EHTEL Association, 49/51, rue de Trèves B-1040 Brussels, Belgium Tel: +32 2 230 1534 Fax: +32 2 230 8440 www.ehtel.org

Partnerships for Innovation in Health Care: Hot Spots in the Euro-Mediterranean area

Report from the two-day study visit to ISMETT, Palermo, Italy

(Part 1 out of 2)

Monday-Tuesday, 26-27 September 2016

Report drafted by Diane WHITEHOUSE, EHTEL with support from EHTEL colleagues

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Part 1 out of 2

Providing integrated care in ISMETT, southern Italy, the euro-Mediterranean region, and wider

Contents Explaining the site visit .............................................................................................................3

Introducing the report ..............................................................................................................4

Providing integrated care in southern Italy - Day 1 ....................................................................4

Introducing the work of ISMETT and UPMC .................................................................................. 5

Exploring the clinical benefits of digital services ........................................................................... 6

Touring ISMETT’s facilities ............................................................................................................. 6

Hearing about a wider EU-US form of collaboration ..................................................................7

Providing integrated care in the Euro-Mediterranean region and Europe - Day 2 .......................7

Transforming health and care in Europe ....................................................................................... 8

Supporting innovation in Europe ................................................................................................... 9

Setting up a platform for health care innovation in Croatia ....................................................... 10

Innovating in ISMETT and UPMC ............................................................................................. 11

Innovating in other parts of Italy ............................................................................................ 14

Learning lessons from Calabria and Campania ............................................................................ 14

Transforming health and care in the Veneto region ................................................................... 15

Summarising the future of health and care in Europe.............................................................. 15

Annex - Agenda for Day 1 and Day 2 of the site visit ............................................................... 17

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Partnerships for innovation in health and care: Hot spots in the Euro-Mediterranean Region

The challenges of geography have inspired a set of innovative solutions for health and social care in Sicily. Tele-consultations enable highly specialised services – including home care – tailored to the needs of patients and professionals. The ISMETT hospital1 was set up through a partnership between the Region of Sicily and the University of Pittsburgh Medical Center (UPMC)2 – a collaboration between a global integrated health enterprise and a United States (US)-based health care leader. This research hospital provides integrated medical services on organ transplantation focused on the South of Italy, and beyond. Indeed, the nearest other transplant hospital is located in Rome. Certified as an Italian hospital, the institution is managed by UPMC.

Explaining the site visit

The hospital was the site of a study visit organised by the European Health Telematics Association (EHTEL)3 for their members and the members of the Association Internationale de la Mutualité (AIM).4 It brought together eHealth practitioners (‘doers’) and insurance scheme specialists, alongside personnel from the European and American civil services. The visit combined a workshop with sessions that focused on the ISMETT context as well as on other partnerships for innovative health services in Euro-Mediterranean regions. Visit highlights included: a tour of ISMETT’s facilities; workshop presentations explaining the collaboration between the two hospitals in Palermo and Pittsburgh; other presentations outlining wider collaborations in Europe; as well as a European Union (EU)-US webinar on the upcoming activities in the EU-US work stream on innovation ecosystems. More than 25 people were at the study visit to the ISMETT-UPMC hospital in Palermo, Italy.

1 http://www.ismett.edu The Scientific Institute for Recovery and Care is the research hospital where the Mediterranean High-Specialist Institute for Transplants and Therapy (ISMETT) is located: http://www.ismett.edu/?q=en/story 2 http://www.upmc.com/Pages/default.aspx 3 http://www.ehtel.eu 4 http://aim-mutual.org

Figure 1. Palermo workshop attendees on Day 1.

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Introducing the report

This report is divided into two parts.

Part 1 (this part of the report) provides an overview of the presentations made during the site visit. For more information on the visit, see the agenda in Annex.

(Note that the order of presentations in this report differs slightly to the actual agenda, due to changes made in ordering and in speakers during the course of the site visit itself.)

Over the two days of the study visit, a whole series of presentations were made about different aspects of the work undertaken by ISMETT, with UPMC, in their mutual collaboration together. These short reports are laid out mainly in the later half of this report. On the first day of the visit, these were concentrated around the UPMC-enabled digital services taking place at ISMETT, and included a brief visit of the hospital. On the second day, the presentations shifted to the wider angle of European cooperation and other initiatives taking place in southern Italy and Europe as a whole.

