Country profile: Spain

The Spanish healthcare system is organized by national and regional entities. The state administration governs health coordination, international agreements concerning healthcare and the regulation of pharmaceutical products.  Healthcare planning, health attendance, and public health care are managed by the autonomous communities (CCAA) 

CCAA use a system of health areas and zones to optimize healthcare in their respective territories. Most health zones are organized around a Primary Health Care Team.

ICT use and eHealth strategy

In general, Spanish GPs are not as well equipped as the average European GPs, despite the fact that local storage of electronic health data and the use of computers in consultations in Spain are above average. Electronic transfer of health records currently occurs rather infrequently, but this is expected to improve in the years to come. One of the main challenges facing the Spanish healthcare system in general and it’s ICT architecture in particular, is the strong decentralization and heterogeneity of the players involved. This leads to similar heterogeneous implementations, available tools and, ultimately, usage rates of ICT in different regions.

Law 11/07, which pertains to electronic access, stipulates that all Spanish citizens must be able to communicate with government authorities by electronic means. These authorities provide the eGovernment framework administrating eHealth policy. Public service providers must reach this goal by 2010. Two specific plans target eHealth more directly:

• The Avanza Plan aims at modernizing public services and expanding the broadband infrastructure
• The quality of the National Health System Plan aims at
  • creating a trusted, unified healthcare user ID system (health card)
  • computerizing all medical records of each user
  • establishing an infrastructure to manage pharmaceutical delivery
  • facilitating appointment logisitics for patients with GPs through teleappointments and telemedicine.

One of the main challenges of the Spanish eGovernment policy is the creation of common infrastructures and services.

Law 11/07 includes a number of actions on this topic: all public administrations will be presented with a joint offer of infrastructure and common services, thereby promoting interoperability. Accepting this offer is purely voluntary and subject to existing contracts between regional and state entitities. High-speed communication networks will be provided to public administrations. Interoperability of required software solutions will be promoted and costs thereof simultaneously reduced.

Legal framework

The Patient’s Autonomy Law 41/02 defines medical documentation, medical records, and medical information. It regulates their use to ensure proper treatment / assistance by healthcare providers. The law also imposes limits on the use of these records to ensure patient privacy, thereby making it the central issue of regulation regarding health records - electronic or otherwise. The technical solution to insure the nationwide compatibility and interoperability of these health records in Spain has been outlined in the Cohesion and Quality Law 16/03.

Spain’s implementation of a privacy law corresponds to the European Directive on Personal Data Protection. Health data can only be processed for general interest reasons or with the explicit consent of the data subject. One of the general objectives of the NHS National Plan is to ensure that healthcare professionals have access to the information they require during the citizen’s attendance only.