Integration: the Good, the
      Bad and the Heroic
Innovation of the healthcare system through ICT: the
                L...
Lombardia healthcare system

                                                 •   9.300.000 Citizens
                 REGI...
eHealth strategy up to 2010: the
CRS-SISS project
Health and Social Services IT System (SISS)

• ICT tools and systems to ...
eHealth strategy up to 2010: the
CRS-SISS project
Health and Social Services IT System (SISS)

• Providing professionals w...
eHealth strategy up to 2010: the
SISS services
• Citizen Identification: Regional General Registry and
  Citizen Card
• e-...
eHealth strategy up to 2010: the
SISS services
• Digitalization of all medical and administrative
  documents in order to ...
eHealth strategy up to 2010: the
SISS documents
The SISS network allows for the gathering and
organisation of documents fo...
eHealth strategy up to 2010: the
SISS documents
The following EHR documents can be accessed via SISS,
independent of the l...
Smart Cards as key access

                                                          Identification and
               Ide...
CRS-SISS implementation
• Distributed citizens cards: 9.740.000 (100%) (including re-
  issuing)
• Citizens joining SISS: ...
CRS-SISS implementation / EHR

•   Monthly contacts: 1.590.000
•   ePrescription – pharmacies (monthly): 4.200.000 (80%)
•...
CRS-SISS implementation

• Timeline of SISS development
                                 Start Date     Estimation of the ...
CRS-SISS implementation

• Pathology networks creation
A new development is the establishment of pathology
networks with t...
CRS-SISS implementation

• Pathology networks creation
A hospital is appointed to define the content standards and
structu...
eHealth strategy towards 2020

• Towards a patient-centred healthcare
  system: the regional healthcare services is
  curr...
eHealth strategy towards 2020

• The scale and complexity of the SISS initiative requires
  very careful planning and grad...
eHealth strategy towards 2020

• The provision of medical information from as many
  healthcare services and facilities as...
eHealth strategy towards 2020
• The main drivers for benefits are data sharing and
  eBooking functionalities.
• Data shar...
eHealth strategy towards 2020

• Lessons learnt: the experience of the CRS-SISS
  points out that such a complex eHealth p...
Contributing to enhance eHealth as an enabler
for cross-border healthcare: EU projects
         epSOS LSP: CIP, 27 Partner...
Integration: the Good, the
      Bad and the Heroic
Innovation of the healthcare system through ICT: the
                L...
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Innovation of the Healthcare System through ICT: the Lombardy Experiment

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Innovation of the Healthcare System through ICT: the Lombardy Experiment. Zuffada R. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Innovation of the Healthcare System through ICT: the Lombardy Experiment