Part 2 (a separate, second part of this report) summarises the content of the webinar organised by the European Commission,5 the United States (US) Department of Health and Human Services,6 the US Department of Commerce,7 with UPMC, on the EU-US work stream on innovation ecosystem. The webinar was entitled Global collaboration and innovation systems and was conducted as a “virtual round table”.

Providing integrated care in southern Italy - Day 1

Simona ABBRO of UPMC and Marc LANGE of EHTEL introduced the two-day visit.

Simona ABBRO highlighted the way in which the ISMETT hospital and UPMC bring together information technology (IT), health and care. She emphasised ISMETT’s role as a “hot spot” in the Euro-Mediterranean area, showing how important is the partnership with UPMC. Similar innovative working relations, between other European and US-based institutions and companies will be increasingly needed.

Marc LANGE showed how the challenges posed by the increasing “digitalisation” of society, the demographics of ageing, and the costs of care now mean that innovation, based on growing access to new IT tools, is really needed in the domains of health and care.

5 https://ec.europa.eu/digital-single-market/en/dg-connect 6 http://www.hhs.gov 7 https://www.commerce.gov

Figure 2. Simone ABBRO of UPMC.

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Introducing the work of ISMETT and UPMC

Giovanni VIZZINI, a medical doctor from ISMETT and UPMC described the background to the ISMETT hospital. ISMETT is a public-private partnership between the Sicilian health authority and UPMC. It is a 78-bed hospital, which has 98 physicians and over 300 nurses. Physically, it was built to the same architectural specifications as a set of buildings in Pittsburgh.

When the relationship with UPMC was established, it was the first time that a hospital in Sicily had been managed by a private organisation. Before ISMETT was founded, people in Sicily who had end-stage organ failure had to travel abroad to receive a transplant.

The hospital does over 140 organ transplants and 4,800 other operational interventions a year, including cardio-thoracic and abdominal operations. In the 15 year time-period between 1999-2014, it did 1,555 transplants of which 925 were of livers. It also undertakes combined interventions, like liver and lung transplants.

ISMETT has achieved many substantial milestones. For example, in 2010, it reached HIMSS8 level 6,9 the first hospital in Sicily to do so. It is now aiming to reach level 7. It was also the first hospital in world to use robotics in the surgical removal of all or part of a liver (a hepatectomy).

Organisationally, ISMETT’s own personnel undertake visits to UPMC in Pittsburgh and do work placements there.

The hospital also hosts young staff from the US on sabbatical in specialist areas of surgery. Indeed, in its approach to young people, the whole region of Sicily is increasingly health-aware. For example, at the local Benedetto Croce Scientific High School10 pupils are “learning to save a life at school”. They are being taught what emergency interventions to take in the event that they come across someone having a cardiac arrest.

Research-wise, the hospital is oriented towards important lines of investigation. Information and communications technology (ICT) in health care is one of the six specific domains in which staff members do research and development.11 In 2019, ISMETT is planning to open a wing that will be totally dedicated to research, to be called ISMETT 2.

8 https://www.himss.org HIMSS is the Healthcare Information and Management Systems Society. 9 https://app.himssanalytics.org/emram/AEMRAM.aspx 10 http://www.liceocroce.it/index// 11 On the day following the study visit, 26 September 2016, ISMETT was having its two-yearly research evaluation when personnel from the Italian ministry of health visited the hospital.

Figure 3. Giovanni VIZZINI of ISMETT and UPMC.

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Exploring the clinical benefits of digital services

In a complementary presentation, the clinical benefits of digital services in a Neapolitan hospital were introduced by Gugliemo TOSCANI of the Federico II12 University Hospital. He

spoke of the work of the 1,000-bed, 2,000-employee, hospital and its involvement in European research.

While Campania – where Naples is located – is a very densely populated region, the largest concentration of residents is in the Neapolitan area. Most elderly people, however, live far away from the capital, often in mountainous regions. The links between home and hospital are therefore vital.

