María Jesús Montero,
Regional Minister of Health,
As the Member States of the European Union continue to make progress in implementing eHealth tools and solutions, regional plans are already well under way in some Member States. One such notable case is that of the Andalucía Region in Spain, which has developed a ‘universal’ health system aimed at fostering social equality amongst the region’s eight million inhabitants.
Founded on the belief that research and development efforts should go hand-in hand, the creation of the Andalusian public health project has, from the beginning, been a public / private collaboration. Led by innovations in the public health system, the system itself has become a driver of the economy. Using technology to improve the relationship between providers and patients, the main goal is that ICT should help to achieve fairness and combat inequality between citizens throughout the region.
The cornerstone of the Andalusian eHealth strategy is the Diraya initiative. Diraya incorporates all the health information for each citizen into a single electronic health record that is integrated into the entire healthcare system. The record is accessible by primary care physicians, at any health-care centre in Andalucía, as long as the user authorises its use. This health card is seen as the component that enables access to the single clinical record between hospitals and primary care centres, ultimately enabling the continuity of care. Diraya consists of several components, amongst which the electronic prescription (Receta XXI), telemedicine and emergency response (SALUD Responde) components are central to the initiative’s success. The electronic prescription component allows citizens to renew their prescriptions without having to return to their healthcare provider.
Meanwhile, the telemedicine component connects rural areas hospitals, allowing healthcare professionals to treat patients at a regional level and assists in the transfer of knowledge between professionals – which is seen as one of the biggest benefits of the initiative. SALUD Respondeis a health response system that connects the entire health system and is accessible via the Internet, telephone and next-generation mobile phone technologies. (to clarify: Salud Responde is like the NHS Direct in the UK).
In an interview with María Jesús Montero, Regional Minister of Health, Andalucía, at the recent World of Health IT conference (Geneva, 10-13 October), we asked about her perspective on the Andalusian eHealth strategy:
What have been the major drivers of the eHealth initiative in Andalucía?
Ultimately, the political will - not only of the services to becoming ones that enable citizens to have the right to universal access to whole society, but also of the government -was responsible for pushing the initiative through. The strong leadership in the government was strategic for the entire region.
The most important aspect of the strategy was to make changes in healthcare organisations from being organisations providing services to becoming ones that enabling citizens to have the right to universal access to citizens to have the right to universal access to healthcare services and the freedom of choice in choosing their own doctors. In order to guarantee these rights, a powerful information system was needed to support and track the care provided throughout the entire healthcare system.
Another important aspect was the universal public financing of the healthcare system, which needed decision support to provide the right data to ensure the ultimate objective: the sustainability of the health-care system.
What were the main challenges faced in implementing this initiative?
First and foremost, it was a huge financial effort just to create and support the infrastructure. It was critically important that we allowed enough flexibility to make necessary adjustments to the budget as the project progressed. Secondly, we needed to change the culture of healthcare organisations and professionals. The idea was not really to reorganise the entire healthcare system, but to reorganise the care process to provide continuity of care.
From a high-level perspective, what are the biggest benefits that have been realised as a result of the eHealth strategy in Andalucía?
From a political point of view, three main benefits have resulted from the strategy. First, the sustainability of the system allowed for changes to be made (as necessary) and has reoriented the healthcare system to focus on the citizen (rather than the other way around). Second, the electronic clinical record has been important not only for the clinician to see the patient’s health data, but also to empower citizens to choose their own doctor and always have their health information available. Third, the quality of care has been improved and we now have greater access to data that is critically needed for future planning.
The Andalusian eHealth strategy has received a lot of recognition across Europe – do you think that it has practical application in other regions across the EU / is it adaptable enough to serve as a model for others to follow?
Yes, definitely! By using events such as this conference and linking people together to share their experiences, best practices and benchmarking, we are able to learn from each other.
It is especially important to share the best parts of this project with others, and to also learn from their experiences in their own Member States or regions. This knowledge sharing, not just from the perspective of institutions, but also from public / private partnerships, encourages the industry to provide the best possible technologies in order for these types of eHealth strategies to be the most productive and beneficial to all of the stakeholders involved.
If you could offer one main lesson learned as the result of the Andalusian eHealth experience to other regions or Member States across Europe who are looking to begin similar projects, what would it be?
Before embarking on these types of initiatives, it is critically important to have a strong commitment from the administration, not only in the interest of technology itself, but in using technology as a tool for change.
First, the structure of the healthcare organisation must change to allow the reshaping of the previous model to become one that is citizen-centred.
Secondly, the sum of the efforts is the most important element – not in focusing on creating new technology, but becoming innovative in using existing technology differently in order to reach the final goals.
Thirdly, the most important factor in the construction of an electronic health record, the basis of any eHealth change, is the buy-in of eHealth professionals. It is essential to the success of the adoption of an electronic health record that eHealth professionals take an active part in the process. (400 healthcare professionals participated in the Diraya project).