he Network of Competent Authorities (NCA) is one of the implementing structures of the Health Information and Knowledge Strand of the EU Public Health Programme 2003-08. 1 The NCA became aware of problems in the field of European public health monitoring related to data protection legislation, and established in 2005, on a voluntary basis, a Work Group on Data Protection, consisting of six members of the NCA with a specific interest in the topic, and two staff members from the NCA's Scientific Assistance Office. 2 The Work Group carried out an explorative survey among researchers in the European public health field, experts on health data protection and the national Data Protection Offices. This exercise resulted in a (non-exhaustive) overview of problems encountered in public health monitoring, and of major differences between national data protection systems regarding possibilities for using person identifiable health data for public health purposes. The major conclusions that can be drawn from this overview is that the legal possibilities for such usage differ to great extents between the Member States, and that this diversity can be traced back to the improper transposition of the EU Directive on Data Protection (Directive 95/46/EC). 3 EU directives are addressed to the Member States, who are obliged to transpose the directive into national law. By now, all Member States indeed have transposed Directive 95/46/EC, 4 though, as the results of the inventory of the Work Group showed, not in a harmonized
Over the last years, the need for changing the current model of European public health systems has been repeatedly addressed, in order to ensure their sustainability. Following this line, IT has always been referred to as one of the key instruments for enhancing the information management processes of healthcare organizations, thus contributing to the improvement and evolution of health systems. On the IT field, Big Data solutions are expected to play a main role, since they are designed for handling huge amounts of information in a fast and efficient way, allowing users to make important decisions quickly. This article reviews the main features of the European public health system model and the corresponding healthcare and management-related information systems, the challenges that these health systems are currently facing, and the possible contributions of Big Data solutions to this field. To that end, the authors share their professional experience on the Spanish public health system, and review the existing literature related to this topic.
This article identifies the main challenges of the National Health Service of Spain and proposes its transformation into a Learning Health System. For this purpose, the main indicators and reports published by the Spanish Ministries of Health and Finance, Organization for Economic Co-operation and Development (OECD) and World Health Organization (WHO) were reviewed. The Learning Health System proposal is based on some sections of an unpublished report, written by two of the authors under request of the Ministry of Health of Spain on Big Data for the National Health System. The main challenges identified are the rising old age dependency ratio; health expenditure pressures and the likely increase of out-of-pocket expenditure; drug expenditures, both retail and consumed in hospitals; waiting lists for surgery; potentially preventable hospital admissions; and the use of electronic health record (EHR) data to fulfil national health information and research objectives. To improve its efficacy, efficiency, and quality, the National Health Service of Spain should be transformed into a Learning Health System. Information and communication technologies (IT) enablers are a fundamental tool to address the complexity and vastness of health data as well as the urgency that clinical and management decisions require. Big Data solutions are a perfect match for that problem in health systems.
SummaryBackground: Spain's health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population's needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type. Objective: To better understand the success criteria, the difficulties encountered and certain issues that must be kept in mind to ensure successful implementation of ICT projects in health organizations, based on Spain's experiences in this field. Methods: The projects' results are analyzed using the criteria of compliance with the expected scope, cost and time frame. Results: The results can be considered satisfactory in primary care facilities, where almost 90% of Spain's general practitioners, pediatricians and primary care nurses are using electronic health record (EHR) systems. In hospitals EHR implementation is more uneven. Over 40% of Spanish primary care centers and 42% of pharmacies are using electronic prescription (the information system that connects the physician to the dispensing pharmacy and the dispensing pharmacy to the payer). Discussion: All of Spain's health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR.
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