The hospital is currently involved in two European projects, PERSSILAA13 and Beyond Silos.14 PERSSILAA focuses on people experiencing frailty and pre-frailty, motivating them to take better personal care of their own situations – an approach which is facilitated by use of personal health

dossiers. Beyond Silos is a service based on pathways that cut across domains. The ultimate aim is to concentrate on creation of integrated care, merging health care, social care, and informal care.

Touring ISMETT’s facilities

The group was taken on a short visit to the ISMETT section of the hospital, and saw the work being done in the intensive care unit, the anaesthesiology unit, and how the hospital reads its digital images.

12 http://www.unina.it/unina-international/about-us/federico-ll-today 13https://perssilaa.com 14 http://www.beyondsilos.eu

Figure 4. Gugliemo TOSCANI of the Federici II University Hospital.

Figure 5. Reading digital images.

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The hospital’s use of telemedicine has increased 100 per cent over a ten-year period. As a result, mortality rates in the intensive care unit have diminished. Inter-disciplinary rounds – with doctors with varying specialisms – can be achieved. Second opinions are easier to give. Through telemedicine monitoring of the patients in the hospital, especially overnight, the unit can ensure greater efficacy of care and avoid burnout on the part of its staff: hence, ISMETT’s staffing and supervisory work models are now improved.

For patients, their bed days are reduced, care is better, and their adherence to treatment is enhanced. Patient safety is better, as is the quality and costs of care.

The overall message was “patient-centred; provider-centred; and systems-centred”.

Hearing about a wider EU-US form of collaboration

Organising the study visit at ISMETT enabled the study visitors to participate in a live webinar about the future plans of the EU-US innovation ecosystem. This experience is reported on separately as Part 2 of this report.

Providing integrated care in the Euro-Mediterranean region and Europe - Day 2

Day 2 of the study visit consisted of a further series of presentations. They ranged from talks with a focus on the European level; an example of work in another European Member State (Croatia); more details on the work undertaken in ISMETT in conjunction with UPMC; and, finally, insights into work being undertaken on eHealth in other Italian regions.

Figure 6. Monitoring equipment and patients.

Figure 7. Attendees on Day 2 of the study visit.

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Transforming health and care in Europe

Sevala MALKIC of DG SANTE and Marc LANGE of EHTEL made highly complementary presentations.

Sevala MALKIC focused her presentation on the work of the European Innovation Partnership on Active and Healthy Ageing15 (EIP-AHA). Sub-divided into six action groups – adherence, falls, decline and frailty, integrated care, independent living solutions, and age-friendly environments – the partnership is working to “connect and engage public and private stakeholders”.

The partnership brings together reference sites16 that provide leading examples of good practice supporting active and healthy ageing. The original set of 38 reference sites, and commitments, has now doubled. From 2015-2020, the aim is towards a “big bang” scale-up, in which active and healthy ageing support activities occur in more than 20 regions in 15 Member States.

Over the next two years, the activities will be concentrated around gathering evidence; developing successful scale-up models; using tools to support implementation; encouraging knowledge transfer; and facilitating coaching in the regions.

In recent times, the European Commission has pushed for two main domains to be expanded: health systems assessment and eHealth solutions.

First, on health systems assessment, the 28 Member States, together with Norway, the World Health Organization,17 the Organisation for Economic Co-operation and Development (OECD),18 and the European Observatory on Health Systems and Policies,19 are all working together on this field. Their mutual initiative involves exchanging experiences, developing tools and methods, and defining together priority areas and criteria. The actions will improve both the working relationships among these international organisations and between them and the Member States. The end-result will ensure that citizens receive primarily better access to safe care. Also as an outcome, the Member States should be able to develop and deploy plans for integrated care.

Second, eHealth solutions is a crucial domain that underpins the digital services infrastructure. These solutions are embedded in the Connecting Europe Facility20 work programme. The focus of the eHealth work continues to be on the Patient Summary and ePrescribing, as well as the providing an IT tool to support the European Reference

15 https://ec.europa.eu/eip/ageing/home_en 16 http://www.scale-aha.eu/rs2016-results.html 17 http://www.who.int/en/ 18 http://www.oecd.org 19 http://www.euro.who.int/en/about-us/partners/observatory 20 https://ec.europa.eu/digital-single-market/en/connecting-europe-facility

Figure 8. Sevala MALKIC of DG SANTE.

