In western Europe, as in the United States, IT-facilitated clinical transformation remains a work in progress, with tremendous variations by geography and by type of patient care organization. One organization in Spain that has made tremendous strides—and which became one of the first European hospital organizations to receive “stage 7” recognition from the HIMSS Analytics division of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), per its EMRAM schematic around electronic health record (EHR) development—is the Hospital de Dénia/Marina Salud S.A., in the suburb of Valencia called Dénia, on the east coast of Spain. Indeed, the leaders of the hospital received the prestigious Davies Award from HIMSS in 2015, and the hospital’s CIO, Vicent Moncho Mas, was presented with the award at HIMSS’ World of Health IT conference in Riga, Latvia, that year.
Moncho Mas spoke of the journey into digitization and clinical transformation on Tuesday, Nov. 22, at World of Health IT 2016 (WoHIT2016), being held this week at the Centre de Conveniones Internacional de Barcelona (CCIB), in Barcelona, Spain.
Speaking of the project that is now optimizing clinical IT after having fully digitized clinical and staff operations, and expanding into patient and community engagement via mobile outreach, Moncho Mas told his audience at the CCIB that “This is a special project. If we want to engage patients, we need to define new information channels. On the other hand, we need to train patients, we need to teach patients for this,” he said, speaking of the opening of a patient portal, and his organization’s plunge into population health work. “The patient portal is the highway; it is the door that we open to our patients for channeling their clinical information. And it’s quite important to have this portal, with some standard functionality, such as access to clinical notes, to records, lab results, radiology, etc.,” he told his audience. “It’s quite important to share this with the patient. Of course, we also need to support mobile apps. We need to give all the information not only on a web platform but also through a mobile platform, because patients always have phones with them, but not laptops.”
In addition, Moncho Mas noted, “Another information channel that we’ve established is the messaging system. And messaging with patients must be like email and must be available inside the platform. And that implies security. We need to be able to assure that all of our information for patients is safe for them.” In addition, with a high rate of chronic illness in the patient population of the health system, “It’s very important for patients to learn about their chronic diseases, such as diabetes,” he added.
One area of particular interest has to do with the fact that the leaders of the Hospital de Dénia have made lab results available to patients in real-time. “In Spain,” Moncho Mas said, “when we have results outside the limits”—abnormal results—“we put a star or asterisk there in the patient record. And some physicians say, what happens when the patient sees an asterisk? We have to teach patients how to interpret results, how to understand those lab results. Another element is knowledge about their actions, with regard to a healthy lifestyle. For instance, a diabetic patient has to know about what they have to eat, measure, etc. Many patients besides diabetes. And we have to provide clinical information to our patients in a way that is adapted to consumer needs and knowledge.” In addition, on the horizon for his organization is the public sharing of more refined indicators around population health, he told his audience.
Meanwhile, just prior to his presentation at WoHIT, Moncho Mas sat down at the CCIB with Healthcare Informatics Editor-in-Chief Mark Hagland to discuss the progress his organization is making along numerous dimensions. “It is important to keep in mind the operational context around what we’re doing,” he said. “Spain is divided into a number of regions, which have a great deal of policy autonomy. Our hospital is located in the Region of Valencia, which is one of 17 regions with autonomous health ministries. It is a 290-bed hospital built on a public/private partnership model, which is a relatively recent one in Spain. What happened is that our hospital was created through a contract with the government that was signed in 2009. Our facility opened in 2011, and we are operating on a 15-year contract for operations. Based on that contract, we are working under full capitation; we receive just 720 euros per patient per year—a very small amount.” (At the time of the writing of this article, the euro-dollar exchange rate was 1:1.06, meaning that €720 PPPY equaled $763.20 PPPY.)
“What’s more,” Moncho Mas said, “we have a large population of seniors, and many of those have chronic diseases, most commonly diabetes. Among that population are northern Europeans [British and Germans especially] who spend their winters in the Valencia area.” (The €E720 PPPY capitated payment that the organization receives for patient care does not include separate payments for pharmaceutical costs and the costs of such items as ambulance transportation, personal medical equipment such as prostheses, etc., for which the hospital does receive additional payments for cost.)
Given the capitated payment involved, naturally, population health management and care management are exceptionally important elements in how the Hospital Marina Salud de Dénia is caring for its patients. At its core, Moncho Mas noted, is the increased empowerment of primary care physicians in a care management context. The organization employs multidisciplinary care teams that work in integrated health centers (as is usual in Spain, the physicians are directly employed by the organization). What’s more, because of the high cost of hospitalization and of ED visits under a capitated payment system, great care is taken to optimize the site of care for patients. Thus, all 11 primary care-based health centers contain urgent care centers, to deflect cases of low clinical intensity away from the system’s hospital EDs.
Asked what the secret to success under capitation is, Moncho Mas said, “The main objective is to keep one’s population healthy. We have a high population of chronically ill older people, especially from the UK and from Germany, many of whom winter in the Valencia area. Right now, 37 percent of our care costs are hospital-based; we’re trying to reduce that proportion.”
And his biggest challenges as CIO? “The biggest challenge was becoming paperless, as well as optimizing clinical documentation and clinician workflow. The reality is that the healthcare industry changes slowly here as elsewhere. And the clinicians need a lot of reassurance.” Asked how he sees the role of CIO leadership in facilitating the kinds of transformational change taking place in Dénia, Moncho Mas said, “CIOs need to let go of a focus on the technical aspects of all this and to look at the human aspects, especially with regard to patients. What we need to do as caregivers is to transform ourselves into consultants to patients. We need to become truly patient-centered, and we have to begin to engage in that language. And we have to create interconnections with the diverse communities within our broader community.”
