LOMBARY CRS-SISS Project: ICT for Innovation of Healthcare System.


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Claudio Beretta, Dirigente Convenzionato, in charge of innovation technologies and European projects and Luciano Bresciani, Direzione Generale Sanità. Regione Lombardia. Italia

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LOMBARY CRS-SISS Project: ICT for Innovation of Healthcare System.

  1. 1. Va Jornada FòrumCIS National and Regional Integration of medical information CRS-SISS Project IT for innovation of HealthCare system Luciano Bresciani – Claudio Beretta Ministry of Health - Lombardy Region ForumCIS, 22 February 2007 - Barcelona 1
  2. 2. Agenda1. Lombardy HealthCare system.2. Why the CRS-SISS.3. CRS-SISS project overview.4. Current situation of the project.5. Economical sustainability of the project.6. Some observations and lessons learnt from the project experience. ForumCIS, 22 February 2007 - Barcelona 2
  3. 3. National Italian Health System Public Budget * All Italian citizens and foreign 93.5 Billion euro workers are insured. (6,3% of GDP) Regions are in charge of the Health System management. Italian government is in charge of the overall coordination of the Health System. All health care treatments (excluding dental) are covered by the National Health system. Compulsory contribution through taxes. The Health System directly pays for all services admitted. Private HealthCare * expenditure* 2006 data ForumCIS, 22 February 2007 - Barcelona (2,1% of GPD) 3
  4. 4. Lombardy Health System 9.300.000 Citizens 160.000 Healthcare employees 7.900 GPs and Pediatricians 2.540 Pharmacies 15 Local Health Authorities 212 Public and Private Hospitals 983 Public and Private Medical Ambulatories 770 Ageing People Shelters 15,5 Billion euro budget for public healthcare (5,1% of GDP) 70% of Healthcare services provided by public providers* 2006 data ForumCIS, 22 February 2007 - Barcelona 4
  5. 5. Why the CRS–SISS ? Health expenditure increase 1.45 89,0 1.4 13,7 1.35 1.3 1.25 Lombardy 1.2 Italy 1.15 1.1 1.05 62,7 10,0 1 1999 2000 2001 2002 2003 2004 Public Private TotalICT expenditure in Hospitals per year (K€) 170.000 90.000 260.000 Lombardy data, year 2006 1,5% 2,4% 1,8% ForumCIS, 22 February 2007 - Barcelona 5
  6. 6. What we tend to have Full capacity to share information and documents: amongst hospitals and between specialists and GPs. Capacity to rationalize administrative processes and make the information technologies “mission critical” in healthcare sector. Identify an interoperability standard used in the hospitals and by all healthcare professionals and make compatible, possibly uniform, the informatics structure of Hospital Information Systems. Capacity to promote some “networks of pathology” for main clinical areas. ForumCIS, 22 February 2007 - Barcelona 6
  7. 7. CRS–SISS overviewThe core of the project is an ‘HealthcareExtranet’, which links professionals, socialservices, organizations and citizens, tracking allthe events in the process of patient care andproviding value added services.The project is based on smartcard technologies, grantingaccess to the Network to bothcitizens and operators by theirpersonal smart cards. ForumCIS, 22 February 2007 - Barcelona 7
  8. 8. Smart Cards features Identification and authentication. Access to all Public Administration services. Certification of the “presence” of the Citizen Citizen (through electronic signature of documents). Identification and authentication. Access authorization to the System. Electronic Signature.Professional ForumCIS, 22 February 2007 - Barcelona 8
  9. 9. Objectives&Functionalities Information sharing and exchange amongst healthcare Citizens operators and professionals to improve quality of healthcare provision (consultation referrals, prescription process, etc.). Improvement of services provided to Citizens through an easy and secure access to the Healthcare System.Administration Information availability at analytical level to monitor healthcare quality and expenditure during the Public process of care for a better planning at Regional level (management, budget control, expenditure). Simplification of administrative processes (through electronic prescription and electronic signature). ForumCIS, 22 February 2007 - Barcelona 9
  10. 10. Two joint implementations CRS (“Regional Services Card”): the personal smart card allow every citizen to access all public administration services and enabling to access to private services. SISS (“Health Care Information System”): the regional network connect all healthcare and social providers in Lombardy and provide e- Health services for ensuring continuous care. ForumCIS, 22 February 2007 - Barcelona 10
  11. 11. SISS major services Prescription management Electronic prescription: drugs and services coding, control, digital signature, storage, display. Healthcare document management Outpatient examination report, Letter of Discharge, Emergency Form: digital signature, notification, display, import in professional’s EPR. Issuing and maintenance of report are in charge of the health care company providing the service. Outpatient booking service Through Unique Regional Call Center or through a software used by GPs and Chemistries. Unique Booking System for all healthcare providers involved by contract in the Regional System. ForumCIS, 22 February 2007 - Barcelona 11
  12. 12. Document ManagementRegional DataBase Maintenance of event index. Maintenance of Prescription Index. Maintenance of citizen and professional register. Maintenance of access grant through Single-Sign-On. Maintenance of coding tables. Management of GPs communication.Hospital Doc. Repository Document management. Maintain the database of signed documents. Communicates to the Hospital Gate for allowing the SISS to access documents. Can be used also by the Hospital software (e.g. EPR). ForumCIS, 22 February 2007 - Barcelona 12
