La salut en mans dels ciutadans. Seminari sobre la Carpeta Personal de Salut - Personal Health Record (PHR). Tecnocampus Mataró, 29 d'octubre de 2010.

1. Regional Service Card
Health & Social Care Information System
(CRS-SISS Program)
29 October 2010
Nicola Contardi
Lombardia Informatica

2. Summary
• Lombardy Region
• The Healthcare Network of Lombardia
• Lombardy’s Region Healthcare Information System evolution
• The CRS-SISS Program
• The underlying philosophy
• Goals and main streams
• Services and Architecture
• Project principles
• Smart Cards Technology
• The “Pillars”: Regional Registry, Electronic Health Record (EHR),
Reception Processes Improvement
• The Electronic Health Record (EHR)
• Main results in 2010
• Open issues
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3. Lombardy Region
• Is one of the twenty Italian Regions
• About 16% of Italy’s citizens
• Is one of the most populated Regions of Europe (more
populated than 14 EU member States)
• Its GNP is about 20% of Italy’s GNP
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4. The Healthcare Network of Lombardia
• 9.500.000 Citizens
• 150.000 Health & Social Care
Operators
• 7.700 General Practitioners
and Pediatricians
• 2.500 Pharmacies
• 15 Local Healthcare Units
• 34 Public Healthcare Services
Suppliers (29 Public Hospital
and 5 Public Medical Research
Institutes)
• Over 2500 Private Healthcare
Services Suppliers
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• Lombardy, like every Italian Region, is directly responsible for HC service provision
REGIONE
LOMBARDIA
PHARMACIES
HEALTH & SOCIAL
ASSISTANCE
GENERAL
PRACTITIONERS
LOCAL HEALTH
CARE UNITS
CITIZENS
HOSPITALS
REGIONE
LOMBARDIA
PHARMACIES
HEALTH & SOCIAL
ASSISTANCE
GENERAL
PRACTITIONERS
LOCAL HEALTH
CARE UNITS
CITIZENS
HOSPITALS

5. Lombardia Informatica
• Lombardia Informatica is a public-owned service company which
was constituted in December 1981 as an initiative of the Lombardy
Regional Government.
• The company designs and develops ICT Systems for the regional
government and is responsible for management of the latter’s
already-existing systems.
• Lombardia Informatica has around 500 employees and a revenue of
about €240.000.000 (2009).
• Lombardy Region has entrusted Lombardia Informatica with the
management and overall responsibility for the CRS-SISS project
(Regional Service Card Health & Social Care Information
System).
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6. Lombardy’s Region Healthcare Information System
evolution
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1978 Collection and filing of hospitalizations
Collection and filing of outpatient visits data1997
1985 Collection and filing of pharmaceutical acquisitions
1982 Regional personal data Registry of Citizens and General Practitioners
CRS-SISS
Project
requirements
definition and
feasabilty
analysis
CRS-SISS
On site pilot
project in
the Lecco District
(300.000 citizens)
1999 2000 -2001 2002
CRS-SISS
Project Financing
and beginning of
the expansion to
all Districts
2008
CRS-SISS
Healthcare
Private Sector
2004 2005
CRS-SISS
2 million
citizens
CRS-SISS
All
Lombardy’s
citizens
(9,5 million)

7. Healthcare DataHealthcare Data
Administrative DataAdministrative Data
General Practiotioner
Practitioner
ASL
Healthcare Local Unit
Pharmacy
Hospital
Healthcare DataHealthcare Data
Administrative DataAdministrative Data
General Practiotioner
Practitioner
ASLASL
Healthcare Local Unit
Pharmacy
Hospital
Data WareHouse
Cluster of Patients
Electronic Health Record
Vision per single Patient
Data WareHouse
Cluster of Patients
Electronic Health Record
Vision per single Patient
The underlying philosophy
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SISS is a Regional Healthcare Information
Network; the Citizen is its centre.
All the data are gathered, organized and
reported on the basis of the citizen’s clinical
treatment within the Regional Healthcare
Network.
SISS implements a work-flow based on the
typical healthcare processes:
• Pharmaceutical
• Outpatient examinations
• Hospitalization
• Emergency
• …

