Collecting data on diverse communities: Challenges and successes from health plans, hospitals, and health departments

The Agencia Valenciana de Salud (Valencia Health Agency) is responsible for providing health services in the Valencia Region to a population of 5,179,279 people (12/2007).
18% of this population (919,207 people) are foreign citizens who we have been able to identify, thanks to our Population Information System (PIS).
The immigrant population is expected to grow considerably over the next few years and this has forced us to plan and design specific strategies after first identifying the different cultural groups in our region.
The Regional Ministry of Health has introduced the Population Information System as the tool for collecting and updating the data to identify, locate and assign health resources (area, zone, centre and doctor) and entitle people resident in the Valencia region to health benefits.
PIS integrates with other information systems in the Regional Ministry of Health which are of interest to the public, such as medical histories in primary and specialised care, register of vaccinations, etc. and with information systems for the management and control of health expenditure and pharmaceutical provision, among others. It is an essential tool for controlling and monitoring Public Health, and necessary and useful for research into health issues, as we shall explain using a wide variety of cases and experiences.
PIS data include four main groups:

• IDENTIFICATION: data which defines the citizen in a unique way (name, date of birth, gender, age, nationality, PIS number…). It avoids any kind of duplicity.
  
• LOCATION: residence adress and telephone numbers, postal adress and original adress provided by the municipal register. The information about the residence adress has helped to design the Health Services Map.
  
• ACREDITATION: indicates the insurance form: health covers and the insurance entity.
  
• ASIGNMENT: health resources which Conselleria offers to the citizen by means of the Health Services Map: Healthcare Center, Primary Healthcare doctor, Specialized Healthcare, Hospital, etc.
  

Being able to cross around 50 types of insurance (unemployed, disabled, no financial resources, workers in employment, retired people, illegal immigrants, European card holders etc.) against residence scheme, nationalities, family groups and co-habitees, etc, permits a very powerful socio-demographic analysis which acquires strategic relevance in Public Health when associated to clinical-welfare information. PIS is designed so that the information generated throughout the system can be analysed in relation to each cultural group of foreigners, with the aim of recognising any public health issues deriving from a particular group and the repercussions on the Welfare Network.
Every Insrance Unit, at hospitals (28) and Healthcare Centers (+700), have access to the data of the PIS registered citizens. It can be carried out an exhaustive control of the data, which can be modified according to the user’s profile.
Particularly, the various cultural groups and the origin of migrants from other countries are known in PIS, as we told before. Nationality is a data included in the population register. This allows carrying out various health studies and knowing the migration impact, which permits to foresee health resources increase.
The European Health Insurance Card (TSE) is also included in PIS project, and it allows invoicing medical attention to any EU citizen within the Valencian Community health system.
Likewise, PIS knows population coming from other Spanish autonomous communities (by their health insurance card) when they are attended in the Valencian Community. This allows the establishment of the Administración Central del Estado (the State) funding increase.
By other hand, there is a complex computer processes group which detects information weakness in order to maintain the high quality.
Furthermore, periodically some PIS crossed information is carried out with external files received from other public organizations such as Social Security, City Councils, insurers (MUFACE, MUGEJU, ISFAS), deceased register, metabolopathies (births), etc. This permits us to maintain the PIS information’s high quality level.
At least once a year, quality campaigns are carried out in Healthcare Centers, in order to obtain statistics of the PIS information quality control by contrast with the patient’s opinion.
The structure in the Valencia region is, approximately, as follows:

• 8,000 authorised PIS users.
  
• 350 system heads in medium and large primary healthcare centres.
  
• 22 PIS technicians in Primary Healthcare (1 in each of the territory’s departments).
  
• 22 hospital PIS units (1 in each department)
  
• 4 provincial Health Insurance units.
  

It is very important the quality control processes in information’s capture. This allows registered information to be coherent, without weakness.
We should mention the existence of a professional team specifically dedicated to maintain a high quality level of PIS information. They are the “Quality Group” in the PIS project.
Another important factor is continuous information given to all staff that works in the system, in order to be able to react in the same way to similar situations using established procedures. In order to improve this aim, there is a user’s callcenter service, in which professionals will advice users about the procedure in each case and how to register a citizen in PIS.
Population Information can be accessed from other Conselleria IS, because incorporation level is very high.
We offer our experience in the development and start-up of this tool for the administrations or teams who wish to develop similar experiments.