By 12 April, 2021 - 10:20pm 4 views
A woman consults her mobile phone during a telemedicine consultation.BSIP / Universal Images Group via Getty
With the medical history there is a paradox. The data belongs to the patient, since it is personal information and, in addition, it is health data, which has a strong intimate component. However, the patient has difficult access to them. For this reason, several medical-scientific associations integrated in the IMAS Foundation Digital Health Group - among them the Spanish Federation of Health Technology Companies (Fenin) or the Spanish Society of Internal Medicine (SEMI), have brought together professionals from the field of healthcare to propose a single, more accessible Digital Health History concept. The idea is to create a new medical record that exceeds current formulas, that is interoperable between communities, and even between EU countries, and that allows citizens to consult their complete file from their mobile.
Carina Escobar Manero, president of the Platform of Patient Organizations , which is also part of the Digital Health Group, points out that the idea is that we can enter our history as we do in the Treasury. It suggests that the formula could be through an application, from the mobile
Dr. Pilar Rodríguez Ledo, from the Spanish Society of General and Family Physicians , also a member of the Digital Health Group, highlights other aspects of the initiative they are considering : “It has to be based on the European concept of a single identity and be interoperable between the different regional health systems. And also, between the private and public systems. So that the health data correspond to the person and they provide them when they need assistance. That the history accompanies the citizen and not the citizen to the history ”, he concludes.
From the Ministry of Health they defend the current digital clinical history. Alfredo González Gómez, Secretary General of Digital Health, Information and Innovation of the SNS, highlights that the Ministry has been working with the Autonomous Communities for more than a decade to guarantee the circulation of clinical information within the scope of the National Health System. "Currently the Digital Health Record of the National Health System (HCDSNS) is available, an interoperability system that allows content extracted from the Electronic Health Record and other information systems of the autonomous communities to be accessible to citizens and professionals authorized health workers, anywhere in the national territory, ”says González.
However, for Dr. Pilar Rodríguez the ability that a doctor has today to access the medical record is not enough. “Actually, they are the same folders that we had on paper, but put in electronic folders. They are not even information. They are non-interrelated data ”. Rodríguez explains that when a doctor opens a patient's file, he finds different folders — the cardiologist's, the urologist's, the family doctor's — and he has to search for the relevant information among all these digital drawers. It states that there is no complete document with a clinical chronology of the patient.
This deficiency is compounded by fragmentation depending on the medical care that the person has received. “In many communities there is a fragmented medical history, because the person has a history in hospital centers and another in primary care. And when a person is cared for in the private system, these data are not transferred to their personal history. ”
Interventions in social health centers, such as nursing homes or drug addiction centers, are also recorded in a separate medical history . "Gaps, repetitions and even duplicate or contradictory data are generated, because they are partial versions of the story," according to Rodríguez. And to this is added that when a person needs to go to the doctor in another autonomous community, their medical history is not easily available to the doctor, says Carina Escobar.
In search of a renewed clinical history
From the Platform of Patient Organizations, Escobar insists that a unique Digital Health Story will contribute to better healthcare. “The clinical data belongs to the patient and has to be accessible. And we want information to be entered in the history that will help you to better understand your illness, to take joint responsibility ”, he highlights.
The Ministry of Health and the Autonomous Communities allow access, with a digital certificate or electronic ID, to a file on the clinical history. Although González admits that there is room for improvement. "The digital medical history must evolve towards a much more integrated model, within the framework of the new 5P medicine (Population, Preventive, Predictive, Personalized and Participatory), so that it acts as a complete element of relationship between health professionals and between them and the patients ”.
The initiative of the unique Digital Health History also intends that the patient can provide information after an operation or during a treatment. "There may be certain fields that allow you as a patient to make known how you have felt with the treatment, that you can monitor your situation," explains Escobar. And for this you need an easily accessible solution, such as that provided by a mobile app.
Data collection doesn't stop there. The idea is that this future clinical history also reflects a social vision. "Living conditions, which in the end are determinants of health, help us make decisions according to the person," says Escobar. For this, it would be necessary for the record to absorb information from other public sources. Thus, it would be possible to know if a person has a dependency request, if they live with a subsidy or if they are the caregiver of another person.
With the unique Digital Health History proposal, in addition, all this information will not only be interoperable between communities. It will also be available among the different EU countries, based on the concept of European digital identity in which the European Commission works
The IMAS Foundation Digital Health Group is in contact with the Ministry to promote this Digital Health Story only. But they recognize that at the moment everything is very stopped. “The covid has eaten up all kinds of innovation that we could do. We need a Ministry of Health that leads the transformation that involves changing this health system that we have. If we do not take advantage of the change now, we will be doing a disservice to the people who come. We want a medical history that will serve us now and serve us for the future, ”says Escobar.
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Spain participates in interoperability projects within the framework of the European Union. "We are currently finalizing the work for the incorporation into real production of the EU Patient Summary project", points out the Secretary General for Digital Health, Information and Innovation of the SNS. It is a selected clinical information product derived from the Electronic Health Record. Its objective is to facilitate unscheduled health care when citizens travel outside of Spain. Communities are also making technical adaptations for interoperability, according to González. And he adds: "The EU Patient Summary will be used in a secure context of e-health services that includes access control, consultation, communications, interoperability and traceability."