ICT Strategy in The Catalan HealthCare and SocialCare System ICT Services
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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
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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
USE
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
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
SMR and PHR
in Catalonia
ICT Services for Integrated Care
Shared Medical Record
in Catalonia
WHY ARE WE DOING IT?
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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 the
necessary tools to
perform better tracking of
patien
Providing interoperability
between different
systems of health care
providers through the
definition of standards
interact with the information systems that make the real map of Catalonia clinical
systems
Lace i-SISS.Cat the Catalan Health System
Personal Health Folder 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.
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
CARE
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
services that support the care process (APPs)
Shared Medical Record in Catalonia
(HCCC)
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News functionalities
Access strong password
Adaptation to mobility from mobile devices
Apointment visits Primary Care
Change of doctor or nurse
Apointment visit to internacional vaccination
Integrated Agenda
eConsulting (pacient-GP/nurse)
Rights ARCO
waiting list
http://lamevasalut.gencat.cat
Access
PC and tablet vision Mobile vision
Personal data
Clinical Information – Clinical Reports
Diagnostics
Active health problem Non active health problem
Reported from health provider
Reported from vaccination book
Reported orally by patient
Duplicated
Vaccines
Medication: electronic prescription
Online: always updated
Printable
Anticipatory wills
Formalities
My controls
•More procedures
•More controls on own health
•Connect with your professionals
•Apps to control my health
•Schedule –programming-
State 2: Functionalities extension
Activities in “Personal Health Folder”
Prova pilot d’accés a LMS amb usuari i paraula de pas
By sex Home 43%
Dona 57%
By age 18-24 1%
25-34 10%
35-44 24%
45-54 33%
55-64 22%
65 9%
Access digital certificate (%)
34%
Access with user / pass word (%)
66%
Acces to users 3,04
By device
PC 85%
Mòbil 11%
Tablet 4%
By health region
Personal Health Folther pilot access with username and password
Access activities to “Personal Health Folder”
Health and social integrated care
Presentation • Objectives
• Advantages
74
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
75
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.
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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
77
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
SNOMED CT
Is an international controlled vocabulary owned by IHTSDO.
Contains more than 400,000 related concepts through different kinds of relationships.
Has a hierarchical structure with different levels of detail and made of 19 axis:
• Clinical finding, Staging and scales, Substance, Procedure, Body structure, Pharmaceutical / biologic product, Social context, etc.
Has concepts that have two or more descriptions, including synonyms.
Supports translation and multilingual.
Has mechanisms to be adapted to the local needs of users:
• Subsets.
• Mappings.
• Extensions.
SNOMED CT
Example:
DescriptionIds
ConceptId
Hierarchy relationships
Clinical Dictionary for iHealth
Is a transversal project of the Generalitat of Catalonia’s Health Department.
• Leaded by the Office of Standards and Interoperability and managed by a permanent commission.
Is organized in domains of content:
• Immunizations, allergies, scales of evaluation of chronic patients, anatomic pathology, clinical variables, spirometry test report, etc.
• Each of them worked by a multidisciplinary team of experts.
Uses SNOMED CT as reference terminology and ontology of representation.
Each domain is organized in subsets of SNOMED CT.
Other controlled vocabularies are included by they are normally mapped to SNOMED CT to achieve full semantic interoperability of contents.
All new elements are created in the Catalan extension of SNOMED CT.
The social domain • Is an open domain of the Clinical Dictionary that includes:
–Types of service.
–Status of requests.
–Scales of evaluation.
–Environment devices.
–Social diagnosis (problems).
• We are mapping all this concepts to SNOMED CT in order to obtain a semantic standard:
–That guarantees the exchange the information from different sources without losing its meaning:
–And allows us to uniquely identify, represent, compare, translate and exploit it.
ICT infrastructure
82
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-centered 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
84
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
Adding Value through ICT: From documents to cooperation
Adds “value” to
professionals
Enables continuity of
care
Sharing Documents
Images Publishing
Professionals share
knowledge
Serving continuity of care
Exchanging Information
ePrescripcion
Clinical practice is
connected with ALL the
agents demanding a
change in behaviour
Increase of quality of care
Collaborative Model
eHealth
i-SISS.Cat
Strategic plan for the implementation and deployment of the platform for the management of
healthcare and social Processes in Catalonia
92
The i-SISS.Cat solution should allow:
Citizen Access to healthcare &
social information
Provide different services to
interact with the system
Personalize assistance
Patient expert communities
and e-learning contents
Healthcare & Social System Accelerate implementation of healthcare strategy
plan
Allow to transform healthcare model (from Activity
towards Outcomes)
Analytics tools for the governance model
Allow process standardization
Social & Healthcare
Providers Interoperate with the rest of
providers
Facilitate the adoption of new
payment models
Implement clinical pathways
in every region
360 vision of patient
Manage the processes and
KPIs measurement
Collaboration environments
Citizen
Agencies
Provider
Governance of the program
Holistic view of the patient
Integral vision of health & social
processes
Integral vision of the citizen
Government programs:
•Creation of programs and tracking key performance indicators (KPIs). •Display of results for program and service provider.
