Transcript Reducing Healthcare Costs in PHC throuh e

PISA, Italy
2011
430.084 inhabitants (2009)
503.762 users NHS (2009)
Surface area 4996 Km²
(320 km line coast)
Members per family – 2,5
(2001)
30000
Crude Birth rate – 11.1 ‰
GDP per capita 2002 - 2008
28500
25100
25000
24400
(2009)
Crude Death rate – 10.9 ‰
25100
24000
21500
(2009)
21400
20000
Natural growth rate– 0.02 %
15000
% Pop > 65 years – 19%
19500
20200
(2009)
(2008)
(EU average – 17.1%, 2008)
Ageing ratio – 122.8
2008
2002
10000
5000
Portugal
European Union
Andalucia
Sacsen-Anhalt
Algarve
Aquitaine
Umbria
East Midlands
Toscana
0
(2009)
THE HEALTH CENTRES GROUPS
ACES Barlavento
Head office in
Portimão
CS Aljezur
CS Monchique
CS Silves
CS Vila do Bispo
CS Lagos
CS Portimão
CS Lagoa
ACES Central
Head office in
Faro
CS Albufeira
CS Loulé
CS S. Brás Alportel
CS Faro
CS Olhão
ACES Sotavento
Head office in Tavira
CS Alcoutim
CS Tavira
CS Castro Marim
CS Vila Real St.António
Benefits of eHCD
(eHCD = eHealth Care Delivery)
Main focus on primary health care.

By connecting health workers to primary health-care centres and
connecting these centres electronically to departments and referral
centres in hospitals for the exchange of data, access and costeffectiveness may be effected:

direct tele-consultation between the community health worker and a
relevant hospital specialist can reduce professional isolation and
provide opportunities for continuing education to the community
health practitioner (e.g. tele-cardiologyfounded on the exchange of
digitalized
ECG,
digitalized
echocardiology
or
digitalized
stethoscopy and tele-radiology based on the exchange of digitalized
X-ray images). Tele-consultations take specialists to the primary
health-care level;

tele-consultations may reduce the need for patients to attend
hospitals, saving them both time and money. Hospitals may then
focus, their resources, on patients who may benefit from treatment
at the secondary level of health service;

similar advantages can be obtained through an eHealth-based
hospital referral system founded on digitalized data obtained
through applications of essential health technologies;

eHealth can become a key driver for improved cost-effectiveness
when applications such as electronic patient records, smart cards,
physician order entry, medications systems and digitalized
diagnostic equipment are available;
It is understood by 'telemedicine' the provision of health services
through the use of information technology and communications in
situations where the health professional and patient (or two health
professionals) are not in the same place. Telemedicine involves secure
transmission of medical data and information necessary for the
prevention, diagnosis, treatment and follow-up, through text, sound,
images or other forms.

Once processed and sent out to health professionals, the data can be
used to optimize the protocols for monitoring and treatment of the
patient.

ARS Algarve IP is starting a research project in this area with the
University of Algarve (UAlg) using a new technology that allows
exchange of information using the signal output on their own network for
free.

Teleradiology is a telemedicine service involves the electronic
transmission of radiographic images from one location to another with
regard to consultation and interpretation.
The
development
of
teleradiology
accompanied the gradual shift in medical
imaging technology of photographic film to
digital technologies.
Teleradiology
helps healthcare facilities to
cope with peak workload, the clock services,
reduce waiting lists for certain examinations
and, above all, to reduce costs.

Order No. 10864/2009 of the Secretary of State for Health, stated
the importance of creating an Electronic Health Record (EHR) then
appointed health record, so that "the clinical information of a citizen
is available to the own and the health professional who will provide
any one service in an appropriate manner but independent of time
and place of delivery. "
EHR
as a tool to induce efficiency and effectiveness in
providing health care, brings benefits to:
◦Citizens: Improving access to health services and
raising standards of quality and speed of service and
care received.
◦Health Professionals: Providing the necessary
information for the professional clinical decision
making and the provision of quality health services,
reducing
the
risk
of
error
in
interventions.
diagnoses
and

EHR as a tool to induce efficiency and effectiveness in providing
health care, brings benefits to:
◦ Health System Management: Reduce costs by avoiding the
replication of documents, efforts and resources, significantly
improving the management information with impact on efficiency
and support for the policy, at various levels.
ALERT® MANCHESTER and ALERT® UBU in the Algarve

ARSAL (the Algarve Regional Healthcare Administration) has just acquired two
software solutions for its Basic Emergency Units in Albufeira, Loule and Vila Real
de Santo Antonio. They are the ALERT® MANCHESTER and the ALERT® UBU.

