22nd International Conference on Integrated Care. Odense, Denmark

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Developing a new model of
information systems and
Electronic Health Records in
Catalonia
Dr Josep Vidal-Alaball. Head of the Central Catalonia Primary Care
Innovation and Research Unit

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Table of contents
Catalonia. Catalan Health System
Catalan Digital Health Platform
Performing during the pandemic
Digital Health Strategy Plan

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Catalonia
7,722,203
Population in Catalonia on
January 1, 2020.

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Catalan Health System
> 160
Health care entities to
provide health care
Universal coverage
The publicly health care system of Catalonia
was founded in 1990 under the principle of
universality; so all individuals and
communities are able to receive the health
services.
Mixed health care model
Integrates into a single public network of
public use all health resources, whether or not
they are publicly owned.
Includes entities historically dedicated to
health care: mutual societies, foundations,
health consortiums, red cross, church
centers…
10,000 M€
Catalan Health Service budget for
2020. The system is funded from
general taxation and government
founds and contributions.
More than 1 in 4 people in
Catalonia have an additional
private health insurance

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Catalan Health System
>16,000
Applications across the Catalan Health System:
1 EHR for primary care.
> 29 EHR products in the Intermediate care
At least 10 different systems for social care
940
Facilities that range from primary health
care centres to hospitals and
intermediate care centres.

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Catalan Digital Health Platforms

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Catalan Digital Health Platforms

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Huge heterogeneity of data models
• 71 hospitals and 29 different vendor products
• Each tertiary hospital has around 800 silos of information
• Each secondary hospital has around 400 silos of information
• Probably there are more than 16k silos of patient related
biggest source (and growing fast due to digital health solutions)
• Huge heterogeneity of proprietary data models
Catalan Digital Health Platforms

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Shared Electronic Health Record of Catalonia (HC3)
Catalan Digital Health Platforms
Yes
Yes DICOM

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Shared Electronic Health Record of Catalonia
Catalan Digital Health Platforms
Yes SNOMED-CT

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Catalan Digital Health Platforms. Limitations:
Broad ecosystem of
applications with buried
and data models.
Old-fashioned solutions
and a dramatic increase in
technical debt.
Communication
between service providers and
the NHS through static and
incoherent interoperability
solutions.
High costs for maintenance,
corrective and evolutionary
development.
Difficulties to scale-up
innovations and best practices.
Rigid model that does not
foster adaptation to change.

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Despite complexity: GOOD performance of the Platforms
• Quick shift to Telemedicine
• eConsultation
• My Health App
• Teleworking / remote working
• Paperless
Not so well:
• Videoconferences
• Nursing homes
• Public Health (but SIVIC project)
Performing during the pandemic

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Performing during the pandemic. Visits:

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• eConsulta is an asynchronous teleconsultation service between citizens and health care
professionals
• The service was introduced in 2015 and was phased in gradually until 2017, when it
became established as a service available to all Primary Care Teams.
• Initially for Family Physicians, can now also be used by pediatricians, midwives, and
nurses.
• Recently introduced in hospitals (Consultants).
• It is as part of the electronic health care records of the public healthcare system of
Catalonia.
Performing during the pandemic: eConsultations

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• From the patient’s point of view, eConsulta is one of the services offered in their
Personal Health Folder, a personal digital space that provides access to personal
access to personal health information, allowing them to make enquiries and perform
specific actions.
• Following a secure authentication process, patients can access an interface that
allows them to submit their query and attach files, if necessary.
• The portal can be customized and keeps a record of previous teleconsultations.
Performing during the pandemic: eConsultations

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Performing during the pandemic: eConsultations

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Performing during the pandemic: eConsultations

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• COVID-19 has led to a significant increase in the use by citizens and health care
professionals.
• Number of e-consultations per 1,000 inhabitants has increased from 5.61 before
pandemic to 33.10 after.
• Currently: 13,000,000 consultations (100.000/week), 20,000 professionals and more
than 2,000,000 citizens
• It has been a great tool in the fight against the virus, enabling citizens to receive remote
assistance (ie, sick leave), updating of electronic prescription plans or monitoring oral
anticoagulant use, among others.
Performing during the pandemic: eConsultations

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Performing during the pandemic: eConsultations

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Digital Health Strategy Plan

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• Consolidate a person-centred model of
information systems that enables
clinical and managerial decision-
making across the care cycle.
• Establish a governance model of
information systems with a solid
community support while ensuring care
continuity.
• Set out a financing framework to
ensure implementation and
sustainability over time
• Create environments and opportunities
to design and implement innovative
person-centred ICT-based care
services.
• Set out an ambitious roadmap, yet
realistic, which will allow a long-lasting,
successful and safe implementation of
the new model
Digital Health Strategy Plan. Goals:

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Digital Health Strategy Plan

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• AIM: to transfer core services, data and capabilities to a new paradigm based
on a knowledge-driven platform, within a service infrastructure and a
modern application development environment.
• We are building an INFOSTRUCTURE
• We will decouple data from applications, storing data in an open format
• This will enable data to follow the patient
Digital Health Strategy Plan

