RICHARD

International workshop

E-Health business models for

chronic conditions – the case

of Andalusia (Spain)

Ana M. CARRIAZO Senior Advisor Regional Ministry of Health and Social Welfare Andalusian Governmente, Espagne anam.carriazo@juntadeandalucia.es

Overview

• Healthcare in Andalusia and

the role of ICT

• Strategies on chronic

conditions in Andalusia

• Living Lab Salud Andalusia

• Economic issues

Andalusia 87,597 Km2 8,415,490 habitants (526,942 foreigners) 21,781,273 tourists during 2011

Andalusian Public Healthcare System 1,506 Primary healthcare centres – 100% coverage

47 Public Hospitals (16,821 beds) – 93% all inpatient beds 102,000 Healthcare professionals 9.33 B € Budget 2012 (6.72% PIB; 1,108 €/habitant)

Political situation • Political autonomy since 1981

• Regional Parliament, Regional Government and Regional Court of Justice

• 1984: Transfer of political competencies on health and public healthcare system management

The Digital Strategy of the Public Healthcare

System of Andalusia • A long-term Strategy: From 1999

• A single health record number for all citizens of Andalusia

• A single electronic Health Record for every person

• A individual smart card for each person as a key for access

• Unified access to all services and levels of care

• Structured information

• A regional eHR shared among:

• Primary care

• Pharmacies • Hospitals

• Emergencies

Health Care Information and Management Integrated System

Appointment Prescription

Radiology

Waiting lists

Functional tests

Pathology

Lab tests

Inpatient care

Referrals

Outpatient care

Primary care

Hospital admission

Data warehouse

Emergency care

Much more than an eHR:

A corporate information system

8.1 Million individual eHR

121 Million e-prescriptions/year

98 Million appointments/year

3.5 Million Rx images/year

An integrated information system

supporting the modernization strategy

Patient centred care Continuity Accessibility Quality and efficiency improvement Variability reduction Patient safety Patient Autonomy Alternatives to inpatient care

Functional architecture

Users Data Base Structure MACO

Users Data Base Structure

MACO

S M

Centro de Salud

Centro de Salud

Centro de Salud

Centro de Salud

Centro de Salud

Centro de Salud

Hospital Hospital Hospital Hospital

External Bus

Pri

mar

y C

are

leve

l H

osp

ital

leve

l

Media mensual de episodios de URGENCIAS registrados en Diraya

0

50.000

100.000

150.000

200.000

250.000

300.000

350.000

2007 2008 2009 2010 2011

Media mensual de episodios de Consultas Externas registrados en Diraya

0

20.000

40.000

60.000

80.000

100.000

120.000

140.000

2007 2008 2009 2010 2011

Emergencies: 3.4 Million

280,000 per month Outpatients: 1.5 Million

125,000 per month

551,716 e-Prescrip

96.8 M XRay Images

19 hospitals 3.5 M inhabitants

(43%)

Hojas de consulta de AP: Media mensual

790.517

1.315.629

2.124.024

2.829.601

3.147.4073.304.527

3.501.972

0

500.000

1.000.000

1.500.000

2.000.000

2.500.000

3.000.000

3.500.000

4.000.000

2005 2006 2007 2008 2009 2010 2011

Primary

Healthcare

3,5 Million consultation sheets per month

41 Million in 2011

118.6 Million e-prescription in 2011

142,000 lab request/month

4.2 Millions results

3 Million

XRay reports

All PC centres

> 1 Billion € savings since 2001

Quality and Efficiency: e-Prescription module usage, % prescriptions by active principle and PHC visits reduction

Aditional savings: 3.1 Million €: printed prescriptionss 3.2 Million €: data mangement

-14 %

Electronic Prescriptions

PHC visits (million)

% PPA

0,2 1,28,9

30,5

66,3

89,2

105,2

118,6

2004 2005 2006 2007 2008 2009 2010 2011

48,5

49,650,1

50,5 50,349,9

44,143,6

2004 2005 2006 2007 2008 2009 2010 2011

2,7

25,7

46,6

57,763

70,975,2 77,1 78,6

8491,1

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

136 Million € saved /year

6,0

0,0

Antes Después

22,8

5,4

Antes Después

Safety and Quality: Lab test errors (pre/post) and response time (p70) after Lab Test Module (MPA) introduction

% ID error p70, hours

-76.32%

4,4

1,6

Antes Después

1,2

0,1

Antes Después

Not enough sample

Lost report

Data from 27 PHC Districs, 5.2 Million inhabitants

Satisfaction: % de users’ satisfaction (phone access)

0

10

20

30

40

50

60

70

80

90

100

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Phone access Satisfaction

Call centre Extension

Institute for Social Studies of Andalusia Spanish Scientific Research Council (CSIC)

