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.

21 experiences receive the certificate at the Third Edition of Centre for Innovation in Health Management in Catalonia (OIGS)

29 Oct

Sense títol

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

Students at the Pompeu Fabra University can respond to the challenges arising from the  OIGS (Centre for Innovation in Health Management in Catalonia) innovation community

Over 600 health professionals met in Barcelona on Monday September 21st during the Third Edition of the Centre for Innovation in Health Management in Catalonia (OIGS), which was attended by the Minister of Health, Boi Ruiz. During the ceremony, 21 innovative experiences received the quality certificate.

The Minister welcomed the involvement of health professionals in “responding to our major concern, which is to improve healthcare” and gave “thanks to the people who believed that the best way to change things is do it from within.” It also found that OIGS is a project of “an extraordinary dimension” and that its current numbers (189 experiences and more than 500 users) denote its consolidation. He also stressed that in times of budgetary constraints, they are undertaking pioneering improvements in the health system to help improve the health care for citizens. Continue reading

Angus Deaton: the Nobel laureate concerned about health inequalities

22 Oct

Sense títolAnna García-Altés, @annagaal, Head of the Catalan Health System Observatory

Last week, on Monday, we found out that the Swedish Royal Academy of Sciences awarded the Nobel Prize in Economics to Angus Deaton a 69 years old Scottish laureate. 

Dr. Deaton, qualified in mathematics, did his PhD at Cambridge University, but has developed his academic career at Princeton University. The committee granted him the award for his work in consumption analysis, poverty and welfare and their applications in microeconomics, macroeconomics and development economics, which has influenced both the politics (and policy-makers) and the scientific community.

deaton A

One of his main achievements has been the development of a system used to estimate the demand for various goods, which is currently the standard tool for measuring the effects of the economic policy, in order to build price indices and to compare the welfare levels of different countries and different timeframes. He also undertook various studies linking consumption and income whilst his most recent work is assessing welfare and poverty mainly -but not exclusively- in the developing countries. In addition to his research subjects, Dr. Deaton’s work is also remarkable for the breadth of methodological approaches used, from theoretical models to the use of econometric methods, mainly household surveys (which is one of his areas of expertise); his knowledge of the data quality commonly available and his careful construction of accurate measurement results. Continue reading