LOSC 25 years: the health information systems

30 Dec

Veva BarbaAnna Garcia-Altés





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.

Nurses with more responsibilities

17 Dec

Sense títol

Montse Moharra (@mmoharra), Dolors Benítez and Anna García-Altés (@annagaal)

The Department of Health provides the basis so that the collective can prescribe medication.

Nurses have increasingly more challenges on their plate. The health care is permanently immersed in innovative processes that improve health care and the services for citizens.

Since last summer, a working committee formed by members of the Department of Health, Catalonia’s Council of Nurses Colleges and Barcelona, Tarragona, Lleida and Girona Official Nurses College is developing a proposal to rule that this group may indicate, use and authorize the dispensing of drugs and medical devices.

In addition, the Department of Health, the CatSalut, the Catalan Health Institute (ICS) and other nurse entities have signed another agreement to improve aspects of the management autonomy, necessary so that its effectiveness and benefits can be exercised and collected by nursing professionals. Thus, among other aspects, it’s intends to continue improving the participation of these professionals in clinical management with more presence in the participating organizations, recognizing nurses’ professional leadership in primary care and improving the organization and management of the sector’s simplification and streamlining.

OIGS’ innovations in nursing management

Catalonia’s Observatory of Innovation in Health Management (OIGS), which incorporates advances within the Catalan health system to innovate different areas of management, has several experiences that focus on improvements affecting nurses. Indeed, two of the initiatives that received AQuAS quality certificate last September during the Third OIGS Conference were focused on innovations within this group.

One of the acknowledged experiences was ‘Integration of skilled nurses into the anaesthetist team for deep sedation in the field of digestive endoscopy’, driven by the service of anaesthesiology and section of digestive diseases and endoscopy unit of the Hospital Clinic of Barcelona. This project has established a special unit formed by anaesthesiologists and nurses specializing in sedation which has improved the service and support ensuring greater safety in this type of processes by giving more responsibility to nurses.

The ‘demand nurse’ experience of Castelldefels Health Agents (CASAP) was also awarded the quality certificate. This project has improved agility and increased encouragement in its primary focus of fostering nursing as a gateway to the system. Thus, it was able to attend to a series of consultations, such as traumas, vomiting and diarrhoea, skin lesions, genitourinary problems or emergency contraception. This initiative allows offering a quick and effective health care to citizens and the general practitioner can devote more time to other services.

Besides these two certified projects from over 180 projects registered in the Observatory, there are other initiatives that emphasize nurses as protagonists of the improvement in health management. This applies, for example, to projects for the implementation of online preoperative services or remote medicine to cure ulcers, activation of a specific high-resolution unit in rheumatic and musculoskeletal diseases that would further the nurse collective’s response capacity or the standardization of care systems. You can view these projects and other innovative experiences in the OIGS’ portal.

Unequal welfare, the present and future of social rights and benefits

10 Dec

foto_portadaGuillem López-Casasnovas

In El bienestar desigual (The Unequal Welfare), I analyze the deplorable state in which our welfare system nowadays finds itself. The title is not a pun, but an acknowledgement of the reality of a discontented citizenry, accustomed to expect more and more social protection.

The economic crisis brought about a certain degree of returning to the past. The lack of income growth and the consequent decrease in tax revenues, caused the customary levels of services with their new features that were taken for granted, to become financially unsustainable. Previously, social spending had been growing even above revenues, the recession at least slowed down its growth.

The outrage caused by sharing the costs of the crisis, the growing inequality of its incipient departure and perception that little or nothing has been done to immunize the economy against another future pandemic, have focused citizen’s hate towards social spending cuts. Consequently, political circles and citizens protest against austerity without assessing what has been achieved and without questioning how it has been achieved, whether the same or less may be better and even more reasonable when faced with potential waste; all of these factors erode financial sustainability and nurture professional corporations who want to be able to decide as self-employed and be charged as employees. Continue reading

Stratification and morbidity database

3 Dec

Foto Emili VelaEmili Vela, Head of “Modules for Tracking Quality Indicators” (MSIQ) Health Care Area, CatSalut

In recent years there has been an increase in the prevalence of chronic diseases partly due to increased life expectancy, an aging population and improved health care. These factors have also led to the emergence of patients with a high number of simultaneous illnesses with a high risk of de-compensation. These patients represent a relatively small percentage of the population but they use up a high amount of health resources. In fact, we can say that, with respect to chronic patients, multiple morbidity is the norm, not the exception.

In these circumstances, the stratification of the population at risk groups, which allows us to know and anticipate future health resources needs is an objective set out in several strategic areas defined in the Catalan Health Plan (2011-2015) and is especially relevant in the transformation of healthcare models (making them more proactive), in the treatment of chronic diseases (establishing target populations for certain actions) and the integration of health and social care levels. Continue reading