Veva Barba & Anna García-Altés (@annagaal)
The evolution of information systems in the last 25 years: from paper to benchmarking*
Since the adoption of the LOSC (Catalan health care planning law), we have witnessed profound changes that have occurred within and outside the health context. The health needs of the population and the ways in which they express them have cause a change in the way citizens relate to the health services. The development of nowadays’ society compared to the one of the nineties has given rise to concepts such as the right to information or shared decisions that twenty five years ago were hardly imaginable. On the other hand, we can foresee a wide range of opportunities for professionals and healthcare organizations that see information as a tool of irreplaceable proficiency in facing the challenge of meeting the population’s health needs with the available resources.
The transformation of health information systems for the past 25 years is the result of changes that have occurred in society and in the health system itself but would not have been possible without the impressive advancement of information technology and communication systems. The current information systems have been built according to each moment’s opportunities and priorities and despite not always having had a clear roadmap, we have been drawing a system model that is increasingly appropriate to fulfil its objective, allowing to relate the health status of the population with resource use and costs and to assess the achievement of the health system’s objectives in terms of effectiveness, efficiency and safety.
The current information system with its weaknesses and its strengths would not be conceived without the existence of some of its elements. The implementation of the individual health card and the register of insured people allow us to place individuals at the centre of the system, both in terms of health care management and in terms of service usage analysis. The computerized medical record with utilities such as shared history has been an element of improving continuity of care and efficiency. The process of purchasing and provision of services would not be conceivable without the MBDS or the pharmacy records.
At another level, the Health Plan and the health survey have facilitated the shift from a health system based on illness and curative care activity towards a new way of understanding health and service guidance. At the level of management and strategic decision making, the Central of economic balance of the nineties and Results Centre of recent years have allowed us to share information in order to evaluate different aspects of the health system. In the context of the Results Centre, one of the most important decisions has been the publishing of nominalised indicators.
In some care areas, the most sophisticated scanning technologies and image transmission function simultaneously with the manual forms, the absolute lack of registration, the most basic data storage and use. In the areas of planning and management we also witness the coexistence of all kinds of systems. The economic information systems allow a good insight in budgetary accounting but are yet to be sufficiently developed in terms of cost analysis. Generally, it’s still too difficult to obtain information on the health needs and on the services’ outcomes. Surely, the challenge of improving the extent of the services’ performance will accompany us for a while.
We’re still facing several challenges for the future. We must develop information subsystems in relatively deficient areas such as the supply of services; we must work to improve the balance between transparency and personal data protection, we must capitalize on the available information, thus facilitating the data access for as many users as possible.
The journey has been long and extensive, but our society and its technological context have also been transformed. The information system must be dynamic enough to adapt to future requirements and should be capable to do it in an environment of necessarily limited resources. The future changes ought to be consistent with a model of information system that all actors in the system know and agree with.
* This post has been adapted and translated from: Barba V, Garcia-Altés A. 25 anys de LOSC. L’evolució dels sistemes d’informació en els darrers 25 anys: del paper al benchmarking. El Referent 2015.
The article just published in the latest issue out of Referent dedicated to analyse the first 25 years of the LOSC.