Insie l 1 Overcoming data protection issues for the development of a regional card service system Experience of Friuli Venezia Giulia Autonomous Region Italy Department of International and European Community Relations of the Presidency Regional Ministry ICT Health, Welfare and ICT Area Overcoming Legal Challengesto eHEalth-Clinical Data Access AER Network Seminar 25 september 2008, Luzern

Insie l 2 Italian Legal Contex I° Legislative decree n.196 of 30-june-03 “code on personal data security” that orders on management of citizen/patient data II°Legislative Decree n. 82 of 07-march-05 (and following modifications) “digital administration code” that orders to Public Administration on digital management of data mentioned in Legislative Decree n. 196 of 30-june-2003

Insie l 3 Italian legal context I° Legislative Decree n. 196 of 30-june-2003: “code on personal data security” Aims –Guarantee for recognition of citizen right on own personal data –To discipline the “treatment” –To avoid that the treatment takes place against citizen’s will

Insie l 4 Health data: –are confidentiality data –treatmnet needs written consensus –the health providers can management health data patient, if patient signs assent Italian legal context I°

Insie l 5 “Digital Administration Code” Aims to order public administration processes through information technology between public administrations and public administration and citizens/user Italian legal context II°

Insie l 6 national service card: document on information device, thar allows to access on line to services of Public Administration citizens and enterprises rights (section II) Right of use Information Technology Citizens and enterprise have rights to ask and obtain of use Information Technology to communicate with public administrations and provider of public service, within limits of code. The rule is applied to regional and local administrations within limits of technologies and organizational resourses and in according to their own legislative. Italian legal context II° Codice dell’amministrazione digitale

Insie l 7 eHealth–FVG pathway Duties and life improvement Duties to guarantee protection of health data citizen to allow citizen to consult on line own data life improvement Life improvement of citizen is the outcome of combination of law duties and Information technology

Insie l 8 Friuli Venezia Giulia Region 7846 square kilometres inhabitants GDP Euro 26,7 billions Approximately 25% over 64 years old More than 75% with at least one chronic disease

Insie l 9 eHealth – FVG model Italian Health Service is a “universalistic model”, with regional jurisdiction and in Friuli Venezia Giulia Autonomous Region there is financial autonomy FVGAR INFORMATION SYSTEM is unique and totally integrated in the Public Administration (Regional Information System) included Regional Social Health Information System (RSHIS) Territorial health structures involved for citizens: 6 Local health agencies(ASL: hospitals and local health centers) 2 Univerity Clinical Centers 1 General Hospital 3 National Research institute (IRCCS) Regional central structure with coordination role Regional Health Agency (RHA) Common Service Centre (CSC) Development and management SISSR are arranged, according to RHP, by a triennial information health plane and a yearly operative plane. The management planes are assigned to technological regional partner

Insie l 10 Hospital Information System (SIO) Admission (ADT), First Aid, Ambulatories Services (operative theatre, laboratori and radiology) Hospital division and stay in hospital Clinical and Nursing file Territorial System GPs/Pediatricians, Pharmacy Consulting-room Mental Health division (DSM) Integrated Domiciliary Aid (ADI) Booking System, 118 Social System Social File Pai, Pei Aid Domiciliary Services (SAD) Front-End Administration System Human resourses Bids and purchases, Orders Warehouses Distribution, Requests, Purchases Manager Government system ETL, Datawarehouse Data mining (BO), Pharmacy Analytics, Activities (DRG, Services, waiting time,…) Support Systems Electronic Signature Electronic documents back-up Management documents Systems National Services Card CNS Health Operator Card eHealth – FVG model

Insie l 11 eHealth–FVG experience “life improvement ” “ Regional Service Card ” Project

Insie l 12 The Regional Card Project is the outcome of an institutional agreement between Friuli Venezia Giulia Region and Internal Revenue Service: Health Cards are distributed by Internal Revenue Service (IRS) in accordance to Friuli Venezia Giulia Region; Health card is complying to National Service Card specification; eHealth–FVG experience

Insie l 13 eHealth–FVG experience Health Card TEAM (Tessera Europea di Assicurazione Malattia) Tax Code the national validity is immediately available (HC, EHCI, FCN), citizens don’t have to do anything, just put the card in their wallet. Aim A single card acts as a multipurpose tool to access on line public services.

Insie l 14 Micro Chip Tax Code Name, Surname, City and date of born Regional Logo National Health Card and multi service regional card Validity Name, Surname and date of born Tax Code Health Insurance Code and validity Europe insurance Health card eHealth–FVG experience

Insie l 15 eHealth – FVG experience Each citizen resident in Friuli Venezia Giulia Region has own Smart Card (Regional Service Card) In order to use Regional Card to access on line services, it is necessary to activate it. –The start up requires the following steps: Citizen goes to front-end and shows his regional card and identity card. Employee checks validity of citizen’s cards and gives him a document to be signed for: –Start up card request –Authorization to use health data –GP Authorization to consult health personal data Citizen receives at home PIN and PUK Citizen accesses on line services by internet portal

Insie l 16 MARIO ROSSI VIA ITALIA, TRIESTE MARIO ROSSI

Insie l 17 eHealth – FVG experience and not transferableall health data are contained in database of the regional health structures, hedged in and not transferable Internet Portal has been developed as point of access to health data: –Citizen is identified by Regional Service Card –Citizen inserts PIN to access own data

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Insie l 19 Authorization Management

Insie l 20 Examination list

Insie l 21 eHealth–FVG experience Health services on line for citizens: Log in Internet Portale RSC (pin code) Access to: –Health personal data –Own exemptions –GP’s data –Vaccination list –Booking stored list –Booking list ongoing Self-declaration to obtain exemption for age or low income Change GP Print paper copy of own Health Card Payment Sending selfmonitoring data to GP Regional pharmaceutical care Authorization management Hospitalization data Homecare nursing stored list Other health online services are in working: Result on line Booking

Insie l 22 Department of International and European Community Relations of the Presidency: President dr. Renzo Tondo Regional Ministry of ICT: Regional Minister dr. Elio De Anna Health, Welfare and ICT Area: director dr. Roberto Panizzo Regional Ministry of Health and Social Care: Regional Minister prof.Vladimir Kosic INSIEL S.p.A: General Director and CEO dr. Dino Cozzi Contacts Tel ; Web site: