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Health online

One of the Quality Plan’s main priorities is to promote the use of Information Technology (IT) within the NHS as a way to improve the care provided to citizens. To this effect, the Plan includes the functional and technological elements required for interoperability between the systems of each autonomous community:

• A reliable system for user identification: the NHS Health Card.
• The computerisation of the clinical records of each user or patient: Electronic Medical Records.
• An electronic prescription system, or e-prescribing, which is an electronic means of performing all the procedures necessary to provide pharmaceutical services to
patients and users (prescription, authorisation, dispensation).
• Mechanisms that improve the accessibility of the health services, such as centralised appointment-making by phone (Teleappointments), and methods for distance diagnosis and treatment, to reduce unnecessary visits to health care facilities (Telemedicine).

The Plan Avanza, managed by the Ministry of Industry, Tourism and Trade through its public company has led to a Framework Collaboration Agreement funded with 141 million euros for the 2006-2009 period. All the autonomous communities have benefited from these funds through bilateral agreements signed with, in coordination with the Ministry of Health and Social Policy.

In addition, the Ministry of Health and Social Policy has, during this same period, allocated another 4.9 million euros of its own funds for territorial cohesion policies, such as the development of IT infrastructures put in place by the autonomous communities to improve health information and to further efforts towards Electronic Medical Records in the NHS.

Review 2006 - 2008

The Electronic Medical Records for the NHS project was formally adopted by the Interterritorial Council on 10 October 2007. The pilot phase has already begun in two autonomous communities (Balearic Islands and Valencia) and in the coming months it is expected that eight more will become a part of it. The evaluation of the pilot is set to take place at the end of 2009 and, save unexpected difficulties, its deployment in the NHS will begin in 2010. The commencement of the pilot and its extension to the rest of the autonomous communities have been possible thanks to the attainment of the following objectives:

• An NHS Health Card database common to all the autonomous communities, which gives an exclusive ID code to each citizen. This database is managed by the Ministry of Health and Social Policy, by the autonomous communities themselves (Catalonia and the Basque Country are currently in the incorporation phase) and by the National Institute for Health Management (INGESA).
• Approval by the Interterritorial Council of an agreement regarding the basic information that must appear in all clinical reports within the NHS. The agreement is based on the proposal prepared by 30 scientific societies specialised in the field of health.
• The agreement regarding functionality and the conditions of access and use of the clinical data in the NHS, also approved by the Interterritorial Council. This agreement is based on a proposal prepared by the 30 aforementioned societies, plus others from the field of health law and bioethics, and also by citizen associations. In addition, the proposal was debated by a group of experts from the autonomous communities before submitting it to the Interterritorial Council for approval.
• A Health Intranet that the Ministry has put at the service of the Electronic Medical Records project and that allows for information exchange between the autonomous communities through the Data Centre used for the exchange of NHS services. This system has the appropriate security measures, because a Back-up Data Centre supports the Data Centre and because this infrastructure has received ISO 27001 certification on information security.

The Health Online project has provided the autonomous communities and the Ministry
with infrastructures and related services:

• 60,000 computers supplied to over 6,000 health care facilities, where more than 33 million citizens receive care and 250,000 professionals work.
• Provisioning and configuration of servers, data storage, radiology displays and equipment, integration services, networking equipment, deployment of WiFi services and access points, telemedical equipment and cabling for medical consultation offices.
• Implementation support for e-prescribing in two autonomous communities (Cantabria and Murcia), with interoperability features.
• Capacity of the NHS Data Centre increased and a Back-up Data Centre put in place. Also, an Information Security Management System has been implemented and has recently received ISO 27001 certification, awarded by the Spanish Association for Standardization and Certification (AENOR).

As part of the e-Health initiative of the European Commission, Spain is participating, along with 12 other Member States, in a European project on the exchange of clinical information (epSOS project). The Ministry of Health and Social Policy and the autonomous communities of Andalusia, Castile-La Mancha and Catalonia are participating as beneficiaries and are at the helm of some of the essential project definition activities.

Activities planned 2009 - 2010

The rate of progress made in this strategy to date needs to be maintained, by strengthening the achievements of recent years and working towards the extension of the services mentioned to the NHS as a whole. For this purpose, the Ministry of Health and Social Policy has signed a new framework agreement with the Ministry of Industry, Tourism and Trade and its public company The agreement involves economic support for the autonomous communities in the amount of 101 million euros during the 2009-2012 period. Collaboration agreements with the autonomous communities will be signed to address in greater detail the actions of the projects covered by this strategy. The objectives are as follows:

• To guarantee the unequivocal identification of each citizen anywhere in the National Health System.
• To have a clinical information access and interchange system available, to be used by different professionals, health care facilities and autonomous communities.
• To promote e-prescribing, with a view to extending it to the entire NHS.
• To guarantee the information’s accessibility, interoperability and appropriate use from anywhere in the system.

