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  • ICT Strategy in The Catalan

    HealthCare and SocialCare System

    ICT Services

  • Table of contents

    TicSalut Foundation. Catalan Healthcare System

    ICT Evolution

    Shared Electronic Health Record. Personal Health Record

    iSIS.Cat. Integration Health and Social Care

    1

    2

    3

    4

  • 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.

  • TicSalut, a responsibility to innovate

    ■ Advancing Knowledge Transfer in the Region

    ■ Providing an Innovation Observatory in the HealthCare domain

    ■ Standardizing Interoperability

    ■ Managing the demand for Innovation across the whole HealthCare system

    ■ Promoting Innovation in HealthCare

  • Current System The 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 centers have the same system (eCAP)

    Interoperability among systems must be guaranteed.

    Decentralized System

  • Catalan Healthcare System

    Insurance Services

    U SE

    R

    CATALAN HEALTHCARE

    SERVICE

    CONTRACTED PROVIDERS

    100%

    DEPARTMENT OF HEALTH: Draws up Health Plan and Transfers economic resources Plans

    Governance

     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

    20%

    Supplementary Private Insurers

    CATALAN INSTITUTE OF

    HEALTH

    Private Centres

    20%

    70%

    10%

  • Goals and health programs

    Chronic care patients orientation

    Integrated care system

    Quality and equitry in tertiary care

    Focused in patients and families

    Outcome-based commissioning

    Clinical and professional knowledge management

    System governance and participation

    Shared information, transparency and evaluation

    eHealth Plan

    Citizen

    centered

    healthcare

    HEALTH PLAN

  • A learning journey implementing ehealth in Catalonia

  • 1985 1990 1995 2000

    Administrative processes

    First PC at doctor’s desk

    Research, first registries

    Gateway to healthcare use

    Market-driven EHR

    Early adopters

    ECAP: the primary care EHR

  • Primary care EHR strategy

    • ICS is a public enterprise that manages 80% of primary care services and 40% of hospital care.

    • Reasons to develop ECAP: • 3 different primary care EHR systems

    within the organisation

    • Provider lock-ins

    • Interoperability issues

    • Development led by clinicians and run by T-Systems

    • Mainstream EHR in Catalonia now

  • ECAP features: day planning

  • ECAP features: diagnostic tests

  • ECAP features: medication plan

    Integrated with e-prescription

  • ECAP features: lab order and report

  • ECAP features: hospital integration

  • ECAP features: clinical guidelines

    Active intelligence

  • ECAP features: quality and performance

  • 1985 1990 1995 2000 2005

    Argos: a hospital care EHR

  • Argos deployment

  • Primary care Hospitals Long term Mental health

    EHR systems map

    Territorial platforms

    Shared EHR

  • http://vimeo.com/114965845

  • EHR Mobile Telemedicine Health

    2.0

  • 15%

    11%

    5% 5% 8% 10%

    13% 11%

    29% 26% 31%

    23%

    30%

    51% 55%

    51%

    6%

    15% 9%

    25% 29%

    37%

    42% 50%

    2007 2008 2009 2010 2011 2012 2013 2014

    Telemonitorització Telediagnòstic Teleconsulta

  • Our learnings...

    Long and windy

    Continuous

    Governed

  • Thank you

    Tino Martí International Project Manager tmarti@ticsalut.cat

  • SMR and PHR

    in Catalonia

    ICT Services for Integrated Care

  • Shared Medical Record

    in Catalonia

  • WHY ARE WE DOING IT?

    40

  • 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

  • 44

  • Video HC3

  • Documents published

    per year

    29.270.546

    • 2.439.212 Average documents published per month

    • 109.838.421 Indexed documents

    • 6.704.591 Patients with reports

    2014 Images > 5 M

    Image publication

    Chronic patients labeled

    24.837 MACA

    More than

    100millions

    clinical

    records

    available

    2014

    113.354 PCC

  • 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

  • % Completion Shared individual treatment plan (PIIC)

    Area

    Area

    Entity provider

    PC center Entity provider

     Instructions for “in cases of crisis”

     Carer whom decisions are delegated

  • News functionalities HC3

    Shared Clinical Course Primary Care

    Structured PIIC 2.0

    Shared Clinical Course Specialized Care

    Integrate Data Social and Healt Care (Pilot BCN)

    Prealt estructurat amb missatgeria (predischarge report with alerts)

    i.siss.CAT

  • Catalan Health Plan (2011-2015)

    Pathways: depression, heart failure , diabetes mellitus ,

    respiratory disease, Chronic Complex Care,

  • HC3/i.SISS.CAT

    Interoperabilty project to facilitate integration between different

    information systems for healthcare providers and social services

    promoting continuity of care and management of healthcare processes

    and social citizen-centric and adapted to the reality of each of the

    territories to oneself to the service of professionals

  • Estacions de treball

    clíniques

    Professionals clínics

    Departament

    de Salut /

    CatSalut

    Pacients

    Gestor de

    processos

    Expanding the information

    available to the public

    through its PHF

    Feeding the data model

    HC3 to provide health

    professionals with th