f. castellani role of ict in actual and planned healthcare policies in tuscany

REGIONAL ICT BASED CLUSTERS FOR HEALTHCARE APPLICATIONS AND R&D INTEGRATION

ROLE OF ICT IN ACTUAL AND PLANNED HEALTHCARE POLICES IN TUSCANY

Francesco Castellani

Settore Sistemi Informativi e Tecnologie Informatiche

DG Diritti di Cittadinanza e Coesione Sociale

Regione Toscana

Seventh Framework Programme Regions of Knowledge Health Grant agreement no: 266262

Presentation Summary

- The ICT infrastructure implemented in Tuscany as a whole

- The ICT infrastructure deployed in the healthcare sector

- Cloud in healthcare: the achieved results


Objective of the ICT in Tuscany Region The objective of the ICT in the Tuscany Region is to create a system that:

- enables the communication and cooperation in the systems actors

- supports the delivery of health Services

- facilitates Access to Services

- assures on-line services accessibility

- creates Inclusion and reduce Digital Divide


The ICT organization in Tuscany Region


The ICT sector in Tuscany Region In Tuscany Region are present two sectors that cover the whole ICT governance with different role:

-Infrastructure and Technologies for the growth of Information Society. This sector defines, organizes and governs the ICT infrastructure for the whole region.

-Information System and knowledge technologies. This sector defines, organize and governs the application layer.

…. and for the healthcare the sector :

- Information system & technological healthcare Innovation


The ICT Infrastructure

To achieve the ICT objectives Tuscany Region creates a network called

RTRT (Rete Telematica Regione Toscana; Telematic Network Tuscan Region – www.rtrt.it)


RTRT

RTRT, created by Regional Law 1/2004, provides support with a governance role in policy development of the Digital Tuscany Agenda.

IT IS

It is a network of public bodies (universities, municipalities, research centres and Local Health authorities, who invested in this project

It is an organizational model of relationships among the various stakeholders based on the concept of shared objectives, cooperation and partnership, able to produce and sustain innovation processes.


It is a Technological Infrastructure with large capacity, spread

throughout the region, connected to the Internet, interoperable,

as meeting the standards promoted by the CNIPA (Italian

Institute for Innovation in technology), the Public Connectivity

System (formerly Unified Network of Public Administration).

It is a unique opportunity for development: the establishment

of new relationships between public administrations and

between them and the citizens, businesses and society in

general, technological innovation and the internal organizational

entities; promotion resources of Tuscany (territory, culture,

business, etc ...) for small and medium-sized enterprises in

technological innovation, and more.

It is not only a network of wires, but an organic

development of the Information Society


HOW IT WORKS Assembly: defines the general guidelines for the activities and projects of the Network. It’s composed by the parties of the RTRT

Strategic Committee: performs functions of guidance and direction of the activities of the Network. It is chaired by the President of the Regional Council and it is composed by thirty representatives of the RTRT parties, a representative of the local Council and a representative of each of the associations of local authorities

Network coordinator: liaises with public and private entities and coordinates all the technical and organizational resources enabled

Technical direction: defines the standard in the network environment for the sysytem interoperability and the application cooperation


TECHNOLOGICAL INFRASTRUCTURE AND PLATFORM

Connectivity Infrastructure (RTRT3)

Application Cooperation Infrastructure (CART)

Authentication & Authorization Infrastructure (ARPA)

VoIP Infrastructure

Platform for on-line payments (IRIS)

Platform for archiviation and long term maintaines (DAX)


TECHNOLOGICAL INFRASTRUCTURE AND PLATFORM

RTRT3

- It is a wide and broad infrastructure, well branched on whole Tuscany, which is autonomous and connected to Internet and further networks.

- It is the SPC (Public Connectivity System) Tuscany hinge and connect all the Tuscany's Public Organization with high-speed connection. SPC is the standard defined by the Italian Departiment for Tecnological Innovation


Aree Provider Internet

RTRT

Management Area

Services Area

Network Area RTRT

Security System

TIX

Area NAP

Firenze

Pisa

Siena

Backbone ATM 155 Mbps

GBE metropolitana

INTERNET

ISP 1 dedicated

ISP 2 dedicated

ISP 2 ISP 1

ISP n

RTRT


CART

TWO definitions before:

1. Interoperability: refers to the ability of two or more systems to exchange information and to activate, to that end, computing processes into their applications.

