1. FINAL EVENT Palazzo Franchetti – Venice 23rd & 24th January 2006 The technical solution adopted by HEALTH OPTIMUM in Spain

2. FINAL EVENT - Venice, 23rd & 24th January 2006 2 BARBASTRO SECTOR

3. FINAL EVENT - Venice, 23rd & 24th January 2006 3 Index  Gobierno de Aragón validation sites  Barbastro sector  Location  Intersectorial map  Structure  Figures  Services selected for the trials  Network  Tele-consultation  Tele-radiology  Shared clinical records  Video  Health Optimum Spanish Pilot  Virtual referral  Tele-counseling  Conclusions (initial deployment)  Contact Spanish Pilot information

4. FINAL EVENT - Venice, 23rd & 24th January 2006 4 Gobierno de Aragón validation sites  The validation sites for the HEALTH OPTIMUM prototype are located in the Barbastro Health area.  The Centre of Excellence and Points of Care where tele- consultation, tele-counselling and Virtual Referral have been installed are the following:  1 Specialised care (Hub)  Barbastro General Hospital  2 Primary Care centres (Spokes)  Fraga Health Centre  Castejón de Sos Health Centre

5. FINAL EVENT - Venice, 23rd & 24th January 2006 5 Barbastro Sector -Location in Spain

6. FINAL EVENT - Venice, 23rd & 24th January 2006 6 Barbastro Sector -Location in Aragón

7. FINAL EVENT - Venice, 23rd & 24th January 2006 7 Barbastro Sector – Intersectorial Map

8. FINAL EVENT - Venice, 23rd & 24th January 2006 8 Barbastro sector – geographical references  Geographical area of +7.500 km2  Consists of well differentiated topographical areas:  In the north - the Pyrenean mountain range  In the centre – the Guara Sierra, marked by canyons and ravines  In the south – a vast plain

9. FINAL EVENT - Venice, 23rd & 24th January 2006 9 Barbastro sector – structure  Primary Health Care  Centres: 13  Continual attention points: 3  Dental health units: 2  Physiotherapy units: 4  Obstetrics units: 7  Specialized Health Care  Barbastro Hospital  Beds: 160  Operating theatres: 5  Surgeries: 36  Medical speciality centre: Fraga y Monzón  Public health care  Fraga Public health centre  Beds: 10  Surgeries: 0  Beds Day care hospital: 0

10. FINAL EVENT - Venice, 23rd & 24th January 2006 10 Barbastro Sector - Economical data expenditure REAL EXPENSES2005 PRIMARYESPECIALISED SOCIO- SAN.TOTAL% ITEM 116.730.22922.166.975737.20239.634.40647,93 ITEM 21.854.08812.302.501188.47214.345.06117,35 ITEM 423.849.0093.427.124 27.276.13332,98 ITEM 6119.8041.314.3547.6971.441.8551,74 TOTAL42.553.13039.210.954933.37182.697.455 %51,4647,411,13

11. FINAL EVENT - Venice, 23rd & 24th January 2006 11 Barbastro Sector - Human Resources ManagementPractitionerPhysiciansNon- physicians InternsTotal line Primary health care 31111075318292 Specialis ed health care 21093031680582 Public health care 12104017 Sector200002 Total Sector 822242022518893

12. FINAL EVENT - Venice, 23rd & 24th January 2006 12 Barbastro Sector - Primary Health Care MEDICINE2.0042.005 Total medical consultation905.653972.047 Home care consultation25.84728.512 Consultations per professional / day40,9042,38 Home care per professional / day1,121,24 Frequency9,099,12 Consultations derived from A. Specialised37.24036.000 Consultations derived from A. Specialised4,1%3,7% Radiological examinations9.32910.702 PAEDIATRICS Total paediatric consultations47.09159.321 NURSING Total nursing consultations479.861486.076 Home care visits43.84643.291 Consultations per professional / day24,5422,96 Tests (blood,,,) at Health Care Centres32.94035.928

