ITALIAN VISION FOR SMART HEALTHCARE National Agenda for e ... · National Agenda for e-Health The...
Transcript of ITALIAN VISION FOR SMART HEALTHCARE National Agenda for e ... · National Agenda for e-Health The...
Eng. Chiara Basile
AgID
Digital Transformation Area
HIMSS ITALIAN COMMUNITY SESSION
2018 May 29
“National Agenda for e-Health”
ITALIAN VISION FOR SMART HEALTHCARE
National Agenda for e-Health
The Strategy for digital growth and the Three-year Plan for Information Technology in Public
Administration have defined the interventions dedicated to the digital healthcare ecosystem and the main
solutions aimed at improving healthcare services, limiting waste and inefficiencies, improving the cost-quality ratio
of healthcare services and reducing the differences among regions.
The ICT Strategic ModelThe Strategic Model can be schematically represented by the graphic:
•The Tools for the generation and
diffusion of digital services define
common rules for the design of interfaces,
services and content,
•The Ecosystems are the policy sectors
or areas where public administration takes
action
•The Interoperability model defines the
mechanisms that facilitate and ensure
correct interaction between the players in
the system
•The Physical infrastructures aim to
increase security, reduce the cost of
technological infrastructure through
rationalisation of Data centers, the
systematic adoption of the cloud pardigm
and the development of connectivity,
e-Health Ecosystem in the ICT strategyThe Healthcare ecosystem has been defined in accordance with the “Health Protection Mission” and the Strategy
Paper for Digital Growth 2014-2020, which identifies the “Digital Healthcare” action.
e-Health Ecosystem in the ICT strategy
•Electronic Health Record (EHR), as an
example of an enabling infrastructure;
•Single Booking center (Centro unico di
prenotazione - CUP), as an example of
simplification of the interaction between
the Public Administration and the citizen;
•Telemedicine, as an example of
connection with the territory.
EHR
Single Booking Center
Telemedicine
The Three-Year Plan for ICT in the Public Administration highlights three projects in this field:
e-Health Ecosystem in the ICT strategy
Electronic Health Record
*Art. 12 c. 1 Law n. 221/2012
Hospitalization
Outpatientcare
Pharmaceutical healthcare
Residentialcare
Homecare
Emergency
…
Patient
Health
Professional
EHR
Electronic health record (EHR) is a set of digital data and documents relating to health and
social health related to the patient and generated from present and past clinical events. (*)
The main legal requirements for Electronic Health Record
AgID is responsible for
design the national
infrastructure for
interoperability
D.P.C.M. 29 September 2015, n. 178
Regolamento in materia di FSE
Guide lines
Technical specification for
interoperability
Decree of the President
of the Council of
Ministers November 11
no.178/2015 define
purposes and technical
specification needed to
implement EHR regional
platforms
March 2014
September 2017
Legislative Decree October 18 2012,
no. 179 and subsequent
amendments: set up of the national
EHR implemented by regions and
define set of data and documents
Electronic Health Record
The EHR is made, with the consent of the patient, by the Regions and Autonomous Provinces for
purposes of prevention, diagnosis, treatment and rehabilitation.
Consultation of data and documents in the Electronic Health Record, for the purposes of care, can
be achieved only with the consent of the patient, except in cases of medical emergency in a manner
determined by regulation. The lack of consent does not affect the rights of health service delivery.
Law no. 179/2012 and subsequent amendments
Electronic Health Record
Law no. no. 179/2012 and subsequent amendments
CARE
Prevention,diagnosis, treatment and rehabilitation.
These aims are pursued by the entities of theNational Health Service and of the
regional social-health services, that take care of
the patient.
RESEARCH
Study and research in themedical, biomedical andepidemiological sectors.
These aims are pursued by the regions and autonomous provinces, the Ministry of Health and the Ministry of
Labour and Social Policy, within their respectiveresponsibilities
assigned by law.
GOVERNANCE
Health planning, verification of the quality of care and
evaluation of health care.These aims are pursued by the
regions and autonomous provinces, the Ministry ofHealth and the Ministry of Labour and
Social Policy, within their respective responsibilities
assigned by law.
