Transcript pbs 2006-2007_11072006_V02 - ehealth

E-Health Programs of Regione Lombardia
Fulvio Barbarito
Lombardia Informatica
13 February 2008
Summary
Lombardy Region
The Healthcare Network of Lombardia
Lombardy’s Region Healthcare Information System evolution
E-Health in the world: who is doing what where?
The CRS-SISS Programme
– The underlying philosophy
– Goals and main streams
– Electronic Health Record (EHR): Architecture and main characteristics
– Services and Architecture
– Project principles
– Smart Cards Technology
– Main results in December 2007
– The Gartner five Technical Challenges and four People Challenges
– The financing model
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Lombardy Region
 Is one of the twenty Italy’s Regions
 About 16% of Italy’s citizens
 Is one of the more populated Regions of Europe (more populated than 14 EU
member States)
 The number of inhabitants per Km2 is 6 times Bulgaria’s one
 Its GNP is about 20% of Italy’s GNP
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The Healthcare Network of Lombardia
As every Italian Region is directly responsible for Healthcare services provision
 9.500.000 Citizens
REGIONE
LOMBARDIA
PHARMACIES
 150.000 Health & Social Care
Operators
HOSPITALS
 8.500 General Practitioners and
Pediatricians
 2.500 Pharmacies
CITIZENS
GENERAL
PRACTITIONERS
LOCAL HEALTH
CARE UNITS
HEALTH & SOCIAL
ASSISTANCE
 15 Local Healthcare Units
 34 Public Healthcare Services
Suppliers (29 Public Hospital
and 5 Public Scientific Services)
 Over 2500 Private Healthcare
Services Suppliers
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Lombardy’s Region Healthcare Information System evolution
Collection and filing of hospitalizations
1978
Regional personal data directory of Citizens and General Practitioners
1982
1985
1997
Collection and filing of pharmaceutical acquisitions
Collection and filing of outpatient visits data
1999
2000 -2001
2002
2004
2005
2008
CRS-SISS
CRS-SISS
CRS-SISS
CRS-SISS
CRS-SISS
CRS-SISS
Project’s
requirements
definition and
feasibilty analysis
On site pilot project
in
Lecco’s District
(300.000 citizens)
Project Financing
and beginning of
the expansion to all
Districts
2 millions
citizens
All
Lombardy’s
citizens
(9,5 millions)
Healthcare
Private Sector
4
E-Health in the world: who is doing what where?
Europe
 Denmark: MedCom, portal, national databases (in use)
 Italy (Lombardy): CRS-SISS Health Portal (in use)
 Scotland: Emergency Care Record (in use)
 England: NHS National Programme for IT (in use)
 Sweden: Stockholm County Council (in use); Carelink (in design)
 Spain (Balearic Islands): Patient summary (in use)
 France: Dossier Medical Personnel (in design)
 Finland: Patient summary (in design)
 Netherlands: NICTIZ Out of Hours and Medication Records (in design)
 Germany: Health card (in preparation)
United States /Canada
 Regional Health Information Organizations (RHIOs)
 Four National Health Information Network (NHIN) pilot projects
 Canada Health Infoway
Asia-Pacific region
 Australia, NZ, Singapore, Hong Kong…
Today, the CRS-SISS Project, is one of the leading project in terms of
implementation stage and completness of features
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The underlying philosophy
SISS is a Regional Healthcare Information
Network, the Citizen is its centre.
All the data are gathered, organized and
reported on the basis of the citizen’s clinical
treatment within the Regional Healthcare
Network.
Hospital
ASL
Healthcare Local Unit
Pharmacy
Practitioner
SISS implements a wok-flow based on the typical
healthcare processes:
 Pharmaceutical
 Outpatient examinations
 Medical examinations
 Emergency
…
Administrative
Administrative Data
Data
Data WareHouse
Cluster of Patients
General Practiotioner
Healthcare
Healthcare Data
Data
Electronic Health Record
Vision per single Patient
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CRS-SISS goals
•The main objectives of the CRS-SISS program are to unify and to protect within a coordinate system the information about the lombard citizen state of health and to
distribute a CRS Card in order to obtain:
• Improve Services for
Citizens: reducing the
“distance” between Citizen
and HC Services Providers
by simplifying procedures
and shortening waiting
time
For Citizens and HC Professionals
Reduce the gap between
Citizen and HC Services
Providers
Assure continuity and
quality of care
• Improve quality of prescription,
diagnosis and care
(appropriateness) processes by
Citizens’ clinical data sharing,
through EHR, among qualified
HC Professionals, securing
Citizens’ Privacy Rights
SISS
• Improve Governance of
Social and HC System
managing costs: enhancing
planning and controlling
instruments (DataWarehouse,
Business Intelligence)
Planning and
Governance of HC
expenditures
Efficiency and
Simplification
Social and HC
Internal Processes
For Administrations
• Improve internal processes
efficiency of HC Services
Providers by a generalized
diffusion of new technologies
(digital signature, electronic
filing, electronic prescription)
to dematerialize documents
(Regional Government and HC Providers)
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CRS-SISS main streams
Healthcare Extranet
as main instrument of innovation
and integration framework
among all actors:
• creation of new services at regional
level for Citizens and HC
Professionals (Electronic Health
Record)
• creation of a large technological
infrastructure
• implementation of an integrated
regional information system
Develop HC Organizations’
Information Systems,
promoting features such as:
• central data base and clinical data
repository (administrative data,
service codes, …)
• solutions for clinical management
of patients
• application integration of
Organization’s Information Systems
through an integration middleware
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Electronic Health Record (EHR): Architecture
Hospital
Hospital
Hospital
Clinical
Doc
Clinical
Doc
Clinical
Doc
Events
Link
ASL
EHR
PS
Healthcare Local Unit
Health documents
HLU: Patient Summary, Vaccine file
Hospitals: Referrals, Health Documents, Therapeutical plans, …
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Electronic Health Record (EHR): Main characteristics
It gathers and organizes synthesis information (documents) for care aim.
