Regional Service Card
Health & Social Care Information System
(CRS-SISS Program)
29 October 2010
Nicola Contardi
Lombardia...
Summary
• Lombardy Region
• The Healthcare Network of Lombardia
• Lombardy’s Region Healthcare Information System evolutio...
Lombardy Region
• Is one of the twenty Italian Regions
• About 16% of Italy’s citizens
• Is one of the most populated Regi...
The Healthcare Network of Lombardia
• 9.500.000 Citizens
• 150.000 Health & Social Care
Operators
• 7.700 General Practiti...
Lombardia Informatica
• Lombardia Informatica is a public-owned service company which
was constituted in December 1981 as ...
Lombardy’s Region Healthcare Information System
evolution
6
1978 Collection and filing of hospitalizations
Collection and ...
Healthcare DataHealthcare Data
Administrative DataAdministrative Data
General Practiotioner
Practitioner
ASL
Healthcare Lo...
CRS-SISS - Goals
8
• Improve Services for
Citizens: reducing the
“distance” between Citizen and
HC Service Providers by
si...
CRS-SISS Main Streams
• creation of new services at
regional level for Citizens and
HC Professionals (Electronic
Health Re...
CRS-SISS Services
• Citizen Identification: Regional General Registry and Citizen Card
• e-Prescriptions Management to ena...
CRS-SISS - Architecture
11
General
Practitioner,
Pediatrician
Level 2
Healthcare
Extranet
Hospital, Operators,
Chemists, …...
CRS-SISS Project Principles
• Web technologies
• Evolution and integration, not replacement, of existing applications
• St...
Smart Cards Technology
• Identification and authentication
• Data storage required for emergency care
(Netlink standard)
•...
CRS-SISS “Pillars”
• Regional General Registry
• Electronic Health Record (EHR)
• Reception processes improvement (booking...
Electronic Health Record (EHR): 2 level architecture
15
Hospital
Hospital
ASLASLASL
Healthcare Local Unit
Events Link
EHR
...
Electronic Health Record (EHR): main features
• Based on a “patient centric” structure, is the fundamental
support for the...
17
Electronic Health Record (EHR): How does it work ?
GP
Pediatricians
HospitalDiagnostic Test Medical Specialist
Electron...
Electronic Health record (EHR): functions
• Give an integrated view of the sanitary history of a specific citizen to the
d...
19
• “Personal zone” for the citizen in his EHR
• Asyncronous Electronic Document consultation
• Diagnostic &Therapuetic p...
CRS-SISS – Main Results in 2010*
20
• Over 9 millions of CRS smartcards delivered
• 96% General Practitioners and Pediatri...
21
• Customer-orientation
 A system also for the healthy
 A user-interface even more user-friendly
 Simple functions in...
22
• EHR for e-Health government
 Developing systems more and more citizen-data centric
 Try to modify some Regional rul...
23
• Interoperability at a regional and european level
• Applications more oriented to the Inetrnet world
• Re-use
• Creat...
Lombardia Informatica S.p.a.
Thank you
Nicola Contardi
nicola.contardi@lispa.it
24
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Regional Service Card. Health & Social Care Information System. Lombardia. Sr. Nicola Contardi

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La salut en mans dels ciutadans. Seminari sobre la Carpeta Personal de Salut - Personal Health Record (PHR). Tecnocampus Mataró, 29 d'octubre de 2010.

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Regional Service Card. Health & Social Care Information System. Lombardia. Sr. Nicola Contardi

  1. 1. Regional Service Card Health & Social Care Information System (CRS-SISS Program) 29 October 2010 Nicola Contardi Lombardia Informatica
  2. 2. Summary • Lombardy Region • The Healthcare Network of Lombardia • Lombardy’s Region Healthcare Information System evolution • The CRS-SISS Program • The underlying philosophy • Goals and main streams • Services and Architecture • Project principles • Smart Cards Technology • The “Pillars”: Regional Registry, Electronic Health Record (EHR), Reception Processes Improvement • The Electronic Health Record (EHR) • Main results in 2010 • Open issues 2
  3. 3. Lombardy Region • Is one of the twenty Italian Regions • About 16% of Italy’s citizens • Is one of the most populated Regions of Europe (more populated than 14 EU member States) • Its GNP is about 20% of Italy’s GNP 3
  4. 4. The Healthcare Network of Lombardia • 9.500.000 Citizens • 150.000 Health & Social Care Operators • 7.700 General Practitioners and Pediatricians • 2.500 Pharmacies • 15 Local Healthcare Units • 34 Public Healthcare Services Suppliers (29 Public Hospital and 5 Public Medical Research Institutes) • Over 2500 Private Healthcare Services Suppliers 4 • Lombardy, like every Italian Region, is directly responsible for HC service provision REGIONE LOMBARDIA PHARMACIES HEALTH & SOCIAL ASSISTANCE GENERAL PRACTITIONERS LOCAL HEALTH CARE UNITS CITIZENS HOSPITALS REGIONE LOMBARDIA PHARMACIES HEALTH & SOCIAL ASSISTANCE GENERAL PRACTITIONERS LOCAL HEALTH CARE UNITS CITIZENS HOSPITALS
  5. 5. Lombardia Informatica • Lombardia Informatica is a public-owned service company which was constituted in December 1981 as an initiative of the Lombardy Regional Government. • The company designs and develops ICT Systems for the regional government and is responsible for management of the latter’s already-existing systems. • Lombardia Informatica has around 500 employees and a revenue of about €240.000.000 (2009). • Lombardy Region has entrusted Lombardia Informatica with the management and overall responsibility for the CRS-SISS project (Regional Service Card Health & Social Care Information System). 5
