Spain began its electronic health record (EHR) initiative in the region of Andalusia, implementing EHRs for 8 million people. This effort has since been expanded to other regions of the country, and the regional health records are now being integrated at the federal level. By 2010, more than 95 percent of primary health-care providers across Spain had used the electronic records.
In 2005, the Spanish government began implementing electronic prescriptions as well, and by 2010 more than 250 million prescriptions were being submitted electronically to pharmacies, placing Spain among the top nations in the world for utilization of these technologies. In the regions where these e-prescriptions are employed, visits to primary care physicians have decreased by about 15 percent. "Years ago, a chronic patient had to go to the pharmacy every week, and had to go to the primary care doctor just to get that weekly prescription," says Pablo Rivero, director of international e-health development for the Spanish Association of the Information and Communications Technology Industry (AMETIC in Spanish). "Now, the patient can simply go directly to the pharmacy." This change has saved significant cost as well as time.
Managing health-care expenses is a key goal of the Madrid-based consulting company everis; everis is one of the top two companies in Spain in experience with EHR and personal health records, and its solutions cover more than 20 million users. The company's engineers are now working to improve chronic disease management. "Chronic patients consume about 50 percent of the global health budget," says everis business director Santiago Martín.
But the management of different diseases demands different plans, so Everis has developed solutions for a number of tasks. First, its software segments a population by sufferers from each disease to be managed, such as diabetes, cardiovascular disease, and lung diseases. Then, for a given disease, the software classifies the population further, depending on the level of care required, and defines the care needed and the technology solutions that can help meet those needs. For instance, one diabetes patient may require only an interface that allows her to upload her weight daily; this can be integrated with a tablet or mobile phone. A more seriously ill patient may require additional technologies, such as advanced sensors for evaluating health outcomes. Martín explains that this segmentation avoids the expense of automatically installing a wide range of health-care technologies in every patient's house.