2. Application Cooperation: refers to the ability of one or more systems to use in their individual application logic, automatic interchange of information with other systems, for their application purposes


CART

CART (Cooperazione Applicativa Regione Toscana = Application Cooperation in Tuscany Region) is:

- software and hardware infrastructure that enables the application cooperation

- SPC private network


CART


CART The Numbers:

• In the last 30 days CART deliveres 51.172.345 messagges

• 251 service agreements

• 2.190 the number of services enabled


eToscana Compliance

The technological infrastructure will not ensure by itself the full interoperability of applications

Tuscany Region has established a process rappresented by the eToscana Compliants for:

1. Public and private organization define collaboratively e.Toscana RFC documents that, if shared and technically valid, become the standard by which entities are required to exchange information.

2. The software house change their applications according to the RFC e.Toscana and accredit their own solutions e.Toscana Compliance Standard.


eToscana Compliance

The number

-230 RFCs are standardized

- 50 software solution accredit


ARPA

-Realize the SSO (Single Sign On) in the Tuscany Region Service

- Mutual authentication for different domain (domain federation)


… and ICT in healthcare environment


Internet

Radiology

Diagnostic

Electronic Health Card

Project

E-Prescription

Surgical Pathway

...further Clinical pathways

Main regional Project


The project arose with Health Plan 2008-2010 and has been

operational since April 2010.

Objective:

The creation of the Fascicolo Sanitario Elettronico, that is the

Electronic Health Record (EHR).

EHR is a collection of electronic health information about patients.

Currently in Tuscany, the EHR contains clinical data including

demographic data, hospitalizations, immunizations/vaccination,

pathology exemption, drugs, emergency events.

CSE - Electronic Health Card Project


Registry: The main role of this subsystem is to keep the information of

the patient, the operator and the organization that operate in the

healthcare

Ndx (Index): The main role of this subsystem is to create an index

between the healthcare events (laboratory report, emergency report,

etc) and the patient, the operator, etc

Repository: The main role of this subsystem is to keep the healthcare

events

CSE – EHR Architecture


CSE - EHR Architecture


CSE - Healthcare events

Principal RFC define in the healthcare environment

- Registry (number 85, 86,87)

- Patient Summary (number 133)

- ePrescription (number 161)

- LIS and RIS (number 101 and 136)

- Vaccination (number 171)

- Emergency (number 106)

- Chronic Care Model (number 208)


National Service Card (CNS)

Access key for on line services .

A chip card contains a digital

authentication certificate.

The card can contain also a digital

signature certificate.

Health Cards (for citizens) already

delivered : around 3.700.000 (whole

tuscan population).

Professional Cards delivered : around

30.000.

CSE - Electronic Health Card Project


The EHR can be created only with the permission

of the patient. The EHR contains events which occurs

after its creation. (Privacy Law)

The patient is the owner of his EHR.

The patient can enter/view his EHR by his own Health

Card (CNS).

At the moment General Practitioners do not access

their patients' EHRS with their own Professional Card

Clinicians will start to access their patients' EHR with

their Professional Cards in an emergency situation.

(Privacy Law)

EHR - Electronic Healthcare Record


The EHR can improve patient care by:

Reducing the incidence of medical errors by improving the accuracy and clarity of medical records. Making the health information available to patient, reducing duplication of tests, making patients well informed to take better decisions. The patient has the opportunity to access and view his own lab reports and clinical data whenever and wherever he wants. (e.g. At home, with his/her GP and specialists, in Assisted Access Point for On line services (PAAS)) Clinical report can be delivered in Real Time.