8. CRS-SISS - Goals
8
• Improve Services for
Citizens: reducing the
“distance” between Citizen and
HC Service Providers by
simplifying procedures and
shortening waiting time (e-
booking, access HER, e-
precription)
•Improve quality of prescription,
diagnosis and care
(appropriateness) processes by
Citizens’ clinical data sharing,
through EHR, among qualified HC
Professionals, securing Citizens’
Privacy Rights
•Improve Governance of Social
and HC System managing
costs: enhancing planning and
controlling instruments
(DataWarehouse, Business
Intelligence)
• Improve internal process
efficiency of HC Service
Providers by a generalized diffusion
of new technologies (digital
signature, electronic filing,
electronic prescription)
to dematerialize documents
SISS
Planning and
Governance of
HC expenditures
Efficiency and
Simplification
Social and HC
Internal
Processes
Assure continuity and
quality of care
For Citizens and HC Professionals
For Administrations
(Regional Government and HC Providers)
•The prerequisite of the Project was the distribution of the personal Smart Card.
•The main objectives of the CRS-SISS Program are to unify and to protect, within a co-ordinated
system, all the information related to the citizens’ state of health.
Reduce the gap
between Citizen
and HC Services
Providers

9. CRS-SISS Main Streams
• creation of new services at
regional level for Citizens and
HC Professionals (Electronic
Health Record)
• creation of a large
technological infrastructure
• implementation of an
integrated regional
information system
• central data base and clinical
data repository (administrative
data, service codes, Patient
Record,…)
• solutions for clinical
management of patients
• application integration of
Organization’s Information
Systems through an
integration middleware
Healthcare Extranet
as main instrument of innovation
and integration framework
among all actors:
Develop HC Organizations’
(Hospitals, HC Local Units, …)
Internal Information Systems,
promoting features such as:
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10. CRS-SISS Services
• Citizen Identification: Regional General Registry and Citizen Card
• e-Prescriptions Management to enable a truly digital use of prescriptions
during their life cycle
• Electronic Health Record (EHR): shares clinical data among HC
Professionals (events, prescriptions, reports, care profile, …), enables on-
line access for Citizens
• Booking and Payment Services for Citizens by Internet, GP, Pharmacies,
Regional Call Center, to improve citizen’s access to HC services
• Business Intelligence and DataWarehouse to make analyses and
forecasts of epidemiological trends and to manage and forecast regional
healthcare expenditure trends
• Digitalization of all medical and administrative documents in order to
improve efficiency and effectiveness of processes
• Accounting information flow management: incremental records of
administrative data in order to ensure on-line updating of Business
Intelligence and Data Warehousing Systems
• Electronic signature, mailing system, encryption functionality
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11. CRS-SISS - Architecture
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General
Practitioner,
Pediatrician
Level 2
Healthcare
Extranet
Hospital, Operators,
Chemists, …
Provider Provider
HealthcareSocial Services
Level 1
Central Repository
Level 3
Operators and
Organisations
Integration Management
Unit
Citizens
SERVICES
Lombardy Region Central Systems

12. CRS-SISS Project Principles
• Web technologies
• Evolution and integration, not replacement, of existing applications
• Strict enforcement of personal data protection (privacy): high
security technologies
• Process reengineering to improve efficiency
• Extensive deployment of digital signature and electronic documents
(dematerialization)
• Smart cards
• Make available to existing applications a common infrastructure
for integration
• Integrate, not substitute, existing functionalities
• Preserve the current user interface as is
• Minimize enhancements to operator's behaviour
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13. Smart Cards Technology
• Identification and authentication
• Data storage required for emergency care
(Netlink standard)
• Access to Public Administration services
• Certification of the “presence” of the
Citizen (through electronic signature of
documents)
• Identification and authentication
• Authorization access to the System
(according to operator’s profile)
• Electronic Signature
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Citizen Card
Operator Card

