EHEALTH TROMSO'NORWAY,

1
I.D.I.T. PROJECTIMAGING DIAGNOSTIC
INFORMATIZATION OF TUSCANY
Tuscany Region General Directorate Health and
Welfare Policies
2
REGIONAL HEALTH SYSTEM AIMS
To improve management and planning functions at
intra and inter hospital level on local health
unit and regional scale referring to "Area Vasta"
Districts
through
Development and implementation of the system
3
CENTRALITY OF DIAGNOSTIC IMAGING AREA
4
TRANSITION FROM ANALOGICAL TO DIGITAL
ENVIRONMENT
5
IDIT PROJECT IN TUSCANY REGION
Implementation of commonly accepted clinical
management systems in the Healthcare Structures
existing in the three "Area Vasta" Districts
Imaging Diagnostic Informatization Project in
Tuscany (IDIT) as established in the decree n.
2074 of April, 4 2003
Financial contributions for RIS PACS in the
"Area Vasta" Districts
6
REDEFINING THE IMAGING DIAGNOSTIC AREA

• STRATEGY
• Homogeneous management strategy in dealing with
  Radiological data (report and image) in the "Area
  Vasta" Districts
• Development of user friendly systems to access to
  the Radiological data /report and image) from
  external users (GPs, Pediatrics etc.)

• GENERAL OBJECTIVES
• Planning of a management system to transfer and
  archive data (report and image) - RIS-PACS
• Definition of a model, that is able to manage the
  specific data from clinical specialties

7
THE THREE "Area Vasta" Districts OF TUSCANY
Central "Area Vasta" District Population
1.504.711 Radiological procedures 1.334.830
ASL 1
ASL 2
ASL 4
ASL 12
ASL 3
ASL 10
AOU Careggi
North-western "Area Vasta" District Population
1.235.062 Radiological procedures 1.225.794
AO Meyer
ASL 11
ASL 5
AOU Pisana
ASL 8
ASL 6
ASL 7 AOU Senese
TUSCANY REGION Population 3.525.877 Radiological
procedures 3.418.088
ASL 9
South-eastern "Area Vasta" District Population
786.104 Radiological procedures 857.464
8
CENTRAL "Area Vasta" District
ASL 10 Florence Catchment area 795.490
inhabitants 2 University Hospitals / 6 Hospitals
/ 7 Healthcare Centres 788.855 radiological
procedures per year
ASL 4 Prato Catchment area 226.202
inhabitants 1 Hospital / 3 Healthcare
Centres 150.000 radiological procedures per year
ASL 3 Pistoia Catchment area 267.858
inhabitants 3 Hospitals / 4 Healthcare
Centres 193.858 radiological procedures per year
ASL 11 Empoli Catchment area 215.161
inhabitants 5 Hospitals / 2 Healthcare
Centres 182.228 radiological procedures per year
9
NORTH-WESTERN "Area Vasta" District
ASL 1 Massa Carrara Catchment area 205.000
inhabitants 2 Hospitals / 3 District
Hospitals 201.999 radiological procedures per year
ASL 12 Viareggio Catchment area 165.455
inhabitants 1 Hospital / 1 Health centre 86.923
radiological procedures per year
ASL 5 Pisa Catchment area 326.000 inhabitants 2
University Hospital, 2 District Hospitals
406.000 radiological procedures per year
ASL 6 Livorno Catchment area 317.000
inhabitants 1 Hospital, 3 District hospitals, 3
health centres 311.139 radiological procedures
per year
ASL 2 Lucca Catchment area 221.607
inhabitants 1 Hospitals / 2 District Hospitals /
2 health centres 219.679 radiological procedures
per year
10
SOUTH-EASTERN "Area Vasta" District
ASL 8 di Arezzo Catchment area 314.369
inhabitants 1 Hospital / 5 District
Hospitals 332.928 radiological procedures per year
ASL 7 di Siena Catchment area 255.420
inhabitants 1 university Hospital, 3 District
Hospitals 2 Health centres 309.763 radiological
procedures per year
ASL 9 Grosseto Catchment area 216.315
inhabitants 1 Hospital / 4 District Hospitals / 2
Health centres 214.773 radiological procedures
per year
11
PROJECT OBJECTIVES
LOGICAL UNIFICATION of the Imaging Diagnostic
Domain in the Hospitals and Local Health
Companies (LHC) of the three "Area Vasta"
Districts, in order to achieve better
integration
12
METODOLOGIC STEPS
13
STEPS TO CARRY OUT THE PROCESS
To guarantee proper imaging quality for an
appropriate diagnosis

• Data Security
• work session identification
• security and privacy policies

Availability of digital images
Integration of existing resources analogical /
no DICOM technology
Conformity to standards (DICOM, IHE, HL7)
14
SYSTEM INTEGRATION MODEL - AREA VASTA DISTRICT
LEVEL -
15
MANAGEMENT MODEL
GPs/pediatrics
Radiological Dossier
Radiological Dossier first step toward a EPR
16
EXPECTED RESULTS OF HEALTHCARE STRUCTURE
BOOKING
CHECK-IN
EXECUTION
data
DELIVERY
work list
images reports
images

ARCHIVE
images reports
ARCHIVING
REPORTING
DISTRIBUTION
17
RE-ENGENERING THE PROCESS WORKFLOW
RIS - PACS
18
Radiological Dossier
SISTEMS INTEGRATION
1. Health information management systems
2. Digital modality
3. Computed Radiography
4. Picture Archive Communication System
5. LAN and WAN
19
INTEGRATION AMONG INFORMATION SYSTEMS
INTEGRATION
RIS
HIS
PACS
CUP
Importance TO USE a common NOMENCLATURE ERDDS
PROJECT
20