In order to guarantee the unequivocal identification of citizens throughout the NHS, by means of the NHS Health Card and the database on the population served by the NHS, the following actions are envisaged:

• Working with the autonomous communities to increase accessibility to the shared Health Card database from all the care facilities in the NHS.
• Identifying, together with the autonomous communities, areas in need of functional improvement in the application that manages the Health Card database, and beginning to work on them.
• Designing, with the administrations in charge of the health protection system, the statistical analysis to be performed on the health card database.

To make progress in the area of Electronic Medical Records and to facilitate clinical information interchange between different professionals, health care facilities and autonomous communities, the following actions are planned:

• Concluding and evaluating the pilot study among autonomous communities, designed to test everything defined in the Electronic Medical Records project, making any modifications that may be called for, and beginning its extension to the NHS as a whole.
• Incorporation of Spain into the International Health Terminology Standards Development Organisation (IHTSDO) and creation of a technical development platform aimed at implementing SNOMED (Systematised Nomenclature of Medicine-Clinical Terms), to achieve semantic interoperability in the NHS through the use of a standardised
clinical terminology.
• Participating actively in the interoperability project within the European initiative e-Health (epSOS project), playing a leading role in different phases of the project.

To promote the electronic prescription system in the NHS, the following actions are to be undertaken:

• Establishing the criteria and technologies that will make it easier for users to benefit from the pharmaceutical service, simplifying as much as possible the steps necessary to ensure the continuity of treatments throughout the NHS.
• Defining the basic functional specifications that any electronic prescription system must have in the context of the NHS.
• Defining the functional requirements that the electronic prescription system will need to have in order to make it operational between autonomous communities.
• Deciding on a technical design for the electronic prescription system in the NHS.

To guarantee the information’s accessibility from anywhere in the system, as well as its interoperability and appropriate use, the following actions are to be undertaken: Communication networks:

Communication networks:

• Improving electronic communications with the necessary bandwidth, to ensure successful completion of all transactions within the information systems.
• Implementing services by which to monitor, maintain and analyse the use of the network.
• Implementing security and contingency plans that guarantee maximum stability for these systems, depending on the type of function supported.
• Installing and upgrading networking equipment used by the agents participating in the system.


• Developing the catalogue of online services, bearing in mind the needs of the autonomous communities.
• Defining the functional and technological standards as well as the exchange formats.
• Assisting in the adaptation of the systems to the standards defined by the NHS and by the standardisation bodies in which Spain participates.
• Developing and maintaining the information systems that enable interoperability between the autonomous communities through the Data Centre.
• Setting up a common area devoted to best practices, by which to share applications and elements used in the autonomous communities.

Use of data:

• Developing and implementing specifications for tools used to access the NHS Health Information System.
• Implementing systems for the display, publication and distribution of data and indicators.
• Maintaining the data storage system, acquiring the elements necessary to ensure data availability and security, and complying with the requirements of the Spanish Law on Data Protection.
• Guaranteeing compliance with existing legislation on the protection of personal data in systems that include this type of data.

Health Online
Plan Avanza funded by the Ministry of Health and Social Policy and, in the amount of 145.9 million euros for the 2006-2009 period and 101 M euros in 2009-2012.
Enhancing the NHS Health Card database and improving its accessibility Electronic Medical Records of the NHS.
• Project approved by the Interterritorial Council on 10 October 2007:
-Basic information common to clinical reports, agreed by 30 scientific societies and the autonomous communities
-Functionality, conditions of access and use of the clinical data, agreed by 30 scientific societies, citizen associations and the autonomous communities
• NHS Health Card database in the Ministry of Health and Social Policy, common to all the autonomous communities, which assigns an identification code to each citizen. • Ministry of Health and Social Policy Health Intranet at the service of the project.
• Finalise and evaluate the pilot of the electronic medical records project and extend it to the rest of the NHS.
• Create within the Ministry of Health and Social Policy the technical development platform with which to implement SNOMED.
Promoting e-prescribing in the NHS.
Continue advancing towards interoperability in the NHS.
European project on cross-border interchange of clinical information (epSOS project)
• Spain is participating, along with 12 other Member States, in a European Project on the exchange of clinical information. The Ministry of Health and Social Policy and three autonomous communities are involved as beneficiaries.