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Networks.21 In turn, it should be possible to incorporate all three of these technology-based solutions into any future integrated care system.

With specific regard to the European Reference Networks,22 up to 20 reference centres on rare conditions and transplantation centres will be selected from a large number of applicants. The Commission is currently in the process of evaluating the selection of these networks.

Supporting innovation in Europe

Marc LANGE, secretary general of EHTEL, described a further set of programmes, among them the former Competitive and Innovation Programme,23 the Horizon 2020 (H2020) programme,24 the European Union (EU) health programme,25 the Connecting Europe Facility26 area’s focus on eHealth, and Interreg.27

Mr LANGE showed how several different regions and sites have used European financing to grow the use of eHealth. Prime among the examples were those covered by European co-financed projects, such as Renewing Health,28 United4Health,29 Smartcare,30 Carewell,31 and BeyondSilos.32

He then highlighted Calls for proposals that are being run in 2016-17 under the H2020 programme, with a view to having projects start at the latter end of 2017.33 Currently running in the Commission’s health programme are two projects that can help initiatives not only learn how to scale up, but actually scale up: they are SCIROCCO34 and ACT@Scale.35 Similarly, the Connecting Europe Facility36 is of considerable help in reinforcing the collaborative work among Member States on challenges like electronic patient summaries and ePrescribing. It is also

21 http://ec.europa.eu/health/rare_diseases/european_reference_networks/index_en.htm 22 http://ec.europa.eu/health/rare_diseases/european_reference_networks/erf/index_en.htm - fragment5 23 http://ec.europa.eu/cip/ 24 https://ec.europa.eu/programmes/horizon2020/ 25 http://ec.europa.eu/health/programme/policy/2014-2020/index_en.htm 26 https://ec.europa.eu/digital-single-market/en/connecting-europe-facility 27 http://www.interregeurope.eu 28 http://www.renewinghealth.eu 29 http://united4health.eu 30 http://www.pilotsmartcare.eu 31 http://www.carewell-project.eu 32 http://www.beyondsilos.eu 33 http://ec.europa.eu/research/participants/data/ref/h2020/wp/2016_2017/main/h2020-wp1617-health_en.pdf 34 http://www.scirocco-project.eu 35 https://www.act-at-scale.eu 36 https://ec.europa.eu/digital-single-market/en/connecting-europe-facility

Figure 9. Marc Lange of EHTEL.

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looking ahead to examine what business models for future collaboration in the field of integrated care might look like (see VALUeHealth).37

The EIP-AHA is a form of ecosystem, to which the champions, reference sites, partners, and community bring their own resources to the initiative – “support in kind”. In turn, the partnership creates important opportunities to meet up with a lot of new people working in the same kinds of fields and endeavours.

All of these programmes have resulted in a lot of useful tools and methods to enable deployment of IT, and measure the degree of deployment, especially with regard to integrated care. Exciting examples of these tools are: impact assessment framework; guidelines for large-scale deployment; business modelling; a cost-benefit toolkit; a maturity model for integrated care; and now an innovation management tool. An interesting challenge will be to combine these tools in a single toolkit!

Setting up a platform for health care innovation in Croatia

Ozren PEZO – Deputy Director for ICT, in the Croatian Health Insurance Fund – outlined the work of the fund in the field of eHealth, which forms part of Croatia’s national eHealth strategy 2012-2020.

The country has been involved in eHealth since 1993. Recently, it focuses its work on eScheduling, eBooking, eReferrals, and electronic health records. In particular, Croatia took part in the epSOS large-scale pilot38,39 on ePrescribing. Croatia also operates a national eLists system to monitor the 900,000+ schedules in its more than 60 public hospitals and 200 public institutions.

As from 20 September 2015, a new services called e-Citizens40 is on offer in Croatia. Through it, Croatian citizens can see their health-related data. Smart card and web portal offer patients access to their electronic health records.

Currently, the system has a two-level security process whereas, in the future, it will have four separate authentication levels.

