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In Catalonia, Health IT Governance Rises Above the Political

June 6, 2018
by Mark Hagland
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The chief executive of Catalonia’s healthcare IT agency shares insights on the progress he and his colleagues have been making in HIT development in that region of Spain

Those who have been following the political scene in Spain lately know that the politics around the independence movement in Catalonia, that country’s wealthy northeast region, has become very intense of late. Certainly, the debate around the future of Catalonia remains heightened and controversial.

But beyond the news headlines, Catalonia (in Spanish, Cataluña; in Catalan, Catalunya)—whose land mass of 12,400 square miles is about the size of the state of Maryland, but whose population of 7.5 million is closer to that of Virginia—is a region noted for its economic and cultural vitality and ingenuity.

What’s more, because of the governmental landscape in Spain and Catalonia, healthcare information technology is in some ways very well-situated in terms of its overall governance. As in nearly all of the western European nations, healthcare is largely government-run in Spain. What’s more, Spain is governed through an architecture of autonomous regions, including Catalonia, which is governed by its own Parliament and regional government, the Generalitat de Catalunya.

Under the governmental architecture of the Generalitat is the Ministry of Health of Catalonia, and, managing the healthcare information technology resources of the Ministry of health, is the TICSalut Foundation. As the TICSalut Foundation’s website explains, “The TicSalut Foundation is an agency within the Ministry of Health that works to promote the development and use of ICT and networking in the field of health, acts as an observatory for new trends, innovation and monitoring of emerging initiatives and provides services for the standardization and accreditation of products. The implementation of ICT in the health sector is now unstoppable and is seen as one of the most transformative elements in the health sector of the future. The fact that the health sector in Catalonia covers 100 percent of citizens within a framework of universal and public coverage, together with the involvement of a variety of agents, organizations, suppliers and subsidiary industries, puts the health sector in an excellent position to act as an economic innovator and energizing influence in the use of new technologies.”

Late last year, Healthcare Informatics Editor-in-Chief Mark Hagland met with Francesc Garcia-Cuyàs, director of the TICSalut Foundation in Barcelona, to discuss some of the innovations taking place in Catalonia, and his perspectives on the Catalan, Spanish, and European healthcare IT development issues, and the comparisons between the Spanish and American situations, with regard to interoperability, health IT investment, and systems integration. Below are excerpts from that interview.

Mr. Garcia-Cuyàs, please tell me a bit about the governance and management aspects of the healthcare system in Catalonia, with regard to healthcare IT development and management?

In the Catalan healthcare system, each hospital has its own information system. But over the course of time, we have been creating full interoperability among all the hospitals in the region. We began an intensive IT harmonization initiative in 2006, and have been evolving it forward ever since.

We have developed a regional plan for digital health, a strategy for healthcare delivery, and for informatics. Our philosophy is that the technology must serve to support specific projects, as well as supporting digital transformation, and the patient experience, among other priorities. Our overall system encompasses both primary care information systems and medical specialty-based systems. And every hospital and outpatient center is able to share electronic health record-related data in our repository; all our hospitals, primary care clinics, and specialty medical practices, are connected. We have a national healthcare system that provides complete integration of EHRs, and allows for nationwide data-sharing, as appropriate. What’s more, all our local and patient care organization repositories are connected. Also, we’ll be moving everything to the cloud soon.

Meanwhile, in Catalonia, we’ve got 7.4 million patients in our regional system, with 18 percent of them over the age of 65, and 2 percent living with at least one chronic illness.

Francesc Garcia-Cuyàs

Tell me about some of the more advanced capabilities in your system?

Yes, we’ve got electronic prescribing, and pharmacy automation, including an integrated electronic prescription system across the entire nationwide healthcare system. What’s more, patients can check their personal electronic health records from their smartphones. We have all test results stored in our EHR. One of our goals is to be as people-centered as possible. We believe that by giving patients relevant information, they will participate in working to improve their health status.

Would you say that the overall regional health information system in Catalonia is one of the most advanced in Spain?

Yes, it really is; Catalonia has advanced faster than some of the other regions here; in fact, other regions are busy copying what we’ve been doing here.

What have been and continue to be, the biggest challenges for you and your team, in managing this very large regional health information system?

There are two. The first is helping our providers to manage the care processes of our citizens who are living with chronic illnesses. The other is moving forward into leveraging artificial intelligence-based tools, particularly to participate in robust data analytics.

But you have been moving forward in that area?


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