Is eHealth taking a siesta in Spain?
eHealth has taken on major steps in Spain ever since the introduction of the electronic prescription a few years ago. Leading institutions, and even some regions, are paving the way with innovative solutions.
But in a country with 17 autonomous governments and health ministers, electronic healthcare advances at different speeds. Whereas Catalonia managed to anchor wearable data to the electronic patient record (EPR), Andalusia has not finished accrediting a basic number of applications, a process which started years ago.
The full potential of eHealth is not being utilised in the peninsula and national benefits are still a long way off, according to Carlos Mateos, Vice President of the Spanish E-health Researchers Association.
"Healthcare professionals are currently not able to access or share the EPR, the patient’s electronic clinical history, on a national level, because each region uses a different system," he said.
Worse, systems are often incompatible within the same region, all of which has a negative impact on healthcare delivery.
"Health facilities within the same region don’t necessarily use the same criteria or data. That’s a mess. There should be just one system. Having to repeat the same examination in another region or hospital costs money, and having to carry around a whole box of examination results is just absurd," Mateos said.
A national agenda on digital affairs does exist, but only to issue recommendations. It is really up to the regions to organise themselves and develop common strategies regarding eHealth. Some co-operate and exchange data, but others just ignore each other.
Appetite for apps
Nonetheless there are common trends on the national scale. Spaniards are still avid app users, and physicians are no exception. Over 250,000 now use idoctus, a platform that offers updated scientific content from over 160 publications.
This appetite has opened opportunities in healthcare. Primary care doctors increasingly recommend apps to their patients, especially those suffering from chronic diseases like diabetes, to help them manage their condition, according to Mateos.
Many Spanish innovations are targeting chronic patients, the biggest consumers of healthcare. According to Osakidetza, the organisation running public healthcare in the Basque country, 80% of interactions between patients and the public healthcare system are related to chronic conditions. Patients suffering from chronic diseases also consume over 70% of total healthcare cost, the organisation reported.
Remote monitoring for this population in the Basque country is rising. In 2016 Osakidetza attended 61,109 chronic patients and 31,000 other patients – 5.5% more than in 2015 – using remote technology.
The Basque e-Suite
Basques were among the first in Spain to embrace eHealth. Their EPR model, Osabide, was launched five years ago and is now used across 21 hospitals and 300 health facilities in the region.
Sharing the same EPR has had a very positive impact on the quality of healthcare, according to Susana Iglesias Tamayo, Head of Applications Development and Maintenance at Osakidetza.
"Using unique procedures, clinical guidelines and alert systems has enabled us to perform deeper analysis. We have saved both time and effort using the same EPR, and it has improved clinical efficiency and productivity," she said.
The organisation has also released a number of applications to enable physicians and patients to access medical reports or get in touch outside of the hospital. Patients are increasingly using a tool called Osasun to access their health records directly from their smartphones and tablets. "We’ve had 72% more consultations through Osasun in 2016. Over 200,000 accesses have been registered and 43,000 persons have accessed at least one of the services offered on the platform," Iglesias said.
Osakidetza has also released apps for professionals within the hospital, for instance nurses providing bedside care. Nurses assessing vital signs, taking blood tests, administering medication administration and nursing care techniques now have the possibility to do so using apps on their tablets.
Results measuring the effect of these tools are not available yet, but they are expected to decrease the number of errors in medication administration or when entering data while performing tests.
Outside the hospital, healthcare professionals may also access part of the EPR to attend patients from home or write them a prescription.
Basque physicians may also use an app to manage cardiac arrest when it occurs outside the hospital. The tool is supposed to help users improve their knowledge and response when dealing with a cardiac arrest patient, notably by improving their ability to use defibrillators.
Wearables: An uncertain future
Projects using wearable devices are multiplying in Spain, especially for diabetes or cardiovascular disease.
At Ramón y Cajal Hospital in Madrid, cardiologist David del Val is working with intelligent clothing to detect arrhythmia in patients who have suffered ictus. In a study comparing 150 patients using either wireless or conventional cardiac monitoring systems, Del Val found that using wireless ECG improved diagnostic performance and quality of life.
"The proportion of wear time with analysable ECG signals was significantly higher in the wireless device group (97.3% vs. 92.6%). Quality of life during the AECG monitoring was superior," he said.
"Healthcare professionals have not been trained and it’s still not clear which storage platforms are safe and which aren’t."
Del Val, who presented the study results at the European Congress of Cardiology earlier this year, also noted superior quality of life and fewer limitations among patients who received the wireless device.
"Not having to wear cables is much more comfortable while signal quality remains very high. Patients can use the device at anytime, including when exercising. Results are more representative because they provide monitoring and diagnostics in real life. Since patients wear these devices longer than conventional ECG, detection of arrhythmic events is also higher," he said.
Data collected from these wearables are currently being stored in a memory card and uploaded on the hospital system. But unfortunately, they still cannot be directly incorporated onto the EPR. "Undoubtedly, this would be a great step ahead," Del Val said.
According to Mateos, another crucial problem remains with the data collected from wearable devices: where to put it? "Healthcare professionals have not been trained and it’s still not clear which storage platforms are safe and which aren’t. There’s a lot of chaos around this. Sooner or later, it will explode," he said.