Most widely used care management systems in Spain

Spain's healthcare IT market is one of the most structurally complex in Europe, not because of a single dominant platform, but precisely because no single platform dominates at a national level. With healthcare responsibilities devolved to 17 autonomous communities, each region has developed, procured, or adapted its own care management infrastructure over the past three decades. For healthcare decision makers evaluating procurement options, understanding this fragmented landscape is not a preliminary step. It is the central challenge.

How Spain's decentralised health system shapes platform adoption

The transfer of healthcare competencies to Spain's autonomous communities, completed progressively through the 1980s and finalised in 2002, means that the Sistema Nacional de Salud (SNS) functions as a coordinating framework rather than a centralised operational authority. Procurement decisions, including the selection of medical record systems, care management platforms, and patient administration systems, are made at the regional level by each community's health service (servicio de salud).

This structure has produced a landscape where medical record systems have been developed and deployed autonomously by each region, with hospital information systems in use since the early 1990s. The practical consequence for decision makers is significant: a platform deeply embedded in Andalusia may have no footprint in the Basque Country, and interoperability between regional systems remains a persistent, unresolved challenge.

According to Grand View Research estimates, the Spain hospital information system market generated USD 1,019.8 million in revenue in 2025 and is projected to reach USD 1,597.5 million by 2033, at a compound annual growth rate of 5.8 per cent. Market sizing figures from commercial research firms vary significantly across providers and should be treated as indicative rather than authoritative. Web-based deployment currently represents the largest segment. Cloud-based solutions are the fastest growing, a trajectory with direct implications for procurement strategy.

The dominant public-sector platforms by region

Andalusia: Diraya

Diraya is one of Spain's most mature regional health information systems, developed by and for the Andalusian Health Service (Servicio Andaluz de Salud, SAS). It functions as an integrated platform covering both primary and secondary care across Andalusia's public network, providing a unified patient record, appointment management, e-prescribing, and clinical documentation. Its longevity and scope make it a reference point in discussions of regional medical record system development in Spain, and it is frequently cited as a model for integrated public-sector health IT.

Catalonia: HC3 and the shared clinical history

The Historia Clínica Compartida de Catalunya (HC3) is Catalonia's shared clinical record infrastructure, designed to support interoperability across the region's mixed public and private provider ecosystem. Unlike systems built around a single organisation, HC3 operates as a federated model, allowing authorised clinicians across different institutions to access a consolidated patient record. This architecture reflects Catalonia's distinctive healthcare model, in which public funding flows through a diverse network of providers, including mutual insurance organisations, hospital consortia, and private entities operating under public contract.

Madrid: AP-Madrid, Horus, and CGM Selene

Madrid's public health service (SERMAS) operates across two distinct platform tracks. In primary care, AP-Madrid handles appointment scheduling, patient registration, and clinical records across the region's health centres. In secondary care, the hospital network uses a combination of systems. CGM Selene, originally developed by Siemens Healthineers, subsequently acquired by Dedalus, and later brought under CompuGroup Medical's portfolio, is deployed across at least 12 hospitals and 6 other health centres in the region, handling over 11 million consultations per year and supporting outpatient, inpatient, and teleconsultation workflows. In parallel, Madrid's five large flagship hospitals, including Hospital 12 de Octubre and Hospital La Paz, use HP-HCIS, now maintained by DXC Technology, as an alternative clinical information system. Clinician feedback on HP-HCIS has been mixed, with documented usability concerns. Ongoing efforts to improve integration between primary and secondary care platforms remain a strategic priority for SERMAS.

A practical example of what medical record system integration can support in Madrid's hospital environment comes from a closed-loop clinical decision support system implemented at two teaching hospitals in the region. Clinical decision support refers to tools embedded in clinical systems that prompt or guide clinician decisions based on patient data. Embedded directly into the medical record system, this system reduced unnecessary preoperative chest X-ray orders by 83 per cent, ECG orders by 54 per cent, and overall preoperative blood test order sets by 29 per cent, generating cost savings of over €1 million across a 69-month period, without increasing surgical cancellations or postoperative adverse events.[citation needed]

Valencia: SIA and Orion Clinic

The Valencian Community uses the Sistema de Información Ambulatoria (SIA) for primary care management, covering appointment scheduling, patient records, and chronic disease follow-up across its health centres. In hospital settings, the region has adopted Orion Clinic, now part of the InterSystems ecosystem, as its clinical information platform. InterSystems' HealthShare and TrakCare products, which Orion Clinic has been integrated into, are positioned around interoperability and enterprise-wide data sharing, making the Valencian deployment a notable example of an internationally developed platform adapted to a regional Spanish context.

