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