PRIMARY CARE:
34
PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability W O R K S H O P Ana Carriazo Senior Advisor General Secretariat for Quality and Modernisation Regional Ministry of Health of Andalusia, Spain e-Health in Primary Care contributing to economic sustainability in Andalusia
description
W O R K S H O P. PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability. e-Health in Primary Care contributing to economic sustainability in Andalusia. Ana Carriazo Senior Advisor General Secretariat for Quality and Modernisation - PowerPoint PPT Presentation
Transcript of PRIMARY CARE:
PRIMARY CARE: Regional strategies to improve efficacy and equity while
guarateeing economic sustainability
W O R K S H O P
Ana CarriazoSenior AdvisorGeneral Secretariat for Quality and ModernisationRegional Ministry of Health of Andalusia, [email protected]
e-Health in Primary Care contributing to
economic sustainability in
Andalusia
13 June 2011
OverviewDiraya’s environmentDiraya’s main featuresFacts and figuresCosts and benefitsLessons learnt
13 June 2011
Healthcare in AndalusiaSpain: National Health System
(universal coverage & free access, publicly funded by taxes)
Regional responsibility for health Andalusia since 1984
8.3 million populationIn 2011 healthcare budget
amounts to 9.39 billion EUR100% of primary care (1500
PHCs) and 72% of specialised care facilities are publicly owned (47 hospitals, 93% of all beds)
Quality PlaneHealth Strategy
13 June 2011
Integrate the healthcare information of every citizen
Diraya´s objective
A SINGLEHEALTHRECORD
13 June 2011
13 June 2011
• 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
Main features
13 June 2011
Appointment Prescription
Radiology
Waiting lists
Functional tests
Pathology
Lab tests
Inpatient care
Referrals
Outpatient care
Primary care
Hospital admissi
onData
warehouse
Emergency care
Much more than an EHR: A corporate information system
13 June 2011
HEALTH RECORD
DATA ANALYSIS
Citizens Data Base
CENTRALISED APPOINTMENT
REQUEST AGENTS
MACO Structure(resources)
PRES-CRIPTION
RECETA XXI
13 June 2011
H.C.H.C.
CENTRALRECORD
Record BrowserRecord Browser
Problems SheetAllergic/ContraindicationsPersonal BackgroundCurrent prescription Sheet Medical Disability NotesDiagnostics TestMedical Referrals
LOCAL RECORD
H.C.H.C.H.C.H.C.
H.C.H.C.
H.C.H.C.
Citizen Register
Diraya’s architecture
13 June 2011
Electronic health record
13 June 2011
Salud Responde
902 505 060
Primary care Outpatient care
Diagnostic tests
Centralisedappointment
13 June 2011
INTRANETCOF
Electronic Record DIRAYACentral Dispensary
Dispensations
Consultation (PC-SC)DIRAYA
CitizensEHR
PHARMA
INTRANET SAS/JJAA Prescriptions
Instructions sheetPharmacie
Dispensations
Dispensations
INTRANETCOF
INTRANETCOF
Electronic Record DIRAYACentral Dispensary
Dispensations
Consultation (PC-SC)DIRAYA
CitizensEHR
PHARMA
INTRANET SAS/JJAA Prescriptions
Prescriptions
Instructions sheetInstructions sheetPharmacie
DispensationsDispensations
Dispensations
Dispensations
Receta XXI – ePrescription module
13 June 2011
Decision support system
•Single medicines record •Updated catalogue (Nomenclátor)•Prescription by active principle•Help in filling up posology •Warnings for double prescription•Evidence based guide by semFYC•Info on drugs•Alergies and contraindications•Help reporting adverse reactions•Interactions•Warning maximun daily doses•Warning therapeutic redundance •Forms included
Increases patients‘ safety
13 June 2011
Lab tests
Catálogo Clínico
CLC00006 (Pla—Colesterol de HDL; c.sust)
GNC00006-01 Srm—Colesterol de HDL;c.sust(calculado)GNC00006-02 Srm—Colesterol de HDL;c.sust(medido)GNC00006-03 Srm—Colesterol de HDL;c.masa(calculado)GNC00006-04 Srm—Colesterol de HDL;c.masa(medido)
Catálogo GeneralLaboratorio ALaboratorio BLaboratorio CLaboratorio D
Unidades, decimales, FC, espécimen, sinónimos Unidad específica, CLC, Muestra, Factor Conversión Primario
13 June 2011
PACS local
PACS local
PACS local
RIS Diraya
PACS central
Catalogue
C.S
C.S
C.S
Radiology
13 June 2011
Current extent of the development
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%
13 June 2011
3 millions hospital emergency care episodes
39.7 millions primary care consultation sheets.
