E-Health experiences in Lombardia

1. E-Health experiences in Lombardia Claudio BERETTA, D. G. Sanità – Regione Lombardia

2. OVERVIEW • e-HEALTH HISTORY IN LOMBARDY: main experiences • THE STRATEGY • The SISS project • Centralized unified booking (CUP) • Telemaco project • Electronic health record

3. e-HEALTHPROJECTS Wide participation of Regione Lombardia since the 90’s consolidated through the RTD FP’s EUand Italian Ministries (Health, Research, Innovation) • Ways of participation: • Direct: as a partner • Indirect: supporting other authorities or organizations • Main themes: • Clinical sector: continuity of the patients centred care, management of the emergency and use of the medicine; • Administrative sector: necessity to use data transmission in order to support the information flows among the health structure. Regione Lombardia Health Directorate General

4. e-HealthHistory:Experiences 1 • TELEREGIONS SUN1 & SUN2(1996-1998 & 1998-2000) • online transmission of information between cardiology and cardio surgery; • remotely exchange of information related to hospital discharged card; • implementation of a common informatics platform. • VIRTUS(2000-2002) • development of a virtual hospital (Teleconsultations, second opinion) Regione Lombardia Health Directorate General

5. e-HealthHistory:Experiences 2 • HECTOR (1994-1998) • first multidisciplinary approach to emergency care integrated in the operating system of the region; • CARDLINK (1994-1998) • smart card medical record for emergency cases. • CRITERIA (2003 - 2005) • cost-efficiency comparison on two homecare programmes for cardiopathic patients: post cardiosurgery rehabilitation homecare process and health home-telesorveillance Regione Lombardia Health Directorate General

6. e-HealthHistory:Experiences 3 • REMEDES (1998-2002) & CHARM (1998-2002) • Tools for internal cooperation (shared databases, safe messages, booking). • Actors: GP and Hospitals. • C-CARE (1998-2002) & C-CUBE (2000-2002) • Creation of a subfolder of the patient’s electronic clinical record finalized to emergency situations; • Data exchange platform for clinical information; • Centralized data repository. • Actors: GP, Hospitals, DG Health, ASL.

7. NETC@RDS Objectives • Netc@rds project is to test the technical options of substituting the present eye-readable European health insurance card and other forms applied by citizens in the implementation of health care services abroad for an electronic document. • Establish a reliable source of information for health care provider front office staff checking insured entitlement or initiating interstate billing/clearing procedures; • Foster the use of Common Administrative electronic dataset for improved health insurance providers back office billing/clearing workflow applications and further modernization of post-processing activities. • The consortium unites the representative organisations from Austria, Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Slovak Republic and Slovenia. • Duration: 2004 - 2006 Regione Lombardia Health Directorate General

8. INCO-HEALTH • Objectives • Define a common operational framework dealing with the European Health Insurance Card (EHIC) • Identify major items referred to the electronic health card domain • Set-up an interregional cooperation through the establishment of a set of tools and services aimed at exchanging experiences and knowledge, sharing know-how and good practices, building up relationships devoted to deploy and reinforce innovative actions on this e-Health sector • The cooperation will result into the installation of a network of regional antennas playing an EU pivotal role in EHIC domain. • The consortium unites the representative organisations from, Italy, Hungary, and Slovenia. • Duration: 2004 - 2007 Regione Lombardia Health Directorate General

9. SUMMA Objectives • The project aims at developing an experimental phase for a new teleconsulting specialized services for GPs. This project is carried out taking into consideration the clinical, economic, and organizational needs. Benefits: • Quality improvements of the Gps and in general healthcare professionals services; • Healthcare professionals satisfaction and ability to change the prescriptional behaviour; • Appropriate access to the appropriate specialized exams; • Services costs. • Duration: 2003 - 2006

