Project - IHE Austria

IHE in Veneto Region
Claudio Saccavini
Technical Manager Arsenal.IT
© 2012 Arsenàl.IT – Tutti i diritti riservati
1
Agenda
Could it be strategic decision the use
of IHE approach for deploying eHealth
regional projects (e.g. RHIOs, HIE,
EHR)?
© 2012 Arsenàl.IT – Tutti i diritti riservati
Veneto Region & Arsenàl.IT
21 Local Health Authorities
• 4,9 M inhabitants (2013 data)
• 18.391 km2 of land surface
•
•
•
Healthcare assistance
(Hospitals)
Territorial
assistance
and social issues (GPs,
outpatients’
clinics,
elderly care, in-home
assistance,
mental
health, disability, drug
addiction, ecc…)
Prevention department
2 Hospital Trusts
•
•
3
University
education
and research
High-specialty services
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The Consortium Arsenàl.IT:
Veneto’s Research Center for eHealth Innovation
Founded in 2005 as “Telemedicine
Consortium”, currently groups all the 23
Local Health Authorities afferent to the
Veneto Region.
Has succeeded in highlighting the critical
issues of interoperability, standardization
and organizational impact as key factors
for driving Telemedicine applications to
the mainstream of the care delivery
process.
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HIMSS
HIMSS - Healthcare Information Management and
Systems Society – is a global, cause-based, not-forprofit organization focused on better health through
information technology (IT). HIMSS leads efforts to
optimize health engagements and care outcomes
using information technology.
HIMSS mission : Globally, lead endeavors optimizing
health engagements and care outcomes through
information technology
© 2012 Arsenàl.IT – Tutti i diritti riservati
HIMSS assessment
The EMRAM (Electronic Medical Record
Adoption Model) is an eight-step process that
allows you to analyze your organization’s
level of EMR adoption, chart your
accomplishments, and track your progress
against other healthcare organizations across
the country. View and compare your scores
in the HIMSS Analytics® Database.
© 2012 Arsenàl.IT – Tutti i diritti riservati
EMRAM
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Veneto Region Hospital EMRAM
EMRAM Score Regione Veneto vs stru ure ospedaliere
italiane ed europee
Eueuropee
Hospitals
Stru ure ospedaliere
(1144)
1,9526
Italy italiane
Hospitals
Stru ure ospedaliere
(392)
1,6101
RegioneHospitals
Veneto (22)
Veneto
2,8636
0
1
2
3
4
5
6
7
© 2012 Arsenàl.IT – Tutti i diritti riservati
BIG projects or SMALL projects?
(profiles)
 HEALTH OPTIMUM European Project – European Telemedicine
Project aimed to diffuse and pilot-test some telemedicine
services (2007-2009)
 VENETO ESCAPE - giving to patient and to healthcare
professional the possibility to obtain digitally signed electronic
medical reports (2009-2012)
 Doge: the GPs Network - Regional project aimed to set up a
network of services for information and document exchange
between GPs, Hospitals and LHAs (2009-2010)
 RENEWING HEALTH - validation in real life settings and
with a common assessment methodology of the use of
Personal Health Systems for innovative Telemedicine
services (2009-2012)
9
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HEALTH OPTIMUM: HEALTHcare Delivery OPTIMisation throUgh
teleMedicine: European telemedicine Project aimed to support
different specialties thanks to the application of Telemedicine.
 Phase 1: Market Validation Phase ( 2004 – 2006)
 11 healthcare Providers in Veneto Region
 3 European Member States: Italy, Spain, Denmark
 Phase 2: Initial Deployment Phase (2007 – 2009)
 Purpose: deploy organizational models based on
telemedicine
 all the 23 healthcare Authorities of Veneto Region
 5 European States: Italy, Spain, Denmark, Sweden, Romania
 Services: Telecounselling service for neurosurgery,
Telelaboratory, Ischemic Stroke management, Oral
Anticoagulation Therapy (OAT) management
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The federative approach
XDS Registry
Provincial area of
Vicenza
Provincial area of
Belluno
XDS
Repository
Provincial
area of
Padova
Provincial
area of
Treviso
Provincial
area of
Venezia
Provincial area of
Verona
1
1
Provincial area of
Rovigo
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Project results: telecounselling service for neurosurgery
Project Results
Quantitative indicators
results
Target EU
% of success
Consultations performed
4.217
2.000
210,9 %
3.379 - 80,13 %
60 %
133,6 %
TAC/RX connected
47
21
233,8 %
Requesting units
58
17
341,2 %
Number of operators involved
736
115
640,0 %
Avoided transfers
Volumes
Avoided patient transfers
Patient transfers after tele-consultation
Source: HO Project Coordination Group, 2009
Period: June 2007 – August 2009
Data for the period June 2009 – August 2010 are being collected
© 2012 Arsenàl.IT – Tutti i diritti riservati
ischemic stroke management
 In the wake of
an organizational model to:
Project, Arsenàl.IT studied
o evaluate stroke on patients through a telecounselling system
o allow the administration of thrombolysis therapy at a
peripheral hospital avoiding the patient transfer
 The key purposes:
o increase the number of patients treated
with thrombolysis within 3 hours from the
beginning of symptoms
o decrease the number of deaths and
disabilities
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IHE Profiles and Veneto RHIO
Profile
Use
XDS
Sharing teleconselling docs
XDS-I
Sharing CT Images
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Veneto ESCAPE
Project services
