An initiative so that citizens can consult all their medical records from their mobile
With the medical history there is a paradox. The data belongs to the patient, as 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 into the IMAS Foundation Digital Health Group ―Among them the Spanish Federation of Health Technology Companies (Fenin) or the Spanish Society of Internal Medicine (SEMI), has brought together professionals in the field of health to propose a concept of a unique, more accessible Digital Health History. 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 Patient Organizations Platform, which is also a member of the Digital Health Group, points out that the idea is that we can enter our history just 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 must 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. Let history accompany the citizen and not the citizen in 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 sanitary facilities, 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 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. He states that there is no complete document with a clinical chronology of the patient.
Fragmentation is added to this deficiency, depending on the medical care 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 treated in the private system, these data are not turned over to their personal history ”.
Interventions in social health centers, such as residences for the elderly or drug addiction centers, are also recorded in a separate medical record. “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 medical history
From the Patient Organizations Platform, Escobar insists that a unique Digital Health Story will contribute to better medical care. “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 DNI, to a file of the clinical history. Although González admits that there is room for improvement. “The digital medical record 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 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 application.
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,” Escobar points out. 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 requested dependency, if he lives with a subsidy or if he is a caregiver for 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 between 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 unique Digital Health Story. 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, ”Escobar points out.
Spain participates in interoperability projects within the framework of the European Union. “We are currently finalizing the work for the incorporation in real production to the project EU Patient Summary (Summary of Patient of the European Union) ”, points out the Secretary General of 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.”