As yet, there is no relevant legal framework in Croatia relating to health data; this regulatory background still

needs to be designed and developed. Croatia is particularly looking to the EU for support with how to apply the 2016 General Data Protection Regulation.41

37 http://www.valuehealth.eu 38 http://www.epsos.eu 39 https://joinup.ec.europa.eu/community/semic/news/epsos-large-scale-pilot-cross-border-e-health-has-come-end 40 https://vlada.gov.hr/the-e-citizens-system/15215 41 http://ec.europa.eu/justice/data-protection/reform/index_en.htm

Figure 10. Ozren PEZO of the Croatian Health Insurance Fund.

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The resulting health data will be particularly important for Croatia’s public institute of health. Croatia is anticipating that the statistics gathered will help the country tell how many people, of what age group, in what months, consume the drugs needed when they are experiencing specific conditions: the example cited was of an influenza outbreak in February 2015.

Further developments that Croatia aspires to include: the integration of all forms of (clinical) registries; continued work on electronic health records; the updating of the patient portal; eNursing, eHomeware, eEmergency; and possible bio-informatics extensions.

Innovating in ISMETT and UPMC

A wide range of presenters spoke about the work of UPMC and the Telemedicine Service Centre at ISMETT.

ISMETT is a key organisation in Sicily, because it is 250+ kilometres distance to many of the towns and cities around the island especially those located in the highly rural areas. Post-operatively, lots of data are needed to do follow-up with patients who have had operations.

Virtual monitoring is invaluable for those who return home. ISMETT’s remote monitoring initiative started in 2011. The positive results of this home monitoring is: reduced deaths; reduced length of patient stay in hospital; and the reduced length of stay due to urgent re-admissions is down to zero (rather than previously 68!). There is a 99 per cent satisfaction rate on the part of patients’ families. Whereas a six-day hospital stay would cost 216,000 euros, the cost of treating a patient at home is 7 euros per day. This leads to an overall saving of 27,000 euros per year.

The presentations made included:

Deb SALAVA, UPMC: Ms SALAVA gave an introduction to the portfolio of digital services offered at ISMETT and UPMC. UPMC has around 20 international sites, several of which are in Europe – including hospitals in both Italy and Ireland. As an institution, it has appeared on the Most Wired list for 17 consecutive years and has built up its commitment to its telemedicine programme over the same time-period. This programme has many lines of activity including teleconsult, telestroke, teleradiology, remote monitoring, and telepathology. A new telepathology telemedicine programme is expected in 2017.

Figure 11. Deb SALAVA of UPMC.

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Rosa LIOTTO, ISMETT & UPMC works on telepathology to support integrated transplantation care, and is eager to expand this work even further. Five generations of equipment have already been used since ISMETT/UPMC started in the telepathology field in 1999. Data archiving is core to the interests of the unit. Weekly web-based quality assurance meetings, and use of a portal, facilitate discussion of patient cases – some 45 over a three-year period since 2012. In 2015, the Unit received a €350,000 grant from the Ministry of Research to work on a Big Data project, and to establish a system to merge digital pathology data with clinical and radiological data and to share data with platforms at other centres. The upcoming Leica Aperio VERSA system, that ISMETT will use, will help with data streaming and image analysis. Dr LIOTTO concluded her talk with the insight, “Until telepathology gets to where DICOM is with teleradiology – until there's a standard! – it is difficult for most companies to make a business out of it.”

Giuseppe CORUANA explored the development of electronic medical records at ISMETT, again over a 17-year time-period. Eventually the hospital hopes to go entirely paperless. Overall, the initiatives taken by the hospital have not just been technology projects; they have had huge impact on both processes and people. The institution uses many well-known standards, such as HL7,42 DICOM,43 and Integrating the Healthcare Enterprise (IHE).44 Mr

42 http:www.hl7.org 43 http://dicom.nema.org 44 https://www.ihe.net

Figure 12. The Leica Aperio VERSA digital pathology scanner to be used at ISMETT.

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CORUANA is also keen on developing fields that can benefit from having good electronic records, such as Big Data, evidence-based medicine, and sound privacy and security mechanisms.

