F. castellani role of ict in actual and planned healthcare policies in tuscany

REGIONAL ICT BASED CLUSTERS FOR HEALTHCARE
APPLICATIONS AND R&D INTEGRATION
ROLE OF ICT IN ACTUAL AND
PLANNED HEALTHCARE POLICES IN
TUSCANY
Francesco Castellani
Settore Sistemi Informativi e Tecnologie Informatiche
DG Diritti di Cittadinanza e Coesione Sociale
Regione Toscana

Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262

Presentation Summary

- The ICT infrastructure implemented in Tuscany as a whole

- The ICT infrastructure deployed in the healthcare sector

- Cloud in healthcare: the achieved results


Objective of the ICT in Tuscany Region

The objective of the ICT in the Tuscany Region is to create a
system that:

- enables the communication and cooperation in the systems actors

- supports the delivery of health Services

- facilitates Access to Services

- assures on-line services accessibility

- creates Inclusion and reduce Digital Divide


The ICT organization in Tuscany Region


The ICT sector in Tuscany Region
In Tuscany Region are present two sectors that cover the whole
ICT governance with different role:

-Infrastructure and Technologies for the growth of
Information Society. This sector defines, organizes and
governs the ICT infrastructure for the whole region.

-Information System and knowledge technologies. This
sector defines, organize and governs the application layer.

…. and for the healthcare the sector :

- Information system & technological healthcare Innovation


The ICT Infrastructure

To achieve the ICT objectives Tuscany Region
creates a network called

RTRT
(Rete Telematica Regione Toscana; Telematic
Network Tuscan Region – www.rtrt.it)


RTRT Grant agreement no: 266262

RTRT, created by Regional Law 1/2004, provides support with a
governance role in policy development of the Digital Tuscany
Agenda.

IT IS
It is a network of public bodies (universities, municipalities,
research centres and Local Health authorities, who invested
in this project

It is an organizational model of relationships among the
various stakeholders based on the concept of shared objectives,
cooperation and partnership, able to produce and sustain
innovation processes.


It is a Technological Infrastructure with large capacity, spread
throughout the region, connected to the Internet, interoperable,
as meeting the standards promoted by the CNIPA (Italian
Institute for Innovation in technology), the Public Connectivity
System (formerly Unified Network of Public Administration).

It is a unique opportunity for development: the establishment
of new relationships between public administrations and
between them and the citizens, businesses and society in
general, technological innovation and the internal organizational
entities; promotion resources of Tuscany (territory, culture,
business, etc ...) for small and medium-sized enterprises in
technological innovation, and more.

It is not only a network of wires, but an organic
development of the Information Society

HOW IT WORKS Seventh Framework Programme
Assembly: defines the general guidelines for the activities and
projects of the Network. It’s composed by the parties of the
RTRT

Strategic Committee: performs functions of guidance and
direction of the activities of the Network. It is chaired by the
President of the Regional Council and it is composed by thirty
representatives of the RTRT parties, a representative of the local
Council and a representative of each of the associations of local
authorities

Network coordinator: liaises with public and private entities
and coordinates all the technical and organizational resources
enabled

Technical direction: defines the standard in the network
environment for the sysytem interoperability and the application
cooperation


TECHNOLOGICAL INFRASTRUCTURE AND
PLATFORM
Connectivity Infrastructure (RTRT3)

Application Cooperation Infrastructure (CART)

Authentication & Authorization Infrastructure (ARPA)

VoIP Infrastructure

Platform for on-line payments (IRIS)

Platform for archiviation and long term maintaines (DAX)


TECHNOLOGICAL INFRASTRUCTURE AND Grant agreement no: 266262

PLATFORM

RTRT3

- It is a wide and broad infrastructure, well branched on whole
Tuscany, which is autonomous and connected to Internet and
further networks.

