LOMBARY CRS-SISS Project: ICT for Innovation of Healthcare System.

1ForumCIS, 22 February 2007 - Barcelona

Va Jornada FòrumCIS

National and Regional Integrationof medical information

CRS-SISS ProjectIT for innovation of HealthCare system

Luciano Bresciani – Claudio BerettaMinistry of Health - Lombardy Region


Agenda

1. Lombardy HealthCare system.

2. Why the CRS-SISS.

3. CRS-SISS project overview.

4. Current situation of the project.

5. Economical sustainability of the project.

6. Some observations and lessons learnt from the project experience.


National Italian Health SystemPublic Budget

93.5 Billion euro (6,3% of GDP)

Private HealthCareexpenditure(2,1% of GPD)

*

*All Italian citizens and foreign workers are insured.Regions are in charge of the Health System management.Italian government is in charge of the overall coordination of the Health System.All health care treatments (excluding dental) are covered by the National Health system.Compulsory contribution through taxes.The Health System directly pays for all services admitted.

* 2006 data


Lombardy Health System

9.300.000 Citizens160.000 Healthcare employees7.900 GPs and Pediatricians2.540 Pharmacies15 Local Health Authorities212 Public and Private Hospitals983 Public and Private Medical Ambulatories770 Ageing People Shelters15,5 Billion euro budget for public healthcare (5,1% of GDP)

70% of Healthcare services provided by public providers

* 2006 data


Why the CRS–SISS ?

11.051.1

1.151.2

1.251.3

1.351.4

1.45

1999 2000 2001 2002 2003 2004

Lombardy

Italy

Health expenditure increase89,013,7

10,062,7

Public Private Total

ICT expenditure in Hospitals per year (K€) 170.000 90.000 260.000Lombardy data, year 2006 1,8%2,4%1,5%


What we tend to haveFull capacity to share information and documents: amongst hospitals and between specialists and GPs.

Capacity to rationalize administrative processes and make the information technologies “mission critical” in healthcare sector.

Identify an interoperability standard used in the hospitals and by all healthcare professionals and make compatible, possibly uniform, the informatics structure of Hospital Information Systems.

Capacity to promote some “networks of pathology”for main clinical areas.


CRS–SISS overview

The core of the project is an ‘Healthcare Extranet’, which links professionals, social services, organizations and citizens, tracking all the events in the process of patient care and providing value added services.

The project is based on smart card technologies, granting access to the Network to both citizens and operators by their personal smart cards.


Smart Cards features

Citizen

Identification and authentication.Access to all Public Administration services.Certification of the “presence” of the Citizen (through electronic signature of documents).

Identification and authentication.Access authorization to the System.Electronic Signature.

Professional


Objectives&Functionalities

Information sharing and exchange amongst healthcare operators and professionals to improve quality of healthcare provision (consultation referrals, prescription process, etc.).Improvement of services provided to Citizens through an easy and secure access to the Healthcare System.

Information availability at analytical level to monitor healthcare quality and expenditure during the process of care for a better planning at Regional level(management, budget control, expenditure).

Simplification of administrative processes (through electronic prescription and electronic signature).

Citi

zens

Publ

ic

Adm

inis

tra t

ion


Two joint implementations

CRS (“Regional Services Card”): the personal smart card allow every citizen to access all public administration services and enabling to access to private services.

SISS (“Health Care Information System”): the regional network connect all healthcare and social providers in Lombardy and provide e-Health services for ensuring continuous care.


SISS major servicesPrescription management

Electronic prescription: drugs and services coding, control, digital signature, storage, display.

Healthcare document managementOutpatient examination report, Letter of Discharge, Emergency Form: digital signature, notification, display, import in professional’s EPR.Issuing and maintenance of report are in charge of the health care company providing the service.

Outpatient booking serviceThrough Unique Regional Call Center or through a software used by GPs and Chemistries.Unique Booking System for all healthcareproviders involved by contract in the Regional System.


Document ManagementRegional DataBase

Maintenance of event index.Maintenance of Prescription Index.Maintenance of citizen and professional register.Maintenance of access grant through Single-Sign-On.Maintenance of coding tables.Management of GPs communication.

Hospital Doc. RepositoryDocument management.Maintain the database of signed documents.Communicates to the Hospital Gate for allowing the SISS to access documents.Can be used also by the Hospital software (e.g. EPR).


Pharmacies GPs

Network Infrastructure

Lombardy Region Central System

Operators

Health CareExtranet

Provider

Hospitals

Citizens

Provider

Citizens

HTTPS

HTTPS


Network Providersthey are the intermediaries between users and the regional trust that are in charge for the project implementation;they are selected and certified by the Region Lombardy;

they provide the access to the SISS Network and to Internet;

they install the “front end” software and the “SISS programs” on the operator’s Work Stations;

they supply the first level “Help Desk” and the “on site”technical support for the SISS;

they are chosen on the market and paid by Hospitals, GPs and Pharmacists.