0

100.000.000

200.000.000

300.000.000

400.000.000

500.000.000

600.000.000

700.000.000

800.000.000

900.000.000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

EU

R

Present value of cumulative costs Present value of cumulative benefits

Cumulative economic performance

100%

Quality

of life

0%

HOME CARE RESIDENTIAL CARE CLINICAL CARE

€ 1 €10 € 100 € 1,000 € 10,000

ICU

Community

Hospital

Specialist

Clinic

Skilled Nursing

Facility

Assisted Living

Doctor's

Office

Community

Clinic

Chronic Disease

Management

Healthy,

independent living Traditional

Health IT

focus

Health and social care costs

Graphic from NHS/BT Global Services

Contribution of ICT to health systems sustainability

Perhaps at no other time in the last decade has the need to extract the best potential benefits out of stretched resources been so

urgent. With public sector budget across Europe being stringently monitored and often curtailed, health care is no exception. In fact,

in quite a few countries, and especially those subject to international loan agreements, the health sector is one of the

areas targeted not only for more immediate cost savings but also for long-term re-structuring and efficiency gains

Finantial crisis impact on health systems

Exhibit 4. Health Care Costs Concentrated in Sick Few—

Sickest 10 Percent Account for 65 Percent of Expenses

Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.

Distribution of health expenditures for the U.S. population,

by magnitude of expenditure, 2009

1% 5%

10%

50%

65%

22%

50%

97%

$90,061

$40,682

$26,767

$7,978

Annual mean

expenditure

http://www.commonwealthfund.org/Publications/Fund-

Reports/2012/Apr/Performance-Improvement-Imperative.aspx

http://www.juntadeandalucia.es/servicios/planes/detalle/14546.html

http://www.patientsorganizations.org/attach.pl/1539/1453/GHPS%20NCD%20Report.pdf

100%

Quality

of life

0%

HOME CARE RESIDENTIAL CARE CLINICAL CARE

€ 1 €10 € 100 € 1,000 € 10,000

ICU

Community

Hospital

Specialist

Clinic

Skilled Nursing

Facility

Assisted Living

Doctor's

Office

Community

Clinic

Chronic Disease

Management

Healthy,

independent living New areas of

development

Health and social care costs

Graphic from NHS/BT Global Services

ICT Role in chronic patients’ management

156 retinógrafos 215.000 patients

20.000 retinopathy cases detected

Continuity of care, quality and efficiency: Digital retinography, teledermatology, telecare…

83 PHC centres with teledermatology

services

Citizens’ access to eHR

Current Health

Problems

Current Allergies

and

Contraindications

Current

Medication

Primary and

Specialized care

Appointments

Clinical reports

Hospital

Admissions

2 M inhabitants

(23.6%)

Citizens’ autonomy: new ICT services

“Facilitate the design and

development of innovative

projects focused on real solutions for detected needs”

Andalusian Public Health System

Different projects with similar elements …

but managed and executed in a separate

way

Good examples of collaboration between health and technology

sectors

Efforts were redundant and little reutilization

Great number of innovative initiatives in

the health sector

Barriers from portotype to

solutions

Solutions without scalability

or isolated (lack of

interoperability)

• Framework Agreement (noviembre 2008)

• User oriented projects

• Developed in collaboration

• Replicability and sustainables

• Baseline for new and better

projects

Living Lab Salud Andalucía

How is this achieved?

Open Innovation Community

Administrations Universities Companies

Users

Management body

99 members currently

Users have the leading role in the innovation process

Participative innovation scenarios

Priority interest areas

National and European activity

(ENoLL)

How is this achieved?

Advantages of these innovation scenarios

• Fast deployment and validation in specific areas

• Common framework for integration and interoperability of

different projects

• Efficiency in the innovative process

Eliminate main barriers for wide deployment of

projects

Services catalogue

RELACIONES Y ALIANZAS

OFICINA DE INNOVACIÓN

TRANSFERENCIA DE TECNOLOGÍA

DEFINICIÓN DE PROYECTOS

GENERACIÓN DE IDEAS/

IDENT. NECESIDADES

PILOTAJE DE

PROTOTIPOS

COMERC. DE PRODUCTO/

SERVICIO

DESARROLLO DE PROYECTOS

ESCENARIOS DE INNOVACIÓN PARTICIPATIVA

ASESORAMIENTO EN CONTRATACIÓN PÚBLICA

DIFUSIÓN CORPORATIVA

ACCESO A INFORMACIÓN DE INTERÉS

VIGILANCIA TECNOLÓGICA

LLSA projects • Main interest areas:

Innovative processes in health

Interoperability

Telemedicine and telecare

New ways of relationship with citizens

Decision support systems

Training and professional collaboration scenarios

• Detailed info at

http://livinglabsalud.es/proyectos

LLSA Scenarios Common use technology platforms

Real healthcare settings

http://livinglabsalud.es

Ana M. Carriazo

Senior Advisor

General Secretariat for Quality and Innovation

Regional Ministry of Health and Social Welfare of Andalusia

Av. Hytasa, 14

41071 Sevilla (España)

T: +34955048138

anam.carriazo@juntadeandalucia.es

www.juntadeandalucia.es/salud

Gracias Thanks Merci Grazie Dzięki Gracias Merci

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Grazie Gracias Thanks Gracias Merci

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