  6. 6. Lombardy’s Region Healthcare Information System evolution 6 1978 Collection and filing of hospitalizations Collection and filing of outpatient visits data1997 1985 Collection and filing of pharmaceutical acquisitions 1982 Regional personal data Registry of Citizens and General Practitioners CRS-SISS Project requirements definition and feasabilty analysis CRS-SISS On site pilot project in the Lecco District (300.000 citizens) 1999 2000 -2001 2002 CRS-SISS Project Financing and beginning of the expansion to all Districts 2008 CRS-SISS Healthcare Private Sector 2004 2005 CRS-SISS 2 million citizens CRS-SISS All Lombardy’s citizens (9,5 million)
  7. 7. Healthcare DataHealthcare Data Administrative DataAdministrative Data General Practiotioner Practitioner ASL Healthcare Local Unit Pharmacy Hospital Healthcare DataHealthcare Data Administrative DataAdministrative Data General Practiotioner Practitioner ASLASL Healthcare Local Unit Pharmacy Hospital Data WareHouse Cluster of Patients Electronic Health Record Vision per single Patient Data WareHouse Cluster of Patients Electronic Health Record Vision per single Patient The underlying philosophy 7 SISS is a Regional Healthcare Information Network; the Citizen is its centre. All the data are gathered, organized and reported on the basis of the citizen’s clinical treatment within the Regional Healthcare Network. SISS implements a work-flow based on the typical healthcare processes: • Pharmaceutical • Outpatient examinations • Hospitalization • Emergency • …
  8. 8. CRS-SISS - Goals 8 • Improve Services for Citizens: reducing the “distance” between Citizen and HC Service Providers by simplifying procedures and shortening waiting time (e- booking, access HER, e- precription) •Improve quality of prescription, diagnosis and care (appropriateness) processes by Citizens’ clinical data sharing, through EHR, among qualified HC Professionals, securing Citizens’ Privacy Rights •Improve Governance of Social and HC System managing costs: enhancing planning and controlling instruments (DataWarehouse, Business Intelligence) • Improve internal process efficiency of HC Service Providers by a generalized diffusion of new technologies (digital signature, electronic filing, electronic prescription) to dematerialize documents SISS Planning and Governance of HC expenditures Efficiency and Simplification Social and HC Internal Processes Assure continuity and quality of care For Citizens and HC Professionals For Administrations (Regional Government and HC Providers) •The prerequisite of the Project was the distribution of the personal Smart Card. •The main objectives of the CRS-SISS Program are to unify and to protect, within a co-ordinated system, all the information related to the citizens’ state of health. Reduce the gap between Citizen and HC Services Providers
  9. 9. CRS-SISS Main Streams • creation of new services at regional level for Citizens and HC Professionals (Electronic Health Record) • creation of a large technological infrastructure • implementation of an integrated regional information system • central data base and clinical data repository (administrative data, service codes, Patient Record,…) • solutions for clinical management of patients • application integration of Organization’s Information Systems through an integration middleware Healthcare Extranet as main instrument of innovation and integration framework among all actors: Develop HC Organizations’ (Hospitals, HC Local Units, …) Internal Information Systems, promoting features such as: 9
  10. 10. CRS-SISS Services • Citizen Identification: Regional General Registry and Citizen Card • e-Prescriptions Management to enable a truly digital use of prescriptions during their life cycle • Electronic Health Record (EHR): shares clinical data among HC Professionals (events, prescriptions, reports, care profile, …), enables on- line access for Citizens • Booking and Payment Services for Citizens by Internet, GP, Pharmacies, Regional Call Center, to improve citizen’s access to HC services • Business Intelligence and DataWarehouse to make analyses and forecasts of epidemiological trends and to manage and forecast regional healthcare expenditure trends • Digitalization of all medical and administrative documents in order to improve efficiency and effectiveness of processes • Accounting information flow management: incremental records of administrative data in order to ensure on-line updating of Business Intelligence and Data Warehousing Systems • Electronic signature, mailing system, encryption functionality 10
  11. 11. CRS-SISS - Architecture 11 General Practitioner, Pediatrician Level 2 Healthcare Extranet Hospital, Operators, Chemists, … Provider Provider HealthcareSocial Services Level 1 Central Repository Level 3 Operators and Organisations Integration Management Unit Citizens SERVICES Lombardy Region Central Systems