IProject resultsSmart Cards distribution

(August 2006)

• Operator Smart Card,53.000 distributed (90% of public)

• Citizen Smart Card,9.200.000 distributed (98,9%)


IIProject resultsCRS-SISS services implementation

(December 2006)

Started Starting1 Pubblic

Hospital in Milano 2

9.200.000 Citizens

53.000 Healthcare Professionals

5.400 GPs and Pediatricians (69%)

2.380 Pharmacies (95%)

15 Local Healthcare Authorities

175 Public Healthcare Structures

4 private Healthcare Structures (private extension starts in 2007)

Actual extension topublic HC structures


IIIProject resultsSISS Transactions 2005/2006

01.000.0002.000.000

3.000.0004.000.0005.000.000

Genuary

March

May

July

Septem

ber

Novem

ber

Genuary

March

May

July

Septem

ber

Novem

ber

per month.

SIS

S Tr

ansa

ctio

ns

Transactions per year2004: 5.364.000 - 2005: 17.413.000 - 2006: 40.200.000


European cooperation

The CRS is compliant with Decisions n°189, 190, 191 of European Administrative Commission, 18 June 2003:

NetLink file system and authentication;

Further cooperation in EU funded initiatives for smartcard interoperability in Europe:

Netc@rds for eEHIC (eTEN)INCO-HEALTH (INTERREG IIIC).


Project Costs

There are not investments of the Lombardy Region:the Region pays a fixed fee for the service.

Fee of service all inclusive is

10.33 € (8.61 + VAT)per citizen / year

(€ 96,000,000 per year).


Involved Companies

LISIT56% Lombardia Informatica44% Partner (Telecom,

Finsiel, Lutech)

LISIT56% Lombardia Informatica44% Partner (Telecom,

Finsiel, Lutech)

Partners: Telecom ItaliaFinsielLutech

Partners: Telecom ItaliaFinsielLutech

ContractorPayment of the service

7 year supply value: ~ 350 million Euro

Lombardia Call100% Lombardia Informatica

Lombardia Call100% Lombardia Informatica

Call Center for the citizens

Supply and consulting

Contract HolderProject Management

Realization of the project

100% RegioneLombardia

8.61 Euro per year / Activated Card

7 year supply value: ~ 5 million Euro

8.09 Euro per year / Activated Card

Note: Values not including VAT


Commentsand

lessons learnt


CRS-SISS achievementsCost saving for public Healthcare system

The CRS-SISS creates an infrastructure which can save 40 million € per year

Type of saving Reports or prescriptions

Saving(person-year)

Saving(K€)

Provider and connection costs - 6.500Report management 48.000.000 880 70.000Report printing and distribution (inpatients) 12.000.000 50 7.200Administrative simplification 1.760 61.000Management of pharmacies reimbursement

62.000.000 8.500

TOTAL 140.200

2006 data


CRS-SISS achievementsTime saving for the citizens

Healthcare services supplied through ICT allow reduction of time spent by citizens to get them

Part of process Events Unit saving Total Saving (K hours)

Booking (including travel) 23.000.000 60 23.000

Reception 30.000.000 1

10

30

500

Payment 18.000.000 3.000

Report issuing (including travel) 28.000.000 14.000

TOTAL 40.500

Average saving per citizen: 7,4 hours per yearAbout 5,5 million Lombardy citizens use healthcare services


Future developments

Jan Walker and oth.: “The Value Of Health Care Information Exchange And Interoperability”Health Affairs, January, 19 2005

**

CRS-SISS as HealthCare ToolThe CRS-SISS system can support the

healthcare processes and must be used toHelp physician into HealthCare processes; Help to share diagnostic and therapeutic guidelines for making clinical protocols;Help to control and to monitor the protocols usage;

The savings from the right knowledge of the clinical history of the patient are estimated to be about 5% of

yearly HealthCare Expenditure *(about 725 million euros per year for Lombardy ).


Lessons learnt

The cost of developing the entire informatics system is a small part of the total investments: we spent for that about 70 mil €;The main economical effort is to upgrade the Hospital Information System: we have already spent for that 250 million €; The security infrastructure cost is smaller then the “Privacy” respect: we spend 200.000 € for security and 20 million € per year for “Privacy”;The training cost is less that we could wait;At present, the health At present, the health professionals accept Regional Healthcare Information System and they are using it more and more.


www.crs.lombardia.it

[email protected] you

Direzione Generale SanitàRegione Lombardia

via Pola 9 – 20124 Milano - ITALY

LOMBARY CRS-SISS Project: ICT for Innovation of Healthcare System.

Health & Medicine

public healthcare

healthcare services

lombardy healthcare

healthcare professionals

national health system

health system management

healthcare operators

healthcare employees