Other notable regional systems

Several other autonomous communities have developed or procured distinctive platforms:

• Galicia (SERGAS): IANUS is the unified medical record system deployed across 14 hospitals and over 400 primary care centres in the region. Part-funded by EU regional policy funds, it supports full patient record sharing across all care settings and has been cited by the European Commission as a model for patient-centred integrated care.

• Basque Country: Osabide Global serves as the integrated clinical information system for Osakidetza, the Basque Health Service, covering both primary and hospital care.

• Asturias (SESPA): Selene is also deployed in Asturian hospitals, with interoperability links to OMI-AP (used in primary care) via a shared patient health summary (Historia Resumida de Salud).

• Murcia: A 2025 EU procurement tender for Casemix-based patient management software illustrates how individual regions continue to procure specialised care management tools alongside their core medical record system infrastructure.

Widely adopted commercial and third-party platforms

CGM Selene (formerly Siemens Healthineers / Dedalus)

CGM Selene represents one of the deepest commercial footprints in Spanish public hospitals. Its functionality spans clinical documentation, order management, patient administration, and, as demonstrated in Madrid, teleconsultation. The platform's ownership history (Siemens Healthineers, then Dedalus, then CompuGroup Medical) is relevant context for procurement teams assessing long-term vendor stability and support continuity.

SAP for healthcare

SAP's solutions are adopted across larger Spanish health networks primarily for back-office and operational functions: financial management, human resources, supply chain, and resource planning. SAP IS-H (Industry Solution for Healthcare) has been deployed in a number of Spanish hospital groups as the administrative backbone running alongside clinical medical record systems. Its role is typically complementary to, rather than a replacement for, clinical documentation platforms.

Oracle Health (formerly Cerner)

Oracle Health maintains a presence in select Spanish hospital groups, positioned as an enterprise medical record and care management platform for larger institutions. Its acquisition of Cerner in 2022 and subsequent rebranding has introduced uncertainty for some existing customers regarding roadmap and support commitments, a consideration that procurement teams in Spain have had to factor into renewal and migration decisions.

Microsoft Dynamics 365 and Azure in healthcare administration

Microsoft's Dynamics 365 platform and Azure-based cloud infrastructure are seeing growing adoption in both public and private Spanish healthcare settings, primarily for care coordination, patient engagement, administrative management, and data analytics. Azure's EU data residency options have made it increasingly attractive in the context of General Data Protection Regulation (GDPR) and Esquema Nacional de Seguridad (ENS) compliance requirements. GDPR is the EU's data protection regulation. ENS is Spain's national security framework for public-sector information systems.

Care management in Spain's private healthcare sector

Spain's private hospital sector, led by groups including Quirónsalud (part of Fresenius Helios), HM Hospitales, and Vithas, operates on a different procurement model from the public system. These organisations typically adopt international commercial platforms or develop proprietary solutions, with procurement cycles that are faster and less constrained by public tender processes.

Quirónsalud has publicly indicated investment in digital infrastructure across its hospital network, though the extent of cross-hospital interoperability varies by site. The private sector's greater openness to new technologies, including AI-assisted documentation, patient-facing digital tools, and integrated care coordination platforms, means it often adopts emerging tools earlier than its public counterparts.

Patient research on eHealth expectations in Spain conducted as part of the TIMELY study found high acceptance of personalised, user-friendly platforms with remote monitoring capabilities among patients with coronary artery disease. These findings are directly relevant to how private providers are designing their digital care management offerings.

Primary care vs. secondary care: different platform priorities

The functional requirements of primary and secondary care are sufficiently distinct that they have historically driven separate platform selections at each level.

Primary care platforms in Spain are typically expected to handle:

• Appointment scheduling and patient registration

• Chronic disease management and follow-up protocols

• E-prescribing and medication management

• Patient communication and, increasingly, remote or virtual consultation

• Population health management and preventive care registers

Secondary care platforms prioritise:

• Inpatient clinical documentation and ward management

• Order management (diagnostics, medications, referrals)

• Discharge summary generation

• Surgical planning and perioperative management

• Integration with diagnostic imaging and laboratory systems

This functional divergence explains why regions like Madrid operate distinct systems for primary care (AP-Madrid) and hospital care (Selene, HP-HCIS), and why integration between the two levels remains a recurring challenge rather than a solved problem.

Interoperability and integration: the persistent challenge

The structural fragmentation of Spain's care management landscape has a direct operational consequence: legacy systems that were not designed to communicate across care settings or regional boundaries remain deeply embedded across the SNS. A patient moving between primary care, a regional hospital, and a specialist centre in a different autonomous community may encounter multiple disconnected record systems.