- It is the SPC (Public Connectivity System) Tuscany hinge and
connect all the Tuscany's Public Organization with high-speed
connection. SPC is the standard defined by the Italian
Departiment for Tecnological Innovation


RTRT Grant agreement no: 266262

TIX
Pisa
Network
Area Services Area
Backbone ATM
155 Mbps
Firenze GBE metropolitana RTRT

Siena Aree
ISP 1 dedicated Provider Security
Internet System
ISP 2 dedicated
RTRT

Area Management
NAP Area

INTERNET

ISP 1
ISP 2
ISP n


CART

TWO definitions before:

1. Interoperability: refers to the ability of two or more systems
to exchange information and to activate, to that end, computing
processes into their applications.

2. Application Cooperation: refers to the ability of one or more
systems to use in their individual application logic, automatic
interchange of information with other systems, for their
application purposes


CART

CART (Cooperazione Applicativa Regione Toscana = Application
Cooperation in Tuscany Region) is:

- software and hardware infrastructure that enables the
application cooperation

- SPC private network


CART


CART
The Numbers:

• In the last 30 days CART deliveres 51.172.345 messagges

• 251 service agreements

• 2.190 the number of services enabled


eToscana Compliance
The technological infrastructure will not ensure by itself the full
interoperability of applications

Tuscany Region has established a process rappresented by the
eToscana Compliants for:

1. Public and private organization define collaboratively
e.Toscana RFC documents that, if shared and technically valid,
become the standard by which entities are required to exchange
information.

2. The software house change their applications according to the
RFC e.Toscana and accredit their own solutions e.Toscana
Compliance Standard.


eToscana Compliance
The number

-230 RFCs are standardized

- 50 software solution accredit


ARPA
-Realize the SSO (Single Sign On) in the Tuscany Region
Service
- Mutual authentication for different domain (domain federation)


… and ICT in healthcare environment


Main regional Project Grant agreement no: 266262

...further Clinical pathways
Electronic Health Card
Project

Surgical Pathway

Radiology
Diagnostic
Internet
E-Prescription


CSE - Electronic Health Card Project

The project arose with Health Plan 2008-2010 and has been
operational since April 2010.

Objective:
The creation of the Fascicolo Sanitario Elettronico, that is the
Electronic Health Record (EHR).

EHR is a collection of electronic health information about patients.
Currently in Tuscany, the EHR contains clinical data including
demographic data, hospitalizations, immunizations/vaccination,
pathology exemption, drugs, emergency events.


CSE – EHR Architecture

Registry: The main role of this subsystem is to keep the information of
the patient, the operator and the organization that operate in the
healthcare
Ndx (Index): The main role of this subsystem is to create an index
between the healthcare events (laboratory report, emergency report,
etc) and the patient, the operator, etc
Repository: The main role of this subsystem is to keep the healthcare
events


CSE - EHR Architecture


CSE - Healthcare events
Principal RFC define in the healthcare environment

- Registry (number 85, 86,87)
- Patient Summary (number 133)
- ePrescription (number 161)
- LIS and RIS (number 101 and 136)
- Vaccination (number 171)
- Emergency (number 106)
- Chronic Care Model (number 208)


CSE - Electronic Health Card Project
National Service Card (CNS)
Access key for on line services .

A chip card contains a digital
authentication certificate.
The card can contain also a digital
signature certificate.

Health Cards (for citizens) already
delivered : around 3.700.000 (whole
tuscan population).

Professional Cards delivered : around
30.000.


EHR - Electronic Healthcare Record
The EHR can be created only with the permission
of the patient. The EHR contains events which occurs
after its creation. (Privacy Law)

The patient is the owner of his EHR.

The patient can enter/view his EHR by his own Health
Card (CNS).

At the moment General Practitioners do not access
their patients' EHRS with their own Professional Card

Clinicians will start to access their patients' EHR with
their Professional Cards in an emergency situation.
(Privacy Law)


The EHR can improve patient care by:

 Reducing the incidence of medical errors by
improving the accuracy and clarity of medical
records.

 Making the health information available to
patient, reducing duplication of tests, making
patients well informed to take better decisions.

The patient has the opportunity to access and
view his own lab reports and clinical data
whenever and wherever he wants. (e.g. At
home, with his/her GP and specialists, in Assisted
Access Point for On line services (PAAS))

 Clinical report can be delivered in Real Time.


