FINAL EVENT Palazzo Franchetti – Venice 23rd & 24th January 2006 The technical solution adopted by HEALTH OPTIMUM in Spain.

FINAL EVENT

Palazzo Franchetti – Venice23rd & 24th January 2006

The technical solution adopted by HEALTH OPTIMUM in Spain

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BARBASTRO SECTOR

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Index Gobierno de Aragón validation sites Barbastro sector

Location Intersectorial map Structure Figures

Services selected for the trials Network Tele-consultation Tele-radiology Shared clinical records Video

Health Optimum Spanish Pilot Virtual referral Tele-counseling

Conclusions (initial deployment) Contact Spanish Pilot information

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Gobierno de Aragón validation sites

The validation sites for the HEALTH OPTIMUM prototype are located in the Barbastro Health area.

The Centre of Excellence and Points of Care where tele-consultation, tele-counselling and Virtual Referral have been installed are the following:

1 Specialised care (Hub) Barbastro General Hospital

2 Primary Care centres (Spokes) Fraga Health Centre Castejón de Sos Health Centre

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Barbastro Sector -Location in Spain

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Barbastro Sector -Location in Aragón

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Barbastro Sector – Intersectorial Map

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Barbastro sector – geographical references

Geographical area of +7.500 km2

Consists of well differentiated topographical areas:

In the north - the Pyrenean mountain range

In the centre – the Guara Sierra, marked by canyons and ravines

In the south – a vast plain

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Barbastro sector – structure Primary Health Care

Centres: 13 Continual attention points: 3 Dental health units: 2 Physiotherapy units: 4 Obstetrics units: 7

Specialized Health Care Barbastro Hospital Beds: 160

Operating theatres: 5 Surgeries: 36

Medical speciality centre: Fraga y Monzón

Public health care Fraga Public health centre Beds: 10 Surgeries: 0 Beds Day care hospital: 0

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Barbastro Sector - Economical data expenditure

 REAL

EXPENSES 2005    

  PRIMARY ESPECIALISEDSOCIO-

SAN. TOTAL %

ITEM 1 16.730.229 22.166.975 737.202 39.634.406 47,93

ITEM 2 1.854.088 12.302.501 188.472 14.345.061 17,35

ITEM 4 23.849.009 3.427.124   27.276.133 32,98

ITEM 6 119.804 1.314.354 7.697 1.441.855 1,74

TOTAL 42.553.130 39.210.954 933.371 82.697.455  

% 51,46 47,41 1,13    

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Barbastro Sector - Human Resources

  Management Practitioner Physicians Non-physicians

Interns Total line

Primary health care

3 111 107 53 18 292

Specialised health care

2 109 303 168 0 582

Public health care

1 2 10 4 0 17

Sector 2 0 0 0 0 2

Total Sector

8 222 420 225 18 893

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Barbastro Sector - Primary Health Care

MEDICINE 2.004 2.005

Total medical consultation 905.653 972.047

Home care consultation 25.847 28.512

Consultations per professional / day 40,90 42,38

Home care per professional / day 1,12 1,24

Frequency 9,09 9,12

Consultations derived from A. Specialised 37.240 36.000

Consultations derived from A. Specialised 4,1% 3,7%

Radiological examinations 9.329 10.702

PAEDIATRICS

Total paediatric consultations 47.091 59.321

NURSING

Total nursing consultations 479.861 486.076

Home care visits 43.846 43.291

Consultations per professional / day 24,54 22,96

Tests (blood,,,) at Health Care Centres 32.940 35.928

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Barbastro Sector – Primary Health Care

EMERGENCIES – CONTINUOUS CARE

Total Emergencies 108.414 113.562

Patients / month / 100 inhabitants 9,07 9,3

Nº Emergencies at Health Care Centres 97.875 102.910

Nº Emergencies at home 10.593 10.651

Problems resolved at Primary Care 95% 95,8%

PHARMACY

Expenses as of December 22.009.702 € 23.849.008 €

Increase in expenses 4,3% 8 %

22 million € 23,8 million €.

Percentage on primary care expense 56.5% 56.05%

Total number of prescriptions 1.705.408 1.866.423

Prescription expenses 12,90 € 12,70 €

12,9 € 12,6 €

Number of prescriptions per active and year 6,8 7

Number of prescriptions per pensioner and year 38,8 43

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Barbastro Sector - Specialized Health Care STRUCTURE 2004 2005

Beds available 149 151

Programmed surgery 4,08 2,75

Consultation sites 36 36

Hospital day working posts 6 6

HOSPITALISATION

Admissions 6946 6927

Stays 43206 44998

Average global stay 6,22 6,46

OPERATING ROOM

Hospital programmed surgical operations 2314 2077

Specific beds 610 813

Minor programmed surgery 1134 1149

TOTAL I.Q. Programmed 4058 4039

I.Q. Hospital Emergency 648 632

I.Q. Emergencies Ambulatory 116 121

TOTAL I.Q. Emergency 764 753

TOTAL I.Q. (*) 4822 4792

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Barbastro Sector - Specialized Health Care

STRUCTURAL L.E.Q.

