The Veneto region of Italy faces challenges of an aging population, rising healthcare costs, and budget constraints. It is addressing these issues through local telemedicine and eHealth initiatives that aim to [1] rationalize the hospital network, [2] reorganize territorial health services, and [3] invest in innovation and ICT. Examples of projects include connecting general practitioners to hospitals, sharing patient records across regions, and remote patient monitoring for disease management. The goals are to improve care quality, reduce costs, and empower healthcare workers through technology.

1. eHealth addressing global
challenges through local actions
When Telemedicine does deliver!
Parallel Session PS 7
Tuesday 16 March, 2010,
14:00 – 15:15

2. Giancarlo Ruscitti MD
Secretary General for Health & Social Services
Veneto Region

3. Background of the experience of the Veneto Region
 Since 2004, the Veneto strategy of economic sustainability and
innovation has meant increasing financial contraints in Human
Resources, and developing policies for the allocation and most
efficient use of health care personnel, empowered by the
appropriate use of e-technologies;
 National budget constraints have forced the Region to reallocate
the health budget in order to guarantee the Essential Levels of
Health Care provision (LEA) to all Veneto Citizens by:
1. rationalizing and renewing the hospital network;
2. re-organizing health services in the territory;
3. investing in innovation, ICT and eProcurement;

4. The Veneto Region: Territory and
Population
Population Structure*
• 4,8 M inhabitants
Members per family 2.6
• 18.391 km2 of land surface Birth rate 9.3
Death rate 9.0
Natural growth rate 0.3
Total growth rate 5.6
% Elderly persons 135.7
% population > 65 years 18.5
% EU population>65 years 14.08
* As of the 2008 General Consensus
4

5. The Veneto Region:
Health Care Providers and Professionals
• 21 Local Health Authorities PUBLIC ACCREDITED
• 2 Hospital Trusts INSTITUTIONS 64
IRCSS (SPECIALIST RESEARCH
1
INSTITUTES)
Public health authority (Az. Osp.) 2
Hospital in the Provincial capital 6
Network hospital / strong integration 33
Integrating hospital of the network 8
Polyfunctional health centres 10
Management experimentation 4
PRIVATE ACCREDITED INSTITUTES 14
Care homes/ hospital 19
Classified hospital 4
• 41.806 Medical & Nursing staff IRCSS (SPECIALIST RESEARCH
1
• 11.702 Laboratory Technician INSTITUTES)
• 6.704 Administrative staff
• 117 Other Professionals
5 (* Veneto Regional Statistics Office data, 2008)

6. New challenges for Veneto Health Care
 Increase in EU citizens expectations;
 Ageing population
 Home-care in rural and mountain areas;
 Rising costs due to technological innovation;
 Reduction of public health care expenditure;
 Patient mobility: Tourists, Immigrants and Long term
residents;
 Lack of health professionals (mainly pediatricians and
nurses);
 Restrictions imposed in public funding by commitments
towards maintaining EU stability treaties.

7. e-Health Priorities
From a technical perspective:
1. Enable the interoperability of Telemedicine services at the regional
level.
2. Build up standardized EHR systems at local level with a view to
establishing a single digital Patient Health Folder system at the regional
level.
3. Develop eHealth-based Disease Management models for the treatment
of outpatients.
4. Foster the interoperability of the above systems/services at the
National level.
5. Foster the interoperability of the above
systems/services at the European level

8. Telemedicine eHealth Projects:
Observatory
Source: “Observatory Number of Telemedicine projects
and projects on
Telemedicine
applications
2009”,
Vol. 1/2009,
Arsenàl.IT
N. progetti number of active Telemedicine projects
Cumulative
18
17
16
14
13
12
11
10
8
7
6
4
3
2 2
1 1 1
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
8

9. e-Health Project Initiatives
HEALTH OPTIMUM Open e-Health Initiative RENEWING HEALTH
Neurosurgical Tele- Patient Summary Personal Health System
counselling & e-Prescription and Telemonitoring
Growing-Together Near-To-Needs NETC@ARDS
Satellite-based Interoperability of health
e-Learning for health
Second Opinion services smart cards
TERREGOV TeleMed-ESCAPE IESS
Paperless handling of Web-based booking of
E-Government services
health documents health services
63 European Projects – Themes: eHealth, Research,
Social Services and ICT
Overall budget: €50M

