Innovation of the Healthcare System through ICT: the Lombardy Experiment. Zuffada R. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Integration: the Good, the
Bad and the Heroic
Innovation of the healthcare system through ICT: the
Lombardy experiment
Roberto Zuffada
Regione Lombardia – DG Health

2. Lombardia healthcare system
• 9.300.000 Citizens
REGIONE
LOMBARDIA • 150.000 Health & Social Care
Operators (public and private)
PHARMACIES HOSPITALS • 7.700 General Practitioners and
Pediatricians
• 2.600 Pharmacies
• 15 Local Healthcare Units
CITIZENS • 112 Public Hospitals
including 8 University Hospitals
GENERAL
PRACTITIONERS
LOCAL HEALTH • More than 400 Private
CARE UNITS
Healthcare Services Suppliers
HEALTH & SOCIAL
• Budget for Health in 2008: 17
ASSISTANCE billions €

3. eHealth strategy up to 2010: the
CRS-SISS project
Health and Social Services IT System (SISS)
• ICT tools and systems to improve and rationalise health
care processes (Technological, Organisational,
Financial/Budget)
• Smart card based technologies ensuring secure
access to the healthcare network both to citizens and
professionals
• Improvement of healthcare services, better and more
targeted planning of the Regional Health System,
and integration of the healthcare services with ICT

4. eHealth strategy up to 2010: the
CRS-SISS project
Health and Social Services IT System (SISS)
• Providing professionals with tailored patient
information through a unique access point
• Introducing innovation in the hospitals’ ICT systems,
including customisation of their IT architecture for the
integration with the SISS system, and organisational
changes in day-by-day work

5. eHealth strategy up to 2010: the
SISS services
• Citizen Identification: Regional General Registry and
Citizen Card
• e-Prescriptions Management
• Electronic Health Record (EHR): sharing clinical data
among HC Professionals (events, prescriptions, reports,
care profile, …), enabling on-line access for citizens
• Booking and Payment Services for citizens by
Internet, GP, Pharmacies
• Regional Call Centre, to improve citizen’s access to
HC services

6. eHealth strategy up to 2010: the
SISS services
• Digitalization of all medical and administrative
documents in order to improve efficiency and
effectiveness of processes
• Accounting information management flow
• Security Services: Identification & Authorisation
- The security and confidentiality principles of SISS are the
following:
- Citizen consent to processing their health data, in
accordance to Art. 29
- Identification and authorisation of users
- Data security
- Limited access

7. eHealth strategy up to 2010: the
SISS documents
The SISS network allows for the gathering and
organisation of documents for clinical purposes. All
citizens registered in the Regional General Registry have a
citizen card and an EHR.
The information can be accessed by all healthcare
professionals and administrators connected to SISS,
provided appropriate identification and the citizen’s explicit
consent. SISS contains metadata that points to the synthesis
reports of all healthcare events

8. eHealth strategy up to 2010: the
SISS documents
The following EHR documents can be accessed via SISS,
independent of the location of the point of care:
• Drug prescriptions
• Vaccination records
• Test results
• Hospital discharge letters
• Therapeutic plans
• Referral letters
• Emergency Services reports.

9. Smart Cards as key access
Identification and
Identification and authentication
CRS Regional authentication SISS Card
Service Card Authorization to access
(citizen) Access to Public (professional)
the System
Administration services
Electronic Signature
Data storage required
for emergency care Enables access to
SISS services
Certification of the
“presence” of the Enables access to the
citizen (through data stored in Citizen
electronic signature of card
documents) Provides an advanced
digital signature

10. CRS-SISS implementation
• Distributed citizens cards: 9.740.000 (100%) (including re-
issuing)
• Citizens joining SISS: 4.960.000 (54%)
• HCPs with professionals cards SISS: 63.000 (76%) (public
sector)
• SISS work stations: 26.100 (public sector)
• GPs joining SISS: 7.167 (92%)
• Pharmacies connected to the SISS network: 2.593 (100%)
• Public hospitals joining SISS: 112 (100%)
• Local Healthcare Units joining SISS: 15 (100%)
• Private healthcare organisations connected to SISS: 355
(96%)

11. CRS-SISS implementation / EHR
• Monthly contacts: 1.590.000
• ePrescription – pharmacies (monthly): 4.200.000 (80%)
• ePrescription – laboratories (monthly): 1.600.000 (58%)
• Lab medical reports (monthly): 490.000 (88%)
• Radiology medical reports(monthly): 140.000 (73%)
• First aid medical reports (monthly): 172.000 (70%)
• Discharge letters (monthly): 58.500 (49%)

