Sociedad Española de Informática de la Salud (SEIS)  (Spanish Society of Health Informatics)
Government of Cantabria. Health and Social Services Advisory Council.

Havana, February 15, 2007

Electronic medical history

• Main strategies
• The setting in Spain
• The new concept of the medical history
• Upgrading opportunities
• Some experience

Strategies: the setting
• Increase of health service demands (population aging and more demanding citizens)
• Immigration
• Increased quality expectancies and new technologies. Higher expenditures.
• Budget restrictions
• Demands from professionals: time, access to knowledge

Setting (figure 1)

Population of Spain (figure 2)
Setting (figure 3)
Strategies:
• Access to clinical information by professionals at any place and at any time.
• Health care
• Creation, analysis and dissemination of best available scientific evidence.
• Producing accurate information for decision-making by managers and planners
• Access of citizens to the medical history. Informed consent.

The ideal:  the vision

V SEIS Report: From the medical history to the electronic health history.

• The health history comprises the entire information related to the health status of a person:
• Throughout his/her life and not limited to certain interventions
• Related to health and disease data
• Generated by all those reponsible for health care who have related to the person at different medical assistance level.
• Electronic health history should be characterized by relevant, non-redundant, heterogeneous and lasting information.
• It should be accessible at any time and place.
• It means to apply Information and Communication technologies to the health activity and to change the traditional concept of the medical history. The electronic health history is part of an integrated clinical information system (fig 4-6)
The ideal: he vision
• Overall.  All episodes included regardless of the place where they took place.
• Interoperable.  It works with the department systems and with other health centers and services.
• Safe and confidential
• Elxible.  It may be used in research, quality improvement projects, management...

Opportunities
• The Electronic Health History (EHH) should apply the ICTs to the core of health activity.
• Access
• Efficiency and quality of care.
• Clinical management.
• Planning and improvement of the health care system.

Access
• Contactign centers:
o Internet portals
o Call centrals
• Advantages.
o Information
o Appointment in advance. Demand management.
o System proactivity.

Efficiency and quality
• Immediate access to the whole information on patient by the health professional.
• Less red tape
• Help in report drafting.
• Test and consultation repetition is avoided
• Improvement of assistance continuity.
• Supporting systems to diagnosis, prescription, protocoles and clinical guidelines.
• Quality assessment.

Clinical management
• Management of the professional´s time.
• Preparation of medical consultation service, surgery and other medical activities in advance.
• Resource allocation
• Evaluation of results
• Complications
• Re-interventions
• Access to knowledge

Some experience
• Centers of prior appointment
• Electronic medical history
o Primary care
o Specialized care
o Medical image designs
• Assistance continuity (information viewfinders)
• Interoperability within the National Healthcare System
• Common aspects :
• Identification
• Dissemination of primary care medical history.
• Electronic medical history in hospitals are underway.
• Image designs
• LOPD
• Attempt to centralize primary care information and to share that of hospital care.
• Diraya
• Abucasis
• Ianus
• Ikonos
• Madrid
• Electronic Medical History of Cantabria

Cantabria
• Electronic medical history integrating the already existing information (primary and specialized cae )  (figure 7)
• New projects:
o Hospital information system (HIS)
o Drug prescription and management
o Clinical request management.
o Medical image
o Integrated information system of the surgical block.

• Public health information system

Electronic health history should be characterized by relevant, non-redundant, heterogeneous and lasting information.

It should be accessible at any time and place.

It means to apply Information and Communication Technologies to the health activity and to change the traditional concept of the medical history. The electronic health history is part of an integrated clinical information system

The ideal: he vision
• Overall.  All episodes included regardless of the place where they took place.
• Interoperable.  It works with the department systems and with other health centers and services.
• Safe and confidential
• Elxible.  It may be used in research, quality improvement projects, management...

Opportunities
• The Electronic Health History (EHH) is supposed to apply the ICTs to the core of health activity.
• Access
• Efficiency and quality of care.
• Clinical management.
• Planning and improvement of the health care system