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Butlletí TICSS

Workshop of Integrated Health and Social Care: A necessary model of efficiency

Autor: Adrià G.Font   /  30 de desembre de 2014

30 de desembre de 2014

The conference sought answers to the question of how to create a model of integrated health and social care with the help of information systems, a challenge not only facing Catalonia, but also countries around the world. Therefore, in accordance with the meeting’s spirit of integration, it was assisted by both local speakers and others from countries collaborating on the European CASA project.

In this summary we review the meeting: from the various Catalan projects such as PIAISS and the HC3; the integrated systems of Scotland, Southern Denmark and Andalusia; ICT solutions in Extremadura, Canada, Northern Ireland and England. For those unable to attend, we provide links to videos of the day and to the individual presentations. Furthermore, Flash TicSalut asked a couple of questions of each speaker, and the answers can also be found below in video form.

First block: Catalonia

Creation of a new integrated social and healthcare system

 

Juan Carlos Contel, the first speaker of the day, spoke about the Program for the Prevention and Care of Chronicity and the Interdepartmental Plan of Care and Health and Social Interaction (PIAISS) as a contributor to both. Referring to the first, he said that care for complex chronic patients (CCP) is "the backbone to integrated care". As for the PIAISS, Contel admitted that the most critical aspect of the plan is the governances, as they have to combine both authorities from different sectors and different territories. The solution, he stated, is to "introduce common objectives" between the social and healthcare sector, and thus to create a "system of shared information" with unique coding.

Òscar Solans, functional coordinator of the Shared Medical Record of Catalonia, spoke about the HC3. The talk served both to report on the status of Catalonia to speakers and foreign participants and to catch up on the objectives and operation of the shared record. One of the projects they are working on now, explained Solans, is the structuring of the data, both in terms of written and numerical documents and images. This will give more play and open up new possibilities both in interpreting and integrating the data. "Integrating social data," he explained, "is the great challenge for the coming year."

The last paper in the block was given by Jordi Gabaldà, director of TIC Salut Centre of Telecommunications and Information Technology of the Government of Catalonia (CTTI). Gabaldà stressed that the key to the effectiveness of the new integrated and increasingly non-face-to-face attendance must be the ability to "lead the patient along the right path." Therefore, the ISISSCat is based on five key points: territorial leadership, integration, care and organizational change (rather than just technological or administrative), system reengineering, ICT and the creation of standards. He concluded that although the use of ICT "has to be improved, we are aware also of the great progress we have made."

Second block: Round table

Experiences of different regions of the CASA project

The roundtable on European experiences was initiated by Donna Henderson, director of NHS 24 services, the Scottish organization for the development of telemedicine. She gave an overview of the Scottish situation regarding social healthcare integration and the application of ICTs. On the first question, she explained that in Scotland integration "is nothing new, we have been working on it since 2000"; when there was a change of approach "towards prevention, emphasizing the public health, local needs and social healthcare work". However, Henderson admitted that Catalonia "has resolved issues that we still have pending," such as creating an eHealth folder.

The case of Southern Denmark is very different, as was immediately seen in the talk by Katrine Vedel, technology consultant at the Center for Innovation in Health of Southern Denmark. In Denmark the IBM Shared Care platform is used to share the clinical record of patients electronically and in a standardised way, and there are now more than 289 telemedical solutions in the region, working "from collecting data to enabling self-management." However, the future will still bring many changes, both in logistics and data standards, telemedicine and equipment. Vedel concluded that "telemedicine is a very important part of the development of integrated care".

 

Finally, José Daniel Soto, head of the ICT Service of the Ministry of Equality, Health and Social Policy of the Government of Andalusia, made us aware of the situation in his autonomous region. In Andalusia the health system is centralized, so all citizens have a unique record number that serves in any community centre. This facilitates both the integration process (which currently only covers health care settings, including pharmacy services) and digitization, which currently has the digital card, which allows "prescriptions XXI" and facilitates the prescription of medication and access to ClicSalud, where you can visit Diraya, a system of electronic health folders.

Third block: Integrated care in Europe and Canada

Model and focus of ICT solutions

Juan José Garrido opened the third block by talking about ICT solutions in Extremadura, where he is general manager of Extremadura Healthcare. Although the system is still not integrated, and in the words of Garrido, "there is need for greater interaction", its electronic health system is already implemented. It is called JARA, and allows "the provision of unique and integrated patient information, for their benefit and that of the professionals". The most important current system functions are the storage of medical images of all types and the analytical repository. We also learned that in Extremadura there have been around 100,000,000 electronic prescriptions, and only 10% of current prescriptions are handwritten. JARA is part of a group of systems that are included in CIVITAS, the single user identification code.

Danielle Beaudry, who is a consultant in case management in the Sherbrooke health experience centre made her presentation with video transfer from Quebec to discuss PRISMA. The PRISMA project (coming from Program of Research to Integrate the Services for the Maintenance of Autonomy) is an integrated care model focused on the elderly which began in 2003, and seeks to facilitate communication between institutions and professionals, and to facilitate patient access to social healthcare.

 

To explain the situation in Northern Ireland we had Des O'Lean, director of eHealth strategies, Design and Program Control Program of the region’s Social and Healthcare Board. In his case, explained O'Lean, they had the advantage of learning from the mistakes of the United Kingdom’s system, which made them decide to digitize the social services system without first unifying the systems. "They did not change any underlying system" but what they did was "to put them all together in a clinical medical record with a centralized database." The system is proving a success for the moment, and 26% of the population of Northern Ireland have already accessed their records electronically since July 2013.

  • Micro-interview:

Finally it was the turn of Deborah Jenkins, associate director of PPL Consulting, a consultancy of health innovation in the United Kingdom. Jenkins explained that for the moment, 14 medical centres in England are doing a pilot trial for a Better Care integrated digital system focused on "people with chronic illnesses, socially isolated, with mental health problems or mobility or transportation difficulties”. She spoke especially of the Tri-borough of London (west of the city), where the Community Independence Service (CIS) has priority because it maximizes patient independence and promotes non-face-to-face attendance in favour of telemedicine.

Conclusions and close

Finally, at five o'clock, the third block was completed with the conclusions and close by those responsible for the day: Jordi Martínez, director of innovation of the Fundació TicSalut, Josep Maria Grego, of the ForumITESS steering committee and the director of the foundation Francesc García Cuyàs. The three reflected on the previous objectives and subsequent evaluations of the day, which you can hear either in the video recording of the day (provided in the section of useful links), or in the subsequent interviews you can find below.

It can be said that the aim of the day which, as Jordi Martínez explains in the video, was "to learn, share and exchange experiences" in AAL, and integrated healthcare within the framework of the CASA project, was more than satisfied. Finally, Francesc García Cuyàs emphasized the importance of the integrated care model, which "is a necessary model of efficiency" that improves "quality of life and quality care to citizens".

Useful links: