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Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative
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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
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!