Report creation

Desk

Mail

… days

Report d

eliv

ery

… days

Electronic

Health

Record

clinician

at home

totem

Real time

Real time

Lab reports can be

delivered to the EHR

in real time

Real time



The State of the Art

Patients can activate the CNS and create EHR at:

Healthcare organizations (ASL/AOU), with about 200 desks

Since last March, at the local pharmacies with about 700 desks (70 % of

pharmacy)

The rate of activation is 34% (1.270.000) of the Tuscany population

(3.700.000)




http: www.regione.toscana.it/cartasanitaria


Electronic Patient Record

Electronic Patient Record is a part of the EHR where the patient can

insert by himself:

- personal informations (eg life style, sport activity, BMI, etc)

- electronic report not automaticaly inserted into the EHR

- diary events on the main healthcare information, appointments on

periodicaly visit, etc

The system automaticaly extracts the main information and creates

the summary of the EPR; this kind of information could be very

important in an emergency situation.


Electronic Patient Record


The CLOUD based datacenter: the achieved results


TIX TIX (Tuscany Internet eXchance) is:

- Services and Data Center for Tuscany Region, the Local Health Authorities and the local public organizations.

- It is a neutral interconnection point between the Public Organizations networks and the Private Organizations.

- The place of the enabling infrastructure for the development of the Information Society


- an opportunity to rationalize the IT cost in the public organization

- a focal point for the innovation process in the public organization

- the CLOUD for the Tuscany public organization. Tuscany Regione is the winner of G-Cloud Award 2012 (http://toscana-notizie.it/blog/2012/11/29/un-premio-alla-regione-toscana-per-la-sua-nuvola/)


TIX TIX (Tuscany Internet eXchange) offers ICT services at the public organization under the paradigm As A Service, as defined in the Cloud Computing:

1. IaaS: Infrastructure As A Service (achieved)

2. PaaS: Platform As A Service (achieved)

3. SaaS: Software AS A Service (in progress)


TIX

SaaS

PaaS

IaaS

Facility

Management

Backup

Archiving

Business continuity

Disaster Recovery

Business Gate

(Security Internet)

SaaS: software as a service (ERP, Application Mngt, ..)

PaaS: platform as a service (database, appl. Engine, middleware, ..)

IaaS: infrastructure as a service (network, storage, RPE, …)


TIX TIX (Tuscany Internet eXchange) offer ICT services at the public organization under the paradigm As A Service, as defined in the Cloud Computing:

1. IaaS: Infrastructure As A Service (achieved)

2. PaaS: Platform As A Service (achieved)

3. SaaS: Software AS A Service (in progress)


… the ICT healthcare organizations


Task Force in innovation


ICT Organization In Tuscany

– Control Team: composed by the three departments of Tuscany Region and the management of ESTAV. The objectives is to define the main target of the innovation

– Coordination for innovation in health: Government, monitoring and control of the coordination areas

– Coordination Areas: the seven main horizontal areas of coordination

– Project Management. Project Planning and management



– Technological Infrastructure. Network (eg TIX) and

service (voip, web conference) infrastructure

– Management Information System. Organization,

coordination and information aggregation for business

and decision process

– Hospital Information System. Coordination project of the

new Regional Hospital

– Department Software. Software used by the main

organization department: health, administrative and

technical



– Technological Platform. Using the application platform

present in the regional environment as a Service (DAX,

IRIS, ARPA, etc)

– Regional, National and International financing

– Project Areas: Working team on specific project. This layer uses the coordination areas directive

– ESTAV: Responsible of the projects realization, in the ASL/AO, as defined in the Project areas


… and the tools


We'd like to move from local services to

regional on-line services, which can be

reached and accessed by the overall

Tuscany population.

CNS is a powerful key to access and to activate on-line services.

Further improvements:

Radiology images online, ticket exemption consultation, GPs choice/ revocation, report from

pharmacies, CUP (reservation) on line, request and acquisition of medical records, digital

chancellery for civil proceedings.

ELECTRONIC HEALTH CARD PROJECT


Email: [email protected]

Phone: +39.55.4383323

www.richardproject.eu

mailto:[email protected]







f. castellani role of ict in actual and planned healthcare policies in tuscany

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