14. CRS-SISS “Pillars”
• Regional General Registry
• Electronic Health Record (EHR)
• Reception processes improvement (booking
and payment Services)
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15. Electronic Health Record (EHR): 2 level architecture
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Hospital
Hospital
ASLASLASL
Healthcare Local Unit
Events Link
EHR
Clinical
Doc
PS
Hospital
Clinical
Doc
Clinical
Doc
• Health documents
• Healthcare Local Unit
• Patient Summary
• Vaccine File
• Hospitals
• Test results
• Health Documents
• Therapeutical plans
• …
Electronic Health Record (1)

16. Electronic Health Record (EHR): main features
• Based on a “patient centric” structure, is the fundamental
support for the care of the citizen
• Gathers and organizes summary information from
organizations and citizens for medical care purposes
• Allows the sharing of medical documents between all the
actors involved into the care processes of the citizen
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Electronic Health Record (2)

17. 17
Electronic Health Record (EHR): How does it work ?
GP
Pediatricians
HospitalDiagnostic Test Medical Specialist
Electronic Patient Record (EHR)
Patient health
conditions
Exams results
Material
Healthcare
Occurrences
Medical
Reports
Ospedale
Specialista
Diagnostic Test
Hospital
2: Results
Exam
Medical Specialist
Diagnostic Test
1: Test
2: Admission
8: Discharge
4: Investigation
5: Results
6: Consultation
7: Advice
Electronic Health Record (3)

18. Electronic Health record (EHR): functions
• Give an integrated view of the sanitary history of a specific citizen to the
doctor who is treating him/her in a specific healthcare episode, with respect to all
the privacy aspects.
• Give consultation functions able to increase the efficacy and efficiency of the
clinical intervention.
• Make clinical reports available to the citizen on-line, reducing need for citizen
to retrieve physically results and, thus, queues
• Simplify the activities of clinical operatives, allowing information exchange,
import/export of documents (e.g. for admission, GP change, …)
• Interface decision support systems to allow secondary usage of information
(health policy, administration, education, research, statistics, …)
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Electronic Health Record (4)

19. 19
• “Personal zone” for the citizen in his EHR
• Asyncronous Electronic Document consultation
• Diagnostic &Therapuetic plans
• Admissions clinical documents management
• Extensive use of structured documents
• Image mangement
Electronic Health Record - Main evolutions (5)

20. CRS-SISS – Main Results in 2010*
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• Over 9 millions of CRS smartcards delivered
• 96% General Practitioners and Pediatricians in the Network
• 100% Pharmacies in the Network
• 75 millions prescriptions
• 14 millions of Clinical Electronic Documents (most referrals)
• 5,8 millions of “active” EHR
• 1,2 millions of EHR consultations from GPs
• All Healthcare Local Units and Public Hospitals of the Region have integrated
their applications to the network
• Private Hospitals started integration in the Network
• Pathology Networks: Oncology, Rare Diseases, Epilepsy, Emathology, Acute
Myocardial Infarction, Nephrology, Emergency, Hearing, Stroke, Sudden Infant Death
Syndrome
• Available on line services for citizens: access to EHR, booking, choice and
revocation of GP, …
* Projection to the end of 2010

21. 21
• Customer-orientation
 A system also for the healthy
 A user-interface even more user-friendly
 Simple functions in a little time-to-market
 Simple bi-directional services for citizens
• An open world
 The citizen may take a care where he prefers
 Privacy: how much of his record the citizen may choose to share ?
Open Issues: EHR for the Regional System

22. 22
• EHR for e-Health government
 Developing systems more and more citizen-data centric
 Try to modify some Regional rules in order to exploit system capabilities
• More earned value for professionals
 To improve the collaboration among the private professional, the general practioner and the
citizen
 Focus on mobile services
 Active involvement of all the stakeholders
Open Issues: EHR for the Regional System

23. 23
• Interoperability at a regional and european level
• Applications more oriented to the Inetrnet world
• Re-use
• Creation of an eco-system of parterns cooperating in developing the
overall system
Open Issues: EHR for the Regional System

24. Lombardia Informatica S.p.a.
Thank you
Nicola Contardi
nicola.contardi@lispa.it
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