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


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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


Indice Provinciale

Gateway

Sistemi Aziendali


Indice Provinciale

Gateway

Sistemi Aziendali


Indice Provinciale

Gateway

Sistemi Aziendali


Indice Provinciale

Gateway

Sistemi Aziendali


Indice Provinciale

Gateway

Sistemi Aziendali


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

Mauro Rizzato


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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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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

[email protected]

m. rizzato / arsenàl.it / veneto region – trieste, june 10, 2009 copyright © 2009 arsenàl.it...

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