The Spanish National Health SystemThe Spanish National Health SystemMinistry of Health and Consumer Affairs

JOINING EFFORTS TO REACH OPTIMAL QUALITY AND EQUITY

Bernat Soria, MD, PhDMinister of Health and Consumer Affairs

SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM

1986 2006Primary

HealthcareFirst Primary Healthcare

Centres built

UNIVERSAL COVERAGEUNIVERSAL COVERAGE

SOCIAL SECURITY SOCIAL SECURITY SYSTEM (UNTIL 1986)SYSTEM (UNTIL 1986)

NATIONAL HEALTH SYSTEM NATIONAL HEALTH SYSTEM (SINCE 1986)(SINCE 1986)CoverageCoverage

All citizens coveredInsured population

Restricted to active employees and their

families

Includes immigrants

13.000 Primary Healthcare

Centres

I. Among the best in the worldI. Among the best in the world

- Ranked 4th among the 19 most developed countriesHealth Affairs ( Health Affairs 27: 58-71 (2008);)

- Ranked 6th among 191 countriesBritish Medical Journal (2001)

- Ranked 7th among 191 countriesWHO (World Health Report 2000. Health Systems. Improving performance )

II. Number one in the world in organ transplantationII. Number one in the world in organ transplantation

SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM

FIRST IN THE WORLD IN CADAVERIC ORGAN DONATION. SPAIN, EU-27 AND USA

COUNTRIESPopulation (million inhabitants)

SPAIN

45.2

EU-27

492.3

USA

303.9

Cadaveric Organ Donor(Rate –pmp-)

1,550(34.4)

8,293(16.9)

8,089(26.6)

5 GOALS.12 STRATEGIES189 PROJECTS

HEALTH STRATEGIES

CLINICAL EXCELLENCE

e-HEALTH

KNOWLEDGE MANAGEMENT

BACK TO THE FUTURE: BACK TO THE FUTURE: QUALITY AND INNNOVATION STRATEGIESQUALITY AND INNNOVATION STRATEGIES

11 Information from Andalusia and Region of Valencia has not been included in the figure

10 Information from Andalusia and Region of Valencia has not been included in the figure

8 Information from Region of Valencia and Andalusia has not been included in the figure

9 Information from Andalusia, Region of Valencia, Galicia and Cantabria (TI) has not been included in the figure

Consultations in Health Centres

National Health System 2007 8Hospital activity in laboratory tests

National Health System 2007 9

Patient management system: External hospital consultations

National Health System 2007 10

Patient management system: Hospital emergencies

National Health System 2007 11

no ICT3%

with ICT97%

with ICT no ICT

with ICT99.8%

no ICT0.2%

with ICT no ICT

no ICT1%

with ICT99%

with ICT no ICT

no ICT2%

with ICT98%

with ICT no ICT

Source: red.es from data supplied by the regional Departments of HealthSource: red.es from data supplied by the regional Departments of Health

ICT: Information and communication technologies

ee--HEALTH: ELECTRONIC HEALTH HEALTH: ELECTRONIC HEALTH RECORD IN SPAIN RECORD IN SPAIN

JOINING EFFORTS TO REACH THE FUTUREJOINING EFFORTS TO REACH THE FUTURE

- Digital health records

- Personal health card

- Electronic prescription

• All the regions have developed EHR:- 90% primary health care doctors have access to EHR- 14 regions have developed advanced

processes of implementation in specialist health care - 95% of electronic prescription in primary health care

• The national government has supported this effort with 141 additional millions (2006-2008)

• The Ministry of health has developed a central point of exchange and a central database of Personal Health Card with an unique number of identification for each citizen

• Electronic prescription: where implemented, 22% unnecessary visits to General Practitioners

EHR IMPROVEMEMENTS EHR IMPROVEMEMENTS 19981998--20082008

CITIZENS ANDCITIZENS AND HEALTHCAREHEALTHCARE SERVICES. II. SERVICES. II. HEALTHCAREHEALTHCARE

Digital medical record in health centres and population covered

National Health System 2007

Popula

tion w

ith H

ealth C

ard

98.8%100%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Population with health card

registered at health centres

Primary care EHR software

Implementation of the main information systems linked to the electronic health record7

National Health System 2007

Nat

ional

Hea

lth S

ervi

ce h

ealthca

re c

entr

es

Health Centres Hospitals

*

96% 97%88% 85% 84%

62%

92%

3%12% 15% 16%

38%

8%4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Primary care EHR

Management software

HospitalInformationSystems

Single- dose

Pharmacy

Radiology

Information

Systems

Pathology cal

Anatomy

Picture Archiving

andCommunication systems

LAB

with ICT no ICT

In developing EHR in each region

In Creating an unified database of personal health cards for all the countries

In agreeing common clinical guidelines

In agreeing common technological standards

JOINING EFFORTS WITH THE JOINING EFFORTS WITH THE REGIONS AND THE HEALTH REGIONS AND THE HEALTH

PROFFESSIONALSPROFFESSIONALS

• 4.5 million people receive every year clinical assistance in a different region than the one they come from

• We have to develop a project for the whole country to guarantee the access to the clinical information at any place and any time regardless where it has been generated

EHR: THE CHALLENGEEHR: THE CHALLENGE

INFORMATION CIRCULATESINFORMATION CIRCULATES

ANDALUCIAARAGÓN

803410

803411

01

803408 FRVR5608149009015

300078991111

743295999X CADUCA 12/ 99

F. JAVIER XXXXXXXXX XXXXXXXXXXX

R E G I O N D E M U R C I A

S.N.S. SERVICIO MURCIANO DE SALUDCONSEJERIA DE SANIDAD Y CONSUMO

• With an unique identifier for each person

• Developed in collaboration with the 17 regions

• Integrated with all the EHR of the Country

• Universal coverage (45 million users)

COLLABORATION IN BUILDING AN UNIFIED PERSONAL HEALTH

CARD DATABASE

Scope: To provide professionals and citizens with access to any clinical datasets that are relevant for healthcare (including diagnostic imaging)

Electronic documents:Patient Summary

Informes Alta y Consulta

Lab tests

Imagen

Otras pruebas

Informes de Urgencias

ImagenImagenImagen

Primary healthcare reports

Informes Alta y Consulta

Imagen

Otras pruebas

Informes de Urgencias

ImagenImagenImagen

Discharge & Sp. Surgery rep.