360 °view of the patient:
• Access to the broad view of the patient and the process •Environments of collaboration between professionals.
Healthcare process integration:
• Shared Social and health-related information •MDT platform
Integral vision of the citizen: • Platform that will allow us to expand the coverage to other social benefits and giving coverage to the unique social and health record.
The i-SISS.Cat solution challenges:
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The i-SISS.Cat solution integrated care:
Actions: •Priorisation of chronic conditions groups •KPIs definition at high level •360º vision design per program •Interoperability standards
Outcome Measurement
Patients enrollment
Pathways Implementation and
EHR integration
Integrated Pathways definition
Program creation and KPIs
Actions: •Pathway definition and KPIs
•Definition of recommendations
Actions: •Technical development to facilitate data flow and exchange from different providers
•Configuration of roles for users
Actions: •Information exchange •360º vision •Alerts definition •Creation of a collaborative environment •Patient monitorization
Actions: •Predictive modeling
•Query utilities to select patients at risk
•Support decision tool
Roadmap i-SISS.Cat
ACHIEVED IN PROGRESS
The i-SISS.Cat solution overview:
Previous experience in integrated care processes: MECASS Project
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Global treatment plan •Access to services and different units for program & provider – best provider for the job
• Integrated activities in a patient workspace (interoperability)
•Provider billing process based on results / success
The i-SISS.Cat solution areas:
360 holistic vision of patient • Patient Segmentation and Stratification
relevant information (CRGs, labels, etc.) • Clinical Data per program • Resource consumption for each Plan • Program cost (plan vs. real)
99
The i-SISS.Cat solution roadmap:
2016
2014
Kick Off
Interoperability
platform
First process definition
(PCC)
Measure KPIs
2017-2018
2015
Deployment of services
for the citizen
Models advanced
analysis, prediction and
knowledge management
Third wave of process
definition
Measure KPIs
Continuous
improvement and
calibration
New processes within
the model
System deployed to all
the country
Measure KPIs
Goal to achieve: a modular solution, that allows to implement the strategic objectives defined in the Health Plan 2011 - 2015
Go Live of integrated
process solution
Opening the door to the
citizen
Integration of health
and social process
Second wave of
process definition
Measure KPIs
• Management the different clinical processes included in the Healthcare Plan
• Govern the health model in terms of efficiency and direct towards processes
• Facilitate the adoption of new models for health care providers billing
• Fit the new models of purchase without adding complexity to the supplier
• Self-management. Customized of the clinic processes to the reality of each of the
territories and suppliers..
• Integrate suppliers at different levels: processes, information and management tool at
the discretion of the level of evolution that they have their systems of information
• Make interoperability between different providers, unifying the model of integration
and sharing of information
• Measure the relevant indicators established within the Health Plan
• Co-responsible for the patient in the management of their health and the health
system itself
The solution i-SISS.Cat should allow
mHealth
Plan Catalunya
mHealth Plan
Mobility in the health and social sector
mH-Bigdata
Interoperability model between the citizen and his/her mobile devices and health and social professionals.
Midle Earth
Marketplace APP display to be prescribed by health and social professionals.
Accreditation model of APPs Trustworthy APPs with quality certificate
Information flows change Health system adaptation to a new citizen.
Health
“Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or infirmity..”
-WHO
According to the WHO definition, two
coexisting health dimensions that have to
be covered in the preparation of the Plan
are detected:
• Healthcare dimension
• Social welfare dimension
Mobility
Móviles y
Tabletas
PDAs y
portátiles
Sensores Equipamient
o
Otros wearables
Set of systems and devices that facilitate the
use of solutions or functions and information
processing under conditions of mobility or
portability
mHealth
Creation of new
solutions and
services through
mobile systems to
improve and
personalise citizen’s
health and social
welfare.
The objective of the Plan is to make mHealth progressively this space is ever expanding, until the delivery
of health and social welfare consider, most, mobility solutions.
Current situation Future situation
It is situated in the space at the intersection between the management
and provision of health and social welfare
mHealth Plan
Conclusion
Integrating the mHealth into the health and social
care pathways
It´s possible
Thank you
Jordi Martínez
Chief Innovation Officer, TicSalut Foundation
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