The EHR’s purposes are:
Electronic Health Record - Regulation Contents
Law n. 178/2015 has defined in a systematicway
The documents that are part of the EHR, with a
minimum dataset and the other documents
The content of the "patient summary" and the
content of the lab report (the first documents to
be activated, with technical details defined as well
in the decree)
The provisions for the protection of the
privacy of the patients (information, consent,
security measures)
Electronic Health Record - Regulation Contents
Minimum Dataset
a)identificative and
administrative data of the
patient;
b)medical reports;
c) emergency reports;
d)discharge letters;
e)patient summary;
f) pharmaceutical dossier;g)choice regarding the
donation of organs and
tissues.
a) prescriptions;
b) reservations;
c) medical records;
d) health checks;
e) home care;
f) diagnosis and treatment plans;
g) semi-residential care;
h) dispensing medications;
i) vaccinations;
l) outpatient care;
m) emergency care;
n) hospital care;
or) medical certificates;
p) patient's personal notebook
Other Documents
q)continuity of care
r) autocertification;
s) participating in clinical trials;
t) exemptions;
u)prosthetic assistance;v)data to support the activitiesof
telemonitoring;
z) data to support the activitiesof
the integrated management of
diagnostic and therapeutic;
aa) other relevant documents
National Infrastructure for Interoperability (INI)
In order to accelerate the IMPLEMENTATION OF THE INTEROPERABILITY SERVICES among the
Regional EHRs, and to speed-up deployment of EHR for Regions behind schedule, the law n.232/2016
modified the provisions regarding the National infrastructure for interoperability.
This infrastructure will provide also a complete EHR solution, to be used by those Regions where the local
implementation is late or too slow, hence enabling a timely roll-out of the EHR.
The INI has been designed by Digital Italy
Agency (AgID), in cooperation with Ministry
of Health and the Ministry of Economy and
Finance, and will be implemented and
managed by the Ministry of Economy and
Finance, within the framework of Italian health
insurance card
Interoperability model
Technical Standard
• Standard ISO/HL7 EHR-S FM R2 (Electronic Health Record System Functional Model Release 2)
• IHE (Integrating Health Enterprise)
Semantic Standard
• ICD 9-CM (International Classification of Diseases 9th revision Clinical Modification)
• LOINC® (Logical Observation Identifiers Names and Codes)
• HL7 CDA Rel. 2
EHR Regulation and state of the art of theimplementation
The Implementation of Italian Electronic Health Record
Active Regions
Active
Electronic
Health Record
digital clinical
report
Region % CDA2
P.A Trento 100%
Veneto 100%
Friuli Venezia Giulia
100%
Liguria 40%
Emilia Romagna 100%
Toscana 70%
Lazio 100%
Molise 100%
Puglia 50%
Sicilia 90%
Sardegna 85%
Digital Clinical Report : lab report
Financed by the Connecting Europe Facility (CEF), the NCPeH is aimed to prepare, test and
deploy the cross-border Patient Summary(PS) and the ePrescription(eP) taking into account the
already existing national infrastructure.
From EHR to NCPeH(National Contact Point for eHealth)
Cross border HealthcareDirective 2011/24/EU on patients’ rights in cross-border healthcare
• Creates a network of National Contact
• Creates EU rules on a minimum list of elements to be
included in a medical prescription taken from one EU
country to another (cross-border prescription)
• Encourages further development of European
Reference Networks of medical expertise,
broadening cooperation between EU countries, with
added benefits to health technology assessments
and e-health.
Cross border HealthcareDirective 2011/24/EU on patients’ rights in cross-border healthcare
Use Cases:
• Patient Summary, provides access forhealth professionals to verified keyhealth data of a patient during anunplanned care encounter while abroad
• ePrescription, enables patients toreceive equivalent medicationtreatment while abroad to what theywould receive in their home country
The interoperability challenge
The consortium involved in NCPeH implementation is composed of the Italian Ministry of
Health, Digital Italy Agency (AgID), Emilia Romagna, Lombardia and Veneto.
Italian National Contact Point for eHealth (NCPeH)
Benefits from the implementation of EHRThe implementation of the Electronic Health Record:
Significantly increases the level of appropriatenessof the responses to the health needs of the citizenand therefore also to pursue the sustainability ofthe health service
Provides assistance according to structured clinicalcare pathways that can be adapted in a flexibleand customized way to the health needs of thecitizen
Improves the quality of life of citizens, especiallywith regard to the elderly and people suffering fromvarious types of fragility and / or disability
Il Paese che cambia passa da qui.
agid.gov.it
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