By adopting ALERT® solutions, these Units are now able to register their
emergency episodes in a paper-free way. On the one hand, ALERT®
MANCHESTER will enable the patients triage by following the Manchester
Protocol. On the other hand, the ALERT® UBU will be used to register clinical
episodes, enabling the Units' integration with the Emergency Department of the
Faro Central Hospital (the main hospital in the Algarve region). This means that
from now on the transfer of patients will be done electronically and all clinical
documentation will be shared amongst all Emergency Units.
Emergent
Red
0 Minutes
Very urgent
Orange
10 Minutes
Urgent
Yellow
60 Minutes
Low urgency
Green
120 Minutes
No urgency
Blue
240 Minutes
Not Classified
White
Not classified
Request of the Xray in the ALERT
Technician receives the
request and performs
the scan
The doctor
sees the exam in the
ALERT via link
with SYNAPSE and
takes decisions
The
image is available
on the SYNAPSE

Set the Objective on deploying eHealth systems, setting
targets for interoperability and the use of electronic health
records telecare (the home monitoring of Patients) an
example is the health information networks link [ing]
hospitals, laboratories, pharmacies, primary care and social
centers.
Hemogram
Biochemistry
Request
on the ALERT
REGIONAL PUBLIC
HEALTH
LABORATORY
Via LAN
O
M
E
G
A
Results available in
ALERT
Troponin
Urine
Quality
control and validation of results
SIV
SIV
SIV
VMER
VMER
VMER
SIV
SIV
VMER
immediate-care ambulances (Lagos, Quarteira, Tavira and Castro Marim)
medical emergency and resuscitation vehicles (Portimão, Albufeira and Faro)
IMPLEMENTED AT
THE NETWORK
Computer applications of Primary Health Care
SIARS
AGILLE
FAMILY HEALTH UNITS
'eAgenda', an online service for booking medical
appointments and allows chronic disease sufferers to
request the renewal of their prescription in any Portuguese
healthcare Centre.
This measure aims to reduce the time to book appointments at
Health Centres and Family Health Units and at the same time
create a new channel with the community.
http://www.medicineone.net
For doctors, nurses and administrative MedicineOne provides the
contextual work modules that streamline the implementation of a
daily processes and promote effective teamwork
Continuing Care
With the creation of new Continuing Care Network, the MedicineOne
been improved to meet the specific needs of these health units,
particularly in relation to billing rules in force in such units.

ARS Algarve starts implementing ALERT® PRIMARY CARE
“A contract has been signed to introduce the clinical information system ALERT®
PRIMARY CARE in two Primary Care Centers in Algarve. “ (JANUARY 2006)

ALERT® REFERRAL adopted by 11 hospitals and 90 Primary Care
Centers
ALERT® REFERRAL is a software for interconnecting Primary Care Centers
and Hospitals, which allows for management and clinical prioritization of
referral requests. This contract includes hospitals and Primary Care Centers
from all 5 Health Regions in Portugal (North, Center, Lisbon, Alentejo and
Algarve). Sites will be operational by January 1st 2007.

ALERT® DATA WAREHOUSE (ADW)
ALERT® DATA WAREHOUSE (ADW) is ALERT®’s analytical reporting tool, which
supports clinical and resource management in healthcare.
http://www.his.pt/

The results of partnership between the HIS and PT Prime. It is an information
system oriented integrated management of the clinical process of the
user,
the
administrative
and
financial
activities,
able
Primary
Care,
to
ensure
the management of health facilities.

It
is
a
versatile
Care,
solution
that
Hospitals
covers
and
Continuing
Clinics,
which
ensures confidentiality and supports the differentiation of profiles in the
handling
of
of
information,
information,
through
and
will
action
classifications of clinical decision support.
also
help
protocols
improve
and
the
quality
international
Software SINUS-SONHO (for administrative work)
ACSS
http://www.manualsam.com
Description
SAM/SAPE is a computer application in Web technology that is based on
the
database
SINUS/
SONHO.
This
system
is
geared to business and allows the physician/nurse to integrate clinical
applications in accordance with the needs and priorities of each hospital and
Health Center.
http://www.first-global.com
Siima
is the information system (cervical screening) that addresses all
the functional circuit involved in registration and monitoring of the user
at all stages of the process from the invitation to the initial examination
to treatment and follow-up.
This
solution is designed to ensure a high degree of complementarity
with other hospital information systems (HIS) and other clinical systems
involved in the process for registration of examinations and diagnoses.
http://www.roche.pt

Omega 3000 – is integrated solutions for laboratory diagnostics,
including the increasingly important information technology systems.
The laboratory information system Omega 3000, together with the
weblab module, permits highly efficient management of laboratory
processes and diagnostic data in specialty laboratories concerned with
areas such as microbiology, blood banks, newborn screening,
pathology, histology, transfusion management, genetics and HLA
typing, as well as point-of-care integration and quality management.
SIARS
AGILLE
http://www.agille.comt

The main sources of information in SIARS are:
◦ MedicineOne
◦ SINUS
◦ SAM/SAPE
◦ Alert
◦ Vitacare
To
the
development
and
investment
in
eHealth
infrastructures and applications We have executed a co-
financing project as well as funding from European
Structural and Regional Funds (POCTEP)
Thank you
Very much