1. The document discusses necessary institutional and organizational changes to implement ICT in chronic disease management from the perspective of Tuscany Region in Italy. 2. It outlines where Tuscany currently stands in terms of health performance and rates of chronic disease. New needs are emerging for patients, healthcare workers, and institutions. 3. Functional changes already made include agreements with general practitioners and specialists and establishing 100 Functional Territorial Aggregations across the region. Structural changes proposed include increasing primary healthcare centers to one per municipality. 4. An ICT-based disease registry and telemedicine network connecting all healthcare facilities and providers is presented as a holistic model to help manage chronic diseases in an integrated manner across the region

1. NECESSARY
INSTITUTIONAL/ORGANISATIONAL
CHANGES NEEDED TO IMPLEMENT ICT IN
THE FIELD OF CHRONIC DISEASES – POINT
OF VIEW OF TUSCANY
Piero Salvadori
RETOS
Tuscany Region Directorate-General
Services to people in the territory

2. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

3. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

4. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
p.salvadori@usl11.toscan
a.it
4
P.A. Bolzano
Puglia
Piemonte
Valle d'Aosta
Lombardia
P.A. Trento
Veneto
Friuli Venezia Giulia
Liguria
Emilia Romagna
Toscana
Umbria
MarcheLazio AbruzzoMolise
Campania
Basilicata
Calabria
Sicilia
Sardegna
-2
0
2
4
6
8
10
12
14
0.30 0.40 0.50 0.60 0.70 0.80 0.90
Ranking performance 2008
Trendindicatori2007-20082008-2
Performances Vs. indicators of Italian Regions
Mediana=3.99
Miglior posizionamentoPeggior posizionamento
Peggioramento
Mediana=0.60
Miglioramento
- Rankink of performances +
-Rankinkofindicators

5. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

6. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
Tuscany Italy
Life expectancy at birth males (years) 79 78
Life expectancy at birth females (years) 84 82
Elderly rate
(N° > 65 age/N° < 14 age)
192 % 130 %
Percentage of immigrants 5 % (some areas over
10%)
4,7
Percentage of chronic diseases 45 % 40 %
CURRENT STATUS COMPARISON BETWEEN
TUSCANY AND ITALY , 2011

7. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
we have in Tuscany Region:
• Hospital impatients rate admission 135
per 1,000 inhabitants
• Per capita age adjusted pharmaceutical
expenditure 150 €
• Per capita age adjusted specialist
expenditure 190 €
• Life expectacy: 84 years for women and
81 for men

8. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

9. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
New needs, new horizons and changes
1. For people and particular for chronic
diseases
2. For healthcare workers and particular
for physicians and nurses
3. For institutions: Region and
Municipalities

10. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

11. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262What we have to do ? Done ?
agreements with GP,
Pediatricians and
medical specialists
already done with GP
and Specialists
establishment in the
territory of aggregations
(FTA: Functional
Territorial Aggregation)
by March 31, 2013
We will have 100 AFT in
Tuscany Region
Each FTA has a GP
coordinator
It take care about 30,000
inhabitants through the
CCM, proactive
medicine.

12. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
We will have 100 F.T.A. each of them is
made up of about 30 doctors:
1. 20 GP,
2. 6 doctors for holidays and
from 20 to 24
3. 4 doctors for medical
emergency from 00 to 8 am

13. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer ?

14. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262What we have to do ? Done ?
We have to increase the
number of Primary
Healthcare Centres
(PHC)
Now we have 20 PHC
Our goal One PHC for each
municipality with
activities H24 and 7/7
days: always open
Done for 15 PHC

15. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
Empoli
Viareggio
Castiglion
Fiorentino
Forte dei Marmi-
Querceta
Certaldo
Some examples of PHC
Some of these are ex-hospitals converted into PHC

16. Index of the presentation
1. Where are we now ?
2. What performances for Tuscany Region ?
3. What are the needs for us and for Tuscan Healthcare
system ?
4. What are the functional answers ?
5. What are the structural answers ?
6. What are the ICT model for a complete holistic answer
?

17. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
THE FTA requires an ICT
based information system
of disease registries,
telemedicine, and warnings
for managing disease and
medical government.

18. FT
A
NE
T

19. What we have What we need
GPs and hospitals with
computers and the use of
electronic prescriptions
connect all hospitals with all
GPs
the server FTA Create a network of FTA
citizens with electronic health
card
Already done
citizens with electronic health
records
Already done
laboratory analysis results, and
diagnostic imaging sent online
To be implemented
the GPs that extract data from
the Chronic Care Model
To armonize, implement
and systematize

20. We need also
to make a new training program for all staff as social
as healthcare workers
to inform the population and implement self
management, according to Kate Lorig Method
(Stanford Univerity USA)

21. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262MODEL APPROACH
We need an holistic
approach
Look for territorial
alliances

22. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
We need:
• A regulatory framework where the
performance in telemedicine are
recognized and reimbursed
• A certification telemedicine
services
Finally what we need to do?

23. Seventh Framework Programme
Regions of Knowledge Health
Grant agreement no: 266262
Thank You.