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Transcript of M. Rizzato / Arsenàl.IT / Veneto Region – Trieste, June 10, 2009 Copyright © 2009 Arsenàl.IT...
1 M. Rizzato / Arsenàl.IT / Veneto Region – Trieste, June 10, 2009
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Arsenàl.ITVeneto’s Research Centre for Innovation in e-Health
AER EHe@lth Network
Trieste
June10th, 2009
Mauro Rizzato
Chief Administrative Officer Arsenàl.IT
2 M. Rizzato / Arsenàl.IT / Veneto Region – Trieste, June 10, 2009
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Contents
Veneto Region’s approach to cross-border patients
HEALTH OPTIMUM
NETC@RDS
N2N
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Contents
Veneto Region’s approach to cross-border patients
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Background
EU's internal market rules are designed to facilitate the free movement of people. One of the consequences of the free circulation of individuals is the increased mobility of patients seeking healthcare in countries other than their own for a variety of reasons.
Patient mobility is a common phenomenon particularly in border regions and is only one of the four possible types of cross-border healthcare, all of which are relevant.
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n. Typology of Cross-border patient1 citizens who, while on holiday, need to use healthcare services in the country they are visiting. Use of
European Economic Area (EEA) to facilitate the process, based on the E111 form, conferring the right to treatment during a temporary visit.
2 citizens who retire to a different country/region and wish to use the healthcare system of the country where they are currently living
3 people sharing close cultural or linguistic links with the region where care is provided. In regions where a natural community is divided by a national frontier, people look for treatment close to home – which happens to be on the other side of the border.
This is often the case where a town that has developed over centuries is divided by a river that forms a country border. When access to cross-border care is relaxed, for instance within the framework of cooperative agreements, these patients are likely to be the first ones to take advantage of the new possibilities.
4 patients who cross a border to receive healthcare or to buy health goods. This is often because of perceived advantages related to quality, accessibility or price, specifically out-of-pocket payments borne by patients. Examples include patients going abroad to avoid long waiting lists in their home country and patients seeking treatments that are cheaper, typically moving from old to new Member States.
5 patients who are sent abroad by their own health system to overcome capacity restrictions at home. It concerns mainly smaller countries or regions with a low population density where the domestic health system cannot reasonably provide a comprehensive range of health care services for its population. Healthcare provided in this category is, in general, actively managed by public authorities, seeking to ensure continuity of care, coverage of extra expenses and appropriate selection of providers abroad. Some patients cross borders within the framework of cooperative agreements in order to share facilities, especially in relation to capital-intensive or highly-specialised services.
Analysis
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Region area
Cross-bording can be between:
EU Member states (Usually)
International
EU regions
Local area organizations (i.e. provinces) with authonomous administrative core
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Veneto Region’s
approach Tools
Organisational Interoperability
Clinical Interoperability
Open administrative systems
IT standards
E-HEALTH
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Veneto Region’s
approach Steps Validation of e-Health services
Deployment of services
Technical network creation
Clinicians consensus building in cross-border patient management
Privacy management
Administration management
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e-Health Project
Initiatives
E-Government services
TERREGOV
Paperless handling of health documents
TeleMed-ESCAPE
Web-based booking of health services
IESS
e-Learning for health
Growing-Together
Satellite-basedSecond Opinion services
Near-To-Needs
Interoperability of health smart cards
NETC@ARDS
Neurosurgical Tele-counselling
HEALTH OPTIMUM
Patient Summary& e-Prescription
Open e-Health Initiative
…
…
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Contents
HEALTH OPTIMUM
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11
Health OptimumInitial Deployment
RR. Giampieretti / Arsenàl.IT / Veneto Region – Vienna, April 11, 2008Copyright © 2008 Arsenàl.IT – Tutti i diritti
riservati
HEALTHcare delivery OPTIMisation throUgh teleMedicine
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The HO model: clinical areas
Neurosurgery
Neuroradiology
Oral Anticoagulation Therapy
Neurology
Dermatology
Radiology
Oftalmology
Oncology
Haematology
Diabetology
Cardiology
Endocrinology
Trombolysis
Dialisys
Coronary Arteriography
Hortopaedics
Alcool rehabilitation
Homecare
Oral and maxillo-facial surgery
General Surgery
Plastic surgery
21 clinical areas where services were successfull tested
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HEALTH OPTIMUM in VENETO
•Neurosurgical tele-counselling
•Telelaboratory
•STROKE Management
•TAO Management
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Neurosurgical tele-counselling
79% of un-useful travel avoided
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I ntensive Care; 14; 26%
EU; 22; 41%
Medicine; 1; 2%
Radiology; 4; 7%
Neurology; 13; 24%
Neurosurgical Tele-counselling
roll-out
36 peripheral hospitals without neurosurgery/neuroradiology units are going to be linked to 7 neurosurgical centres
Emergency 22
Intensive Care 14
Neurology 13
Radiology 4
Medicine 1
tot. 54
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Telelaboratory
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Tele-laboratory roll-out
Units61
Elderly Homes
10
Local Districts
7
GP 2
tot. 80
80 peripheral sites are going to be linked to hospital LIS systems
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The technical and organisational model has been defined;
the technical infrastructure is almost the same used for neurosurgical telecounselling, more speed has to be guaranteed
the group of the involved neurologists defined the clinical form; a working group is already defining a shared clinical protocol.