  12. 12. CRS-SISS Project Principles • Web technologies • Evolution and integration, not replacement, of existing applications • Strict enforcement of personal data protection (privacy): high security technologies • Process reengineering to improve efficiency • Extensive deployment of digital signature and electronic documents (dematerialization) • Smart cards • Make available to existing applications a common infrastructure for integration • Integrate, not substitute, existing functionalities • Preserve the current user interface as is • Minimize enhancements to operator's behaviour 12
  13. 13. Smart Cards Technology • Identification and authentication • Data storage required for emergency care (Netlink standard) • Access to Public Administration services • Certification of the “presence” of the Citizen (through electronic signature of documents) • Identification and authentication • Authorization access to the System (according to operator’s profile) • Electronic Signature 13 Citizen Card Operator Card
  14. 14. CRS-SISS “Pillars” • Regional General Registry • Electronic Health Record (EHR) • Reception processes improvement (booking and payment Services) 14
  15. 15. Electronic Health Record (EHR): 2 level architecture 15 Hospital Hospital ASLASLASL Healthcare Local Unit Events Link EHR Clinical Doc PS Hospital Clinical Doc Clinical Doc • Health documents • Healthcare Local Unit • Patient Summary • Vaccine File • Hospitals • Test results • Health Documents • Therapeutical plans • … Electronic Health Record (1)
  16. 16. Electronic Health Record (EHR): main features • Based on a “patient centric” structure, is the fundamental support for the care of the citizen • Gathers and organizes summary information from organizations and citizens for medical care purposes • Allows the sharing of medical documents between all the actors involved into the care processes of the citizen 16 Electronic Health Record (2)
  17. 17. 17 Electronic Health Record (EHR): How does it work ? GP Pediatricians HospitalDiagnostic Test Medical Specialist Electronic Patient Record (EHR) Patient health conditions Exams results Material Healthcare Occurrences Medical Reports Ospedale Specialista Diagnostic Test Hospital 2: Results Exam Medical Specialist Diagnostic Test 1: Test 2: Admission 8: Discharge 4: Investigation 5: Results 6: Consultation 7: Advice Electronic Health Record (3)
  18. 18. Electronic Health record (EHR): functions • Give an integrated view of the sanitary history of a specific citizen to the doctor who is treating him/her in a specific healthcare episode, with respect to all the privacy aspects. • Give consultation functions able to increase the efficacy and efficiency of the clinical intervention. • Make clinical reports available to the citizen on-line, reducing need for citizen to retrieve physically results and, thus, queues • Simplify the activities of clinical operatives, allowing information exchange, import/export of documents (e.g. for admission, GP change, …) • Interface decision support systems to allow secondary usage of information (health policy, administration, education, research, statistics, …) 18 Electronic Health Record (4)
  19. 19. 19 • “Personal zone” for the citizen in his EHR • Asyncronous Electronic Document consultation • Diagnostic &Therapuetic plans • Admissions clinical documents management • Extensive use of structured documents • Image mangement Electronic Health Record - Main evolutions (5)
  20. 20. CRS-SISS – Main Results in 2010* 20 • Over 9 millions of CRS smartcards delivered • 96% General Practitioners and Pediatricians in the Network • 100% Pharmacies in the Network • 75 millions prescriptions • 14 millions of Clinical Electronic Documents (most referrals) • 5,8 millions of “active” EHR • 1,2 millions of EHR consultations from GPs • All Healthcare Local Units and Public Hospitals of the Region have integrated their applications to the network • Private Hospitals started integration in the Network • Pathology Networks: Oncology, Rare Diseases, Epilepsy, Emathology, Acute Myocardial Infarction, Nephrology, Emergency, Hearing, Stroke, Sudden Infant Death Syndrome • Available on line services for citizens: access to EHR, booking, choice and revocation of GP, … * Projection to the end of 2010
  21. 21. 21 • Customer-orientation  A system also for the healthy  A user-interface even more user-friendly  Simple functions in a little time-to-market  Simple bi-directional services for citizens • An open world  The citizen may take a care where he prefers  Privacy: how much of his record the citizen may choose to share ? Open Issues: EHR for the Regional System
  22. 22. 22 • EHR for e-Health government  Developing systems more and more citizen-data centric  Try to modify some Regional rules in order to exploit system capabilities • More earned value for professionals  To improve the collaboration among the private professional, the general practioner and the citizen  Focus on mobile services  Active involvement of all the stakeholders Open Issues: EHR for the Regional System
  23. 23. 23 • Interoperability at a regional and european level • Applications more oriented to the Inetrnet world • Re-use • Creation of an eco-system of parterns cooperating in developing the overall system Open Issues: EHR for the Regional System
  24. 24. Lombardia Informatica S.p.a. Thank you Nicola Contardi nicola.contardi@lispa.it 24

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