1.1 millions hospital outpatient specialised care episodes
17,000 professionals 3,500 pharmacists
Utilisation in 2010
13 June 2011
0
5.000.000
10.000.000
15.000.000
20.000.000
25.000.000
2006 2007 2008 2009 2010
InterSas Salud Responde
902 505 060
Citas MF y PED por canal (ene11 )
23,0%
15,8%
61,2%
Salud Responde InterSas En el centro
13 June 2011
Number of dispensations according to type of prescription (2004-2010)
Impact on the prescription model
Dispensing procedures 2010: 105 millions
0,18 0,88
6,10
19,46
39,71
50,31
58,18
0
20.000.000
40.000.000
60.000.000
80.000.000
100.000.000
120.000.000
2004 2005 2006 2007 2008 2009 20100,00
10,00
20,00
30,00
40,00
50,00
60,00
Recetas manuales Recetas impresas RXXI % Receta XXI
13 June 2011
% dispensations according to type of prescription (2004-2010)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2004 2005 2006 2007 2008 2009 2010
RXXI Recetas impresas Recetas manuales
13 June 2011
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
13 June 2011
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
13 June 2011
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%
277 Primary care centers 10 hospitals
13 June 2011
2008-09: Independent evaluation of Diraya and Receta XXI chosen by the EC as best practices to be analysed.
BENEFITS: • Efficiency (83%)• Quality (17%)• Accessiblitty (1)
COSTS: • ICT• Negative impacts of Diraya use: adaptation period, changes in the organization and way of working …
Method: Economic conversion of costs and benefits according to the model, including non financial aspects.
Case studies. European Comission. http://www.ehr-impact.eu/cases/cases.html
07/2009 The socio-economic impact of Diraya, the regional EHR and ePrescribing system of Andalucía’s public health service. http://www.ehr-impact.eu/cases/documents/EHRI_case_DIRAYA__final.pdf
07/2009 The socio-economic impact of Receta XXI, the regional ePrescribing system of Andalucía’s public health service.http://www.ehr-impact.eu/cases/documents/EHRI_case_Receta_XXI_final.pdf
13 June 2011
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
13 June 2011
0
50.000.000
100.000.000
150.000.000
200.000.000
250.000.000
300.000.000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
EUR
Present value of cumulative costs Present value of cumulative benefits
Receta XXI – cumulative economic performance
13 June 2011
First year cumulative benefits: 9a
Cumulative economic performance
By 2010, the cumulative net benefit to cost ratio reaches +1.77, meaning that for every 100 EUR in costs, there are 277 EUR worth of socio-economic
benefits.
13 June 2011
Costs and Financing of Diraya
Source: EHR Impact Study
• IT costs – 50% of overall costs
• Organisational costs (non-IT costs)– Development, engagement, adaptation
• Total value of socio-economic investment over 12 years:– 245 million EUR
13 June 2011
Benefits from Diraya by stakeholders• Citizens
– Patient safety – sharing of clinical data reduces risk of adverse events, makes healthcare more effective and more timely
– Efficiency gains – time savings and avoided travel costs• Fewer re-assessment procedures for patients frequently changing their
GPs• Fewer repeat questions• Facilitated (referral) bookings (satisfaction surveys)• Avoided visits by chronic patients with long-term ePrescriptions
(validity: up to one year)• Doctors & nurses
– Comfort for GPs• Benefit from pride, professionalism and satisfaction• Decisions are based on comprehensive & reliable information• Provision of more efficient healthcare
Source: EHR Impact Study
13 June 2011
Benefits from Diraya by stakeholders II• Benefits to the Andalusian health service
– Reduction in exposure to risk due to better clinical governance • Assurance that medical information is recorded correctly and fully• Assurance that advice is based on better information
– Time savings – redeployment of resources:• Fewer repeat questioning about medication and medical history• Avoided visits for re-assessment and for renewal of prescriptions (reduced
by ca. 15%)• Better allocation of resources through eBooking• Cost savings from generic prescribing• Cost avoidance through central server
– Regulation and standardization of procedures and tools
• Benefits to the regional Ministry of Health– Information from research feeds into evidence-based standards– Dissemination of guidelines through Decision Support (DS) tools– Support & integration of strategic initiatives (improved care processes)
Source: EHR Impact Study
13 June 2011
Patients’ satisfaction
0,00
10,00
20,00
30,00
40,00
50,00
60,00
70,00
80,00
90,00
100,00
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Diraya coverage HealthResponds Overall Satisfaction
Telephone access GP Appointment Telephone appointment
Institute for Social Studies of Andalusia.Spanish Scientific Research Council (CSIC)
13 June 2011
•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: risks
13 June 2011
• Align the EHR development with the regional government’s health strategy, supporting it
• Bottom-up approach: critical role of health care professionals in the design and development
• Integrate the projects needed for each module into a single project that delivers interoperable clinical and health 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 (collaborative model)
• Strong political support in the long run
Lessons learnt: key factors for success
13 June 2011
Gracias Thanks Merci Grazie Gracias Merci Grazie Thanks Gracias Merci Grazie Thanks Gracias Thanks
Merci Grazie Gracias Thanks Merci Grazie Gracias
Thanks Merci Grazie Gracias
Thanks Gracias Merci Grazie Thanks Gracias Thanks Merci Grazie Ana M. Carriazo
Senior AdvisorGeneral Secretariat for Quality and ModernisationRegional Ministry of Health of AndalusiaAv. de la Innovación s/n, Edificio Arena 141020 Sevilla (España)T: +34955006613anam.carriazo@juntadeandalucia.eswww.juntadeandalucia.es/salud