STROKE management
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The technical and organisational responsibles have been designated;
the architecture proposed has been accepted and shared with Directions;
the budget has been defined, written communication has been sent and the funds have been allocated;
the technical architecture is going to be more precisely detailed; the integration among systems according to standard HL7 messages is being studied
OAT Management
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XDS framework in Veneto
Provincia Belluno
Provincia Vicenza
Provincia Treviso
Provincia Venezia
Provincia RovigoProvincia Verona
Provincia Padova
Governance system
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
Sistemi Aziendali
Sistema di Teleconsulto
Indice Provinciale
Gateway
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N2N assett
Application to
neurochirurgical telecounsuelling
Tele-oncology
Shared clinical FORM
semantic interoperability between Italy and Romania
Timisoara Connection
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HO: European volumes
5.000 telecounselling
38.000 laboratory tests
800 tele-referrals
52.000 radiological images
2.000 videoconferences
More than 4.000.000 exchanged clinical data
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HO: interoperability aspects
• Technical architectures developed according to international standards• Sharing of clinical and organizational paths
The path developed during the HEALTH OPTIMUM project had often been recognized and adopted on a larger scale.
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Conclusion
The HEALTH OPTIMUM model showed its validity, linking specialists and health operators in different clinical areas e and different geographical, health and legal contexts.
This innovative model may be easily replied also in other countries and contexts, not only in the healthcare field.
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Contents
NETC@RDS
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Netc@rds – Smart Card and Network Solutions for the Electronification of the European Health Insurance Card
Slides from: Central Research Institute of Ambulatory Health Care in Germany (ZI), Herbert-Lewin-Platz 2, 10623 Berlin; email:
[email protected]; Tel.: +49-30-4005-2418
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Pan-European initiatives to foster mobility & skills inside the E.U with common rules for social protection
Since June 2004: common EU Health Insurance Card (EHIC) – ensures access to health care when abroad inside the EU & the EEA
Announced decision on long-term course – 2008+ to introduce will progressively replace the eye-readable EHIC
But in 27 Member States + other EFTA countries – different health systems and care entitlement, different levels of IT infrastructure -
NETC@RDS challenge: to demonstrate potential of same service for all EU/EFTA citizens based on different but interoperable national/regional IT infrastructures
Context & Challenges
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Project at a Glance
Consortium of 28 partners from 16 EU/EFTA countries : Austria, Bulgaria, Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Liechtenstein, Norway, Poland, Romania, Slovak Republic, Slovenia
Partners: statutory health insurance institutions, technical or economical organisations, hospitals, health practitioners associations.
