Investment in sustainability of future Health Care: a health information infrastructure Innovation of the healthcare system through ICT: the Lombardy experience Regione Lombardia DG Health
Lombardia healthcare system PHARMACIES GENERAL PRACTITIONERS REGIONE LOMBARDIA CITIZENS HEALTH & SOCIAL ASSISTANCE HOSPITALS LOCAL HEALTH CARE UNITS 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 Hospitals including 8 University Hospitals More than 400 Private Healthcare Services Suppliers Budget for Health in 2008: 17 billions
Regione Lombardia: Promoting long term Health Care system sustainability Tighter control on utilisation of allocated resources Comprehensive ehealth adoption strategy Better information on RHS s performances Better circulation of clinical information Better programming
Regional Health Care Master plan year 1999-2001 : Major focus points Scalability and sustainability of the HC system oriented to ICT reducing costs for the administrative procedures booking, accounting, shift from paper to digital improving the appropriateness of the diagnostic paths. covering of the SISS maintenance through reduction of HC System cost (estimated in 2012) Regional healthcare towards 2020 based on intensive use of ICT SISS as a strategic choice towards HC System planning continuity of care through direct connectivity between hospitals and territory involvement of all the relevant players PA, HC professionals and organisations, ICT industry, citizens) Bring innovation to citizens: take up innovation to citizens HC System centred on citizens more accessible and user friendly tools, data access via web, Better circulation of clinical information
functions The prerequisite of the Project was the distribution of the personal Smart Card. The main objectives of the CRS-SISS Program are to unify and to protect, within a co-ordinated system, all the information related to the citizens state of health. For Citizens and HC Professionals Improve Services for Citizens: reducing the distance between Citizen and HC Service Providers by simplifying procedures and shortening waiting time Reduce the gap between Citizen and HC Services Providers SISS 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, guaranteeing Citizens Privacy Rights Improve Governance of Social and HC System managing costs: enhancing planning and controlling instruments (DataWarehouse, Business Intelligence) Planning and Governance of HC expenditures For Administrations Efficiency and Streamlining of Social and HC Internal Processes (Regional Government and HC Providers) Improve internal process efficiency of HC Service Providers by a generalized diffusion of new technologies (digital signature, electronic filing, electronic prescription) to dematerialize documents
Lombardy s Region Healthcare Information System evolution 1978 Collection and filing of hospitalizations 1982 Regional personal data Registry of Citizens and General Practitioners 1985 Collection and filing of pharmaceutical acquisitions 1997 Collection and filing of outpatient visits data 1999 2000-2001 2002 2004 2005 2008 CRS-SISS Project requirements definition and feasibility analysis CRS-SISS On site pilot project in the Lecco District (300.000 citizens) CRS-SISS Project Financing and beginning of the expansion to all Districts CRS- SISS 2 million citizens CRS-SISS All Lombardy s citizens (9,5 million) CRS-SISS Healthcare Private Sector
ehealth strategy 1999-2010: the CRS-SISS project 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 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
ehealth strategy up 1999-2010: the 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 Digitalization of all medical and administrative documents in order to improve efficiency and effectiveness of processes Accounting information management flow Security Services: Identification & Authorisation Management of Citizens consent to their health data to be processed throughout the CRS system in accordance to Art. 29 Identification and authorisation of users Data security Limited access
Smart Cards as key access
The underlying philosophy Hospital ASL Healthcare Local Unit Pharmacy SISS is a Regional Healthcare Information Network, the Citizen is its centre. All the data are gathered, organized and reported on the basis clinical contacts of each citizen within the Regional Healthcare System. SISS implements a work-flow based on the typical healthcare processes: Pharmaceutical Outpatient examinations Medical examinations Emergency General Practiotioner Practitioner Administrative Data Data WareHouse Cluster of Patients Healthcare Data Electronic Health Record Vision per single Patient
CRS-SISS Architecture Lombardy Region Central Systems Social Services Healthcare Level 1 Central Indexes Provider Integration Management Unit Provider Level 2 Healthcare Extranet Citizens SERVICES Hospital, Operators, Chemists, General Practitioner, Pediatrician Level 3 Operators and Organisations
Gate Gate Extranet architecture Service Users and Suppliers Booking Referral Consultation Private Intranet (LHCU, Hospitals ) Gate Booking and Prescription management Citizen Identification Referral Consultation. Gate Private Intranet (GPs, ) Health Care Extranet Integrated Management Unit IT Service Provider User of the Services Intranet of of the Health Care Central Domain Data Bases of HealthCare
CRS at the center of citizen s life egovernment online services ehealth (CRS-SISS) Health service payment Public libraries Welfare services Fuel discount card Access Control Deployed Test phase Study phase Transportation Private Services (parking, discount, fidelity, eticketing...)
