BACKGROUND

PROTECTION, HEALTH PROMOTION AND PREVENTION

WORKING TOWARDS EQUITY

Promoting health policies based on best practices

Analysing health policies and proposing actions to reduce health inequities, with special emphasis on gender inequality

ADAPTING THE HUMAN RESOURCES OF THE NATIONAL HEALTH SYSTEM TO THE NEEDS OF THE HEALTH SERVICES

ACHIEVING CLINICAL EXCELLENCE

Accrediting and auditing health care facilities and services

Improving patient safety in health care facilities

Improving care given to patients with certain pathologies

Improving clinical practice

USING INFORMATION TECHNOLOGY TO IMPROVE CARE PROVIDED TO CITIZENS

Health Online

INCREASING TRANSPARENCY

Designing a NHS Health Information System that is reliable, appropriate and accessible

SUMMARY AND CONCLUSIONS

ANNEX: Acronyms and abbreviations

Designing a NHS health information system that is reliable, appropriate and accessible

The NHS Health Information System is a vital element in our response to the challenges arising from the new organisational situation within the NHS and from the increasing demands that citizens, patients, professionals and the health administrations themselves are making of the public health services, for more and better information.

The NHS Health Information System must be based on unquestionable technical credibility and neutrality within the NHS, as it will earn the recognition of those who use its services only through a high degree of participation by the generators and users of the information and through a permanent effort towards transparency. To develop it, a policy of continuous improvement and innovation will be applied and the process towards its consolidation will be based on the following:

• Using explicit methodologies that are technically rigorous.
• Producing an annual report on its development, to be presented to the Interterritorial Council.
• Collaborating permanently with NHS agents.
• Disseminating reliable, appropriate, up-to-date information suited to the needs of the different users.

Review of 2006-2008

The three years that the Quality Plan has been in effect have been characterised, as regards the Health Information System, by a high degree of participation by the autonomous communities in the construction of a common information system. Under the co-ordination of the Ministry of Health and Social Policy, the Key Indicators of the NHS have been selected and defined, and actions aimed at creating an NHS data bank have also been carried out. Similarly, improvements have been made to the existing subsystems of information related to the large health areas (state of health, health care system, citizen satisfaction).

• Key Indicators of the NHS. These indicators are a prioritised set of information covering aspects considered relevant to health and the Spanish health system. Once they have been established and presented to the Interterritorial Council and the Board of Ministers, they will be made known to the public. For this purpose, a Statistics Portal is currently in development. The Portal, along with the Key Indicators, will provide different types of statistical information regarding health and the health system in a speedy and innovative manner. This tool will be at the service of health care authorities, managers, health professionals, researchers and the general public.

• NHS Data Bank. There is now public access, free of charge, to anonymised microdata and time series metadata from the statistical and information systems of the Health Information Institute, about: health (Spain’s National Health Survey, series 1987 - 2006), health care centres (Catalogue of Primary Care Centres, series 2007 and National Catalogue of Hospitals, series 1995 - 2007), activity (Statistical Study on Inpatient Medical Facilities, series 1996-2005) and citizen opinion (Health Barometer, series 1996 - 2007). Also, the National Register of Deaths database has been set up to allow for consultation by researchers.

• Furthermore, applications have been developed and can be used through the website to obtain data from the Minimum Basic Data Set-Hospital Discharge (MBDS-HD).

-Which includes the Register of NHS Hospital Admissions, mortality, the National Health Survey and population figures.

• Among the improved information subsystems, the following advances must be mentioned:

-The revised version of the National Health Survey, which was presented in May of 2008 and has brought about significant improvement in the detection and measurement of health inequalities (especially in relation to gender and social class, mental health and the health determinants related to the physical and social environment).
- The newly-created Primary Care Information System (PCIS), which serves to fill a transcendental information gap that existed in the NHS.
-The General Register of Health Centres, Services and Facilities, which gathers and updates the list of health care providers authorised by the autonomous communities (in development phase).
-The new plan for the use of indicators from the Statistical Study on Inpatient Medical Facilities, which contains the main data concerning the structure, activity and expenditure of Spain’s hospitals.
-The innovation project regarding the model of analysis of the MBDS-HD, the main source of information about morbidity attended and the care process in hospitals, which enables in-depth analyses to be made on the characteristics of hospital care given to patients in the NHS.
-Extending the MBDS-HD to the field of hospitalisation without overnight stay (Major Outpatient Surgery and Day Hospital).
-Enabling access, for research purposes, to the National Register of Deaths, through the Ministry’s website.