Roberto MIRAGLIA, ISMETT & UPMC is Deputy Head of the Teleradiology Unit at ISMETT, and is interested to see teleradiology services expand beyond the use currently being made of them. Teleradiology has existed at ISMETT since 2012. The service employs nine radiologists, a nuclear medicine physicians, ten nurses, and 17 technicians. One neuroradiologist at UPMC is available 24/7 for consultations. From 2017 onwards, ISMETT will become the hub centre for seven other Sicilian spoke centres in terms of scarring of the lungs (idiopathic pulmonary fibrosis). In addition, ISMETT and UPMC are planning at least six different collaborative research projects, based around various conditions such as cognitive status, neurovascular health, and liver transplantations.

Gaetano BURGIO, ISMETT & UPMC spoke of tele-consultation and networking between intensive care units – he calls the field TeleICU. In his speech, he drew on several historical developments in both the US and the European Union. He also referred to many articles and research citations, among them ones which have recorded developments in Sicily particularly with adult patients. The field is faced, liked many others in medicine, with reduced resources. As he said, “You can't improve what you can't measure.” As a result, ISMETT is likely to rely more heavily on artificial intelligence, alert systems, and computerised algorithms.

Giovanna PANARELLO of ISMETT described how it is possible to reduce mortality in paediatrics between 10-25 per cent by using IT networks, especially when connected to rural areas where resources are limited. Out of a pilot project started in 1999, ISMETT has developed its pathology network. ISMETT’s Tele ICU system involves remote physicians discussing cases via a videoconferencing system called Centricity Enterprise Web, provided by General Electric.

Figure 13. Gaetano BURGIO of ISMETT and UPMC.

Figure 14. Giovanna PANARELLO of ISMETT.

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Last but not least, Wissam ISMAIL of the El Noor Initiative, a part of the UPMC enterprise, spoke of the wide continuum of healthcare services provided by UPMC in the United Arab Emirates, supported by telemedicine. The chief challenges lie in providing healthcare both to the regular citizens of the country as well as the numerous expatriates and visiting workers.

Innovating in other parts of Italy

The two-day study visit also enabled insights into what is happening in three other Italian regions: Calabria, Campania, and Veneto. Summaries of these talks follow.

Learning lessons from Calabria and Campania

Mariangela CONTENTI of Federsanità (Italy) explained how the Confederation of Healthcare Organisations and National Association of Italian Municipalities are working together to ensure that sustainable technologies are available for older people. The focus is on public procurement for innovation in the health care sector around elderly people whose health and care is enabled by ICT.

A key example is through the STOPandGO45 project which will continue its work into 2018. It is expected that the project will result in seven commercial tenders that will take place in six regions and one municipality, in four countries. In Campania, for example, a preliminary market consultation was due to be completed by the end of October 2016. Calls for tender are scheduled for launch before 2016 finishes. Providers on the market appear to be very interested in the public-private partnerships on offer.

45 http://stopandgoproject.eu

Figure 15. Wissam ISMAIL of the El Noor Initiative.

Figure 16. Mariangela CONTENTI of Federsanità.

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Many lessons have also been learned. Internally, the multi-disciplinary and multi-professional team-building that results from this form of integrated care is both very challenging and very satisfying. As Ms CONTENTI said, it leads to both “joy and sorrows”. Much of what has been learned lies in the field of organisational theory and behaviour and change management. It is all about:

Learning from good practice.

Creating synergy among local regions.

Negotiating with management and with professionals.

Ensuring key industry representatives are present.

Transforming health and care in the Veneto region

Antonella FORESTIERO of Arsenal.IT focused her own presentation on the outcomes of the Carewell46 project, co-financed by the European Commission. The project supports the integration of care in six European regions. Its work is on improving the provision of care for frail elderly patients through patient monitoring, patient self-management and the involvement of informal care-givers involvement. Over 60 collaborators with multi-disciplinary skills are taking part in the initiative.

The care pathways are shifting location, towards the home, and with different personnel being involved e.g., social workers. One example is the work done in the town of Feltre in the Veneto region, with its 85,000 citizens. There, Carewell involves 160 patients over 65 years old. The project’s action plan includes nurse-assisted monitoring, remote monitoring, teleconsultation between specialists and general practitioners, and general education for the workforce.