Imagen

Otras pruebas

Emergency Room Reports

ImagenImagenImagen

Other tests

Imaging

Nursing Care reports

AGREED SCOPE AND CONTENT

Professional Consensus (37 Professional Citizens and Technical Associations)

Agreement on the contents of the e-documentsWork Groups: Group 1

Group 2

Group 3

Group 4

Group 5

Group 6

Group 7

Summarised Medical RecordPrimary Health Care Report

C. Discharge Report Consultation Report

Emergency Room Report

ARS

Nursing Care Report

Lab Tests Report

Imaging Tests ReportImaging Attributes

HOW?HOW?

Healthcare

Healthcare

Healthcare

Healthcare Intranet

SNS

Healthcare

Healthcare

HealthcareHealthcare

Healthcare

RegionalIntranet

Regional Node

No Central Data Base but Exchange Data SystemNo Central Data Base but Exchange Data System

Central node

Online patient referrals to specialized care: implementation and useNational Health System 2007

Healthcare centres with online patient referral

systems

Annual patient referrals arranged online*

Healthcare centres with online referral systemsHealthcare centres without online referral systems

Online referrals

Traditional referrals

36%

64%

2,256 health centres with online patient referral systems

33%67%Health centres

without online patient referral systems

9,283,836

Source: red.es from data supplied by the regional Departments of Health

Presential

Telephone

Users

CEISCEIS

eMail

Web

Data WarehouseOthers channels

Back Office

Centralized appointment

B D U

60 Million Centralized Appointments in 2007(data from one region of 8 million inhabitants)

Provides users with access to pharmaceutical facilities thus making it unnecessary for patients in poor health to go in personSimplifies and speeds up authorization of prescriptions

Increases time devoted to patients. 22% LESS OF UNNECESARY VISITS….22% MORE OF AVAILABLE TIME OF GPsEntire treatment prescribed by specialistsPossibility of better support for correct prescription

Significant promotion of Pharmaceutical AssistanceReduction of management expenses and billing of prescriptions.

Improved follow-up and control of rational use of drugs (RUD) Correct assignment of responsibility in RUD among levelsGreater control in alerts and pharmacovigilance programs

OUTCOME: Improve effectiveness in primary care

2003 2005• 1st visit after GP referral, average time 8.2 days 3.4 days• Mammogram delay after request, average time 37 days 8 days• Pathology diagnostic report after biopsy 5 days Same day• Surgical average time after diagnosis 37 days 16 days• 1st visit in less than 1 week after GP referral 60,6% 92,8%• Surgery in less than 1 month after pathology 63,44% 96,29%• Conservative surgery 30% 62%• Request for mammograms, percentage from 2003 --- -24%• Global Patient Satisfaction 85.01% 93.3%

Breast Cancer ( results of the comprehensive approach) Health area of 1.2 million people

2008 marks a new era in legal and policy framework for EU Cooperation on eHealth

• Proposal for a European Directive on patients’ rights in cross-border healthcare

• Commission Recommendation on cross-border interoperability of electronic health record systems

• Commission Communication on telemedicine for advanced home care and chronic diseases

• eHealth Standardisation Mandate 403

epSOS – a highly political project

• Member State obligation to deliver the best possible medical treatment – at home or when travelling

• Introducing a new dimension in national healthcare systems

• Main political objectives:– support patient mobility nationally and in the EU– ensure that patient safety is guaranteed– increase efficiency and cost-effectiveness

in cross-border care

The EHR is being implemented in each of the 17 regions (90% Primary Care)

It has been created a national database with more than 40 million users

We are implementing through a collaborative effort EHR forthe whole country (starting on March 2009 with 10 regionsrepresenting more than 60% of the Spanish population)

CONCLUSSIONSCONCLUSSIONS

The epSOS Project Team

• The Project Team consists of 27 beneficiaries from 12 member states:

– 9 National Ministries of Health– 16 National/regional Competence Centers Including

100+ Contributors

– IHE-Europe representing ICT industry team

– Empirica responsible for administrative management

Reminder - From Strategies to Services

• Provide concrete cross border services that ensure safe, secure and efficient medical treatment for citizens when travelling across Europe

• Focus on services close to the patient:– European Patient Summary– ePrescribing across the EU

• Build on existing National eHealth Projects and use experiences and knowledge from all Member States

THE NATIONAL AGREEMENT FOR HEALTHCARE (TO BE SIGNED IN

JUNE 2009)

• Involving the 17 Regions• Involving all the Political Parties

TOPICS OF THE AGREEMENT

• Human Resources Policy• Common Services• Sustainability of the Health Budget• Health Policies• Quality and Innovation• Prevention of Addictive Drugs

Consumption

TO MOVE THE AGENDA TO MOVE THE AGENDA FORWARDFORWARD

NHS SPAIN

Barcelona 2010, 15-18 march