  13. 13. Network Infrastructure Citizens Pharmacies GPs Lombardy Region Provider Central System Health Care HTTPS Extranet Provider HTTPS Hospitals Operators Citizens ForumCIS, 22 February 2007 - Barcelona 13
  14. 14. Network Providers they are the intermediaries between users and the regional trust that are in charge for the project implementation; they are selected and certified by the Region Lombardy; they provide the access to the SISS Network and to Internet; they install the “front end” software and the “SISS programs” on the operator’s Work Stations; they supply the first level “Help Desk” and the “on site” technical support for the SISS; they are chosen on the market and paid by Hospitals, GPs and Pharmacists. ForumCIS, 22 February 2007 - Barcelona 14
  15. 15. Project results I Smart Cards distribution (August 2006) • Operator Smart Card, 53.000 distributed (90% of public) • Citizen Smart Card, 9.200.000 distributed (98,9%) ForumCIS, 22 February 2007 - Barcelona 15
  16. 16. Project results II CRS-SISS services implementation (December 2006) 9.200.000 Citizens 53.000 Healthcare Professionals 5.400 GPs and Pediatricians (69%) 2.380 Pharmacies (95%) 15 Local Healthcare Authorities 175 Public Healthcare Structures 4 private Healthcare Structures (private extension starts in 2007) Started Starting 1 Pubblic Hospital Actual extension to in Milano 2 public HC structures ForumCIS, 22 February 2007 - Barcelona 16
  17. 17. Project results III SISS Transactions 2005/2006 per month.SISS Transactions 5.000.000 4.000.000 3.000.000 2.000.000 1.000.000 0 Genuary March May July September November Genuary March May July September November Transactions per year 2004: 5.364.000 - 2005: 17.413.000 - 2006: 40.200.000 ForumCIS, 22 February 2007 - Barcelona 17
  18. 18. European cooperation The CRS is compliant with Decisions n°189, 190, 191 of European Administrative Commission, 18 June 2003: NetLink file system and authentication; Further cooperation in EU funded initiatives for smartcard interoperability in Europe: Netc@rds for eEHIC (eTEN) INCO-HEALTH (INTERREG IIIC). ForumCIS, 22 February 2007 - Barcelona 18
  19. 19. Project CostsThere are not investments of the Lombardy Region: the Region pays a fixed fee for the service. Fee of service all inclusive is 10.33 € (8.61 + VAT) per citizen / year (€ 96,000,000 per year). ForumCIS, 22 February 2007 - Barcelona 19
  20. 20. Involved Companies Contractor Payment of the service Call Center for the citizens 8.61 Euro per year / Activated Card Lombardia Call Lombardia Call 100% Regione 100% Lombardia Informatica 100% Lombardia Informatica Lombardia Contract Holder 7 year supply value: ~ 5 million Euro Project Management 8.09 Euro per year / Activated Card Supply and consulting Partners: Telecom Italia Partners: Telecom Italia Finsiel Finsiel LISIT Lutech Realization of Lutech 56% Lombardia Informatica 56% Lombardia Informatica 44% Partner (Telecom, 44% Partner (Telecom, the project 7 year supply value: ~ 350 million Euro Finsiel, Lutech) Finsiel, Lutech)Note: Values not including VAT ForumCIS, 22 February 2007 - Barcelona 20
  21. 21. Comments andlessons learnt ForumCIS, 22 February 2007 - Barcelona 21
  22. 22. CRS-SISS achievements Cost saving for public Healthcare system The CRS-SISS creates an infrastructure which can save 40 million € per year Reports or Saving Saving Type of saving prescriptions (person-year) (K€)Provider and connection costs - 6.500Report management 48.000.000 880 70.000Report printing and distribution (inpatients) 12.000.000 50 7.200Administrative simplification 1.760 61.000Management of pharmacies 62.000.000 8.500reimbursement TOTAL 140.200 2006 data ForumCIS, 22 February 2007 - Barcelona 22
  23. 23. CRS-SISS achievements Time saving for the citizens Healthcare services supplied through ICT allow reduction of time spent by citizens to get them Total Saving Part of process Events Unit saving (K hours)Booking (including travel) 23.000.000 60 23.000Reception 30.000.000 1 500Payment 18.000.000 10 3.000Report issuing (including travel) 28.000.000 30 14.000 TOTAL 40.500 Average saving per citizen: 7,4 hours per year About 5,5 million Lombardy citizens use healthcare services ForumCIS, 22 February 2007 - Barcelona 23
  24. 24. Future developments CRS-SISS as HealthCare Tool The CRS-SISS system can support the healthcare processes and must be used to Help physician into HealthCare processes; Help to share diagnostic and therapeutic guidelines for making clinical protocols; Help to control and to monitor the protocols usage; The savings from the right knowledge of the clinical history of the patient are estimated to be about 5% of yearly HealthCare Expenditure * (about 725 million euros per year for Lombardy ).*Jan Walker and oth.: “The 2005 Of Health Care Information Exchange And Interoperability” Health Affairs, January, 19 Value ForumCIS, 22 February 2007 - Barcelona 24
  25. 25. Lessons learnt The cost of developing the entire informatics system is a small part of the total investments: we spent for that about 70 mil €; The main economical effort is to upgrade the Hospital Information System: we have already spent for that 250 million €; The security infrastructure cost is smaller then the “Privacy” respect: we spend 200.000 € for security and 20 million € per year for “Privacy”; The training cost is less that we could wait; At present, the health professionals accept Regional Healthcare Information System and they are using it more and more. ForumCIS, 22 February 2007 - Barcelona 25
  26. 26. www.crs.lombardia.it Thank youclaudio_beretta@regione.lombardia.itDirezione Generale Sanità Regione Lombardiavia Pola 9 – 20124 Milano - ITALY ForumCIS, 22 February 2007 - Barcelona 26