FROM

1. FROM call center strategy TO Directorate-General for Health Care Innovation,Systems and Technologies a multichannel approach to the citizen Pablo Rivero Corte Sevilla. May 2006

2. 24 /7 in andalusia health Personalised web areas Telephone helplines SMS Services Expectations and Participation Multi-format audiovisual contents

3. The AndalusianPublic Health System in the framework of the renewed Lisbon Strategy  The Public Health System has… 1,459 primary care centres 91,000 healthcare professionals € Budget: more than 7 billion € 7.5% of the regional GDP Health Care Technological Platform in Andalusia 34 public hospitals 9,500 Diraya work stations The APHS is a key factor for growth and employment

4. The Andalusian Public Health System in the framework of the renewed Lisbon Strategy  The APHS as a test bed for the development of EU policies LISBON STRATEGY Projects A C T I O N L I N E S Citizens 2nd MODERNISATION Of ANDALUSIA i2010 e-Health 2006 Technological platform Professionals Enterprises LLL 2010 ERDF ESF HEALTH STRATEGY FP7 CIP

5. Electronic Health Record The Andalusian Public Health System in the framework of the renewed Lisbon Strategy  Quality and productivity in the APHS through intensive use of ICTs Integrated and Available at any time or any place AAll the health information on each citizen Citizen Information and Services Centre Specialised Care Primary Care Telemedicine System continuity in the healthcare process … A centralised appointment system, an electronic prescription system …

6. Types of Innovation INTEGRATED FRAMEWORK OF CITIZEN RELATIONS “The configuration of a new role and greater demand from public services means that Interaction with the citizen via multiple channels, the proactivity and interactivity of the system (especially in the area of promotion and prevention) and the personalisation of the service are all essential steps which must be taken in order to achieve proximity with the citizen.” ICTS AND PROFESSIONAL FULFILLMENT “The accumulated knowledge within the health system on the need for new IT systems as a support to clinical practice and the various management areas, together with the impressive development of ICTs, allows this knowledge to be converted into new and powerful technological tools that will facilitate and reinforce the fulfillment of the APHS professional. ORGANISATIONAL INNOVATION “The continuous learning which takes place in a complex system of continual interaction such as the public health system (in the case of Andalusia there are more than 80,000 professionals and 8 million users) facilitates transformation into more efficient forms of organisation”

7. New Services for the Citizen Audiovisual Multimedia Platform Health Respose Contact Center New World of the Stars Educates (3-16 years) Entertains (3-16 years) SMS Educates Informs Entertains Healthcare info. Health advice New Website CITIZENS Telephone Enquiries Usability Personalised Transparency Info. on pathologies, Citizen´s rights Information on Quality in Health Centres Health Info. Assesment Centre Assesses and divulges Information on Helath Initiatives Map e-Administration Accesibilidad Ventanilla Única Teleassistance Telemonitoring Mobile Units Collection of expectetions to promote participation and information Expectations Bank Telemedicine

8. Diraya MTI Information Treatment Modules SALUD RESPONDE RECETA XXI Contact center Electronic prescription CENTRALIZED APPOINTMENT HEALTH RECORD UDB STRUCTURE OCAM users professionals resources

9. Diraya.Health Response Web Centralized appointment B D U Back Office Telephone CEIS Users eMail Presential Data Warehouse Others channels

10. Diraya. Corporate appointment APPOINTMENT CENTRAL MODULE for • Primary Care • Specialized Care • Diagnostics Tests

11. Requests PACS Destiny Clinical modules Requests agents Laboratories Laboratory Cross consultation Specialists Specialist consultation Emergency Primary Care Appointment Functional tests RIS Radiological tests Results reports Corporate catalogues Diraya. Corporate appointment

12. Diraya. Corporate appointment • Usuario OCAM

13. Diraya. Health Response

14. SMS Operating System Health information, prevention and promotion campaigns Tobacco addiction Pollen count by province Heatwave prevention plan, etc Incorporation into the health care activity Metabolopathy programmes Adult vaccinations (Anti-influenza and Anti-tetanus). “CHOOSE YOUR MEANS OF CONTACT” With a closer, more accessible system. The APHS adapts to modern society by using new technologies for communicating with the citizen. SMS messages provide the citizen with immediate, personalised information The APHS adapts to modern society by using new technologies for communicating with the citizen. . The citizen can now choose how to receive required information

