innovation of the healthcare system through ict: the lombardy experiment

Integration: the Good, the

Bad and the Heroic

Innovation of the healthcare system through ICT: the

Lombardy experiment

Roberto Zuffada

Regione Lombardia – DG Health

Lombardia healthcare system

REGIONE LOMBARDIA

PHARMACIES

HEALTH & SOCIAL ASSISTANCE

GENERAL PRACTITIONERS

LOCAL HEALTH CARE UNITS

CITIZENS

HOSPITALS

REGIONE LOMBARDIA

PHARMACIES

HEALTH & SOCIAL ASSISTANCE

GENERAL PRACTITIONERS

LOCAL HEALTH CARE UNITS

CITIZENS

HOSPITALS

• 9.300.000 Citizens

• 150.000 Health & Social Care Operators (public and private)

• 7.700 General Practitioners and Pediatricians

• 2.600 Pharmacies

• 15 Local Healthcare Units

• 112 Public Hospitalsincluding 8 University Hospitals

• More than 400 Private Healthcare Services Suppliers

• Budget for Health in 2008: 17 billions €

eHealth strategy up to 2010: the

CRS-SISS project Health and Social Services IT System (SISS)

• ICT tools and systems to improve and rationalise health care processes (Technological, Organisational, Financial/Budget)

• Smart card based technologies ensuring secure access to the healthcare network both to citizens and professionals

• Improvement of healthcare services, better and more targeted planning of the Regional Health System, and integration of the healthcare services with ICT


CRS-SISS project Health and Social Services IT System (SISS)

• Providing professionals with tailored patient information through a unique access point

• Introducing innovation in the hospitals’ ICT systems, including customisation of their IT architecture for the integration with the SISS system, and organisational changes in day-by-day work


SISS services• Citizen Identification: Regional General Registry and

Citizen Card

• e-Prescriptions Management

• Electronic Health Record (EHR): sharing clinical data

among HC Professionals (events, prescriptions, reports,

care profile, …), enabling on-line access for citizens

• Booking and Payment Services for citizens by

Internet, GP, Pharmacies

• Regional Call Centre, to improve citizen’s access to

HC services


SISS services• Digitalization of all medical and administrative

documents in order to improve efficiency and

effectiveness of processes

• Accounting information management flow

• Security Services: Identification & Authorisation

- The security and confidentiality principles of SISS are the

following:

- Citizen consent to processing their health data, in

accordance to Art. 29

- Identification and authorisation of users

- Data security

- Limited access


SISS documentsThe SISS network allows for the gathering and

organisation of documents for clinical purposes. All

citizens registered in the Regional General Registry have a

citizen card and an EHR.

The information can be accessed by all healthcare

professionals and administrators connected to SISS,

provided appropriate identification and the citizen’s explicit

consent. SISS contains metadata that points to the synthesis

reports of all healthcare events


SISS documentsThe following EHR documents can be accessed via SISS,

independent of the location of the point of care:

• Drug prescriptions

• Vaccination records

• Test results

• Hospital discharge letters

• Therapeutic plans

• Referral letters

• Emergency Services reports.

Smart Cards as key access

Identification and authentication

Access to Public Administration services

Data storage required for emergency care

Certification of the “presence” of the citizen (through electronic signature of documents)

CRS RegionalService Card

(citizen)

Identification and authentication

Authorization to access the System

Electronic Signature

Enables access to SISS services

Enables access to the data stored in Citizen card

Provides an advanced digital signature

SISS Card

(professional)

CRS-SISS implementation

• Distributed citizens cards: 9.740.000 (100%) (including re-issuing)

• Citizens joining SISS: 4.960.000 (54%)

• HCPs with professionals cards SISS: 63.000 (76%) (public sector)

• SISS work stations: 26.100 (public sector)

• GPs joining SISS: 7.167 (92%)

• Pharmacies connected to the SISS network: 2.593 (100%)

• Public hospitals joining SISS: 112 (100%)

• Local Healthcare Units joining SISS: 15 (100%)

• Private healthcare organisations connected to SISS: 355 (96%)

CRS-SISS implementation / EHR

• Monthly contacts: 1.590.000

• ePrescription – pharmacies (monthly): 4.200.000 (80%)

• ePrescription – laboratories (monthly): 1.600.000 (58%)

• Lab medical reports (monthly): 490.000 (88%)

• Radiology medical reports(monthly): 140.000 (73%)

• First aid medical reports (monthly): 172.000 (70%)

• Discharge letters (monthly): 58.500 (49%)


• Timeline of SISS development

Functionality / Service

Start Date

(First issue/

Service

Activation)

Estimation of the

Status of work in

Aug-2009

(deployment)

