INFOCLINIC, A CSC TOOL FOR MANAGING PHARMACEUTICAL COSTS
InfoClinic is an application created by CSC which enables users to exploit CatSalut data on pharmaceutical costs in order to compare centres' own costs with set objectives, improve on targets, and avoid penalties.
The Catalan Health Service (CatSalut) sets providers a series of objectives, one of which is related to monitoring pharmaceutical costs, both in primary health centres and in hospitals. InfoClinic is a product created by CSC which enables users to exploit CatSalut data on pharmaceutical costs in order to compare centres' own costs with set objectives, improve on targets, and avoid penalties.
Mario Rabaseda, from the CSC Systems team is the creator of the program on which InfoClinic is based.
What is InfoClinic and what needs does it meet for centres and professionals?
- Infoclinic InfoClinic is a service which makes it possible to use information about the prescription of medicines. Every month CatSalut passes on information about the prescriptions issued by professionals in each organization. From this information a number of indicators are drawn. These are difficult to calculate, vary each year and involve complicated processes (maintenance of product catalogues, maintenance of indicators, etc.). CatSalut calculates this information on a macro level, by organization and centre. InfoClinic makes it possible to extend this calculation to a micro level, within the centre itself, selecting information by professional, by team or in whichever grouping is desired. The management team of the organization is thus capable of managing the achievement of objectives and complementing the training of professionals
- One way of looking at it is to say that CatSalut provides data on the whole of Catalonia right up to the door of the centre and InfoClinic provides data "in-house", right up to the professional. For results to be considered valid it is essential that the two systems (the data on the centre level) are perfectly compatible. With InfoClinic we are able to ensure that indicators square with those of CatSalut up to last decimal point. We pursue the slightest discrepancy until it has been resolved.
- In addition, InfoClinc creates its own indicators which make it possible to measure improvements in the prescribing behaviour of professionals. It is also possible to analyse this information from different points of view, in order to exploit prescribing information, and to create our own indicators and other custom-made functions based on centres' requirements.
How many associates does it provide its services to?
- InfoClínic also offers its services to other providers within the CatSalut system. There are currently 29 organizations using the service, 5 of which are not associated with the Consortium. It is used both in large organizations, such as the Consorci Sanitari de Terrassa and in the Consorci Sanitari Integral - which manages 3 hospitals and 5 core areas - and in district hospitals with no primary or community health care.
What advantages are there in using the InfoClinic program?
If every organization's information technology teams had to do this work, which requires training as an advanced IT specialist, for one or two days a week, the costs would be extremely high for all. With InfoClinic one can create economies of scale and some procedures can be carried out just once. By working with a number of centres, those who have joined the system can forget about having to do certain types of tedious and complicated work, such as entering all the new annual indicators onto the system.
Are there any disadvantages?
As with all tools, there is a learning curve. In addition, the main users of the app, who are, above all, hospital and primary care pharmacists, often don't have training in analytical tools and need to have intensive training when starting. But the Consorci is able to provide this level of training and also to resolve and provide back-up in the event of any incidents. During the 8 years that InfoClinic has been working people have been satisfied with the product.
Does InfoClinic have any competition?
- The Barcelona Col·legi Oficial de Médicos created its own tool, but only for quantitative analysis; it doesn't create and change all the indicators, which is the most difficult part as they vary and it is difficult to keep the information constantly up to date. InfoClinic does do this and it is a key added value.
- The ICS also provides the so-called Quality Standards in Pharmaceutical Prescription tool, but this only calculates the ICS indicators, in accordance with its own objectives.
- The advantage of InfoClinic is both its versatility (being able to make changes, new indicators and the tools for professionals to create their own indicators) and its integration into the system: InfoClinic makes it possible for data obtained to be exploited by systems professionals as well as by pharmacists and others in the organization who may work with it.
How has it developed? How is it that CSC decided to create a product, which is basically an IT tool?
- We have benefited from the close collaboration of expert users of the application, in particular Carmen Solera from the Consorci Sanitari de Terrassa, who has helped us every year with changes needed to be made to the indicators, and from Maite Pérez from the Consorci Sanitari Integral and other members of the CSC Primary Health Care Committee, who have supported InfoClinic from the beginning and have helped us develop it. All of these people have helped us develop product functions and in the management and creation of indicators.
- InfoClinic started in 2004 as it met a need which all centres had and for which there was no practicable solution. Existing tools were either custom-made for a specific user, such as the one created for ICS, or they were too expensive or difficult to implement. In the end CSC decide to develop its own tool, which, as we have already mentioned, could be rolled out more extensively.
- In fact, InfoClinic existed as early as 1998. It was a tool to exploit hospital admissions; it was actually my final degree project which I developed and adapted for this new use. The current version has existed since 2004. At the beginning it was a tool designed to generate reports and data bases. Later, in 2007, we added OLAP (On Line Analytical Processing), which makes it possible to see information rapidly from different points of view. And last year an open source OLAP display was adapted which makes it much easy to access this information and analyse it much more carefully. InfoClinic is a highly active tool which is in constant process of development.
From CSC's point of view, has the experience been satisfactory?
- I think so. Very. On two separate occasions the monitoring information centre indicators provided by the regional health authorities was incorrect whilst InfoClinic had calculated them correctly. When the two sources of information do not square, our users have learnt to trust InfoClinic first!
- It is also very satisfying for us to know that the application started with 10 users and now it has 29, although at no time have we produced any publicity or undertaken promotional activities.
What challenges does InfoClinic now face?
- The most important thing is to move on from purely economic indicators to those related to care. To go back to the tool's origins. At the very beginning, InfoClinic, together with the CMBD-AH (hospital admissions registration), was used to produce care indicators. It currently provides prescription information by doctor, not by patient. This is economic information, economic monitoring information, not information on the appropriate use of prescriptions. What all the users are asking us - and where we would like to go - is to add patient information and connect it with information from other sources: CMBD admissions in primary health, in hospitals, and in accident and emergency departments.
- To get there it will be necessary to make technological and functional changes, but, as has been the case with prescriptions, we believe we are amongst the few who are in an ideal position to achieve it, as we have the tools, the "customers", the expert users, and the knowledge to achieve it.