12. CRS-SISS implementation
• Timeline of SISS development
Start Date Estimation of the Finish Date
Status of work in
Functionality / Service
(First issue/ (Full deployment Source: “Report on
Service Aug-2009 and/or The socio-economic impact
Activation) (deployment) distribution)
of the health information
platform Sistema SISS in the
eBooking Before 2002 70% 2010
region of Lombardy, Italy”
Digital Signature:
Electronic Cards and Client 2002 90% 2010 empirica-TanJent, 2009
Peripherals;
Digital Signature:
2002 100% 2008
Infrastructure
Clinical applications:
Ambulatory reports 2006 70% 2010
Lab reports 2006 95% 2010
Radiology reports 2006 92% 2010
A&E 2006 88% 2010
Discharge letters 2006 88% 2010
Managing Prescribing 2006 100% 2009
ePrescribing of drugs 2006 88% 2010

13. CRS-SISS implementation
• Pathology networks creation
A new development is the establishment of pathology
networks with the aim of utilising the opportunities provided by
SISS for continuous and ubiquitous care for those who need it.
Currently, there are 3 active pathology networks, for
- Oncology
- Epilepsy and
- Rare pathologies
Another 5 networks, covering cardio-vascular and stroke
diseases, dialysis, hearing, and the phenomenon of infants
death, are in the process of being implemented.

14. CRS-SISS implementation
• Pathology networks creation
A hospital is appointed to define the content standards and
structures of the documents for the respective network.
Pathology networks already exchange documents that are
based on structured data, and for future documents shared
in SISS are envisaged to consist of structured data.

15. eHealth strategy towards 2020
• Towards a patient-centred healthcare
system: the regional healthcare services is
currently moving towards a new model from
“hospital-centred” to “patient-centred”
services, tailored on citizens, oriented to a
better integration of the healthcare service on
the territory (2012-2020).

16. eHealth strategy towards 2020
• The scale and complexity of the SISS initiative requires
very careful planning and gradual implementation.
• The functionalities already in place generate a
respectable socio-economic return.
• Legislation has a direct impact on deployment of
functionalities and benefit realisation.
• The future potential of SISS lies in integration of HPOs
not yet part of the network, which are mainly private
sector providers, and expansion of functionalities to all
healthcare services.
Source: “Report on
The socio-economic impact of the
health information platform Sistema
SISS in the region of Lombardy, Italy”
empirica-TanJent, 2009

17. eHealth strategy towards 2020
• The provision of medical information from as many
healthcare services and facilities as possible increases
the extent of benefits, especially regarding patient
safety. This, in turn increases the necessity for
healthcare professionals, both in GP practices and
hospitals, to actively integrate information sharing into
their clinical routine.
• The pathology networks already active of in the process
of establishment will both foster continuity of care and
impact health professionals’ attitude towards the
necessity of data exchange without local restrictions.
Source: “Report on
The socio-economic impact of the
health information platform Sistema
SISS in the region of Lombardy, Italy”
empirica-TanJent, 2009

18. eHealth strategy towards 2020
• The main drivers for benefits are data sharing and
eBooking functionalities.
• Data sharing
• renders safer healthcare provision, especially in cases where
patients would otherwise not bring their referrals or discharge
letters;
• it allows for data validation and counter-checking of test results, for
preparation of consultations in advance, for the creation of new
healthcare models, and time savings and increased productivity.
• eBooking
• fosters HPOs’ resource planning and allocation,
• saves time and travel costs and
• makes scheduling much more convenient for patients.

19. eHealth strategy towards 2020
• Lessons learnt: the experience of the CRS-SISS
points out that such a complex eHealth projects call for:
• strong political commitment, robust legal and regulatory
frame, and long-lasting decision makers determination;
• a deep involvement of relevant stockholders mainly
professionals, healthcare organisations and industry;
• an evolutionary and self-adapting approach towards the
implementation of the ICT solutions.
More information on SISS project: “Report on The socio-economic
impact of the health information platform Sistema SISS in the region of
Lombardy, Italy”
http://www.ehr-impact.eu/
empirica-TanJent, 2009

20. Contributing to enhance eHealth as an enabler
for cross-border healthcare: EU projects
epSOS LSP: CIP, 27 Partners, 12 MS
“to develop a practical eHealth framework and ICT infrastructure that will
enable secure access to patient health information, particularly with respect
to a basic Patient Summary and ePrescription, between European healthcare
systems”
NEC@RDS: eTEN, 27 Partners, 16 MS, eEHIC deployment service
“to achieve the initial deployment of the eEHIC through a service allowing
automated data capture for identification, on line verification of entitlement
via National Portals, back-office interstate billing”
ALIAS: Alpine Hospitals Networking for Improved Access to Telemedicine
Services, 10 partners, 7 Regions – ERDF Territorial Cooperation
“to network Alpine hospitals for better access to healthcare through the use
of existing infrastructures of connectivity in order to optimise the delivery of
HC services (telemedicine and data sharing)”

21. Integration: the Good, the
Bad and the Heroic
Innovation of the healthcare system through ICT: the
Lombardy experiment
Roberto Zuffada
Regione Lombardia – DG Health