Budget: 20 M€ co-funded by the EC DG INFSO e-TEN Programme (30% of eligible costs)
Time table: Phase A1 Market Analysis & Technical Requirements (2002 –
2003) Phase A2-A3 Validation of the Service (2004 – 2006) Phase B Initial Deployment (2007 – 2009) Phase C Full Deployment of the Service (2010+)
Common objective for phases A, B & C: A stepwise approach on the way towards introduction of the e-
EHIC
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Proposed definition
An electronic European Health Insurance Card (e-EHIC) is a digital process with the result of a trustworthy data set for entitlement at
the healthcare provider
It can be used for associated inter-state back office e-billing reconciliations as well
Thus, the introduction of a new specific health insurance smart card is not necessary whilst the e-EHIC trustworthy dataset can be obtained either by
scanning the eye-readable EHIC or by reading national/regional health smart cards then by checking data on-line
Basic Concepts
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Objectives of Netc@rds
• Online verification of insurance data to prevent fraud and misuse
• Fostering mobility of European citizens
• Simplification of procedures for involved institutions:
- Health insurance providers
- Healthcare providers
- Interstate clearance bodies
• Integration of electronic data sets for EHIC into national cards
• Contribution to interoperability of eHealth in Europe
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Work items of Netc@rds
1. Status survey and analysis on EHIC handling
2. Technical proposal based on the NETC@RDS-cases
• Proposal for electronic data storage on chip cards
• Suggestions on interoperable infrastructure components
• Demonstrator setup of a verification network
• Automated optical data capture of conventional EHIC
• Post-processing interface of EHIC data (XML Output file)
3. Strategic proposal for eEHIC introduction
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Case 4: datasetcaptured from eye-readable medium
(EHIC, paper)
Home CountryMember-State
Member State ofTemporary Stay
Case 2: dataset captured from chip card & server
Case 3: datasetcaptured from server
Case 1: dataset captured from chip
cardhealth
insurancedata server
Netc@rdsdataset
Netc@rdsdataset
Netc@rdsdataset
Netc@rdsdataset
Netc@rds-Cases1-4
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National portal
EHIC database
Smart card database
Smart card & EHICdatabase
NETC@RDS pan-european infrastructure
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Slovenia
Austria
Germany
France
Italian Regions
Eye-readable EHIC
Cards Accepted by NETC@RDS
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Summary
Online verification of entitlements rights
Replacement of paper forms
Contribution to interoperability
Interoperable dataset to foster electronic post-processing
Cost-effective extension to new card schemes
Simplified access to foreign healthcare systems
Fostering mobility of European citizens
Fastening Administrative reimbursement for patient mobility
German-Italy (i.e. tourism flow): timing for reimbursemen
4years <6month
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Contents
N2N
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CONTEXT
Protocol intent between Veneto Region and Timis Region
Twinning between Treviso and Timisoara Municipalities
Considerable presence of Italian enterprises in Timis Region
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ACTORS INVOLVED
European Space Agency
Treviso ULSS9 healthcare authority – Veneto Region
Timisoara Spitalul Clinic Judetean de Urgenta
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OBJECTIVES
Analyse the potential of a satellite platform in healthcare
Promote the integration and sustainability of ICT in daily healthcare provision and medical/nursing training.
Provide specialist healthcare thanks to the help of qualified personnel who are connected remotely;Act as a star centre for network connections with local Romanian Centres of Excellence;
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PROJECT ARCHITECTURE
Satellite connection between Treviso and Timisoara hospitals to provide the following services:
♦ telecounselling
♦ telelaboratory
♦ e-learning
♦ epidemiology
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Project architecture
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E-LEARNING
In order to enhance cooperation between the two hospitals:
♦ videoconference sessions between specialists to discuss clinical cases or to share experiences
♦ e-learning sessions for nurses
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EPIDEMIOLOGY
Service to collect data on hospital acquired infections
Data analysis and comparison for statistical studies at international level
Study of an early warning alert system via satellite, for epidemiological emergencies
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ADVANTAGES
Realization of an electronic registry, ELETTRONIC HEALTH RECORD, cointaing the clinical history of the patient, which can be easily consulted by the authorized physicians, both from Timisoara and from Treviso
Epidemiological studies for the prevention and the treatment of the infectious diseases
Easy deployment of the model overcome of geographical barriers
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RESULTS
• Telecounselling requests performed
• Videoconferences between the cardiology staffs
• E-learning course for nurses
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OVERALL EVALUATION OF THE SERVICE
0%
6%
54%
40% insufficient
poor
good
very good
RESULTS
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Conclusions
Existing experiences shows that technical interoperability is possible
Administrative, clinical and cultural must be achieved
Interregional policy must be defined
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Thank you for your attention.
Mauro RizzatoChief Administrative Officer Arsenàl.IT