  1. 1. Integration: the Good, the Bad and the Heroic Innovation of the healthcare system through ICT: the Lombardy experiment Roberto Zuffada Regione Lombardia – DG Health
  2. 2. Lombardia healthcare system • 9.300.000 Citizens REGIONE LOMBARDIA • 150.000 Health & Social Care Operators (public and private) PHARMACIES HOSPITALS • 7.700 General Practitioners and Pediatricians • 2.600 Pharmacies • 15 Local Healthcare Units CITIZENS • 112 Public Hospitals including 8 University Hospitals GENERAL PRACTITIONERS LOCAL HEALTH • More than 400 Private CARE UNITS Healthcare Services Suppliers HEALTH & SOCIAL • Budget for Health in 2008: 17 ASSISTANCE billions €
  3. 3. eHealth strategy up to 2010: the CRS-SISS project Health and Social Services IT System (SISS) • 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
  4. 4. eHealth strategy up to 2010: the CRS-SISS project Health and Social Services IT System (SISS) • 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
  5. 5. eHealth strategy up to 2010: the SISS 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
  6. 6. eHealth strategy up to 2010: the SISS services • Digitalization of all medical and administrative documents in order to improve efficiency and effectiveness of processes • Accounting information management flow • Security Services: Identification & Authorisation - The security and confidentiality principles of SISS are the following: - Citizen consent to processing their health data, in accordance to Art. 29 - Identification and authorisation of users - Data security - Limited access
  7. 7. eHealth strategy up to 2010: the SISS documents The SISS network allows for the gathering and organisation of documents for clinical purposes. All citizens registered in the Regional General Registry have a citizen card and an EHR. The information can be accessed by all healthcare professionals and administrators connected to SISS, provided appropriate identification and the citizen’s explicit consent. SISS contains metadata that points to the synthesis reports of all healthcare events
  8. 8. eHealth strategy up to 2010: the SISS documents The following EHR documents can be accessed via SISS, independent of the location of the point of care: • Drug prescriptions • Vaccination records • Test results • Hospital discharge letters • Therapeutic plans • Referral letters • Emergency Services reports.
  9. 9. 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
  10. 10. CRS-SISS implementation • Distributed citizens cards: 9.740.000 (100%) (including re- issuing) • Citizens joining SISS: 4.960.000 (54%) • HCPs with professionals cards SISS: 63.000 (76%) (public sector) • SISS work stations: 26.100 (public sector) • GPs joining SISS: 7.167 (92%) • Pharmacies connected to the SISS network: 2.593 (100%) • Public hospitals joining SISS: 112 (100%) • Local Healthcare Units joining SISS: 15 (100%) • Private healthcare organisations connected to SISS: 355 (96%)
  11. 11. CRS-SISS implementation / EHR • Monthly contacts: 1.590.000 • ePrescription – pharmacies (monthly): 4.200.000 (80%) • ePrescription – laboratories (monthly): 1.600.000 (58%) • Lab medical reports (monthly): 490.000 (88%) • Radiology medical reports(monthly): 140.000 (73%) • First aid medical reports (monthly): 172.000 (70%) • Discharge letters (monthly): 58.500 (49%)
  12. 12. CRS-SISS implementation • Timeline of SISS development Start Date Estimation of the Finish Date Status of work in Functionality / Service (First issue/ (Full deployment Source: “Report on Service Aug-2009 and/or The socio-economic impact Activation) (deployment) distribution) of the health information platform Sistema SISS in the eBooking Before 2002 70% 2010 region of Lombardy, Italy” Digital Signature: Electronic Cards and Client 2002 90% 2010 empirica-TanJent, 2009 Peripherals; Digital Signature: 2002 100% 2008 Infrastructure Clinical applications: Ambulatory reports 2006 70% 2010 Lab reports 2006 95% 2010 Radiology reports 2006 92% 2010 A&E 2006 88% 2010 Discharge letters 2006 88% 2010 Managing Prescribing 2006 100% 2009 ePrescribing of drugs 2006 88% 2010
  13. 13. CRS-SISS implementation • Pathology networks creation A new development is the establishment of pathology networks with the aim of utilising the opportunities provided by SISS for continuous and ubiquitous care for those who need it. Currently, there are 3 active pathology networks, for - Oncology - Epilepsy and - Rare pathologies Another 5 networks, covering cardio-vascular and stroke diseases, dialysis, hearing, and the phenomenon of infants death, are in the process of being implemented.
  14. 14. CRS-SISS implementation • Pathology networks creation A hospital is appointed to define the content standards and structures of the documents for the respective network. Pathology networks already exchange documents that are based on structured data, and for future documents shared in SISS are envisaged to consist of structured data.
  15. 15. 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).
  16. 16. eHealth strategy towards 2020 • 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. Source: “Report on The socio-economic impact of the health information platform Sistema SISS in the region of Lombardy, Italy” empirica-TanJent, 2009
  17. 17. eHealth strategy towards 2020 • The provision of medical information from as many healthcare services and facilities as possible increases the extent of benefits, especially regarding patient safety. This, in turn increases the necessity for healthcare professionals, both in GP practices and hospitals, to actively integrate information sharing into their clinical routine. • The pathology networks already active of in the process of establishment will both foster continuity of care and impact health professionals’ attitude towards the necessity of data exchange without local restrictions. Source: “Report on The socio-economic impact of the health information platform Sistema SISS in the region of Lombardy, Italy” empirica-TanJent, 2009
  18. 18. eHealth strategy towards 2020 • The main drivers for benefits are data sharing and eBooking functionalities. • Data sharing • renders safer healthcare provision, especially in cases where patients would otherwise not bring their referrals or discharge letters; • it allows for data validation and counter-checking of test results, for preparation of consultations in advance, for the creation of new healthcare models, and time savings and increased productivity. • eBooking • fosters HPOs’ resource planning and allocation, • saves time and travel costs and • makes scheduling much more convenient for patients.
  19. 19. eHealth strategy towards 2020 • Lessons learnt: the experience of the CRS-SISS points out that such a complex eHealth projects call for: • strong political commitment, robust legal and regulatory frame, and long-lasting decision makers determination; • a deep involvement of relevant stockholders mainly professionals, healthcare organisations and industry; • an evolutionary and self-adapting approach towards the implementation of the ICT solutions. More information on SISS project: “Report on The socio-economic impact of the health information platform Sistema SISS in the region of Lombardy, Italy” http://www.ehr-impact.eu/ empirica-TanJent, 2009
  20. 20. Contributing to enhance eHealth as an enabler for cross-border healthcare: EU projects epSOS LSP: CIP, 27 Partners, 12 MS “to develop a practical eHealth framework and ICT infrastructure that will enable secure access to patient health information, particularly with respect to a basic Patient Summary and ePrescription, between European healthcare systems” NEC@RDS: eTEN, 27 Partners, 16 MS, eEHIC deployment service “to achieve the initial deployment of the eEHIC through a service allowing automated data capture for identification, on line verification of entitlement via National Portals, back-office interstate billing” ALIAS: Alpine Hospitals Networking for Improved Access to Telemedicine Services, 10 partners, 7 Regions – ERDF Territorial Cooperation “to network Alpine hospitals for better access to healthcare through the use of existing infrastructures of connectivity in order to optimise the delivery of HC services (telemedicine and data sharing)”
  21. 21. Integration: the Good, the Bad and the Heroic Innovation of the healthcare system through ICT: the Lombardy experiment Roberto Zuffada Regione Lombardia – DG Health

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