Two frameworks are shaping how this challenge is being addressed:

• SNS Nodo is the national interoperability node developed by the Ministry of Health to support cross-regional sharing of key clinical data, including patient summaries, e-prescriptions, and vaccination records, across all autonomous communities. It represents the primary national mechanism for bridging regional system silos.

• The European Health Data Space (EHDS), proposed by the European Commission and advancing through EU legislative processes, establishes a framework for secure cross-border health data sharing across EU member states. For Spanish healthcare organisations, EHDS compliance will increasingly shape procurement requirements, particularly around data standards, patient consent mechanisms, and secondary use of health data.

The GATEKEEPER project, a European H2020 initiative with a Spanish implementation site, demonstrates one model for how interoperable, standards-based eHealth frameworks can be deployed across heterogeneous healthcare environments, including chronic disease management, integrated care coordination, and AI-assisted monitoring. Its methodology offers a practical reference for organisations designing interoperable care management architectures.

Interoperability progress has been uneven. While SNS Nodo has achieved meaningful cross-regional data exchange for specific data types, full clinical record interoperability across all care settings and regions remains an aspiration rather than a current reality for most of the Spanish system.

Emerging priorities shaping platform selection in Spain

Several criteria are increasingly influencing how Spanish healthcare organisations evaluate and select care management platforms:

• GDPR and ENS compliance: Platforms operating within the Spanish public health system are expected to meet ENS certification requirements alongside GDPR obligations. Procurement teams are increasingly requiring vendors to demonstrate both.

• EU data residency: Following heightened scrutiny of data transfers to non-EU jurisdictions, many Spanish health organisations, particularly in the public sector, are specifying EU data residency as a contractual requirement. This has implications for cloud-based platform vendors operating global infrastructure.

• AI-assisted clinical documentation: Interest in ambient voice technology, which uses microphones to capture and transcribe clinical conversations in real time, and real-time transcription for clinical note generation is growing across Spanish healthcare settings. Automated ICD-10 code classification for Spanish medical reports using machine learning has been an active research area, reflecting the broader push toward structured, codeable clinical data. SNOMED CT adoption is also advancing as part of Spain's alignment with European clinical terminology standards.

• Structured data and clinical coding: Platforms that support structured data capture, rather than free-text-only documentation, are increasingly preferred, as they support downstream analytics, population health management, and AI model training.

• Cloud-native architecture: As the market data indicates, cloud-based deployment is the fastest-growing segment in Spain's hospital information system market, driven by scalability requirements, cost models, and the need for remote access.

What healthcare decision makers should evaluate before procuring

For organisations assessing care management platforms in the Spanish market, the following evaluation criteria are consistently relevant:

• Regional regulatory compliance: Does the platform meet ENS certification requirements for the relevant autonomous community? Does it align with the specific data governance requirements of the regional health service?

• Interoperability with existing systems: Can the platform exchange data with the region's primary or secondary care systems, SNS Nodo, and, where relevant, cross-border EU systems under EHDS requirements?

• Data security certifications: ISO 27001 (International Organisation for Standardisation standard 27001) certification provides a baseline indicator of information security management maturity. ENS compliance is specifically required for public-sector deployments in Spain.

• Vendor support in Spanish: Operational support, documentation, training, and implementation resources in Spanish are a practical necessity for clinical teams.

• Scalability across care settings: Can the platform serve both primary and secondary care functions, or does it require complementary systems? What are the integration costs and complexity?

• AI-native workflow readiness: Does the platform support, or have a credible roadmap for, ambient voice documentation, real-time transcription, clinical decision support integration, and structured data output?

• Vendor stability and roadmap: Given the ownership changes affecting platforms such as Selene and Cerner/Oracle Health, assessing the long-term commercial stability and product roadmap of any vendor is a material due diligence requirement.

Navigating a fragmented but evolving market

Spain's care management platform market is regionally diverse, legacy-heavy, and in active transition. No single platform dominates nationally. Regional procurement decisions reflect decades of independent investment, political priorities, and technical choices that will not be unwound quickly. At the same time, the convergence of EU regulatory frameworks (GDPR, EHDS), national interoperability initiatives (SNS Nodo), and commercial pressure from cloud-native and AI-assisted vendors is creating genuine momentum for change.

For healthcare decision makers, platform evaluation in Spain requires region-specific due diligence, not a generic enterprise software assessment. Understanding which systems are already embedded in a given region's infrastructure, and what the interoperability obligations are, is as important as evaluating the features of any new platform in isolation.

