Evolution of the health record in the basque country. From the paper to an intelligent-integrated eHR

摘要

Introduction : After the era of paper health record, in 2002 standard questionnaires for chronic patients were collected and registered by a hospital nurse. Since then, our electronic health record has been evolving. Nowadays the same electronic health record (eHR) is shared by the whole public health system that attends 2 million people, nursing homes included. The next step forward comes with the creation of standard questionnaires within an “Integral Program Manager”, this meaning that relevant information of the patient will be registered and analyzed giving identical recommendations in any setting (primary care, specialist or hospital) in a given clinical change. This will lead to “message reconciliation” in the system avoiding contradictions and helping educate and empower the patients for self-control. The creation of the personal health record and the new technologies (smartphones) will enable patients to fill the questionnaires by themselves. Description of practice change implemented : Change of paper based fragmented health record to an electronic and integrative one. Aim : Same electronic health record, questionnaires and recommendations in different settings Target population : All patients, but specially: - Pluripathological patients - Home-dependent patients - Nursing home residents - End of life patients Timeline : *Until 1996: health record on paper. *1996-2000: some reports are digitalized and the copy is carried by the patient. *2000-2009: basic electronic health record, different for primary care *Since 2002: assessment questionnaires for heart failure and COPD by phone by a case management nurse *2009-2012: health care based on an electronic health record, but different for hospital and primary care. Beginning of a electronic prescription tool (same for all) *Since 2012: creation of personal health records for patients *2012-2018: integrative electronic health record accessible for all healthcare workers, old paper reports are digitalized, warnings (allergies e.g.), same prescription tool (“Presbide”). *Since 2018: beginning of electronic application forms including those for pluripathological patients. Beginning of the “Integral Program Manager” to suggest recommendations according to clinical changes registered in the application forms. Highlights : -Creation of the electronic health record. -Computer integration: only one electronic health record -Healthcare integration: same questionnaires for all pluripathological patients (generic and specific disease related application forms). Information collected in any setting (call center, primary care physician or hospital) and creation of recommendations accordingly (by the “Integral Program Manager”) leading to remote treatment adjustment, face-to-face assessment in primary care or direct hospital admission. Sustainability : The unification of theelectronic health record reduces maintenance costs and those related to the lack of coordination. Transferability : Transferable for all health services with compatible information systems. Conclusions : Integrative electronic health record and healthcare process with the same questionnaires and recommendations are desirable for a coordinated health care, especially for multipathological patients. Discussion : The new technologies should allow patients to choose the easiest way to fill in control questionnaires by themselves. Lessons learned : This process is not easy because apart from the technical difficulties requires important habit changes, but is the only way to achieve our goals.