Benefits of a long-term e-health strategy

Quick facts of Andalusia 8,415,490 Inhabitants

87,597

Km2

Regional responsibility on health policy and healthcare since 19841,146 Primary Care Centers

47 Public Hospitals (16,281 beds)9,390.2 M €

Healthcare Budget 2011

Leaders in Health IT Symposium - Regional PanelBenefits of a long term e-Health strategy at regional level

José

L. Rocha General Secretary for Quality and ModernizationRegional Health MinistryAndalusia Region -

Spain

josel.rocha@juntadeandalucia.es

Andalusia

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

Graphic from NHS/BT Global Services

E-Health: Improving quality of care and reducing health and social care costs

Main objective of the Andalusian

e-health strategy (the DIRAYA project):Integrate all the healthcare information of every patient in a Single Health Record

for each citizen

•

A long-term

Strategy: From 1999•

Unique health record number

for all citizens of Andalusia

•

A individual smart card

for each person as a key for access•

A regional EHR shared among:–

Primary

care

–

Pharmacies–

Hospitals

–

Emergencies

EHR in Andalusia: main features

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

Completion level Tool Population Cases in 2010▌▌▌▌▌▌▌▌▌▌ Clinical Station 100% 7.9 M Pat / 39.7 M Sheets▌▌▌▌▌▌▌▌▌▌ Appointment 100% 83 Million▌▌▌▌▌▌▌▌▌▌ Referral tool 100% 3 Million│▌▌▌▌▌▌▌▌▌ e-Prescription 99.5% 105 Million

│▌▌ Analysis 25% 360,000▌▌▌▌▌▌▌▌▌▌ CS-Hosp. Emergencies 100% 3 Million

▌▌▌▌▌▌▌▌ CS-Outpatients 80% 1.1 Million▌ CS-Inpatients 10% 916,890▌ Admission 10% 60,000

▌▌▌▌▌▌▌▌▌▌ Appointment 100% 12 Million│▌▌▌ e-Prescription 33% 99,778│▌▌ Analysis 25%

│▌▌▌▌▌ Radiology 52% 3.4 Million▌ Out of Hosp. Emergencies 10%

Current extent of the development

47.910

56.522

Before After

Primary Care appointments after the introduction of e-Prescription

-15.28%38 Million visits saved from 2006

6 months trial with the same cohort of population

e-Prescription % by INN (International Nonproprietary Name) and estimated savings

446.1 Million € saved from 2001

2,7

25,7

46,6

57,763

70,975,2 77,1 78,6

84

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

6

0

Before After

23

5

Before After

% of sample id errors and results delivery time (p70) after the introduction of the e-Lab module (MPA)

% of id errors p70 time, hours

-76.32%

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

EUR

Present value of cumulative costs Present value of cumulative benefits

Cumulative economic performance

•Unrealistic expectations•Technology fascination: e-health as an objective itself•Insufficient IT training of healthcare workers•Underestimate preparation for implementation•Inadequate IT infrastructure•Disappointing short-term results

Lessons learnt: warnings/risks

•

Align

the EHR development with the regional government’s health strategy, supporting it

•

Integrate

the projects needed for each module into a single project

that delivers interoperable all the information

•

Step by step

implementation assuring its use after a carefully designed piloting

•

Ensure that the project horizon is long

enough, so that there is enough time to involve stakeholders and to adapt the system accordingly.

•

Bottom-up

approach: critical role of health care professionals in the design and development.

•

Strong political support

in the long run

Lessons learnt: keys for success

Thank you very much!