LEQ total 1189 1342

LEQ 0 at 3 months 905 837

LEQ 3 to 6 months 284 505

LEQ more than 6 months 0 0

Average delay 66 81

HEMODIALISIS

Hospital Dialyses 35 35

Private centre Dialyses 14 22

Peritoneal Dialyses 4 2

OUTPATIENT CONSULTATIONS

First outpatient consul. 38345 38735

Successive 97961 96006

Index successive >/ first visit 2,55 2,48

Total patient waiting list 5543 6360

Waiting list patients V/I 1047 1444

Average global delay 41 66

Waiting list patients >60 d 1117 2141

Outpatients consult. High resolution(*) 2014 1955

Total pre-appointments 0 0

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Barbastro Sector - Specialised Health Care

HDD

HDD sessions 3245 3115

EMERGENCIES

Total Emergencies 31765 31694

Emergencies – no hospital admission 27418 27077

BIRTHS

Births + Caesareans 585 567

CENTRAL SERVICES

Patient clinical analysis 95.212 117451

Certain clinical analysis 1.192.022 1363003

Simple radiology 54.273 55327

T.A.C. 5050 5537

Mammography 3478 3617

Ecography 6.418 6281

Biopsies 5.844 5501

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Barbastro Sector – Public Health Care

ACTIVITY 2004 2005

Admissions of hospital beds 40 51

Generated stays 3511 3923

Admission during period 42 50

Private centre generated stays with IASS * 3321 3230

Private geriatric stays with IASS * 8 8

Temporary private centre stays with IASS * 2 2

* IASS: Instituto Aragonés de Servicio Social

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Services selected for the trials

Tele-radiology. Transmission of digital images to primary care doctor in real-time

Tele-counselling: Tele-counselling between a specialised doctor and primary

care doctor, without a patient involved Oncology: The trials will support specialised assistance to

patients in the primary care setting. Nephrology: Trials will facilitate specialist tele-assistance

in the Primary Care Centre

Virtual Referral: Virtual tele-consultation with presence of patient.

Haematology: The trials will cover patients treated with anticoagulants, to facilitate consultation between the primary care doctor and the Haematology specialist.

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Network

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Network

Network enhancements undertaken for Health Optimum pilot are:

Hospital of Barbastro connected to the RACI by means of 155 Mb optical fibre.

Hospital of Barbastro connected to Fraga Health Centre by an 4 Mb ADSL line.

Hospital of Barbastro connected to Castejón de Sos Health Centre by two 512 Kb ADSL lines.

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Tele-consultation

Components

Tele-consultation tool, implemented in JAVA, PHP and HTML, and hosted on a Linux server with Apache, Tomcat and SSL protocol is being used. It accesses the different databases of the different servers by means of JDBC1

Tele-consultation reports are made with HP-Doctor tool, which are published in real time in the Intranet of the sector

Sets of healthcare-specific components, one installed at each partner’s validation site (Point of Care)

Videoconferencing services established with Plycom software; Tandberg software has also been tested and validated.

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Tele-consultation

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Tele-consultation

Tele-consultation general enhancements

Acquisition of equipment for the transmission of high quality radiological images.

Implementation of primary attention module for health sector Intranet.

Audit underway to adapt the intranet security to data protection laws: Law 15/1999 and 41/2002. In addition, measures will be taken according to the mandatory Spanish legislation (Ley Orgánica de Protección de Datos), so as to guarantee that requirements for personal data privacy are fulfilled.

Tele-consultation appointment books.

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Tele-radiology

Tele-radiology enhancements

A PAC’s scalable system installed to allow the storage and distribution of images.

Acquisition of a diagnostic station for the Barbastro Hospital with:

Two monitors of 5 Mpixels, and several 2 Mpixels CR (Computed Radiology)

Foreseen for 2006, the acquisition of a digital radiology system for the Fraga PoC, as well as Monzón PoC with:

CR (Computed Radiology) 6 Chassis A station for identification and pre-post view A drought printer, along with the required software.

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Shared clinical records

Shared clinical records

Gobierno de Aragón has currently an initiative in shared clinical records between primary (ER physicians and General Practitioners) and specialised care. This is being integrated within the HEALTH OPTIMUM framework.

As indicated before, a module to generate inter-phase files between the application of tele-laboratory and the program of shared clinical records of primary attention (currently in use) is being rolled out.

In addition files for bi-directional communication (requests and results) have been completed.

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Shared clinical records

Components

The Intranet links all the available primary and specialised information relative to a patient. By means of a tabs system, it is possible to access the primary or specialised information

The matching between primary and specialised care clinical records belonging to a certain patient, through the Primary Authentication Code (PAC) is included within each patient’s sanitary card.

When a patient is selected, his/her primary and specialised information is shown (classified in different table-spaces).

This means that both, the primary and specialised care sides have access "online" to the same clinical information of the patient.; thus, they can share all the computerised clinical information of the patient.

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Video

Video

Health Optimum Spanish Pilot Virtual referral Tele-counseling

Conclusions (initial deployment)

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Contact Spanish pilot information

Gobierno de AragónHealth Departmentwww.aragon.es

Aragonesa de Servicios TelemáticosE-mail: [email protected]

Barbastro HospitalE-mail: [email protected]

TB-Solutionswww.tb-solutions.comE-mail: [email protected]

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Health Optimum

THANK YOU FOR YOUR ATTENTION