ITALY towards eHealth

1
ITALYtowards e-Health ?
CEN / TC251 Strategic Meeting Bruxelles,
2000-12-11

• A. Pastorino 1, A. Rossi Mori 2
• 1 Head of Italian Delegation
• 2 National Research Council

2
the Italian Health System

• all inhabitants covered by public Health System
• with complementary private insurances
• Health is a Regional responsibility
• with a decreasing role of the State
• provision of healthcare through
• Aziende Sanitarie (Local Trusts, Hospitals)
• with a predefined budget
• Regional price lists for specialist acts
• DRGs for hospital reimboursement

3
lack of culture and infrastructure

• Italy is not the Land of Standardsculture of
  do-it-yourself, creative solutions,fear of
  uniformity / standardisation
• uniform solutions usually imposed by lawand
  authoritative regulations
• most medical opinion leaders not familiar with
  information processing and telematics
• low attention to ICT in medical universities
• delays in telecom and networks infrastructure

4
lack of policy on health telematics

• National/Regional Health Information
  Systemsbiased towards central control and
  budget,no interest in (clinical) routine of
  facilities
• wide Regional autonomy with low
  coordinationamong Regions and with the State
• facing 2 to 5 years of delay in health
  informatics,
• health networks, health informatics standards
• with respect of other developed countries

5
a promising (increasing) reaction

• increasing awareness on Information Societyin
  National and Regional governments, users and
  decision-makers
• Forum on Information Societyby the Presidence
  of Council of Ministers
• AIPA - Authority for Informatics in Public
  Administrations
• internal reform of UNI
• planned reform of Ministry of Health
• (with a new department for innovation ?)

6
Policy on legislation

• electronic signature
• XML as syntax for all Public Administrations
• identity cards (merged with previous health card
  regulations)
• electronic prescriptions lt 2002
• control of a predefined budget for GPs
• reimboursement for telemedicine services
• regional networks
• support body on Health Telematics

7
Policy on research

• interoperability in Information Systems
• virtual ward, continuity of care
• clinical guidelines and workflow management
• electronic health record
• datawarehouses for management and control
• quality of Web resources
• telemonitoring
• mobile phones

8
Policy on education

• University reform
• new programs for medicine students
• web-learning
• for (medical) students
• for continuous education
• special plans for training in informatics
• computers for students and schools

9
Ongoing National initiatives

• health card (NETLINK), now within identity card
• virtual network for Public Administrations
  (National and Regional RUPAs)
• promotion of electronic health records (PROREC)
• implementation of National networks (blood,
  transplants, cancer, Alzheimer)
• National project on chronic diseasesand virtual
  hospitalisation
• Demonstration Project on Continuity of care also
  with mobile devices

10
Further ongoing initiatives

• Regional emergency call centers (DIAL 118)
• local unified booking centers (CUP)
• public and private teleconsultation services
• local datawarehouses
• co-financing by Regions to local trusts (ASLs)
  of improvement plans in health informatics
• Regional virtual health networks
• Regional projects (e.g. home care)
• HISA-based call for tenders

11
Data Base on Organ Transplants

• co-ordination Italy (Sept 2000)
• donations, withdrawals, transplants
• waiting list management
• European network (Council of Europe countries)
• National Transplant Organisations (GR, F, I,
  P,E,UK)
• Eurotransplant, Scandia Transplant
• European Medical Association
• interconnetted databases
• secure access via the Internet

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perceived need for a central body

• coordination among Regional Authorities
• involvement of professional societies and
  citizens organisations
• promotion of standards
• content standards, XML repository
• promotion, support and basic services
• monitoring and comparing initiatives
• handbooks on introduction of ICT

13
current trends - 1

• towards electronic transactions for all clinical
  documents(budget control, more quality,
  continuity of care)
• security and electronic signature
• monitoring electronic prescriptions
• datawarehouses for management and control
• Regional networks
• standards on content (professional societies)
• knowledge resources (e.g. clinical guidelines)

14
current trends - 2

• virtual healthcare facilities
• virtual hospitals and home care
• common booking centers
• emergency call centers (dial 118)
• new technologies (e.g. UMTS)
• attention (e.g. by medical librarians)to the
  issues of quality of web resources
• filtering of illegal selling of drugs ?

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an impression

• Italy is passing from paper and pencil (or
  paper and printer, e.g. prescriptions printed
  by GPs are handled by the patient )
• directly to e-health,
• skipping many gradual steps
• in the introduction of health informatics
• if properly managed,
• it is a good opportunity for an effective change
• based on foreign experiences

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towards a strategy on standards

• the UNI mirror group has not yeta long-term
  National strategy
• the quick evolving Italian scenario suggests a
  fully operative mirror group by end 2001
• UNI vs Authorities subdivision of tasks ? (e.g.
  in financial law 2001, the prescriptions are the
  feeders of budget datawarehouse)
• need for a support/coordination group
• (CEN, HL7, formal representatives of
  Natl/Regional Authorities, professional and
  industrial associations)