E-Health Programs of Regione Lombardia

Fulvio BarbaritoLombardia Informatica

13 February 2008

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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

Summary

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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

9.500.000 Citizens

150.000 Health & Social Care Operators

8.500 General Practitioners and Pediatricians

2.500 Pharmacies

15 Local Healthcare Units

34 Public Healthcare Services Suppliers (29 Public Hospital and 5 Public Scientific Services)

Over 2500 Private Healthcare Services Suppliers

REGIONE LOMBARDIA

PHARMACIES

HEALTH & SOCIAL ASSISTANCE

GENERAL PRACTITIONERS

LOCAL HEALTH CARE UNITS

CI TI ZENS

HOSPITALS

REGIONE LOMBARDIA

PHARMACIES

HEALTH & SOCIAL ASSISTANCE

GENERAL PRACTITIONERS

LOCAL HEALTH CARE UNITS

CI TI ZENS

HOSPITALS

As every Italian Region is directly responsible for Healthcare services provision

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Lombardy’s Region Healthcare Information System evolution

1978 Collection and filing of hospitalizations

Collection and filing of outpatient visits data1997

1985 Collection and filing of pharmaceutical acquisitions

1982 Regional personal data directory of Citizens and General Practitioners

CRS-SISS

Project’s requirements definition and feasibilty analysis

CRS-SISS

On site pilot project inLecco’s District(300.000 citizens)

1999 2000 -2001 2002

CRS-SISS

Project Financingand beginning of the expansion to all Districts

2008

CRS-SISS

Healthcare Private Sector

2004 2005

CRS-SISS

2 millionscitizens

CRS-SISS

All Lombardy’s citizens(9,5 millions)

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E-Health in the world: who is doing what where?

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)

Europe

Regional Health Information Organizations (RHIOs) Four National Health Information Network (NHIN) pilot projects Canada Health Infoway

United States /Canada

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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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.

SISS implements a wok-flow based on the typical healthcare processes: Pharmaceutical Outpatient examinations Medical examinations Emergency …

The underlying philosophy

Healthcare DataHealthcare Data

Administrative DataAdministrative Data

General Practiotioner

Practitioner

ASL

Healthcare Local Unit

Pharmacy

Hospital

Healthcare DataHealthcare Data

Administrative DataAdministrative Data

General Practiotioner

Practitioner

ASLASL

Healthcare Local Unit

Pharmacy

Hospital

Data WareHouseCluster of Patients

Electronic Health RecordVision per single Patient

Data WareHouseCluster of Patients

Electronic Health RecordVision per single Patient

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CRS-SISS goals

• Improve Services for Citizens: reducing the “distance” between Citizen and HC Services Providers by simplifying procedures and shortening waiting time

•Improve quality of prescription, diagnosis and care (appropriateness) processes by Citizens’ clinical data sharing, through EHR, among qualified HC Professionals, securing Citizens’ Privacy Rights

•Improve Governance of Social and HC System managing costs: enhancing planning and controlling instruments (DataWarehouse, Business Intelligence)

•Improve internal processes efficiency of HC Services Providers by a generalized diffusion of new technologies (digital signature, electronic filing, electronic prescription) to dematerialize documents

Reduce the gap between Citizen and HC Services Providers

SISS

Planning and Governance of HC expenditures

Efficiency and Simplification Social and HC

Internal Processes

Assure continuity and quality of care

For Citizens and HC Professionals

For Administrations

(Regional Government and HC Providers)

•The main objectives of the CRS-SISS program are to unify and to protect within a co-ordinate system the information about the lombard citizen state of health and to distribute a CRS Card in order to obtain:

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CRS-SISS main streams

• 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

• 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

Healthcare Extranet as main instrument of innovation

and integration frameworkamong all actors:

Develop HC Organizations’ Information Systems,

promoting features such as:

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Electronic Health Record (EHR): Architecture

Health documents

HLU: Patient Summary, Vaccine file

Hospitals: Referrals, Health Documents, Therapeutical plans, …

Hospital

Hospital

ASLASLASL

Healthcare Local Unit

Events Link

EHR

ClinicalDoc

PS

HospitalClinical

Doc

ClinicalDoc

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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,…).

Electronic Health Record (EHR): Main characteristics

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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

Services

2 LEVEL

Healthcare Extranet

Hospital, Operators, Chemists, …

Provider Provider

Lombardy Region Central System 1 LEVEL

Central Repository

3 LEVEL

Operators & Organizations

General Practitioner, Pediatrician

Integrate Management Unit

Citizens

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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 of digital signature and electronic documents (dematerialization)

Smart cards

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Smart Cards Technology

Citizen Card

Operator 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

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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

Main Results in December 2007

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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 Challenges1. 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

0

10.000.000

20.000.000

30.000.000

40.000.000

50.000.000

60.000.000

2003 2004 2005 2006 2007

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-

5.000.000

10.000.000

15.000.000

20.000.000

25.000.000

30.000.000

35.000.000

40.000.000

45.000.000

50.000.000

2004 2005 2006 2007

Exams/Visits

Pharma

Currunt usage: Total system Transactions

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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

The financing model

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Thank you

13 February 2008Fulvio BarbaritoLombardia Informatica