15. Primary Care programmed appointments in APHS Health Centres Free choice of hospital for surgical operations Second medical opinion Community liaison nursing. Monitoring of post-hospital discharge patients due to fragility or climatic conditions APHS AIDS Health card Oral Hygiene Health Programme Living Will Declaration Much more than a Contact Center. The citizen can now choose how to receive required information

16. More services More channels Stepwise development A response for every need Personalised information Interactive and pro-active service HealthResponse is available 24/7 health in andalusia24/7 aims to develop new services and boost current services available through HealthResponse:

17. To offer our citizens a new service for healthcare and health information, 24 hours a day 365 days a year, accessible through different communication channels, providing immediate and personalisedresponsethat is adapted to the needs of each individual. Mission

18. Specific aims Provide information and advice 24 hours a day (365 days a year) in line with particular health problems Give information on services, resources and help available personally, immediately and directly Meet the information needs of our citizens providing quality information, swiftly and efficiently Provide integrated and consistent response from different services Ensure multichannel formats to improve accessibility to the healthcare system for citizens Bring health and services closer to people In particular, to support patients and their families facing greater difficulties in accessing healthcare services and greater need for care (dependent persons, chronic patients, family carers...) Provide help for the professional throughout the process of providing information to patients Generate trust in the APHS, devising strategies from the user’s standpoint capable of meeting his/her expectations

19. Information viadifferent channels: telephone, web, mobiles, email, DTT... Information on demand: a citizen (or professional) seeks and finds information on different channels Responses are adaptedto the different members of the public(men and women, youth, the elderly, different ethnic groups... Qualityinformation (AHQA), that is evidence-based and backed by accessible guides from any GP practice or user information unit Up-to-date information available when needed by the enquirer Pro-active information, via the most appropriate channel in line with the target population and profile of needs Using set referral criteria when required Link with healthcare services (helplines at health centres, 24-hour helplines within integrated plans, 061, emergency services, primary care consultation, liaison nurse) Characteristics

20. health in andalusia24/7 is backed by the Healthcare Information Management Centre and the Expectations and Participation Bank: • The mission for the Healthcare information management Centre (Healthresponse, keeps you informed...)is toprovide our citizens with accessible, easy-to-understand, quality information with full APHS guarantees. • The various initiatives that are currently under development on this topic in different areas of the APHS will be integrated and strengthened (A network centre, with different, fully coordinated, syngergistic nodes). • The Expectations and Participation Bank (Healthresponse, listens to you...), will compile information on the expectations, needs, suggestions and proposals from patients and citizens for improvements in healthcare provision. • The different channels for participationwill be implemented through the “”WEB face” of the Bank (Expectations and Participation Web).

21. EXPECTATIONS AND PARTICIPATION BANK (New channels for participation) TEL WEB In person AHTAA Complaints/Claims (Single model) Quantitative and Qualitiative surveys 7 tools for participation: Focal groups Citizen panels • Theme-based forums • Electronic questionnaires • Working desktop for correspondents • Area for access to citizen expectations • Area for participation by associations • Citizen Panels • Area for Participation Resources Information Assessment System Specific reports Segmented Web for professionals Segmented Web for citizens

22. Healthcare information management Centre Generates quality, up-to-date, accessible information through different channels Content production for different formats and channels Updated, accredited, useful and easy-to-read information Printed materials WEB Tele-phone 3G Mobile SMS DTT Video E- mail Radio Health Response Health in Andalusia 24/7 Multi-channel healthcare and health information Content production for different formats and channels Updated, accredited, useful and easy-to-read information

