eHealth addressing global challenges through local actions When Telemedicine does deliver! Wednesday, 18 th November 2010

Giancarlo Ruscitti MD CEO - Fondazione Opera S. Camillo

Background of the experience of the Veneto Region  Since 2004, the Veneto strategy of economic sustainability and innovation has meant increasing financial contraints in Human Resources, and developing policies for the allocation and most efficient use of health care personnel, empowered by the appropriate use of e-technologies;  National budget constraints have forced the Region to reallocate the health budget in order to by:  National budget constraints have forced the Region to reallocate the health budget in order to guarantee the Essential Levels of Health Care provision (LEA) to all Veneto Citizens by: 1.rationalizing and renewing the hospital network; 2.re-organizing health services in the territory; 3.investing in innovation, ICT and eProcurement;

The Veneto Region: Territory and Population 4 4,8 M inhabitants 4,8 M inhabitants km 2 of land surface km 2 of land surface Population Structure* Members per family 2.6 Birth rate 9.3 Death rate 9.0 Natural growth rate 0.3 Total growth rate 5.6 % Elderly persons % population > 65 years 18.5 % EU population>65 years As of the 2001 General Consensus * As of the 2001 General Consensus

5 The Veneto Region: Health Care Providers and Professionals 21 Local Health Authorities 21 Local Health Authorities 2 Hospital Trusts 2 Hospital Trusts PUBLIC ACCREDITED INSTITUTIONS64 IRCSS (SPECIALIST RESEARCH INSTITUTES) 1 Public health authority (Az. Osp.)2 Hospital in the Provincial capital6 Network hospital / strong integration33 Integrating hospital of the network8 Polyfunctional health centres10 Management experimentation4 PRIVATE ACCREDITED INSTITUTES14 Care homes/ hospital19 Classified hospital4 IRCSS (SPECIALIST RESEARCH INSTITUTES ) Medical & Nursing staff Medical & Nursing staff Laboratory Technician Laboratory Technician Administrative staff Administrative staff 117 Other Professionals 117 Other Professionals (* Veneto Regional Statistics Office data, 2008 )

The Veneto’s responsibility in policy-making in the Health & Social Sector Minister for Social Policies Minister for Health Policies Regional Secretary for Health & Social Services 21 Local Health Authorities 2 University Teaching Hospitals 582 Municipalities in the Veneto Region 2 Scientific Reseach Hospitals Minister for Animal Health

New challenges for Veneto Health Care Increase in EU citizens expectations; Increase in EU citizens expectations; Ageing population Ageing population Home-care in rural and mountain areas; Home-care in rural and mountain areas; Rising costs due to technological innovation; Rising costs due to technological innovation; Reduction of public health care expenditure; Reduction of public health care expenditure; Patient mobility: Tourists, Immigrants and Long term residents; Patient mobility: Tourists, Immigrants and Long term residents; Lack of health professionals (mainly pediatricians and nurses); Lack of health professionals (mainly pediatricians and nurses); Restrictions imposed in public funding by commitments towards maintaining EU stability treaties. Restrictions imposed in public funding by commitments towards maintaining EU stability treaties.

Telemedicine eHealth Projects: Observatory 8 Number of Telemedicine projects Source: “Observatory and projects on Telemedicine applications 2009”, Vol. 1/2009, Arsenàl.IT N. progetti Cumulative number of active Telemedicine projects

9 The Consortium Arsenàl.IT : Veneto’s Research Center of eHealth Innovation  Founded in 2005 as “ Telemedicine Consortium ”, currently groups together all the 23 Local Health Authorities of the Veneto Region.

The Consortium Arsenàl.IT: Veneto’s Research Center of eHealth Innovation 10  Has acted as Observatory by performing systematic surveys on Telemedicine applications developed over time by the member Health Authorities.  Has succeeded in highlighting the critical issues of interoperability, standardization and organizational impact as factors for driving to the diffusion of Telemedicine applications in care delivery process.

Telemedicine eHealth Projects: ESCAPE 11 Example in a Local Health Authority Extraction Hospital wards & Internal Services Digital Signature Forwarding Storage Certification Diagnostic Services producing Clinical Reports Mail Service GPs Home PC Territorial Service Providers Citizens Citizens’ Clinical Document Sharing

Telemedicine eHealth Projects: Doge, General Practitioners Network 12 A Regional project to create a communication network and connect general practioners and family doctors to the hospital and Local Health Authority. ACTORS : Regional information system Information system of Locl Health Authorities GP Citizens Personal EHR SHARED INFORMATION: Population data and personal data E-prescription Clinical data, documents and reports Consents (privacy) SERVICES GP(Primary Care) Care) VENETO REGION Citizens (Personal EHR) (Personal EHR) Information System LHAs

Telemedicine eHealth Projects: DREAMING & Telecare system 13

Telemedicine eHealth Projects: HEALTH OPTIMUM 14 Provincial area of Vicenza Provincial area of Belluno Provincial area of Treviso Provincial area of Venezia Provincial area of Rovigo Provincial area of Verona Provincial area of Padova XDS Repository XDS Registry

RENEWING HEALTH: The Consortium 15 GREECE FINLAND SPAIN NORWAY DENMARK ITALY AUSTRIA GERMANY SWEDEN EUROPEAN ASSOCIATIONSCOUNTRY European Patients’ Forum (EPF)Luxembourg European Health Telematics Association (EHTEL) Belgium COMPETENCE CENTERCOUNTRY Arsenàl.ITItaly Medcom InternationalDenmark Center for Distance-spanning HealthcareSweden Norwegian Center for Integrated Care and Telemedicine Norway Catalan Agency for Health Technology Assessment and Research (CAHTA) Spain VTT – Technical Research Center -Finland e-Trikala AEGreece TSB Innovationsagentur Berlin GmbHGermany ADVISORY BOARDCOUNTRY Continua Health Alliance Private Stichting (CHA) Belgium Integrating the Healthcare Enterprice (IHE) Italy, Spain, UK

RENEWING HEALTH: The expected impacts 16  Reduce hospitalisation and improve disease management  Increased links and interaction between patients and health professionals, facilitating more active participation of patients in care processes  Improvement of quality of life for patients suffering form chronic conditions  Increased use of existing or commonly agreed standards and demonstration of interoperability of the new solutions in regular healthcare practice  Provide a convincing business case to be presented to National, Regional and Local Health Authorities and to stimulate them to speed up the deployment of patient-centered eHealth service solution

Conclusions and challenges  The Veneto Region is actively involved in the area of innovation and health care reforms, with purchasing, payment systems and contracting as tools for restructuring, and in benchmarking its health care system;  eHealth development is a way of empowering the quality of human resources;  eHealth development is a way of empowering the quality of human resources;  The use of modern technologies in and out of hospital should be understood as a way of improving quality and safety for the benefit of patients.

Thanking you for your kind attention!