Much of the discussion that resulted from Ms FORESTIERO’s presentation concentrated on the challenges of arranging successful twinning and coaching among regions (especially when they have different forms of reimbursement system – Beveridge or Bismarckian – underpinning them). Emphasis was also placed on the financial and budgetary squeeze taking place in the public sector, in both the health domain and in social services.

Summarising the future of health and care in Europe

These applied and concrete presentations of actual progress especially excited the attendees, who were full of questions about how to make further advances in eHealth use

46 http://www.carewell-project.eu/home.html

Figure 17. Antonella FORESTIERO of Arsenal.IT.

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in different countries – especially in Eastern Europe, which are the majority of European countries that will host the presidency of the European Union from late 2017 to 2020.47

The visit showed how a concrete public-private partnership can work in real life, and how innovation in healthcare can materialise. ISMETT itself illustrates a high, and realistic, degree of professional specialism in conjunction with access to ICT. Cross-Atlantic relationships are certainly an interesting subject to look at!

The European Commission staff, Gérald CULTOT and Sevala MALKIC, were offered especial thanks for the European Commission’s support in enhancing the content of the visit: it was particularly important to hold the EU-US webinar on collaboration around eHealth ecosystems on the first day of the workshop (see Part 2 of this report).

In summing up the outcomes of the study visit, Marc LANGE of EHTEL thanked warmly both ISMETT and UPMC for hosting the two days. Simona ABBRO, on UPMC’s behalf, added how pleased she was to have had the two associations (AIM and EHTEL) visit the hospital site and show their interest in ISMETT’s work. It is strongly anticipated that these kinds of visits will form part of all the on-going work on EU-US involvement in innovative ecosystems.

47 http://www.consilium.europa.eu/en/council-eu/presidency-council-eu/

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Study Visit Organisers:

EHTEL – European Health Telematics Association 49/51, rue de Trèves, B-1040 Brussels, Belgium

Tel: +32 2 230 15 34 Web: www.ehtel.eu To register: Send Email to registration@ehtel.eu

Study visit facilitated by www.ehtelconnect.eu

Monday, 26 September 2016, 13:30 – 18:30 ISMETT Hospital, Via Ernesto Tricomi 5, 90127 Palermo

Meeting Room ACR (Main Building)

13:30 – 14:00 Welcome with Sandwich Lunch

14:00 – 14:15 Welcome by the Host and the Organisers: Opportunities of the Study Visit Simona Abbro, UPMC Italy and EHTEL Vice-President

John Crawford, EHTEL President and IBM Healthcare Leader, Europe

14:15 – 15:00 Integrated Care in Southern Italy: Strategy, Service Positioning and Digital Use Cases Facilitator: Giovanni Vizzini, ISMETT, Palermo, Italy

14:15 – 14:30 Welcome by the Healthcare Commissioner of the Region of Sicily and by the ISMETT Director

Baldassarre Gucciardi, Healthcare Commissioner of the Region of Sicily, Palermo, Italy

Angelo Luca, Director of ISMETT-IRCCS, Palermo, Italy

14:30 – 14:55 Impact of Healthcare Innovation – Clinical Benefits of Digital Services Guido Iaccarino, EIP on AHA Reference Site, Federico II Hospital, Naples, Italy

15:00 – 15:20 Tour on ISMETT Hospital Premises and Telemedicine Service Centre Introduction to Digital Services in the Portfolio of ISMETT Giovanni Vizzini MD, ISMETT & UPMC Pittsburgh

15:20 – 16:25 UPMC enabled Digital Services at ISMETT – Telemedicine Service Centre

15:20 – 15:35 Tele-ICU - Tele-consultation for Networking Intensive Care Units Gaetano Burgio MD, ISMETT & UPMC Pittsburgh

15:35 – 15:50 Telepathology in Support of Integrated Transplantation Care and beyond Rosa Liotta MD, ISMETT & UPMC Pittsburgh

15:50 – 16:05 Teleradiology Services for Southern Italy and beyond Roberto Miraglia MD, ISMETT & UPMC Pittsburgh