Frequently asked questions

▶ Why does Spain have so many different care management platforms rather than one national system?

Spain transferred healthcare responsibilities to its 17 autonomous communities progressively through the 1980s, with the process finalised in 2002. Each region's health service makes its own procurement decisions, including the selection of medical record systems and patient administration platforms. This means a platform deeply embedded in one region may have no footprint in another, and no single platform dominates at a national level.

▶ Which medical record systems are used in Spain's main public health regions?

Andalusia uses Diraya, an integrated platform covering both primary and secondary care. Catalonia operates the Historia Clínica Compartida de Catalunya, a federated shared clinical record. Madrid's public health service runs AP-Madrid for primary care, and uses CGM Selene and HP-HCIS (now maintained by DXC Technology) across its hospital network. Valencia uses the Sistema de Información Ambulatoria for primary care and Orion Clinic in hospital settings. Galicia uses IANUS, and the Basque Country uses Osabide Global.

▶ What is the difference between primary care and secondary care platform requirements in Spain?

Primary care platforms in Spain are typically expected to handle appointment scheduling, patient registration, chronic disease management, e-prescribing, and remote or virtual consultation. Secondary care platforms prioritise inpatient clinical documentation, order management for diagnostics and medications, discharge summary generation, surgical planning, and integration with imaging and laboratory systems. These distinct requirements explain why regions like Madrid operate separate systems for each care level, and why integration between the two remains a recurring challenge.

▶ How is interoperability between Spain's regional health systems being addressed?

Two frameworks are shaping progress. SNS Nodo is the national interoperability node developed by Spain's Ministry of Health to support cross-regional sharing of patient summaries, e-prescriptions, and vaccination records. The European Health Data Space, advancing through EU legislative processes, establishes a framework for secure cross-border health data sharing across EU member states. Progress has been uneven: SNS Nodo has achieved meaningful data exchange for specific data types, but full clinical record interoperability across all care settings and regions remains an aspiration rather than a current reality.

▶ What role do commercial platforms like CGM Selene and Oracle Health play in Spain's public hospitals?

CGM Selene, which has passed through the ownership of Siemens Healthineers, Dedalus, and now CompuGroup Medical, is deployed across at least 12 hospitals in Madrid and handles over 11 million consultations per year. Oracle Health, formerly Cerner, maintains a presence in select Spanish hospital groups as an enterprise medical record and care management platform. Its acquisition by Oracle in 2022 and subsequent rebranding has introduced uncertainty for some existing customers regarding product roadmap and support commitments.

▶ How does Spain's private healthcare sector approach care management platform procurement?

Private hospital groups such as Quirónsalud, HM Hospitales, and Vithas operate on a different procurement model from the public system. They typically adopt international commercial platforms or develop proprietary solutions, with procurement cycles that are faster and less constrained by public tender processes. The private sector's greater openness to new technologies, including AI-assisted documentation and integrated care coordination platforms, means it often adopts emerging tools earlier than public counterparts.

▶ What compliance requirements should vendors meet to operate in Spain's public health system?

Platforms operating within Spain's public health system are expected to meet the Esquema Nacional de Seguridad, Spain's national security framework for public-sector information systems, alongside General Data Protection Regulation obligations. ISO 27001 certification, the International Organisation for Standardisation's standard for information security management, provides a baseline indicator of security maturity. Many public-sector organisations are also specifying EU data residency as a contractual requirement, following heightened scrutiny of data transfers to non-EU jurisdictions.

▶ What emerging technologies are influencing platform selection in Spain's healthcare market?

Interest in ambient voice technology, which uses microphones to capture and transcribe clinical conversations in real time, and real-time transcription for clinical note generation is growing across Spanish healthcare settings. Automated clinical coding using machine learning has been an active research area, reflecting a broader push toward structured, codeable clinical data. Cloud-native architecture is the fastest-growing deployment segment in Spain's hospital information system market, driven by scalability requirements and the need for remote access.

▶ What should healthcare decision makers evaluate when procuring a care management platform in Spain?

Procurement teams should assess whether a platform meets Esquema Nacional de Seguridad certification requirements for the relevant autonomous community, and whether it can exchange data with existing regional systems, SNS Nodo, and cross-border EU systems under the European Health Data Space framework. Vendor stability matters: ownership changes affecting platforms such as Selene and Cerner/Oracle Health illustrate why assessing long-term commercial stability and product roadmap is a material due diligence requirement. Operational support, documentation, and training in Spanish are also a practical necessity for clinical teams.