RobertoNardi_Zuffada_LHI_Symposium_20110330

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					  Leaders in Health IT Symposium

Potential of electronic information exchange
 and communication in regional healthcare
                   networks
           Panel Session Regional Level
                Roberto Zuffada
                 Roberto Nardi
 Lombardia Informatica s.p.a/Regione Lombardia
             Budapest 2011-05-10
       Leaders in Health IT Symposium - Panel Session/Regional Level

                      Regione Lombardia Healthcare System
                                                                 •   9.300.000 citizens (99%)
                                                                 •   150.000 Health & Social Care
                           REGIONE                                   Operators (public and private)
                           LOMBARDIA
                                                                 •   7.800 General Practitioners and
                                                                     Pediatricians (97%)
PHARMACIES                                        HOSPITALS
                                                                 •   2.600 Pharmacies (100%)
                                                                 •   15 Local Healthcare Units (100%)
                                                                 •   35 Hospital Cluster Units (100%)
             CRS SISS – Health & Social Services IT System       •   112 Public Hospitals
                           CITIZENS                              •   More than 2.500 Private Healthcare
                                                                     Services Suppliers
GENERAL                                           LOCAL HEALTH   •   Budget for Health in 2010: 18 bil €
PRACTITIONERS                                     CARE UNITS
                                                                 •   75.000.000 prescriptions
                                                                 •   14.000.000 Electronic Health Files
                          HEALTH & SOCIAL
                          ASSISTANCE                             •   Around 6.000.000 Electronic Health
                                                                     Records
                                                                 •   Around 1.200.000 medical report
                                                                     consultations by GPs
          CRS- SISS System in use: year 2009 figures
     Pharmaceutical orders – Diagnostic orders - Referrals

90.000.000

80.000.000

70.000.000

60.000.000

50.000.000

40.000.000

30.000.000

20.000.000

10.000.000

         -
             2005     2006            2007                 2008      2009

                         Pharma   Exams/Outpatients   Med. Reports
The underlying philosophy
                                                                    SISS is a Regional Healthcare
                                                                    Information Network, the Citizen is its
                                                                    centre.
                                                                    All the data are gathered, organized and
                                                                    reported on the basis clinical contacts of
                                 Hospital                           each citizen within the Regional Healthcare
                                                                    System.
                                                                    SISS implements a work-flow based on the
                                                       ASL          typical healthcare processes:
                                                                     Pharmaceutical
                                                                     Outpatient examinations
                                            Healthcare Local Unit    Medical examinations
                           Pharmacy
                                                                     Emergency
                                                                    …

                                Practitioner
                                                                                                   Data WareHouse
                                                                         Administrative Data
                                                                         Administrative Data        Cluster of Patients

   General Practiotioner

                                                                          Healthcare Data
                                                                          Healthcare Data      Electronic Health Record
                                                                                                  Vision per single Patient
            SISS: functional view
Up to now all documents
are stored in                                    PRACTITIONER
                                                 WORKSTATION
Pdf format
                                                  Central
                                                  Data
                  CRS-SISS              DOC
                                      POINTERS    Base




        DOC                 DOC                        DOC
     REPOSITORY          REPOSITORY                 REPOSITORY


 Health Care          Health Care                Health Care
 Provider #1          Provider #2                Provider #3
Lombardy’s Region Healthcare Information System
                  evolution
 1978      Collection and filing of
           hospitalizations
    1982          Regional personal data Registry of Citizens and General Practitioners

        1985        Collection and filing of pharmaceutical acquisitions

           1997       Collection and filing of outpatient visits data



 1999                 2000 -2001             2002                2004        2005            2008

CRS-SISS             CRS-SISS                CRS-SISS            CRS-        CRS-SISS        CRS-SISS
                                                                 SISS
Project              On site pilot project   Project Financing               All             Healthcare
requirements         in the Lecco District   and beginning of    2 million   Lombardy’s      Private Sector
definition and       (300.000 citizens)      the expansion to    citizens    citizens
feasibility                                  all Districts                   (9,5 million)
analysis
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level


The Lombardy Region Health and Social Services IT System (SISS) 1/4

          eHealth strategy up to 2010: the CRS-SISS project

  • ICT tools and systems to improve and rationalise health care
    processes (Technological, Organisational, Financial/Budget)

  • Smart card based technologies ensuring secure access to the
    healthcare network both to citizens and professionals

  • Improvement of healthcare services, better and more targeted
    planning of the Regional Health System, and integration of the
    healthcare services with ICT
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level


The Lombardy Region Health and Social Services IT System (SISS) 2/4

        eHealth strategy up to 2010: the CRS-SISS project

  • Providing professionals with tailored patient information
    through a unique access point

  • Introducing innovation in the hospitals’ ICT systems,
    including customisation of their IT architecture for the
    integration with the SISS system, and organisational
    changes in day-by-day work
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