13. FINAL EVENT - Venice, 23rd & 24th January 2006 13 Barbastro Sector – Primary Health Care EMERGENCIES – CONTINUOUS CARE Total Emergencies108.414 113.562 Patients / month / 100 inhabitants9,07 9,3 Nº Emergencies at Health Care Centres97.875 102.910 Nº Emergencies at home10.593 10.651 Problems resolved at Primary Care95%95,8% PHARMACY Expenses as of December22.009.702 €23.849.008 € Increase in expenses4,3%8 % 22 million €23,8 million €. Percentage on primary care expense56.5%56.05% Total number of prescriptions1.705.4081.866.423 Prescription expenses12,90 €12,70 € 12,9 €12,6 € Number of prescriptions per active and year6,87 Number of prescriptions per pensioner and year38,843

14. FINAL EVENT - Venice, 23rd & 24th January 2006 14 Barbastro Sector - Specialized Health Care STRUCTURE20042005 Beds available149151 Programmed surgery4,082,75 Consultation sites36 Hospital day working posts66 HOSPITALISATION Admissions 69466927 Stays4320644998 Average global stay6,226,46 OPERATING ROOM Hospital programmed surgical operations23142077 Specific beds610813 Minor programmed surgery11341149 TOTAL I.Q. Programmed40584039 I.Q. Hospital Emergency648632 I.Q. Emergencies Ambulatory116121 TOTAL I.Q. Emergency764753 TOTAL I.Q. (*)48224792

15. FINAL EVENT - Venice, 23rd & 24th January 2006 15 Barbastro Sector - Specialized Health Care STRUCTURAL L.E.Q. LEQ total11891342 LEQ 0 at 3 months905837 LEQ 3 to 6 months284505 LEQ more than 6 months00 Average delay6681 HEMODIALISIS Hospital Dialyses35 Private centre Dialyses1422 Peritoneal Dialyses42 OUTPATIENT CONSULTATIONS First outpatient consul.3834538735 Successive9796196006 Index successive >/ first visit2,552,48 Total patient waiting list55436360 Waiting list patients V/I10471444 Average global delay4166 Waiting list patients >60 d11172141 Outpatients consult. High resolution(*)20141955 Total pre-appointments00

16. FINAL EVENT - Venice, 23rd & 24th January 2006 16 Barbastro Sector - Specialised Health Care HDD HDD sessions32453115 EMERGENCIES Total Emergencies3176531694 Emergencies – no hospital admission2741827077 BIRTHS Births + Caesareans585567 CENTRAL SERVICES Patient clinical analysis95.212117451 Certain clinical analysis1.192.0221363003 Simple radiology54.27355327 T.A.C.50505537 Mammography34783617 Ecography6.4186281 Biopsies5.8445501

17. FINAL EVENT - Venice, 23rd & 24th January 2006 17 Barbastro Sector – Public Health Care ACTIVITY20042005 Admissions of hospital beds4051 Generated stays35113923 Admission during period4250 Private centre generated stays with IASS *33213230 Private geriatric stays with IASS *88 Temporary private centre stays with IASS *22 * IASS: Instituto Aragonés de Servicio Social

18. FINAL EVENT - Venice, 23rd & 24th January 2006 18 Services selected for the trials  Tele-radiology. Transmission of digital images to primary care doctor in real-time  Tele-counselling:  Tele-counselling between a specialised doctor and primary care doctor, without a patient involved  Oncology: The trials will support specialised assistance to patients in the primary care setting.  Nephrology: Trials will facilitate specialist tele-assistance in the Primary Care Centre  Virtual Referral:  Virtual tele-consultation with presence of patient.  Haematology: The trials will cover patients treated with anticoagulants, to facilitate consultation between the primary care doctor and the Haematology specialist.