10. Telemedicine eHealth Projects:
ESCAPE
Citizens
Citizens’ Clinical Document Sharing
Certification Home
PC
Digital
Storage
Signature
Mail
Diagnostic Services Service
producing Clinical
Reports
Forwarding
GPs
Extraction Territorial
Service
Hospital wards &
Providers
Internal Services
Example in a Local Health Authority in
Veneto
10

11. Telemedicine eHealth Projects:
HEALTH OPTIMUM
XDS Registry
Provincial area of
Provincial area of
Vicenza
Belluno
XDS
Repository
Provincial
Provincial
area of
area of
Padova
Treviso
Provincial
area of
Venezia
Provincial area of Provincial area of
Verona Rovigo
11

12. RENEWING HeALTH
REgioNs of Europe WorkINg toGether for HeALTH
 Programme: Competitiveness and Innovation Framework Programme CIP runs from
2007-2013
 Funding Scheme: Information and Communication Technologies Policy Support
Programme ICT PSP; Funding Instruments: Pilot Type A
 Principle Actor Involved: Regional Healthcare Authorities
 Content of the 3rd Call of Proposals in 2009
 Theme: ICT for Health, ageing and inclusion
 Objective: ICT for patient-centered health services
 Budget: € 14 M - European Co-financing: € 7 M
 Duration: 32 months
 Starting date: 1st February 2010
Kick Off Meeting: 8th February 2010, Venice

13. RENEWING HEALTH:
The Consortium
EUROPEAN ASSOCIATIONS COUNTRY
European Patients’Forum (EPF) Luxembourg
European Health Telematics Association Belgium
(EHTEL)
COMPETENCE CENTER COUNTRY
FINLAND
Arsenàl.IT Italy SWEDEN
Medcom International Denmark NORWAY
Center for Distance-spanning Healthcare Sweden
Norwegian Center for Integrated Care and Norway
Telemedicine
Catalan Agency for Health Technology Spain
Assessment and Research (CAHTA)
DENMARK
VTT – Technical Research Center - Finland
e-Trikala AE Greece
GERMANY
TSB Innovationsagentur Berlin GmbH Germany
ADVISORY BOARD COUNTRY
Continua Health Alliance Private Belgium AUSTRIA
Stichting (CHA)
Integrating the Healthcare Enterprice Italy,Spain,
(IHE) UK
ITALY
SPAIN GREECE
13

14. RENEWING HEALTH:
The expected impacts
 Reduce hospitalisation and improve disease management
 Increased links and interaction between patients and health professionals,
facilitating more active participation of patients in care processes
 Improvement of quality of life for patients suffering form chronic conditions
 Increased use of existing or commonly agreed standards and
demonstration of interoperability of the new solutions in regular healthcare
practice
 Provide a convincing business case to be presented to National, Regional
and Local Health Authorities and to stimulate them to speed up the
deployment of patient-centered eHealth service solution
14

15. The Consortium Arsenàl.IT:
Veneto’s Research Center of eHealth Innovation
 Has acted as Observatory by
performing systematic surveys
on Telemedicine applications
developed over time by the
member Health Authorities.
 Has succeeded in highlighting
the critical issues of
interoperability, standardization
and organizational impact as
factors for driving to the diffusion
of Telemedicine applications in
care delivery process.
15

16. The DOGE Project
The General Practitioner Network
A Regional project to create a communication network and
connect GP and Primary Care sites to the hospital and Local
Health Authority (LHA).
VENETO REGION
ACTORS:
 Regional information system HIS Hospital
CITIZEN
EHR
Information System
 Information System of LHAs
 GP
 Personal EHR GP and
PRIMARY CARE
Project start: June 2009
Doge Pilot Test is located in Adria Local Health Authority
n. 19 involving 70 GPs and SCCs

17. Conclusions and challenges
 The Veneto Region is actively involved in the area
of innovation and health care reforms, with
purchasing, payment systems and contracting as
tools for restructuring, and in benchmarking its
health care system;
 eHealth development is a way of empowering the
quality of human resources;
 The use of modern technologies in and out of
hospital should be understood as a way of
improving quality and safety for the benefit of
patients.

18. Thanking you for your kind attention!
giancarlo.ruscitti@regione.veneto.it