Col·legi d’Economistes de la Salut - OSI i Fòrum CIS
Bresciani bcn beretta
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
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2. Agenda
1. 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.
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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. 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
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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 Total
ICT expenditure in Hospitals per year (K€) 170.000 90.000 260.000
Lombardy data, year 2006 1,5% 2,4% 1,8%
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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.
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7. CRS–SISS overview
The core of the project is an ‘Healthcare
Extranet’, which links professionals, social
services, organizations and citizens, tracking all
the events in the process of patient care and
providing value added services.
The project is based on smart
card technologies, granting
access to the Network to both
citizens and operators by their
personal smart cards.
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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
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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).
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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.
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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.
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12. Document Management
Regional 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).
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13. Network Infrastructure
Citizens
Pharmacies
GPs
Lombardy Region Provider
Central System Health Care HTTPS
Extranet
Provider
HTTPS
Hospitals
Operators
Citizens
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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.
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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%)
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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
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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
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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).
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19. Project Costs
There 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).
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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
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21. Comments
and
lessons learnt
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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 - 6.500
Report management 48.000.000 880 70.000
Report printing and distribution (inpatients) 12.000.000 50 7.200
Administrative simplification 1.760 61.000
Management of pharmacies 62.000.000 8.500
reimbursement
TOTAL 140.200
2006 data
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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 23.000
Reception 30.000.000 1 500
Payment 18.000.000 10 3.000
Report 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
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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
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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.
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26. www.crs.lombardia.it
Thank you
claudio_beretta@regione.lombardia.it
Direzione Generale Sanità
Regione Lombardia
via Pola 9 – 20124 Milano - ITALY
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