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

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

FINAL EVENT - Venice, 23rd & 24th January 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

FINAL EVENT - Venice, 23rd & 24th January 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

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

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

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

FINAL EVENT - Venice, 23rd & 24th January Barbastro sector – geographical references  Geographical area of 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

FINAL EVENT - Venice, 23rd & 24th January 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

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector - Economical data expenditure REAL EXPENSES2005 PRIMARYESPECIALISED SOCIO- SAN.TOTAL% ITEM ,93 ITEM ,35 ITEM ,98 ITEM ,74 TOTAL %51,4647,411,13

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector - Human Resources ManagementPractitionerPhysiciansNon- physicians InternsTotal line Primary health care Specialis ed health care Public health care Sector Total Sector

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector - Primary Health Care MEDICINE Total medical consultation Home care consultation Consultations per professional / day40,9042,38 Home care per professional / day1,121,24 Frequency9,099,12 Consultations derived from A. Specialised Consultations derived from A. Specialised4,1%3,7% Radiological examinations PAEDIATRICS Total paediatric consultations NURSING Total nursing consultations Home care visits Consultations per professional / day24,5422,96 Tests (blood,,,) at Health Care Centres

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector – Primary Health Care EMERGENCIES – CONTINUOUS CARE Total Emergencies Patients / month / 100 inhabitants9,07 9,3 Nº Emergencies at Health Care Centres Nº Emergencies at home Problems resolved at Primary Care95%95,8% PHARMACY Expenses as of December € € Increase in expenses4,3%8 % 22 million €23,8 million €. Percentage on primary care expense56.5%56.05% Total number of prescriptions 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

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector - Specialized Health Care STRUCTURE Beds available Programmed surgery4,082,75 Consultation sites36 Hospital day working posts66 HOSPITALISATION Admissions Stays Average global stay6,226,46 OPERATING ROOM Hospital programmed surgical operations Specific beds Minor programmed surgery TOTAL I.Q. Programmed I.Q. Hospital Emergency I.Q. Emergencies Ambulatory TOTAL I.Q. Emergency TOTAL I.Q. (*)

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

FINAL EVENT - Venice, 23rd & 24th January Barbastro Sector - Specialised Health Care HDD HDD sessions EMERGENCIES Total Emergencies Emergencies – no hospital admission BIRTHS Births + Caesareans CENTRAL SERVICES Patient clinical analysis Certain clinical analysis Simple radiology T.A.C Mammography Ecography Biopsies

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

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

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

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

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

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

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

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

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

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

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

FINAL EVENT - Venice, 23rd & 24th January Contact Spanish pilot information Gobierno de Aragón Health Department Aragonesa de Servicios Telemáticos Barbastro Hospital TB-Solutions

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