10. RADICI Objectives • Study and evaluate programmes and models of care to foster integration between Hospitals and territory; • Design a network for health services based on the improvement of the Hospital structures to develop better healthcare systems on territories; • Apply the model through pilot-processes of care which could provide network answers to care and prevention demands, particularly in the following fields: • diabetic patients • artificial home nutrition • Define an experimental cost list for specific types of patients and their processes of care. Duration: 2005 - 2007

11. e-CARDIO Objectives Publish on internet the projects developed on the Pavia’s area and which already foresee the use of ICT tools guaranteeing cardiopathic patients continuity of care. • It integrates people providing instruments to support a message structure which enables a coordination and a comparison through operators involved in the care processes of patients; • It integrates projects data, accessible and useble by health professionals although time and space location, to constitute a Multimedia Cardiology Database (CS); • It is foreseen the interaction between the Cardiology support System with the Central Domain SISS Duration: 2005 - 2007

12. COCOON • Objectives • COCOON aims at supporting health care professional in reducing risk management in their daily practices by building knowledge driven & dynamically adaptive networked communities within European healthcare systems. • On this basis the main COCOON project research directions are twofold: • on one side the socio-economic research on health care risk management and the related business model for reducing risk by enabling the COCOON technologies; • on the other side the technological research that wants to deal an innovative tool-set for risk management • The consortium unites public and private organisations from Italy, UK, Belgium, France, Greece, Israel, Spain. • Duration: 2004 - 2007 Regione Lombardia Health Directorate General

13. STRATEGY (1) “Health authorities and managers are responsible for the proper organisation and running of health system. They do this against the background of increasing budgetary pressures rising patient expectations. e-Health systems can play a major part in meeting those pressures by making the health sector more productive, and delivering better results with fewer resources” Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions: e-Health – making healthcare better for European citizens: An action plan for European e-Health Area, COM(2004)356 final, Brussels 30.04.2004. Regione Lombardia Health Directorate General

14. STRATEGY (2) How the context is changing: • Ageing of population • New and more chronic diseases • Decreasing of resources • Increasing of patients’ expectations • Developing of new tools and technologies • Care for patients delivered by different specialists in different locations • Greater demand of patient-related information Regione Lombardia Health Directorate General

15. Hospital centred medicine; Centralized information; Patient has to move for receiving care; Few and peculiar telemedicine services. Homecare centred medicine; Distributed information; The system is “patient centred”; Telemedicine network. STRATEGY (3) How the health care delivering is changing: Past Future Regione Lombardia Health Directorate General

16. The same services through new tools BUT New services through new tool STRATEGY (4) Telemedicine as a set of toolsnot for delivering Regione Lombardia Health Directorate General

17. PROSPECTIVES new prospectives and problems • Telemedicine as an integrated instrument inside the daily health professionals practice • Different relationship established among Hospitals, GP’s and integrated care • A new model for the “continuity of care” • Payment system for new telemedicineservices Regione Lombardia Health Directorate General

18. OBJECTIVES Telemedicine development is an objective*of the Regional Health System strategythrough: *The Regional Social-Health Plan (2002-2004) * The Plan 2006-2008 is under development • A robust infrastructure (SISS) based on an easier access for citizen (CUP) • A distributed health patient information accessible to the right person at the right time anywhere (SISS) • A defined price for telemedicine services integrated in the ordinary care services (Telemaco) • An Electronic Distributed Health Care Record

19. SISS OVERVIEW The CRS–SISS is the basic project fore-health development • The core of the project is an ‘Healthcare Extranet’, which links operators, social services, organizations and citizens, tracking all the events which occur in the patient treatment 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.

20. FUNCTIONALITIES • Information sharing and exchange among healthcare operators to improve quality of healthcare provision (referrals consultation, prescription process, etc.) • Improvement of services provided to Citizens through an easy and secure access to the Healthcare System. Citizens • Information availability at analytical level to monitor healthcare quality and expenditure for a better planning at Regional level • Simplification of administrative processes (through electronic prescription and electronic signature). Public Administration

21. TWO IMPLEMENTATIONS • CRS(“Regional Services Card”): the personal smart card which allows every citizen to access public administration services and enabling to access to private services. • SISS(“Health Care Information System”): the regional network connecting all healthcare and social players in Lombardia and providing e-Health services for ensuring continuous care.