It allows the sharing of the medical information to all the actors who are
responsible for the care of the citizens .
It has a patient centric structure.
It has a temporal horizon of along period
It is the fundamental support for the care of the citizen .
It collaborates datawarehouse which supports the uses of the information with
institutional-administrative aims (government of the healthcare system,
epidemiological analysis, searches)
It’s open to the citizen.
It contains specialized Pathology Network Data (Oncology, Epileptic,…).
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CRS-SISS Services
 Citizen Identification
 Electronic Prescriptions Management
 Electronic Health Record (EHR):
- share clinical data: events, prescriptions, referrals, care profile, …
- on line access for Citizens and HC Professionals
 Clinical information exchange among HC Professionals
 Support to GP’s electronic patient dossier
 Booking Services (for Citizens by internet, GP, Pharmacies, Regional Call
Center)
 Accounting information flow management
 Electronic signature, mailing system, encryption functionality
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CRS-SISS Architecture
1 LEVEL
Lombardy Region Central System
Central
Repository
2 LEVEL
Provider
Provider
Healthcare
Extranet
Integrate
Management Unit
Citizens
3 LEVEL
Services
Hospital, Operators,
Chemists, …
General Practitioner,
Pediatrician
Operators &
Organizations
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Project principles
Web technologies
Evolution and integration, not replacement, of existing applications
Strict enforcement of personal data protection (privacy): high security
technologies
Process reengineering to improve efficiency
Large deployment
(dematerialization)
of
digital
signature
and
electronic
documents
Smart cards
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Smart Cards Technology
Citizen Card
 Identification and authentication
 Storage of information needed for emergency care
(Netlink standard)
 Access to Public Administration services
 Certification of the “presence” of the Citizen (through
electronic signature of documents)
 Identification and authentication
 Authorization to gain access to the System (according
to operator’s profile)
 Electronic Signature
Operator Card
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Main Results in December 2007
About 9 millions CRS delivered
More than 80% General Practitioners and Pediatricians in the Network.
100% Pharmacies in the Network
About 60 millions transactions during 2007
All Healthcare Local Units and Public Hospitals of the Region have integrated their
applications to the network
More than half Public Hospitals are generating events, referrals and clinical
documents, signed electronically, into EHR to share data with other operators
Oncology Lombardia Network and Rare Disease Network available
Available on line the service of choice and revocation of GP and pediatricians
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The Gartner five Technical Challenges
1. Achieving semantic interoperability
– You will always have a mixture of structured and unstructured data
2. Implementing standards
– HL7 v.3, HL7 CDA, CEN EHRcom, SNOMED, IHE, Continua
3. Deciding between federated and centralised data architectures
– Hybrid solutions are emerging
4. Integrating legacy systems
– Healthcare is an extremely complex environment
5. Improving quality of data
– Lives are at stake
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The Gartner four People Challenges
1. Engage clinicians
– Involve them in decision-making
– Ensure the systems benefit them
2. Engage citizens
– They trust clinicians, not the government!
– Their top concerns are privacy and security of data
3. Manage vendors
– Balance risk and reward
– Supervise consortia carefully
4. Ensure effective governance
– Leadership, political engagement, funding
– Balance between top-down and bottom-up decisionmaking
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Currunt usage: Total system Prescriptions
60.000.000
50.000.000
40.000.000
30.000.000
20.000.000
10.000.000
0
2003
2004
2005
2006
2007
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Currunt usage: Total system Transactions
50.000.000
45.000.000
40.000.000
35.000.000
30.000.000
Exams/Visits
25.000.000
Pharma
20.000.000
15.000.000
10.000.000
5.000.000
2004
2005
2006
2007
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The financing model
Lombardia Informatica S.p.A.: is Lombardia Region’s
operative Business into the ICT field. It is responsible for
Project Management.
LISIT S.p.A.: is the special purpose entity created by
Lombardia Informatica to implement the Project with three
Private Partners:
Awarded by a Public Auction. They own 44% of LISIT’s equity
and participate to the Project implementation.
Project Financing Model
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Thank you
Fulvio Barbarito
Lombardia Informatica
13 February 2008
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