Finally, actions have been undertaken to increase the transmission and transparency of information. Such actions include reducing the lag time between the production and the dissemination of data, through both the improvement of production processes and the publication of provisional information in the form of “previews”. Similarly, the development of contents related to the Health Information System that are available on the Ministry of Health and Social Policy’s website, as well as the holding of Annual Forums on the NHS Health Information System, have also contributed to increased transparency.

Activities planned 2009-2010

To maintain the rate of progress attained in the NHS Health Information System, consolidating the achievements of previous years and taking further steps in improvement and innovation, the following actions are to be undertaken.

Key Indicators of the NHS

• Disseminate the Key Indicators of the NHS and continually update the information available.
• Complete the information covered by the indicators by progressively incorporating additional data (pharmaceutical service, dietary health, environmental health and other aspects of health and the health care system).

NHS Data Bank

• Consolidate and broaden the bank by incorporating new databases and updating the ones already present.

Improving and integrating existing information subsystems.
Standardisation:

• Improvements in coding

-Action plan for the transition to and implementation of ICD 10.
-Strengthening the existing Technical Coding Unit by adopting the International Classification of Primary Care (ICPC-version II).

• Creation of a system for NHS recognition of the validity of health registers that already exist in professional and scientific spheres.

Developments in integration and improvement:

• Consolidation of the data concerning primary care activity and continuing the project for the construction of the Clinical Primary Care Database.
• Continuation of work begun with the autonomous communities to revise the Statistical Study on Inpatient Medical Facilities.
• Implementation of the model of indicators and analytical themes pertaining to hospitalisation, based on the use of the MBDS-HD, and implementation of webbased
supporting tools with which to examine results, adjustment measures, comparative analyses and time series analyses.
• Finalizing construction of the National Register of Health Centres, Services and Facilities.
• Finishing construction of the Information System on NHS Waiting Lists for specialist consultations and diagnostic tests.
• Improving information processing, integrating the data from different perspectives (organisational, functional, territorial or any other that may be deemed relevant).
• Maintaining and developing the Ministry of Health and Social Policy’s statistical planning and coordination activities, enhancing the dynamism of the Interministerial Statistics Commission and the works undertaken in relation to the National Plan on Statistics and its corresponding Annual Programmes.

Further develop the plan to improve data accessibility and the dissemination of information

• Improving the content structure of the website and increasing data accessibility by using a variety of formats and including bilingual summaries of information (Spanish-English) for the main statistics.
• Publishing and planning the dissemination of the items published by the Information System of the NHS in the various formats (paper, CD and online publications) included in the Ministry’s Publishing Programme.
• Broadening the variety of microdata and metadata that can be downloaded directly from the Ministry’s website, with complete confidentiality guaranteed at all times.
• Opening the Statistics Portal of the Ministry of Health and Social Policy to the public and consolidating its access system and functioning. The Portal will allow for interactive consultation and generation of reports based on the following information systems:

-Basic data and statistics from the MBDS-HD.
-Statistical Study on Inpatient Medical Facilities.
-Mortality Statistics.
-The National Health Survey.
-The Health Barometer.
-Database of the Key Indicators of the NHS.
-Basic data from the Primary Care Information System (PCIS).

• Ensuring that a proper response is given to all requests for general information received through the e-mail
informacionsanitaria@msc.es and also any to requests made by citizens and more specialised users for the right to use data.
• Reinforcing the relationship of the Ministry of Health and Social Policy with international organisations such as DG SANCO, Eurostat, WHO and OECD, through active participation in the different forums and compliance with the commitments made regarding the sending of data.