16:05 – 16:20 Integrated Home Monitoring Giovanni Vizzini MD, ISMETT & UPMC Pittsburgh

16:25 – 16:40 Networking and preparing for Webinar in Meeting Room ARC

16:45 – 18:15 Public Webinar: Global Panel on EU-US-MoU Collaboration & Innovation Ecosystems Facilitator: Stephan Schug, EHTEL, Brussels, Belgium (on site with audience) Webinar URL: https://attendee.gotowebinar.com/register/128267204828350978

16:45 – 17:00 Work-Streams of the EU-US-MoU as Enablers for Innovation in Digital Health Gerald Cultot, Policy Officer, DG Connect, European Commission (on site with audience)

17:00 – 17:25 Mission and milestones of the Innovation Ecosystems Work-stream in the EU-US MoU Stephen Konya, Senior Innovation Strategist, DHHS/ONC-HIT, Washington DC, USA Matthew Hein, International Trade Specialist, DOC/International Trade Association, USA

17:25 – 17:45 Innovating across Continents – Providing Telepresence to Sicily from the US Andrew Watson MD, Chief Medical Information Officer, UPMC International, Pittsburgh, USA

17:45 – 18:15 Q & A on Innovation Ecosystems and other Work streams of EU-US MoU

18:30 Mini-Bus Transfer to Hotels 20:30 EHTELconnect Study Visit Dinner Restaurant Sanlorenzo Mercato

Via San Lorenzo 288, 90146 Palermo

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Study Visit Organisers:

EHTEL – European Health Telematics Association 49/51, rue de Trèves, B-1040 Brussels, Belgium

Tel: +32 2 230 15 34 Web: www.ehtel.eu To register: Send Email to registration@ehtel.eu

Study visit facilitated by www.ehtelconnect.eu

Tuesday, 27 September 2016, 09:00 – 13:30

ISMETT-UPMC Office, Via Discesa Dei Giudici 4, 90133 Palermo Meeting Room, floor 2

08:30 – 09:00 Welcome Coffee and Networking

09:00 – 10:15 Integrated Care in Europe & Italy: Innovation and Regional Networking Facilitator: Simona Abbro UPMC Italy

09:00 – 09:20 Enabling Integrated Care for All in Europe Sevala Malkic, Policy Officer, European Commission, DG Santé

09:20 – 09:40 EU in Support of Integrated Care and Networks for Innovation Marc Lange, EHTEL

09:40 – 10:00 Innovations in Health and Care - Lessons learned in Calabria and Campania Mariangela Contenti, Federsanità ANCI

10:00 – 10:15 Round Table on Transforming for Integrated Care in Europe and its Regions All Speakers

10:15 – 10:40 Coffee Break

10:40 – 12:00 UPMC enabled Integrated Care and Digital Services at ISMETT Facilitator: Deb Salava, VP UPMC International

10:40 – 11:00 Introduction to Digital Service Use Cases in the portfolio of ISMETT and UPMC Deb Salava, VP UPMC International / Wissam Ismail, CIO ISMETT

11:00 – 11:20 Second Generation EMR at ISMETT Giuseppe Caruana, IT Manager at ISMETT/UPMC

11:20 – 11:40 Integrated Telemedicine in Paediatrics Antonio Arcadipane MD, ISMETT & UPMC

11:40 – 12:00 Q & A on Demonstrations

12:00 – 13:30 Transforming Health and Care in the Euro-Mediterranean Area Facilitator: John Crawford, EHTEL

12:00 – 12:20 Croatian eHealth Services Infrastructure – a Platform for Health Care Innovation Ozren Pezo, Health Insurance Fund of Croatia, Zagreb

12:20 – 12:40 Health Care Innovation in the National Telemedicine Network for the Aegean Islands Lambis Platsis, 2nd Regional Health Authority of Greece, Piraeus

12:40 – 13:00 Digital Transformation towards Integrated Health and Social Care in the Region of Veneto Antonella Forestiero, Arsenal.IT, Treviso, Region of Veneto, Italy

13:00 – 13:30 Wrap-up: Future of Health and Social Care in the Euro-Mediterranean Area All Speakers - Audience

13:30 – 14:30 Closing Networking with Farewell Sandwich Lunch