… days

Desk

Report delivery
… days
Mail
Report creation

Real time
Lab reports can be
delivered to the EHR
in real time clinician
Electronic
Health Real time
Record

Real time

at home

totem


The State of the Art

Patients can activate the CNS and create EHR at:
Healthcare organizations (ASL/AOU), with about 200 desks
Since last March, at the local pharmacies with about 700 desks (70 % of
pharmacy)

The rate of activation is 34% (1.270.000) of the Tuscany population
(3.700.000)


http: www.regione.toscana.it/cartasanitaria


Electronic Patient Record
Electronic Patient Record is a part of the EHR where the patient can
insert by himself:

- personal informations (eg life style, sport activity, BMI, etc)
- electronic report not automaticaly inserted into the EHR
- diary events on the main healthcare information, appointments on
periodicaly visit, etc

The system automaticaly extracts the main information and creates
the summary of the EPR; this kind of information could be very
important in an emergency situation.


Electronic Patient Record


The CLOUD based datacenter: the achieved results


TIX

TIX (Tuscany Internet eXchance) is:

- Services and Data Center for Tuscany Region, the Local
Health Authorities and the local public organizations.

- It is a neutral interconnection point between the Public
Organizations networks and the Private Organizations.

- The place of the enabling infrastructure for the development of
the Information Society


- an opportunity to rationalize the IT cost in the public
organization

- a focal point for the innovation process in the public
organization

- the CLOUD for the Tuscany public organization. Tuscany
Regione is the winner of G-Cloud Award 2012 (http://toscana-
notizie.it/blog/2012/11/29/un-premio-alla-regione-toscana-per-la-
sua-nuvola/)


TIX

TIX (Tuscany Internet eXchange) offers ICT services at the
public organization under the paradigm As A Service, as
defined in the Cloud Computing:

1. IaaS: Infrastructure As A Service (achieved)

2. PaaS: Platform As A Service (achieved)

3. SaaS: Software AS A Service (in progress)


TIX

Facility
Business continuity Management

Disaster Recovery
SaaS
Backup

PaaS
Business Gate
Archiving
(Security Internet)
IaaS

SaaS: software as a service (ERP, Application Mngt, ..)
PaaS: platform as a service (database, appl. Engine, middleware, ..)
IaaS: infrastructure as a service (network, storage, RPE, …)


TIX

TIX (Tuscany Internet eXchange) offer ICT services at the public
organization under the paradigm As A Service, as defined in the
Cloud Computing:

1. IaaS: Infrastructure As A Service (achieved)

2. PaaS: Platform As A Service (achieved)

3. SaaS: Software AS A Service (in progress)


… the ICT healthcare organizations


Task Force in innovation


ICT Organization In Tuscany
– Control Team: composed by the three departments of
Tuscany Region and the management of ESTAV. The objectives
is to define the main target of the innovation

– Coordination for innovation in health: Government,
monitoring and control of the coordination areas

– Coordination Areas: the seven main horizontal areas of
coordination

– Project Management. Project Planning and management



– Technological Infrastructure. Network (eg TIX) and
service (voip, web conference) infrastructure

– Management Information System. Organization,
coordination and information aggregation for business
and decision process

– Hospital Information System. Coordination project of the
new Regional Hospital

– Department Software. Software used by the main
organization department: health, administrative and
technical


– Technological Platform. Using the application platform
present in the regional environment as a Service (DAX,
IRIS, ARPA, etc)

– Regional, National and International financing

– Project Areas: Working team on specific project. This layer
uses the coordination areas directive

– ESTAV: Responsible of the projects realization, in the ASL/AO,
as defined in the Project areas


… and the tools

ELECTRONIC HEALTH CARD Seventh Framework Programme

PROJECT
CNS is a powerful key to access and to activate on-line services.

We'd like to move from local services to
regional on-line services, which can be
reached and accessed by the overall
Tuscany population.

Further improvements:

Radiology images online, ticket exemption consultation, GPs choice/ revocation, report from
pharmacies, CUP (reservation) on line, request and acquisition of medical records, digital
chancellery for civil proceedings.


Email: francesco.castellani@regione.toscana.it
Phone: +39.55.4383323

www.richardproject.eu

F. castellani role of ict in actual and planned healthcare policies in tuscany

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