Local Radiological Dossier
STRUCTURE
21
ARCHITECTURE OF THE REGIONAL RADIOLOGICAL DOSSIER
AT REGIONAL LEVEL IN TUSCANY
ASL 1 Massa Carrara ASL 2 Lucca ASL 5 Pisa ASL
6 Livorno ASL 12 Viareggio Un. Hosp. Pisa
ASL 10 Florence ASL 4 Prato ASL 3 Pistoia ASL
11 Empoli Un. Hosp. Careggi Un. Hosp. Mayer
NW AV District
C AV District
ASL 8 Grosseto ASL 9 Grosseto ASL 7
Siena Un.Hosp. Siena
SE AV District



REGIONAL REGISTRY OFFICE
MASTER PATIENT INDEX
Structure Healthcare Provider Patient
ID Accession Number Study ID
TUSCANY REGION PROJECT
22
BENEFITS FOR THE LOCAL HEALTH SYSTEM

availability of data, medical reports and images
requested, improving the diagnostic process
quality
23
BENEFITS FOR HOSPITALS AND HEALTH CENTRES
24
BENEFITS FOR CITIZENS
25
IDIT PROJECT
NORTH WESTERN "Area Vasta" District
CENTRAL "Area Vasta" District
RADIOLOGICAL DOSSIER C AVD
RADIOLOGICAL DOSSIER NW AVD
RADIOLOGICAL DOSSIER SE AVD
REGIONAL RADIOLOGICAL DOSSIER
SOUTH EASTERN "Area Vasta" District
26
WORKING PROGRES AT MAY 2005
NORTH WESTERN Area Vasta District
CENTRAL Area Vasta District

• Project planning
• at the end of tender procedures
• 1 local RIS-PACS already implemented (Empoli)

• Project planning
• Starting the tender procedures
• 2 local RIS-PACS already implemented (Livorno,
  Viareggio)

• Project planning
• in the middle of tender procedures

SOUTH EASTERN Area Vasta District
27
INVESTIMENT COSTS ANALISYS
28
INVESTMENT COSTS
29
RETOURN OF INVESTEMENT ANALYSIS
30
LAN AND WAN STRUCTURE
31
TUSCANY TELEMATIC NETWORK
ASL 10
Un. Hosp. Careggi
Link ASL/PHC 8-10Mbps
Un. Hosp. Meyer
ASL 3
INTERNET
TUSCANY REGION VIA DI NOVOLI
TIX
backup ISDN
METROPOLITAN LAN
Switched users
ASL 11
RTRT FLORENCE AREA
Wireless users
FLORENCE
BACKBONE ATM 155Mbps
ASL 8
ASL 1
PISA
SIENA
ASL 2
RTRT PISA AREA
RTRT SIENA AREA
ASL 5
Un. Hosp. Siena
ASL 6
ASL 12
ASL 7
Sites RTRT leased-line ADSL, HDSL, CDN, Frame
Relay, ATM
ASL 9
Un. Hosp. Pisa
32
TUSCANY INTERNET EXCHANGE TIX (N)
TIX is the gateway to the Public Administration
Network
33
NAL CA-Architecture of the USL and Municipality
NAL
Up-load Down-load
File System
case
Applying Logic of NAL
Data Base
watching
Start-up locic
Data start-up
Java
shaping
Closed function
checking Of NAL
approving
Approving logic
Rule and results
Java
results
File System
Request management, watching and shaping NAL
signature
Signature logic
Web Server - JSP
E.signature
Requests and results
Java
results
Signature station
SSL
DB Inv.Civ.
publishing
case
Java
signing
Broker PS
Smart card reader
SSL
HTTPS
Client PS
Certificate
Browser
SSL
Server LDAP
SSL-SOAP
SOAP Server - JAX-RPC
Opened function
Certificate
DB XXXX
34
NAL CA-Architecture of Municipality
(putted down in Region)
NAL of Municipality
Up-load Down-load
File System
Applying Logic of NAL

case
Data Base
Start-up logic
watching
Data check-in
Java
shaping
Closed fuction
checking Of NAL
approving
Approving logic
Roles and results
Java
results
File System
Request management, watching and shaping NAL
signature
Signature logic
Web Server - JSP
E.signature
Request and results
Java
results
Signature station
SSL
DB Inv.Civ.
publishing
casei
Java
signingi
Broker PS
Smart card reader
SSL
HTTPS
Client PS
Certificate
Browser
SSL
Server LDAP
SSL-SOAP
SOAP Server - JAX-RPC
Open fuction
Certificate
DB XXXX
35
NAR CA-Architecture
NAR
Applying Logic of NAR
Servizio Notifica Mail

Browser
Server SMTP
Server POP3
Certificate
HTTPS
Notific logic
Java
SSL
Request management, watching and shaping NAL
Web Server - JSP
watching
NAR control
shaping
Servizio PS
Client PS
Broker PS
Logica PS
Java
SSL
Smart card reader
Server LDAP
SSL
JAX-RPC SOAP Server
SSL
Opened fuction XXXXXX
DB XXX.
Certificate
36
Signature Station CA-Architeture
Signature station
local user interface
Local management requests
reader and signature management
Remote requests management
creating request
signed documents acquisition
checking
GET request
PKCS11
Java
request documents to read and to sign signed
documents
request acquisition
Interface per remote users
CRL
CA
GETdoc
Gest- CRL
HTTPS
documents to sign
Java
signed document
TS
Java
PUT Signed documents