Gobierno de Aragona

For the GOBIERNO DE ARAGON in Spain, Barbastro Health Area is the Centre of Excellence involved in the Health Optimum Project. The chosen specialities for the experimentation and trials are Oncology, Haemotology, Radiology, Haemodialysis and Laboratory.The participating peripheral healthcare units are Fraga and Castejòn de Sos, which are awaiting  the start of this collaboration enthusiastically. 
The start of the trials has been delayed due to technical reasons, however the services will begin as soon as the problems are overcome. The health authorities are very interested in the project and are seriously working for the future deployment of Health Optimum services in Aragon.
Functional Architecture

TELE CONSULTATION
A diary for tele-medicine, with schedules differentiated for each of the involved specialties has been created in the hospital information system. It is used to make appointments with the healthcare centres. The procedure for a tele-consultation request is as follows:
- For any of specialities, the request of a tele-consultation service is realised in the agenda of the specialist doctor within a fixed hour range for each of the specialities.
- The time for this type of services is posted on the intranet.
- The primary care doctor receives the confirmation of the appointment.
- The specialist care doctor fills in the report of the activity that will be registered in the intranet.

TELE LABORATORY
Tele-laboratory services are especially relevant in the monitoring of patients undergoing anticoagulation treatment. The Aragon?s Health services have launched a plan for decentralising the monitoring of these patients. The tele-laboratory process is understood as follows:An electronic request for clinical analysis issued by the GP and sent to hospital laboratory.
The patient blood test is carried out in his/her Health Care Centre.
The automatic insertion by the laboratory of the results of the analysis in a unique patient clinical record, available telematically to Primary Care.
The quality of the information improves, since its manipulation diminishes. In addition, the time to access results on the part of the attending physicians is substantially reduced, and it also reduces the administrative load.
The patient is the main beneficiary of the tele-laboratory process. The use of the tele-laboratory procedures and protocols allows the patients to see a drastic reduction in the time intervals between the welfare demand, the diagnosis and the subsequent treatment.

 Technical Architecture
All data communications are over TCP/IP in the health intranet area. A local intranet (LAN) exists connecting several PCs at the Barbastro validation area. The Barbastro General Hospital and the Health Centre of Fraga have a 4 MB ADSL line. The Health Centre of Castejón de Sos has a 512 KB ADSL analogue line.

CLINICAL DATA REPOSITORY
Gobierno de Aragón has a project for shared clinical records between primary (ER physicians and GPs) and specialised care.
The Intranet links all the available primary and specialised information related to a patient. By means of a tabs system, it is possible to access primary or specialised information.
The matching between the primary and specialised care clinical records of a patient is done through the Primary Authentication Code (PAC) included in each patient?s health card. When a patient is selected, his/her primary as well as specialised information are shown. This way, both the primary and the specialised care sides have access "online" to the same computerised clinical records of the patient.
This way both, the primary and the specialised care sides, have access "online" to the same computerised clinical records of the patient.

TELE CONSULTATION
An open source tele-consultation tool is being used, implemented in JAVA, PHP and HTML, and hosted on a Linux server with Apache and Tomcat. It accesses the different databases of the different servers (General Hospital and those in the Health Centres) by means of JDBC (JDBC technology is an API that provides cross-DBMS connectivity to a wide range of SQL databases) to Informix Database.
Bookings for tele-consultation are made by a tele-appointment module, accessible from the General Hospital and the Health Centres, to arrange the tele-consultation meetings.
Tele-consultation reports are made with HP-Doctor tool (using HL7 standard), to be published in real time in the Intranet of the sector and included in the patients? records; this data is visible from both the hub and the spokes.
HL7 is being used in modules of the three pilot sites. "Level Seven" refers to the highest level of the International Standards Organization?s (ISO) communications model for Open Systems Interconnection (OSI), the application level. The seventh level supports functions such as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring. Reports generated in tele-consultation are stored in SQL standard databases and thus are interchangeable with other SQL databases. The results may be published in HTML pages to be viewed, subject to previous authentication of user.

TELELABORATORY
The tele-laboratory service is based on the same principles that have been set for the tele-consultation, with regards to activity telematics request. In common with the rest of the services included in the project scope, it incorporates the results in the unique clinical record.
Primary Care Centres have been provided with auto-analysers capable of assessing INR (International Normalized Ratio) levels in order to monitor and adjust anticoagulant prescriptions.
A module to generate inter-phase files between the clinical data repository and the tele-laboratory application will be implemented as well in a near future. Files for bi-directional communication (for both requests and results) will also be completed.