CRS-SISS System: Total Transactions 2005-2011 FORECAST 300.000.000 250.000.000 200.000.000 150.000.000 100.000.000 50.000.000 0 2005 2006 2007 2008 2009 2010 2011 Source: Lombardia Informatica
CRS-SISS System: Total Prescriptions 2005-2009 70.000.000 60.000.000 50.000.000 40.000.000 30.000.000 20.000.000 10.000.000-2005 2006 2007 2008 2009 Pharma Exams/Outpatients Source: Lombardia Informatica
90.000.000 80.000.000 70.000.000 60.000.000 50.000.000 40.000.000 30.000.000 20.000.000 10.000.000 CRS- SISS System in use: year 2009 figures Pharmaceutical orders Diagnostic orders - Referrals - 2005 2006 2007 2008 2009 Pharma Exams/Outpatients Med. Reports Source: Lombardia Informatica
CRS SISS system: current situation from a functional perspective All documents are stored in Pdf format CRS-SISS DOC POINTERS PRACTITIONER WORKSTATION Central Data Base DOC REPOSITORY DOC REPOSITORY DOC REPOSITORY Health Care Provider #1 Health Care Provider #2 Health Care Provider #3
CRS SISS system: EHR Navigation 18
CRS SISS System-EHR timeline view
CRS-SISS system: HL7 compliant clinical documents as EHR building blocks Already deployed and under test: Laboratory report Discharge report Patient Summary Under study: Referral letter (from GP to Hospital/Specialist) Emergency room report Specialist report Diagnostic reports Imagery report Diagnostic test report 20
CRS - SISS system: future trends HCP DOC REPOSITORY Consultation Structured Clinical Document production Relevant sections of Structured Clinical Document are marked EPISODE ZZ WW DATE: DIAGNOSTIC LABEL hypertension PRESCRIPTION: Enapren 1 cp m IMAGING; ECOCG xxx xxx : normal CRS- SISS DOC POINTERS Central Data Base Remote GP EMR Episode oriented Dinamical Patient history EPISODE XX YY DATE DIAGNOSTIC LABEL: right tibial fracture : OBSERVATIONS buon trofismo cutaneo Fiches assolutamente pulite PRESCRIPTIONS: controllo tra 1 mese IMAGING: RX yyy yyy : Buona consolidazione
CRS-SISS implementation Distributed citizens cards: 9.740.000 (100%) (including reissuing) Citizens registering to the SISS: 4.960.000 (54%) HCPs with professionals cards SISS: 63.000 (76%) (public sector) SISS work stations: 26.100 (public sector) GPs adhering to SISS: 7.167 (92%) Pharmacies connected to the SISS network: 2.593 (100%) Public hospitals connected to SISS: 112 (100%) Local Healthcare Units connected to SISS: 15 (100%) Private healthcare organisations connected to SISS: 355 (96%)
CRS-SISS Estimated annual costs 180.000.000 160.000.000 and benefits Euro 140.000.000 120.000.000 100.000.000 80.000.000 60.000.000 40.000.000 20.000.000 Source: Report on The socio-economic impact of the health information platform Sistema SISS in the region of Lombardy, Italy empirica-tanjent, 2009 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Present value of total annual costs Present value of annual benefits
CRS SISS system: main drivers for benefits Digitalisation of Clinical data promotes continuity of care and allows advanced health care models makes healthcare provision safer, allows time savings and increased productivity allows better resource planning and allocation reduces paper consumption Electronic Access to Health Care saves time and travel costs promotes equity and availability makes scheduling much more convenient for patients.
CRS SISS system: lessons learnt strong political commitment, robust legal and regulatory frame, long-lasting decision makers determination; a deep involvement of relevant stockholders professionals, healthcare organisations industry; an evolutionary and self-adapting approach towards the implementation of the ICT solutions.
Investment in sustainability of future Health Care: a health information infrastructure Thank you! Regione Lombardia DG Health roberto.zuffada@cnt.lispa.it