ESCAPE: Electronic Signature in Care Activities for Paper Elimination
Local Health Authority
Citizens
Certification
Authority
Digital
Signature
Diagnostic Services
producing Clinical
Reports
Home
PC
Archiviation
Mail
Service
Extraction
GPs
Distribution
Hospital wards &
Internal Services
1
5
Territorial
Service
Providers
© 2012 Arsenàl.IT – Tutti i diritti riservati
IHE Profiles and Veneto RHIO
Profile
Use
XDS
Sharing teleconselling docs, lab reports
XDS-I
Sharing CT Images
XD-LAB
Lab report structure
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Project’s goal: develop a network of services for the exchange of
clinical data and documents between the different actors of the
care process (LHAs, GPs, Paediatricians, etc…)
Actors involved
 Regional Health Information System
 LHAs’ Health Information Systems
 Primary Care actors
 Citizens
Veneto Region
LHAs
Health Information
Systems
Project Services
 Patient demographic services
 Clinical Documents
 ePrescription
 Privacy & patient informed consent
Citizens
Primary care
actors
© 2012 Arsenàl.IT – Tutti i diritti riservati
IHE Profiles and Veneto RHIO
Profile
Use
XDS
Sharing teleconselling docs, lab reports,
ePrescription, eReferral
XDS-I
Sharing CT Images
XD-LAB
Lab report structure
EUA/XUA
User security
ATNA
Connection security, audit
XDW
Workflow management
XBeR-WD
eReferral workflow
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RENEWING HEALTH
in a nutshell
 A Large Scale Pilot project co-funded by
EU (CIP ICT-PSP)
and 9 regions with 3 European NGOs
 Project start date: 1st of February 2010
 Project duration: 32 months
 Total budget: 14.000.000 Euros
 EU contribution: 7.000.000 Euros
 26 pilot sites, grouped in 9 clusters and
distributed over 9 EU regions
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Objectives
 Clinical objectives
 improving the quality of life of chronic patients suffering
from diabete, COPD and CVD and who account for
well over 15% of the EU adult population by
 removing anxiety about health conditions
 reducing the need for the patient to use emergency
services and/or hospital stays
 avoiding and/or slowing down the worsening of their
disease and the insurgence of complications
 providing clinical evidence that a telemedicine-based
delivery network can supply healthcare services with an
appropriate level in clinical quality and reliability
© 2012 Arsenàl.IT – Tutti i diritti riservati
REgioNs of Europe WorkINg
toGether for HEALTH
NORWAY
SWEDEN FINLAND
CIP ICT PSP Pilot A: 2010-2012
Budget : 14.000.000 €
DENMARK
Partners : 9 Regions
GERMANY
AUSTRIA
SPAIN
ITALY
GREECE
© 2012 Arsenàl.IT – Tutti i diritti riservati
From Telecare to Telemedicine
Hospital or Local
Health District
Patient’s home
Telemonitorin
g devices
2
Regional eHealth
Centre
3
1
General
Practitioner
Gateway
7
4
Patient
6
5
Alarm device
Regional Centre’s
Operator
Social worker
Family
Data transmission
Data access through Home Care portal
Alarm management
Contact with the patient
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IHE Profiles and Veneto RHIO
Profile
Use
XDS
Sharing teleconselling docs, lab reports,
ePrescription, eReferral, telehomemonitoring
summaries
XDS-I
Sharing CT Images
XD-LAB
Lab report structure
EUA/XUA
User security
ATNA
Connection security, audit
XDW
Workflow management
XBeR-WD
eReferral workflow
XTHM-WD
Telehomemonitoring workflow
© 2012 Arsenàl.IT – Tutti i diritti riservati
Veneto Region RHIO (FSER)
REgioNs of Europe WorkINg
toGether for HEALTH
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The DOGE Project (2010-2012)
General Practitioner Network
Regional project to create a communication network
and connect GP and Primary Care sites to the hospital
and Local Health Authority.
ACTORS:
• Regional information
system
• Information System of
Local Health Authorities
• GP
• Personal EHR
VENETO REGION
HIS Hospital
Information System
CITIZEN
EHR
GP and
PRIMARY CARE
© 2012 Arsenàl.IT – Tutti i diritti riservati
Pitfalls and results
 Arsenal’s role was only to write specs
 Specs too technical not Use Case oriented
 No relation management between
different vendors during implementation
Result: ONE framework with SIX dialects
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New National ePrescription Project
 Very short time to deploying the entire
project
 National specs NOT standard oriented
 Need to have ONE implementation
oriented to Regional EHR
© 2012 Arsenàl.IT – Tutti i diritti riservati
ePrescribing Project
Legacy
National
Healthcare System
40 M prescriptions by year
XDS + XUA +ATNA+ Legacy
XDS + XUA + ATNA + Legacy
Veneto
HIE/EHR
GP (4000)
Pharmacy (1500)
© 2012 Arsenàl.IT – Tutti i diritti riservati
Project roadmap
 Technical specs & Test plan (Dec 2012 - May 2013)
 Setup gazelle platform (July 2013)
 Pre-Labeling test (August 2013 - October 2013)
 Labeling session (November 2013)
 Pre-production test (February 2014 – March 2014)
 Deploying phase (April 2014 – May 2014)
© 2012 Arsenàl.IT – Tutti i diritti riservati
Labeling results
Products
Systems
Vendors
GP EHR
14
10
Pharmacy
10
8
Total
24
18
1354 mails from vendors
168 hours for F2F labelling
3,5 FTE for T&T
58 users 3200 login
31 different test case
950 Verified Tests
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State of the art
© 2012 Arsenàl.IT – Tutti i diritti riservati
For the times they are a-changin’ *
but core business will be always the same
*
© 2012Allen
Arsenàl.IT –Zimmerman
Tutti i diritti riservati
By Robert

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