Transformar o financiamento PADP em automação clínica à escala regional

Servicio Cántabro de Salud

Turning PADP funding into region-wide clinical automation

Facing a small, largely rural region with a rapidly aging, high-chronicity population, the Servicio Cántabro de Salud (SCS) chose not to pilot digital health; it chose to implement it, at the scale of an entire regional system.

~5,000

patients impacted in the first month of go-live

clinical pathways in scope for region-wide rollout

25%

response rate to automated questionnaires

Compared with other Spanish regions, Cantabria is small in population but disproportionately large in territory. That combination shapes a distinctive challenge for its health system: caring for a dispersed, aging, chronically ill population across a network that stretches from a highly specialized university hospital to dozens of rural clinics and primary-care emergency points.

It also made Cantabria an unusually good candidate for something larger regions often can't attempt: a region-wide implementation rather than a contained pilot.

Regional Insights:

~594,000 inhabitants
5,321 km² of predominantly rural and mountainous territory
4 hospitals, 42 primary health centers, 109 local clinics, and 28 primary-care emergency units (SUAPs)
+50% of Cantabrian adults live with at least one chronic condition
+900,000 emergency episodes attended per year across the region

Problem

A fragmented, siloed care model that made it difficult to coordinate patients across primary care, hospital care, and emergency services;
A demographic and epidemiological profile - high rates of long-term disease, an aging and dispersed rural population - that the existing model was not built to anticipate or manage proactively;
A widening gap between care teams' response capacity and the exponential growth in patient needs, with no structural way to reverse that imbalance under the existing model;

“Our thinking behind PADP wasn't to run pilot projects. It was to take advantage of our population size, which let us move faster and pursue projects at the scale of the entire community. ”

Luis Carretero

General Director

Project Goals

Exponentially increase care teams' capacity to respond to patient needs, closing the gap between demand and available clinical resources without a matching increase in headcount;
Implement clinical pathways effectively, giving every patient access to care aligned with the best available evidence;
Foster teamwork between professionals, ensuring each patient gets the right amount of attention at the right level of care;
Make the patient a more active participant in managing their own condition;
Improve access for patients, bringing care closer to their homes and reducing unnecessary travel;
Improve the operational efficiency of the care processes involved, helping reorient the organization around patient needs rather than institutional silos.

Framed around Spain's PADP program, the project sits within Cantabria's broader Plan de Salud 2025–2029 and is structured across three pillars: digitizing the support services that sustain daily healthcare activity, building a "smart" hospital and health center network through better clinical technology, and personalizing care to each patient's specific needs. UpHill's Clinical Automation Platform was deployed as one of the connecting pieces across this ecosystem, giving the region a common infrastructure rather than a collection of disconnected tools.

Preparing clinical work before patients and clinicians even meet

Traditionally, the work of assessing, testing, and treating a patient only begins once a clinician is physically in front of them - after triage, after waiting, often after avoidable delay. UpHill's Clinical Automation Platform shifts part of that work earlier, structuring it into three steps that run before, during, and after the patient interaction itself.

Receive and read
Before any conversation with the patient begins, the platform pulls together what's already known: history, labs, medications, and allergies, straight from the EHR. Nothing starts from a blank slate and every subsequent step draws on this context automatically.
Interview the patient
The patient responds and talks freely, and the conversation adapts in real time based on the underlying clinical protocol. As the exchange unfolds, structured clinical facts are captured and passed to UpHill's clinical engine, which uses them to decide what to ask next.
Execute and write back
Based on what the interview surfaces, the platform automatically triggers the next steps: requesting exams, scheduling appointments, and generating episode notes. All is written directly back into the patient's electronic health record. As part of this step, an AI-generated clinical note summarizes the interaction in a clear, structured format the clinical team can review at a glance, rather than requiring a clinician to draft it manually from scratch.
Review and approve
The clinician stays firmly in the loop. Prepared cases and recommended care plans are surfaced through population-level and individual "cockpit" interfaces, providing clinical teams with an overview of everyone in a pathway, along with the detail needed to review, adjust, and approve each case.

“The main technological challenge has been integration, bringing all these new projects together, and the only way to make that work in practice is by relying on technological standards.”

Raúl Martínez Santiago

CIO

How this plays out in Cantabria: two use cases

Emergency department

Immediately after triage, the automated interview begins working in parallel with the patient's wait, before a clinician has even opened the case. That head start is used in three ways: to anticipate which tests or therapeutic measures the patient is likely to need, so they can be prepared in advance rather than requested from scratch; to reduce the time patients spend waiting for the process to move forward; and to optimize the time clinicians spend in face-to-face observation, so that time is focused on the decisions that actually require a clinician in the room.

Chronic disease management

Rather than depending entirely on scheduled visits, patients are interviewed through structured digital touchpoints between appointments. The platform executes and writes back the resulting notes and follow-up actions to the EHR, and the clinical team reviews prepared cases through the population cockpit, allowing them to detect early signs of deterioration, keep long-term conditions from being managed only reactively, and dedicate in-person time to the patients who need it most.

In both settings, the same underlying idea holds: preparing the clinical work before the patient and clinician are in the same room, so that when they do meet, the visit is faster, safer, and better informed.

Solution details and highlights

UpHill's Clinical Automation Platform is deployed as shared infrastructure across primary care, hospital care, and emergency services (not a standalone tool in a single department);
Omnichannel patient interviews conducted over chat, email, or voice AI, adapting in real time based on the patient's own responses;
Automatic patient risk detection and severity-based case stratification;
Interoperability with the region's existing clinical systems, reducing duplicate work across care levels;
Built as a scalable foundation with a roadmap toward 13 clinical pathways region-wide, including oncology care and pre- and post-operative journeys.

Disclaimer

This data is specific to this use case at this institution and is presented as an example of how UpHill Route indirectly supports patient management processes in a context where clinical decision support systems are used. The institution itself collected the underlying data. UpHill Route does not claim any direct clinical benefit leading to readmission reduction, access increase, or unnecessary appointment reduction.

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