Health and social information sharing
54
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
Professionals
(general practitioner, nurse)
Health centre, palliative care, home care, nursing
homes...
Professional (social worker)
Social services centre
Supplementary
information
Economic information: pharmaceutical copayment
Legal incapacity: process, date, guardian
Health
information
Health factors (diagnostic)
Chronically ill categorization
Very ill categorization
Disability: recognized level, kind of disability, disable scale.
Dependent people: recognized level.
Risk alert (coronary heart disease, fall s...)
Needs
assessment
Barthel ADL index
Lawton-Brody's index
Pfeiffer cognitive evaluation test
Zarit Burden Interview
Barthel ADL index
Lawton-Brody's index
Pfeiffer cognitive evaluation test
Zarit Burden Interview
Social risk factors (Health at home - Salut a Casa) Social diagnosis
Intervention
Individual health intervention plan
Individual Treatment
Previous medical discharge (24-48 ours before)
Medical discharge documents
A&E documents
EMS (emergency medical services )documents
Services:
Home care services
Telecare
Food assistance
Day care centres
Community care Programs/projects Programs/projects
ICT infrastructure
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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.
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).
Security Common repository
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.
Informed consent will be custodied in a common repository. It will be validated by both systems. It will do periodic checks.
Send informed consent and check
Technological terms
Health Departament
Information System
Social Service
Information System
Size of the project
57
PILOT
Health Departament with HCCC
(Shared Medical History of
Catalonia)
City Council of Barcelona with SIAS
(Social Service Information System
of Barcelona).
Centres, programs and facilities of health and social
care, that are property of the City Council of Barcelona
and of the Health Department.
Phase 1 - Basic primary social services
Phase 2 - Specific social services
WHO IS INVOLVED?
PLANNING
