The technical solutions adopted in the Italian field trail

1. The technical solutions adopted in the Italian field trail Roberto Ongaro TMR - Telemedicina Rizzoli S.p.A.

2. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Company Profile • Private/public company born in year 2000 • Joint venture between: • Desstone Group, a fifteen years old private company with a significant experience in health services design and management. • Istituti Ortopedici Rizzoli, one of the main important health organisation of Europe in Orthopedy and bones tumours care. • Montecatone Institute of Rehabilitation, a national centre of excellence in spinal cord injury treatment. • Based in Bologna - Italy

3. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Our mission: • Telemedicine services and system design • To support Health organizations in defining and putting into action innovative services based on the use of telemedicine • To design specific telemedicine technical solutions integrated with legacy systems • To partecipate to UE project concerning telemedicine and e-health solution.

4. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Main realizations:

5. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM SIAT (teleconsultation regional network of emergency- urgency for cranial and cerebro-vascular traumas management) • Realization of the regional system Hub-Spoke of teleconsultation in emergency/urgency for neuro-surgery and neuro-radiology. • From the First Aid the physician can transmit images and clinical data to the expert of reference getting in a short time indications to complete the diagnostic organization of the patient • 6 HUBs (neurosurgery, neuroradiology) are reachable from 27 points of regional First Aid (Spokes).

6. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Our Telecouselling network: Brescia – ISTITUTO S.GIOVANNI DI DIO Fatebenefratelli (Mind impairment – ALZHEIMER disease) Bologna – ISTITUTI ORTOPEDICI RIZZOLI (ORTHOPEDY, BONES TUMORS) FOGGIA BARI NAPOLI LECCE PALERMO CROTONE CAGLIARI COSENZA CATANIA Centre of excellence (hub) Remote out-patients department (spoke)

7. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM

8. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Our role in Health Optimum: • To define functional and technological specifications of the platforms used in the project and support the teamwork in the deployment of the systems. • To define the Quality of Care Indicators and users questionnaires (patients and physicians)

9. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Functional and technological specifications

10. TECHNOLOGICAL GOALS IN VENETO REGION WE HAVE WANTED TO ACHIEVE: • Integration between databases in compliance with international rules and standards • a common technological language, respecting the every existing application experience • the correct patient data management, according to security and privacy regulations

11. SAME METHODS AND STANDARDS Neurosurgical Tele-counselling Geographic management of critical neurosurgical patient, exchanging radiological images (DICOM), counselling requests and opinions (CDA r.2) Tele-Laboratory an ICT application to laboratory diagnostic instrumentations, decentrating laboratory through connections wireline (LAN, ISDN..) or wireless (GPRS/UMTS) to central laboratory system (LIS) and using: • IHE POCT • IHE LSWF • HL7, CDA r.2 EHR the clinical documents produced (HL7, CDA release 2 and PDF) are published in the regional EHR using IHE rules: • Laboratory, Radiology and ITI domains • Longitudinal Record and XDS profile VENETO REGION

12. images and request DICOM CT images XML CDA r2 opinion request XML CDA r2 opinion IHE XDS EHR NEUROSURGICAL TELE-COUNSELLING STANDARDS PERIPHERAL HOSPITAL NEUROSURGICAL CENTRE ON CALL Neurosurgery Radiology Neurosurgeon ER, Neurology, Intensive-care Neuroradiology XML CDA r2 Neurosurgical tele-counselling request Neuroradiologist

13. CENTRAL LABORATORY RSA /ADI PODCDM Central QUALITY CONTROL XML CDA r2 report HL7 messages POCDM Client RESULTSREPORT IHE XDS EHR LIS POCT Laboratory Information System Tele-laboratory Information Systems • Guidelines and Technical framework • Structure based on POCT-POCDM-LIS framework • IHE recommendations for tele-laboratory technical framework; • HL7 v.2.5 messages;

14. THE HEALTH OPTIMUM IHE-XDS

15. TECHNOLOGICAL OBJECTIVES ACHIEVED Technological standardization allows: • to manage electronic documentation digitally signed, which have complete legal acknowledgment according to national and international rules in force • to implement an EHR, where clinical documentation produced (images, requests, opinions, results, reports, ...) will be published, accessible to Physicians and other Healthcare Structures • to spread the obtained results to other Structures and fields comparing them with different experience • To guarantee the interoperability among different healthcare units of diagnostic instrumentation

16. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Quality of Care Indicators

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25. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Patient Questionnaire Dear patient, The medical visit you have just finished has been enabled by a new telemedicine service funded by a research project of the European community. In this way, you have been visited and/or treated by a specialist without the need to travel to a distant hospital. In order to further improve our service and to record eventual difficulties or problems, we would like to ask you some questions. Please give us your opinion. Feel free to respond, questionnaires are anonymous and personal or medical information is not stored.

26. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM • Is this your first time to use telemedicine? • [  ] Yes • [  ] No • 2. What was the medical speciality / service related to your visit? • [  ] Cardiology • [  ] Endocrinology (Diabetes) • [  ] Haematology • [  ] Nephrology (Dialysis) • [  ] Oncology • 3. How would you rate the overall quality of the telemedicine consultation? • [  ] Excellent • [  ] Good • [  ] Fair • [  ] Poor • 4 . Do you think that the medical care you received from this telemedicine • service is as good as the care you would have received if you had seen the physician face-to-face? • [  ] Yes, just as good • [  ] About the same • [  ] No, not as good • [  ] I am not sure

27. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM 5. Were you comfortable during the telemedicine consultation? [  ] Yes, I was very comfortable [  ] Yes, I was somewhat comfortable [  ] No, I was somewhat uncomfortable [  ] No, I was very uncomfortable 6. Was this telemedicine consultation more convenient than travelling to see a specialist? [  ] Yes, more convenient [  ] About the same [  ] No, less convenient [  ] I would not have travelled to see a specialist 7. Did you have any difficulties seeing or hearing the specialist during the telemedicine consultation? [  ] No, not at all [  ] Yes, I had some difficulty [  ] Yes, I had much difficulty 8. Are you worried that telemedicine might not protect you privacy? [  ] Yes, I am very worried [  ] Yes, I am slightly worried [  ] No, I am not worried 9. Would you use this telemedicine service again? [  ] Yes [  ] Maybe [  ] No

28. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Physician Questionnaire Dear Doctor, Thank you for your participation in the HEALTH OPTIMUM telemedicine field trial. In order to evaluate the impact of the new telemedicine service on the quality of medical care, the project coordinators need your feedback regarding your personal experience using the HEALTH OPTIMUM installation that was deployed in your health facility. The questionnaire should be filled in by all physicians who used Health Optimum applications during the field trial at all primary and specialist health facilities.

29. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Physician Questionnaire Physicians name [physicians name] Name of the Hospital or Health Centre where the Health Optimum Service was used [Centre name] Medical speciality in which the Health Optimum Service was used: [  ] Cardiology [  ] Endocrinology (Diabetes) [  ] Haematology [  ] Anticoagulation monitoring [  ] Nephrology (Dialysis) [  ] Oncology

30. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Physician Questionnaire • How do you rate the overall quality of the telemedicine service? • [  ] Excellent • [  ] Good • [  ] Fair • [  ] Poor • 2. How do you rate the technical quality of the telemedicine service? • [  ] Excellent • [  ] Good • [  ] Fair • [  ] Poor • 3. Were you comfortable using the telemedicine service? • [  ] Yes, I was very comfortable • [  ] Yes, I was somewhat comfortable • [  ] No, I was somewhat uncomfortable • [  ] No, I was very uncomfortable

31. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Physician Questionnaire 4. How do you rate the quality of care delivered by the telemedicine service when compared to the quality of traditional care? [  ] Better [  ] About the same [  ] Not as good [  ] I am not sure 5. Do you feel that the Health Optimum telemedicine service may influence the health status of your patients? In what way? [  ] Improved health [  ] No change [  ] Negative effects on health 6. Did you experience technical difficulties that might affect the quality of care delivered by the telemedicine service? [  ] No, not at all [  ] Sometimes [  ] Often If yes, please specify the type of problem:

32. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Physician Questionnaire 7. Did you experience organizational or other difficulties that might affect the quality of care delivered by the telemedicine service? [  ] No, not at all [  ] Sometimes [  ] Often If yes, please specify the type of problem: 8. Would you continue to use the telemedicine service? [  ] Yes, in the same way as the service has been deployed [  ] Yes, but with the following improvements [  ] No

33. TELEMEDICINA RIZZOLI IN HEALTH OPTIMUM Thank you for the attention