QUALITY OF CARE: COST OR INVESTMENT?"

IT IS POSSIBLE A HEALTHCARE SYSTEM LOW COST?

1. WHO WE ARE 2. WHAT WE HAVE DONE 3. AN EXAMPLE OF ROI – IMPLEMENTATION OF THE UNITED COMMUNICATION

ASL NAPOLI 2 NORD

10/8/2014 2

1. WHO WE ARE: ASL NAPOLI 2 NORD

3

SURFACE AREA : 411,43 Kmq

POPULATION : 1.045.790 citizens

CITIES: 32

HEALTH DISTRICTS: 13

DEPARTMENTS: 6

HOSPITALS: 5

RESIDENCE FOR THE ELDERLY: 2

INVESTMENT EXPENSES ARE JUSTIFIED BY ITS COSTS?

COST - EFFECTIVENESS (outcomes assessment

in natural units of health benefit)

COST – BENEFITS (outcomes assessment

in monetary terms)

COST –EFFETTIVENESS

COST – BENEFIT

TOWARD DIGITAL HEALTHCARE

I.C.T. balanced scorecard (BSC)

Financial

Learning & growth:

Customer: Process & People:

The total cost of the ICT

system is commensurate

with that produces on

the company's

management ?! Processes, management and

internal resources are tailored to the needs

of the company ?!

Approach adopted

- LEGACY - INFRASTRUCTURES - TECHNOLOGIES - RESOURCE - ICT MANAGEMENT

NEW APPLICATIONS

- BPR - SISTEMI LEGACY - APPLICAZIONI WEB

ADJUSTMENT OF INFRATRUCTURES, SKILLS AND MANAGEMENT OF ICT

ICT DEVELOPMENT PLAN: PROGRAM & CHANGE MANAGEMENT

QUICK WINS

Construction of an ICT strategic plan

strongly connected to business needs,

characterized by a high level of expected

efficiency and effectiveness of the

investment required Progetti in corso

Strategia ICT

Vision e processi

ICT Strategic Plan

“e-propositions”

ICT Architecture of reference

Evaluation State of art

Summary Positioning Technology - application diagram

Directional Area

Intranet Portal of Services – Central Reservation Service

Infrastructural Area

External bodies

SOGEI

Disaster recovery In cloud Connettivity – adapters – HL7 – Web Services

Repository / PHR - Documentum Register of assisted - MS CRM

Region

INPS

INAIL

Regional bodies

other P.A.

Administrative Area Hospital Area Territorial Area

Management Control Administrative

Datawarehouse

Cespiti ed inventario

Ordini beni sanitari

Gare appalto

Sale operatorie

Consultorio familiare

Igiene ambientale

Contabilità generale

Controllo Fatturaz.

Paghe Rilevazione

presenze

Magazzino economale

Gestione risorse umane

Gestione ADT

CUP Interno

RIS / PACS

Pronto soccorso

Sistema Cuprecall

Visite fiscali

Cure paliative

Vaccinaz. Riabilitaz. Protesica

Assistenza socio sanit.

Smart ADI

Medicina legale

SIEM – DAM Log accessi

ESB Documentum

Protocollo Workflow

WEB Mail

ICT Asset inventory

Proxy e Antivirus

Help Desk

Reporting SLA

Trouble Shooting

Ordini beni Non sanitari

Controllo SDO

Sanitary Datawarehouse

Management Dashboard- MD

Asset Inventory

Contabilità intramuraria

SMART C6 (Malattie)

Laboratorio analisi

Gestione Accreditam.

Anatomia patologica

PUA

Sceening oncologico

Visite ispettive

DWH Flussi farmacie

Affari legali

2. WHAT WE HAVE BEEN

3. WHAT WE HAVE DONE NEW DATA PROCESSING CENTER - HW TODAY (2013)

• ONE PROCESSING SYSTEM SIZED FOR THE NEXT 10 YEARS • A COMPLEX STORAGE SYSTEM FOR ALL KIND OF NEEDS (SAS SATA SSD DISK) • PROCESSING CAPACITY THAT ADAPTS TO THE PREVAILING • REDUCED COST OF POWER SUPPLY

UNTIL TODAY WE HAVE SAVED MORE THAN 150.000,00 EUROS PER YEARS OF

SERVER MAINTENANCE

VIRTUALIZATION SCHEMA

VMware vSphere

Compute Storage Network

Servizi per le Applicazioni

Scalabilità Sicurezza Disponibilità

Servizi per le Applicazioni

Vshield Zones VmSafe

DRS Hot Add

Vmotion Storage vMotion HA Fault Tolerance Data Recovery

ESX e ESXi DRS e DPM Memory Overcommit

VMFS Thin Provisioning Storage I/O Control

Distribuited Switch Network I/O Control

VMware vCenter Suite

Cluster A.D. Cluster Applicazioni ASL Cluster Exchange Cluster Lync

OUR INFRASTRUCTURE NETWORK DATA

DPC

MPLS

PRIVATE CLOUD

INTERNET

PCS

Two separate way for network data exchange

OUR CLOUD

VoIP IDENTITY USER (AD)

APPLICATION SW

MAILING

FREE DATA

the only access point from outside to our cloud through the portal of services

MEDICAL CARE MODELS

HOSPITAL

(HUB)

SPOKE 1

SPOKE 2

Proposed Model

• High-tech specialist hospitals • In-mobility medical care • Population screening in the field to

increase knowledge and prevent • Continuous medical education and

training • Health care planning and control to

predict and organize effective response • High modularity to develop and roll-out

the global medical care

Current Model

• Often complex and large hospital infrastructures

• High management costs and capital investments

• Difficult territory reach

• Hospital beds often used to care for chronic old patients

• Long waiting times for specialist exams

• No economies of scale

Patients

Hospital

Medical Care

Patients

EXAMPLE OF ROI: THE UC PROJECT

2009

PUBLIC PHONE

PUBLIC PHONE

CENTRAL

IP PBX Alcatel

INTERNAL PHONE

Exchange Mail

Active Directory

MOBILE

Intranet

Phase 1: ibrid system toward the UC FULL IP

Telefono pubblico

Centrale telefonica Pubblica

Telefono interno

Exchange

Mail e VoiceMail

Active Director

y

VoIP Gateway

Cellulare

Internet

Intranet

Cellulare

Lync 2010

Lync 2010 Edge

IP PBX Alcatel

Phase 2: UC FULL IP

WHAT DOES IT MEAN SWITCH TO VOIP:

SERVICE COST/YEAR IN 2009 COST/YEARS AT CONCLUSION OF

PHASE 2

SAVING/YEAR

MAINTENANCE TRADITIONAL VOICE 111.932,80 35.000,00 76.932,80

CDN FEES 24.260,00 0 24.260,00 RTG, PRA, BRA FEES 58.072,32 29.036,16 29.036,16

TOTALI 194.265,12 64.036,16 130.228,96

RETAIL COST AND ESTIMATED SAVING

MOBILITY COST SAVING

COST OF TIME

TOTAL COST SAVING

AT END INNOVATION IS A INVESTMENT

IF IT IS WELL KNOWN

FROM WHERE YOU START

AND WHAT YOU WANT TO GET

THANK YOU

Imma.orilio@aslnapoli2nord.it