The Lombardy Region Health and Social Services IT System (SISS) 3/4
                eHealth strategy up to 2010: the services
 • Citizen Identification: Regional General Registry and Citizen Card
 • e-Prescriptions Management
 • Electronic Health Record (EHR): sharing clinical data among HC Professionals
   (events, prescriptions, reports, care profile, …), enabling on-line access for
   citizens
 • Booking and Payment Services for citizens by Internet, GP, Pharmacies
 • Regional Call Centre, to improve citizen’s access to HC services
 • Digitalization of all medical and administrative documents in order to
   improve efficiency and effectiveness of processes
 • Security Services: Identification & Authorisation (identification and
   authorisation of users; data security; limited access)
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

The Lombardy Region Health and Social Services IT System (SISS) 4/4
             eHealth strategy up to 2010: the documents

 All information can be accessed by all healthcare professionals and
 administrators connected to SISS, providing appropriate identification
 and the citizen’s explicit consent. The following EHR documents can be
 accessed via SISS:
 • Drug prescriptions
 • Vaccination records
 • Test results
 • Hospital discharge letters
 • Therapeutic plans
 • Medical reports
 • Emergency Services reports
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

 The Lombardy Region Health and Social Services IT System (SISS)
                          Smart Cards as key access
                                                                Identification and
                     Identification and                         authentication
      CRS Regional   authentication              SISS Card
      Service Card                                              Authorization to access
        (citizen)    Access to Public          (professional)   the System
                     Administration services
                                                                Electronic Signature
                     Data storage required
                     for emergency care                         Enables access to
                                                                SISS services
                     Certification of the
                     “presence” of the                          Enables access to the
                     citizen (through                           data stored in Citizen
                     electronic signature of                    card
                     documents)                                 Provides an advanced
                                                                digital signature
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

               eHealth strategy towards 2020

  • Towards a patient-centred healthcare system: the
    regional healthcare services is currently moving
    towards a new model from “hospital-centred” to
    “patient-centred” services, tailored on citizens,
    oriented to a better integration of the healthcare
    service on the territory (2012-2020).
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

                What can you bring home 1/4

  • The scale and complexity of the SISS initiative requires very
    careful planning and gradual implementation.
  • The functionalities already in place generate a respectable
    socio-economic return.
  • Legislation has a direct impact on deployment of
    functionalities and benefit realisation.
  • The future potential of SISS lies in integration of HPOs not
    yet part of the network, which are mainly private sector
    providers, and expansion of functionalities to all healthcare
    services.
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

                What can you bring home 2/4

  • Lessons learnt: the experience of the CRS-SISS points out
    that such a complex eHealth project call for:
     • strong political commitment, robust legal and
        regulatory frame, and long-lasting decision makers
        determination;
     • a deep involvement of relevant stakeholders mainly
        professionals, healthcare organisations and industry;
     • an evolutionary and self-adapting approach towards
        the implementation of the ICT solutions.
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

                 What can you bring home 3/4

      • Lessons learnt: Infrastructure comes first but not alone
          • Implementation of such a project implies allocation of large
             amount of resources which are not limited to financial and
             technical domains. A huge investment has to be reserved to
             organisational and “cultural” issues
           • Ensuring proper “human” environment is almost as
             important as providing adequate infrastructures.
               • Clear communication of system’s overall goals must be
                 provided at all levels
               • Educational aspects related to the IT tools being
                 developed must be adequately addressed in parallel with
                 technical deployments
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

                What can you bring home 4/4

  • Lessons learnt: Layout of the clinical information to be
    circulated within the system has to be defined very early
     • Clinical architecture design is almost as important as
        technical architecture design
             • Adoption of coding of clinical information
             • Coding has to be kept as much hidden as
               possible to final users is a critical factor
             • Event management capability to promote shared
               care
Leaders in Health IT Symposium(LHIT) - Panel Session Regional Level

 ... to develop a practical eHealth framework
 and an Information & Communication
 Technology (ICT) infrastructure that will enable
 secure access to patient health
 information, particularly with respect to basic
 patient summaries and ePrescriptions
 between different European healthcare
 systems.
                                           ... The current phase of the NETC@RDS for e-EHIC
                                           ID project is aiming at achieving initial deployment of
                                           an on-line service for the “electronification” of the
                                           European Health Insurance Card (e-EHIC) in 17
                                           EFTA/EU countries. The initial deployment project
                                           phase now extends implementations to enable
10th Anniversary Conference                healthcare access for European citizens who provide
eHealth Week, 10th May 2011                evidence of entitlement in any of the upcoming 320
                                           Service Units (SU) and around 600 Service Points
       16:45 – 18:45                       (SP) across the 17 participating countries (AT, BG,
                                           CH, CZ, DE, FI, FR, GR, HU, IT, LI, NL, NO, PL,
                                           RO, SL, SK) at the end of the project.
Leaders in Health IT Symposium


Roberto Zuffada
Lombardia Informatica
Lombardy Region
Directorate General for Health,
International Health Projects
roberto.zuffada@cnt.lispa.it

				
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