Catalonia is an autonomous community inside Spain and has full powers regarding its citizens' healthcare. It is developing a National Healthcare System that grants assistance to every citizen, over seven million in 2006, and where different services are requested to different providers.
The ICT Strategic Plan 2008 – 2011 focuses on two groups: Citizens and professionals. The plan seeks to guarantee citizens' right to access information and to support the task of professionals to improve the quality of healthcare assistance. The department is developing a leadership role in the ICT sector, promoting both the image of Catalonia as an innovative territory and the participation of all healthcare actors.
There are four key ICT projects in Catalonia: Telemedicine, electronic prescribing, medical image digitisation and the Personal Health Folder (see Figure 1). These systems are interconnected; the focus is on interoperability. The forthcoming HC3 will be connected to other strategic projects such as the digitalised medical images central repository or the Catalan Cancer Register, both developed under the Catalan Health Department leadership. Through the implementation and interconnection of different products like we have just mentioned, we are building up a very solid HC3 in terms of healthcare continuity and we are also forcing the establishment of a high quality communication network.
The Health Personal Folder (HPF) is a space where the Catalan Department of Health will store and offer to all Catalan citizens, through the Internet, relevant information about their health status. This project represents the evolution of the Shared Medical Record of Catalonia, where not only health professionals will be able to access health information. The development of this project is based on a new concept identified by surveys made to the population, who demand more information and access to their health records.
The main principles and objectives of the HPF are as follows:
- The citizen as owner of his data;
- To generate confidence in the system;
- A shared model of information management, and
- The use of communication standards and catalogues.
- Encourage citizens' co-responsibility for their own health;
- Enable the participation of citizens in the management of preventive actions and healthcare, and
- Improve the quality of care, the coordination between different healthcare levels and between the professionals involved.
The overall goal is to reach an interactive model of consultation and work between patients and the health system (professionals included) to promote citizen's commitment to their own health.
There are clear benefits for all the relevant actors involved. For citizens, they have more autonomy, there is more emphasis on prevention and monitoring and the HPF can be recognised as the main source of health information. For healthcare providers, HPF brings a unique view of health services and reduces errors and redundant tests. For the government, the HPF allows for the better and more efficient use of health resources and as a result of increased prevention and citizen commitment to their health, cost reductions.
Currently, the PHF has some functionalities and information available to the citizens. As well as the basic consultation like prescribed medicines, medical reports, etc, some virtual procedures are available at the virtual office. Specifically important are those related to patients who are diabetic, pregnant women, and blood donors.
Due to the information available in the future model of the HPF, it will directly change the relationship between patient, doctor and administration. Citizens are more implicated in the care of their own health and there are a wide range of procedures available and information is personalised. Through the PHF procedures and consultation are simplified and all actors can make better use of available resources. In order to extend the functions of the HPF with new features and to boost the new relationship model between patient-physician-administration, the key concept is interactivity.
A usability study of the PHF was conducted during 2009 in Calella based on a group of approximately 100 people. Following this study, a survey was carried out on the participants showing unanimous support and acceptance of the PHF. Although July is a month where many people begin their holidays in this city, 217 citizens accessed the PHF. More important is the fact that they made an average of 2.2 activities. They do not access only the first page, but to consult and make use of other functionalities available.
Outlook for the Future
New features will gradually become available, improved and expanded and with special attention to those points that enable the citizen to upload their own information and self control tools. The health department has been expanding the PHF throughout Catalonia since the usability study. The deployment has been gradual, starting with cities of 20,000 inhabitants and communities with specific patients/citizens (blood donors, diabetics) and was subsequently extended to the whole territory. Finally, and with interactive functionalities available, one of the new projects being carried out is a pilot to secure access through mobile phone due to the widespread tendency and importance of these devices in citizens' lives.