Finish Date

(Full deployment

and/or

distribution)

eBooking Before 2002 70% 2010

Digital Signature:

Electronic Cards and Client

Peripherals;

2002 90% 2010

Digital Signature:

Infrastructure2002 100% 2008

Clinical applications:

Ambulatory reports 2006 70% 2010

Lab reports 2006 95% 2010

Radiology reports 2006 92% 2010

A&E 2006 88% 2010

Discharge letters 2006 88% 2010

Managing Prescribing 2006 100% 2009

ePrescribing of drugs 2006 88% 2010

Source: “Report on

The socio-economic impact

of the health information

platform Sistema SISS in the

region of Lombardy, Italy”

empirica-TanJent, 2009


• Pathology networks creation

A new development is the establishment of pathology

networks with the aim of utilising the opportunities provided by

SISS for continuous and ubiquitous care for those who need it.

Currently, there are 3 active pathology networks, for

- Oncology

- Epilepsy and

- Rare pathologies

Another 5 networks, covering cardio-vascular and stroke

diseases, dialysis, hearing, and the phenomenon of infants

death, are in the process of being implemented.


• Pathology networks creation

A hospital is appointed to define the content standards and

structures of the documents for the respective network.

Pathology networks already exchange documents that are

based on structured data, and for future documents shared

in SISS are envisaged to consist of structured data.

eHealth strategy towards 2020

• Towards a patient-centred healthcare

system: the regional healthcare services is

currently moving towards a new model from

“hospital-centred” to “patient-centred”

services, tailored on citizens, oriented to a

better integration of the healthcare service on

the territory (2012-2020).


• The scale and complexity of the SISS initiative requires

very careful planning and gradual implementation.

• The functionalities already in place generate a

respectable socio-economic return.

• Legislation has a direct impact on deployment of

functionalities and benefit realisation.

• The future potential of SISS lies in integration of HPOs

not yet part of the network, which are mainly private

sector providers, and expansion of functionalities to all

healthcare services.Source: “Report on

The socio-economic impact of the

health information platform Sistema

SISS in the region of Lombardy, Italy”



• The provision of medical information from as many

healthcare services and facilities as possible increases

the extent of benefits, especially regarding patient

safety. This, in turn increases the necessity for

healthcare professionals, both in GP practices and

hospitals, to actively integrate information sharing into

their clinical routine.

• The pathology networks already active of in the process

of establishment will both foster continuity of care and

impact health professionals’ attitude towards the

necessity of data exchange without local restrictions. Source: “Report on

The socio-economic impact of the

health information platform Sistema

SISS in the region of Lombardy, Italy”



• The main drivers for benefits are data sharing and

eBooking functionalities.

• Data sharing

• renders safer healthcare provision, especially in cases where

patients would otherwise not bring their referrals or discharge

letters;

• it allows for data validation and counter-checking of test results, for

preparation of consultations in advance, for the creation of new

healthcare models, and time savings and increased productivity.

• eBooking

• fosters HPOs’ resource planning and allocation,

• saves time and travel costs and

• makes scheduling much more convenient for patients.


• Lessons learnt: the experience of the CRS-SISS

points out that such a complex eHealth projects call for:

• strong political commitment, robust legal and regulatory

frame, and long-lasting decision makers determination;

• a deep involvement of relevant stockholders mainly

professionals, healthcare organisations and industry;

• an evolutionary and self-adapting approach towards the

implementation of the ICT solutions.

More information on SISS project: “Report on The socio-economic

impact of the health information platform Sistema SISS in the region of

Lombardy, Italy”

http://www.ehr-impact.eu/





Contributing to enhance eHealth as an enabler for cross-border healthcare: EU projects

epSOS LSP: CIP, 27 Partners, 12 MS

“to develop a practical eHealth framework and ICT infrastructure that will enable secure access to patient health information, particularly with respect to a basic Patient Summary and ePrescription, between European healthcare systems”

NEC@RDS: eTEN, 27 Partners, 16 MS, eEHIC deployment service

“to achieve the initial deployment of the eEHIC through a service allowing automated data capture for identification, on line verification of entitlement via National Portals, back-office interstate billing”

ALIAS: Alpine Hospitals Networking for Improved Access to Telemedicine Services, 10 partners, 7 Regions – ERDF Territorial Cooperation

“to network Alpine hospitals for better access to healthcare through the use of existing infrastructures of connectivity in order to optimise the delivery of HC services (telemedicine and data sharing)”

Integration: the Good, the

Bad and the Heroic

Innovation of the healthcare system through ICT: the

Lombardy experiment

Roberto Zuffada

Regione Lombardia – DG Health

innovation of the healthcare system through ict: the lombardy experiment

Health & Medicine