19. FINAL EVENT - Venice, 23rd & 24th January 2006 19 Network

20. FINAL EVENT - Venice, 23rd & 24th January 2006 20 Network  Network enhancements undertaken for Health Optimum pilot are:  Hospital of Barbastro connected to the RACI by means of 155 Mb optical fibre.  Hospital of Barbastro connected to Fraga Health Centre by an 4 Mb ADSL line.  Hospital of Barbastro connected to Castejón de Sos Health Centre by two 512 Kb ADSL lines.

21. FINAL EVENT - Venice, 23rd & 24th January 2006 21 Tele-consultation  Components  Tele-consultation tool, implemented in JAVA, PHP and HTML, and hosted on a Linux server with Apache, Tomcat and SSL protocol is being used. It accesses the different databases of the different servers by means of JDBC1  Tele-consultation reports are made with HP-Doctor tool, which are published in real time in the Intranet of the sector  Sets of healthcare-specific components, one installed at each partner’s validation site (Point of Care)  Videoconferencing services established with Plycom software; Tandberg software has also been tested and validated.

22. FINAL EVENT - Venice, 23rd & 24th January 2006 22 Tele-consultation

23. FINAL EVENT - Venice, 23rd & 24th January 2006 23 Tele-consultation  Tele-consultation general enhancements  Acquisition of equipment for the transmission of high quality radiological images.  Implementation of primary attention module for health sector Intranet.  Audit underway to adapt the intranet security to data protection laws: Law 15/1999 and 41/2002. In addition, measures will be taken according to the mandatory Spanish legislation (Ley Orgánica de Protección de Datos), so as to guarantee that requirements for personal data privacy are fulfilled.  Tele-consultation appointment books.

24. FINAL EVENT - Venice, 23rd & 24th January 2006 24 Tele-radiology  Tele-radiology enhancements  A PAC’s scalable system installed to allow the storage and distribution of images.  Acquisition of a diagnostic station for the Barbastro Hospital with:  Two monitors of 5 Mpixels, and several 2 Mpixels  CR (Computed Radiology)  Foreseen for 2006, the acquisition of a digital radiology system for the Fraga PoC, as well as Monzón PoC with:  CR (Computed Radiology)  6 Chassis  A station for identification and pre-post view  A drought printer, along with the required software.

25. FINAL EVENT - Venice, 23rd & 24th January 2006 25 Shared clinical records  Shared clinical records  Gobierno de Aragón has currently an initiative in shared clinical records between primary (ER physicians and General Practitioners) and specialised care. This is being integrated within the HEALTH OPTIMUM framework.  As indicated before, a module to generate inter-phase files between the application of tele-laboratory and the program of shared clinical records of primary attention (currently in use) is being rolled out.  In addition files for bi-directional communication (requests and results) have been completed.

26. FINAL EVENT - Venice, 23rd & 24th January 2006 26 Shared clinical records  Components  The Intranet links all the available primary and specialised information relative to a patient. By means of a tabs system, it is possible to access the primary or specialised information  The matching between primary and specialised care clinical records belonging to a certain patient, through the Primary Authentication Code (PAC) is included within each patient’s sanitary card.  When a patient is selected, his/her primary and specialised information is shown (classified in different table-spaces).  This means that both, the primary and specialised care sides have access "online" to the same clinical information of the patient.; thus, they can share all the computerised clinical information of the patient.

27. FINAL EVENT - Venice, 23rd & 24th January 2006 27 Video  Video  Health Optimum Spanish Pilot  Virtual referral  Tele-counseling  Conclusions (initial deployment)

28. FINAL EVENT - Venice, 23rd & 24th January 2006 28 Contact Spanish pilot information Gobierno de Aragón Health Department www.aragon.es Aragonesa de Servicios Telemáticos E-mail: ncampillo@aragon.esncampillo@aragon.es Barbastro Hospital E-mail: inform.hbrb@salud.aragon.esinform.hbrb@salud.aragon.es TB-Solutions www.tb-solutions.com E-mail: hurtadom@tb-solutions.com

29. FINAL EVENT - Venice, 23rd & 24th January 2006 29 Health Optimum THANK YOU FOR YOUR ATTENTION