Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative

1. Leaders in Health IT Symposium - Regional Panel
Benefits of a long term e-Health strategy at regional level
José L. Rocha
General Secretary for Quality and Modernization
Regional Health Ministry
Andalusia Region - Spain
josel.rocha@juntadeandalucia.es
Quick facts of Andalusia
8,415,490 Inhabitants
87,597 Km2
Regional responsibility on health policy and healthcare since 1984
1,146 Primary Care Centers
47 Public Hospitals (16,281 beds)
9,390.2 M € Healthcare Budget 2011
Andalusia

2. E-Health: Improving quality of care and
reducing health and social care costs
100%
Healthy, Community
independent living Clinic
Chronic Disease Doctor's
Management Office
Assisted Living
Quality Skilled Nursing Specialist
of life Facility Clinic
Community
Hospital
ICU
Graphic from NHS/BT Global Services
HOME CARE RESIDENTIAL CARE CLINICAL CARE
0% €1 €10 € 100 € 1,000 € 10,000

3. Main objective of the Andalusian e-health
strategy (the DIRAYA project):
Integrate all the healthcare information of every patient
in a Single Health Record for each citizen

4. EHR in Andalusia: main features
• A long-term Strategy: From 1999
• Unique health record number for all citizens of Andalusia
• A individual smart card for each person as a key for access
• A regional EHR shared among:
– Primary care
– Pharmacies
– Hospitals
– Emergencies

5. Much more than an EHR:
A corporate information system
Appointment Prescription
Referrals
Waiting lists Pathology
Hospital Lab tests
admission
Functional
Data tests
warehouse
Radiology
Emergency Inpatient care
care
Primary care Outpatient
care

6. Current extent of the development
Completion level Tool Population Cases in 2010
▌▌▌▌▌▌▌▌▌▌ Clinical Station 100% 7.9 M Pat / 39.7 M Sheets
▌▌▌▌▌▌▌▌▌▌ Appointment 100% 83 Million
▌▌▌▌▌▌▌▌▌▌ Referral tool 100% 3 Million
│▌▌▌▌▌▌▌▌▌ e-Prescription 99.5% 105 Million
│▌▌ Analysis 25% 360,000
▌▌▌▌▌▌▌▌▌▌ CS-Hosp. Emergencies 100% 3 Million
▌▌▌▌▌▌▌▌ CS-Outpatients 80% 1.1 Million
▌ CS-Inpatients 10% 916,890
▌ Admission 10% 60,000
▌▌▌▌▌▌▌▌▌▌ Appointment 100% 12 Million
│▌▌▌ e-Prescription 33% 99,778
│▌▌ Analysis 25%
│▌▌▌▌▌ Radiology 52% 3.4 Million
▌ Out of Hosp. Emergencies 10%

7. Primary Care appointments after the introduction
of e-Prescription
38 Million visits
-15.28% saved from 2006
56.522
47.910
Before After
6 months trial with the
same cohort of population

8. e-Prescription % by INN (International
Nonproprietary Name) and estimated savings
84
77,1 78,6
446.1 Million € 75,2
70,9
saved from 2001
63
57,7
46,6
25,7
2,7
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

9. % of sample id errors and results delivery time (p70)
after the introduction of the e-Lab module (MPA)
6 23
-76.32%
5
0
Before After Before After
% of id errors p70 time, hours

10. Cumulative economic performance
900.000.000
800.000.000
700.000.000
600.000.000
500.000.000
EUR
400.000.000
300.000.000
200.000.000
100.000.000
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Present value of cumulative costs Present value of cumulative benefits

11. Lessons learnt: warnings/risks
•Unrealistic expectations
•Technology fascination: e-health as an objective itself
•Insufficient IT training of healthcare workers
•Underestimate preparation for implementation
•Inadequate IT infrastructure
•Disappointing short-term results

12. Lessons learnt: keys for success
• Align the EHR development with the regional government’s
health strategy, supporting it
• Integrate the projects needed for each module into a single
project that delivers interoperable all the information
• Step by step implementation assuring its use after a carefully
designed piloting
• Ensure that the project horizon is long enough, so that there
is enough time to involve stakeholders and to adapt the
system accordingly.
• Bottom-up approach: critical role of health care professionals
in the design and development.
• Strong political support in the long run

13. Thank you very much!