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The aim of such a platform is to allow health professionals to structurally
represent their knowledge with a longitudinal vision. This representation
becomes requirements for software development (transactional and
informational) in an automated manner
Knowledge-driven platform
• Separate semantic definitions from software and
databases
• Define a method of formal and explicit
representation of this semantics
• Be focused on the requirements of representation in
the field of Health
• Have tools that give autonomy to "knowledge
specialists" in the management of semantic
definitions
• Provide tools that allow the translation of this formal
semantics, highly complex, into software solutions

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• The longitudinal Electronic Health Record (EHR) for all the Catalan Health System is the main
piece of the Strategic Plan.
• Represents the functional and technical repository of all the information of citizens that need to
be registered and shared throughout the health system.
• It is not just, or mainly, a technological update, but a model for data management and an
architecture of information systems that corresponds to and anticipates the changes that are
taking place in the healthcare model in:
 citizen's relations with the healthcare system
 work processes
 relations between the professionals themselves
A unique Electronic Health Record

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Some functionalities:
1. Transactional capacity. The system could serve, at the same time, as
an ordinary medical record history system for organizations that cannot
afford to maintain and/or upgrade their current system.
2. Communication tool. Professionals interacting via the EHR must be
able to interact regardless of their profile, both among themselves and
with citizens.
3. Integration of the citizen’s personal data. When a professional deems
appropriate, viewing and integration of the data collected by the citizen
must be allowed either through the personal health folder or telehealth
and mobility health applications.
4. Integration of information from other healthcare systems.
A unique Electronic Health Record

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Some functionalities:
5. Service layer (API). Different APIs for accessing the information
contained in the unique data model should be developed. In this way,
professionals, service providing entities, and industry can develop
innovative services around the EHR.
6. Integration of information given by the patient about
complementary therapies not included in the Catalan Health Service
7. Advanced search system. A semantic system is required to easily find
information about a citizen or other fields or literal expressions within the
EHR.
8. Analytical repository of data. Available to providers to facilitate the
analysis of large amounts of data with reduced response times.
A unique Electronic Health Record

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Already a new viewer for the Shared Electronic Health Records
A unique Electronic Health Record

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Shared Electronic Health Record with specific section for chronicity
A unique Electronic Health Record

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New semantic search system
A unique Electronic Health Record
• More agile
• Predictive search: as
you type it shows the
results as you type.
• Tolerant of spelling
mistakes.
• Search in different
languages.
• Search by particles
(results independent
of order).
• Sorted by frequency.

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Big Data processing and analytics:
• A data repository with analytical objectives is part of the EHR.
• This warehouse incorporates:
 Data from healthcare processes and resources
 Data from different types of devices (medical technology or patients’
 External data from other sources of health information, both from
health, social services, justice, or education, among others) and from
networks, public records, and, in general, open data) and in different
sensors, etc.).
• The model is a combination of concepts and technologies from the Data
that will include a wide variety of processes and analytical tools.
Innovation and Digital Transformation

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Telehealth and Mobility:
• The use of these technologies should contribute to the evolution of the
healthcare model towards a more preventive and more personalized
model.
• These technologies must serve to establish new models of care and
communication channels between professionals and citizens
• Citizens must be offered the possibility of interacting with the healthcare
system remotely, to the greatest extent possible, and preferably from
their cell phone as this is the most widespread technology and it can
easily replace other remote care tools.
• The implementation of these technologies must be universal
Innovation and Digital Transformation

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Artificial Intelligence:
• AI is considered complementary and not a substitute for the work of
different health professionals to increase the value, quality, and safety of
healthcare practice.
• AI is based on the construction of information-based products and
services, such as assistants for speech or writing recognition, diagnostic
assistance, proposing or recommending treatments, responding to
consultations through natural language, recognizing patents and
predictions of behavior, or automating control and resource planning.
Innovation and Digital Transformation

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Artificial Intelligence:
Innovation and Digital Transformation

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The Internet of Things:
• The Plan proposes IoT to be a new source of data with great future
growth.
• There are numerous IoT applications in the healthcare field.
 scenarios where data on assets and infrastructure are collected within
hospitals or mobile elements (ambulances, hospital beds, people)
 scenarios where the data collected is from patients (sensors in
hospitals, at home, while moving about, etc.).
• Depending on the type of data collected, there will be different
technological, security, ethical, and legal implications.
Innovation and Digital Transformation

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The Internet of Things:
Innovation and Digital Transformation

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Views for the future:
• This will foster better integration and collaboration
• It will help scaling-up innovations
• We believe the key point is establishing a strong data governance
and industry
• We know this won’t be easy but political commitment helps!
Digital Health Strategy Plan

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Jordi Piera Jimenez and Oscar Solans Fernandez
Digital Health Strategy Office and eHealth Office.
Catalan Department of Health
For the provision of information and slides
Special thanks to

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Josep Vidal-Alaball
jvidal.cc.ics@gencat.cat
@jvalaball
While technology is important, it's what we do with it that truly matters
Muhammad Yunus