EHTO Trends in Health Telematics in the European Union
Health Information Systems are central in the strategy of the Spanish National Health System
Health Information Systems are becoming increasingly integrated into the strategy of health care organisations at all levels. Strategy is orientated to the creation of an integrated information system, including administrative, clinical and social-demographic data. Telematics is now attracting interest throughout the health service.
Background
The Spanish public health system, "Sistema Nacional de Salud" (National Health System), is formed from the Health Services of the State Administration and the Health Services of the Autonomous Communities (regional governments).
At the State level, general coordination of health policy, international affairs, and the regulation of pharmaceutical products are dealt with. All other health activity is to be organised by the regional authorities, apart from public-health functions which are assigned to local authorities. To date, health competencies have been transferred to the Autonomous Communities of Andalucia, Catalonia, Basque Country, Valencia, Galicia, Navarra, and Canary Islands. The National Institute of Health (INSALUD) manages health care services in the rest of the country.
The Spanish National Health System is based in the principles of university, equity, solidarity and public funding. Its objectives is to provide integral care including health promotion, and preventive care. The concept of "health services" includes also the right to information, the right to privacy, and the guaranty of quality.
Public health services covers the 99% of the population, about 40 million citizens. In addition, a variety of private services are offered ranging from international companies to independent professionals. There are 40 insurance companies operating in Spain serving about 5.5 million people around 14.2% of the population. As with other European Member States, the Spanish health system is faced with the need to satisfy a growing demand of services and increasing requirements of quality but being constrained by limited budgets.
Strategy in the public system has been concerned with setting boundaries to health expenses. Main actions have been oriented to: the definition of the service provision; the separation of the roles of insurance, administration, and provision of the services, and the promotion of new organizational structures.
Scenario and trends
Health telematics in Spain presents a rapidly evolving scenario. The increasing decentralisation of health care competencies, and the transfer of power to the Regions have resulted in proliferation of policy forming structures and decision making bodies. IT&T Strategy development in health care is strongly variable depending on technical literacy and different attitudes toward innovation of the organisations.
Strategic factors
Some strategic factors are particularly relevant in assessing on the major trends which will characterize the health telematics development in Spain:
- the general economic situation, especially the impact of the single European currency.
- the structural changes of public health care organisations
- the evolution of IT&T products and services
- the regulatory framework
- the impact of different political options between regional and central governments.
Current position
The potential of telematic technologies in solving health problems is increasingly recognized by health organisations in Spain. Some current strategic actions are:
- The promotion of standardization in health telematics by supporting the activities of the national technical committee AENOR - CTN139 and improving the co-operation with the CEN-TC251.
- The development of pilots and demonstration projects with co-operation between technology providers and users. Key applications include communications, integrated emergency services, and telemedicine.
- Development of Health Research Network (REUNI) linking 160 health centres in Spain, by providing Internet connectivity.
The majority of the commercial applications being used in the Spanish health sector are oriented to specialised care and, particularly, to hospital management. INSALUD is developing several projects concerned with the information system in the public health care sector. The most relevant ones are concerned with
- Information System for Primary Care Centres (SICAP)
- Project: Information System for the Pharmacy Service (SIFAR)
- Project: Integrated Management System for Hospitals (SIGNO)
Regional health services promote similar applications, and R&D projects implemented include activities involving primary care, health records, telemedicine, mobile communications, EDl and health area communications. Most Medical Professional Organisations are involved in providing telematic services to their members.
Main Barriers to IT&T implementation
Whilst there are many factors assisting in the widespread adoption of health care telematics in the Spanish health system, there are a number of barriers inhibiting development. These include administrative constraints due to legal requirements, resistance from health care professionals, and budget constraints.
Major Trends
Very recently suppliers have adopted a new approach, oriented toward problem solving and satisfying user needs, rather than being product oriented.
For the user side, a recent health sector survey indicates that main benefits would be in the following areas:
- facilitating patient management
- facilitating resource management and the widespread usage of computerized health records
- facilitating communication and co-ordination between health providers.
- supporting clinical and epidemiological research
- facilitating professional continuous training and access to medical literature and scientific knowledge
There are a indications of an increasing demand for integrated solutions to enable communication between primary/community care and hospitals. In addition telematic solutions for home care services, such as assistance for the handicapped and elderly, are likely to grow rapidly, as are use of network services and multimedia. The development of the patient data card is possible if the cost can be contained. In any event there are very significant implications for education and training for health professionals and managers.
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