22. SMART CARDS FEATURES • Identification and authentication • Storage of information needed for emergency care (Netlink standard) • Gaining access to Public Administration services • Certification of the “presence” of the Citizen • Identification and authentication • Authorization to gain access to the System • Electronic Signature Citizen Operator

23. DOCUMENT MANAGEMENT Regional DataBase • Maintenance of event index • Maintenance of citizen and professional register • Maintenance of access grant through SingleSignOn • Maintenance of coding tables • Management of healthcare professional 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)

24. SISS USAGE: GPs October 2005 8 Countries with SISS started before September

25. SISS USAGE: TRANSACTION

26. CALL CENTER:UNIQUE BOOKING CENTER Service for citizens; it gives information on the CRS-SISS project and on the Regional Services Card. CRS-SISS Information • Service which allow citizens to book exams in 8 different Hospitals in Milan • Service which allow citizens to book exams in the Pavia, Cremona and Garbagnate Hospitals. • Pilot Regional Call Center for the Hospitals of Varese and Como Local Health Units Unique Centre for booking CUP New services for citizens • Customer satisfaction surveys • Sms • Internet booking • CNS services support

27. BOOKING: CALLS DISTRIBUTION Regional Calls Distribution 3 Hospitals Booking center Pavia Cremona Garbagnate 305.542 Pilot Phase Varese Como Health Services Milano 840.628 16.000 8 Hospitals 11 Hospitals 2005 Infomation and Booking calls • Services started: • Milano Health Service January 2001 • Booking Centre Pavia, Cremona, Garbagnate: March 2005 • Pilot Phase Varese and Como: • November 2005 661.703 700.000 600.000 500.467 500.000 400.000 300.000 200.000 100.000 - Booking Operations Information

28. TELEMACO (1) • Telemedicine for small town • Towns with less than 2000 inhabitants and remote located areas • Objectives • Develop Telemedicine and ICT tools for a qualified continuity of care in disadvantaged areas and lagging behind in development • Public Health operators • Private Health Operators • Local communities • ICT services producers • ICT Centres of excellence

29. TELEMACO (2) Services • Home health services for patients (serious chronical pathologies); • Services to support the integration among Hospitals at different levels (second opinion on clinical examinations, follow-up on patients); • Network Informatics services offered for Gps to make easier prevention and care (such as specialized second opinion models); • New model of management for the acute coronaric syndrome developed through the integration of the different Hospital resources. Total expenditure: 2.500.000 € Duration: 2006 - 2008

30. BEGINNING TELESORVEILLANCE GPs Hospitals GP asks Hospital for the beginning of the service for his/her patient  Hospital accepts/refuses the proposal (considering the characteristics of the patient pathology) Hospital asks GP and Patient for the beginning of the service GP accepts/refuses the proposal Involved Specialities: CARDIOLOGY, PNEUMOLOGY, DIABETOLOGY, RHEUMATOLOGY

31. Clinical Group Hospital Gp Services Centre Biomedical Instruments - Management - Web Patient Organizational Model Telemaco involves 4 actors • The Gp who asks for the specialist teleconsulting; • Patient nearby the Gp; • Hospital specialists who provide teleconsulting; • Services Centre which offers the technological and organizational support and which manages the clinical basic documents.

32. ELECTRONIC HEALTH RECORD • provides an easy and fast access to that essential medical information, which can be needed when a health care professional is in front of an unknown patient outside scheduled activities; • does not replace “traditional” Electronic Patient Records, but is a summary of basic information • thanks to the automatic extraction, does not generate relevant extra work for the health care professionals • Provide “real time” administrative information

33. PERSONAL E. H. R.

34. Thanks for your attention Claudio Beretta Progetti di qualità, ricerca e comunicazione claudio_beretta@regione.lombardia.it