23. Healthcare information management Centro de evaluación de información Centre sanitaria Generates quality, up-to-date and accessible Genera información de calidad, actualizada y accesible en distintos canales information via different channels Producción de contenidos para distintos formatos y canales Content production for different formats and channels Updated, accredited, useful,easy-to-read information Información actualizada, acreditada, útil y legible Material Printed materials WEB WEB Tele- phone Teléfon 3G mobile Móvil 3G SMS SMS TDT DTT Video Víde E E - - mail mail Radio Radio impreso o o Salud Responde Health Response Health in Andalusia 24/7 Salud Andalucía 24 horas Atención e información sanitaria, Healthcare and health information, multicanal multichannel Content production for different formats and channels Producción de contenidos para distintos formatos y canales Información actualizada, acreditada, útil y legible Updated, accredited, useful, easy-to-read information Information on expectations GENERATED IN DIFFERENT AREAS OF THE APHS. Integration and management of scattered information through the Bank Information COMPILED DIRECTLY THROUGH the EXPECTATIONS and PARTICIPATION WEB (forums and other channels for participation). (Healthresponse, listens to you...) Information for the citizen Healthresponse, keeps you informed... EXPECTATIONS AND PARTICIPATION WEB Information for managers. Information for professionals

24. General information for the citizen on services and resources • Health information open to all citizens • Personalised information on major health problems • Information on how to tackle healthcare emergencies 4 levels of information

25. 2.-Health Information The citizen needs (requests) information Telephone Protocol-based information guidelines Frequently asked questions and answers WEB Telephone E-Mail WEB • Smoking • AIDS • Healthy eating • Cardiovascular disease prevention • Accident prevention • Avoiding unwanted pregnancy • Alcohol and drugs, etc. In person (at the surgery, at the UIS) E-Mail In person (at the surgery, at the UIS) Digital television The citizen receives information Digital television Mobile Mobile

26. Information on the most common health problems • Progressive implementation: • Medical problems • Adults: allergies, cardiovascular and respiratory • Children: allergies, otitis, ... • Surgiocal problems • Adults: AMS (Cataracts, GI tract (copro)) • Children: Tonsillectomy

27. Protocol-based information guides Most common questions and answers The citizen seeks information The citizen receives information Available on the WEB Accessible by telephone If protocol-based problems are pinpointed, referral to healthcare personnel (similar to follow-up for frail patients) Through the WEB: interactive tutorials, information adapted to different profiles, most common questions and answers, videos, links, etc. Through subscription email Through telephone operators at HR responding to the most common previously protocol-based questions When problems are detected, assistance is provided by healthcare personnel or the case is referred to the 061 helpline or emergency services Call is referred to healthcare centre if available. Access from healthcare centre to the same information guides (consistent information throughout the APHS)

28. WEB CHANNEL TELEPHONE CHANNEL IN PERSON CHANNEL Enquirer accesses Health in Andalusia 24/7 via WEB Finds information on his/her health problem Enquirer accesses Health in Andalusia 24/7 by TELEPHONE Information is insufficent and he/she calls Operator attends call and resolves doubt or problem with protocol-based information Referral Health centre Operator attends call and gives appointment for primary care, liaison nurse or specialist consultation (only for cases matching protocols) Referred to seek further information on the WEB Operator receives call and refers to To Primary Care Consultation A healthcare professional by phone To Emergency Service Resolves Refers

29. CONCLUSIONS and STRONG POINTS • Modernisation over the past 5 years (BDU, scheduled appointments, Webs, ...) has led to a major leap in quality towards a Multi-service, Multi-channel Information Centre • The “natural” strategic development of HealthResponse tends towards this model • Technology convergence (Web+TF+Mobile+Audiovisual) in 2006-2007 • A challenge and a great opportunity to shape Health in Andalusia24/7 • The new model for HealthResponse is not a “substitute” for already existing services and info lines (Web, Tel, AHTAA, ...), rather it boosts and strengthens the overall approach

30. ¡Muchas gracias por su atención! Nous vous remercions pour votre attention! Thank you for your kind attention! Directorate-General for Health Care Innovation,Systems and Technologies FROM call center strategy TO a multichannel approach to the citizen Pablo Rivero Corte Sevilla. May 2006