1. E-prescriptions Healthcare card system Italy
Session 12: «e-services for all»
First time-slot: in depth workshop
Healthcare card system
E-prescriptions
Italy
Antonietta Cavallo - Manager “Tessera Sanitaria” project
15th May 2017

2. Healthcare card system (“Tessera Sanitaria” System)
Built in 2003 (art. 50 DL 269/2003), implemented by MEF (in accordance with the Italian Ministry of Health )
Goal: strengthening national, regional and local instruments for the governance of public health spending
Monitoring the prescriptive appropriateness either in pharmaceutical and specialistic field
How:
«Tessera Sanitaria» (electronic health card) is given to each citizen (access to online services) and provides unique identification
Regional system implementation: online networking of all prescribers and all public and private health facilities nationwide (pharmacies, local health authorities, hospitals, clinics, laboratory)

3. Interconnection and Interoperability

4. Project Background starting point (2003)
Standardisation
Registries
Interconnection
Interoperability
Regions Investments
Infrastructures
CF-Unique code

5. + “Tessera Sanitaria” System - TS
The STS harmonizes the regional systems (database and software) according to the local peculiarity. This was the major problem encountered
Additional regional laws about health and payment
National laws about health and payment
national registry

6. “Tessera Sanitaria” System - TS
The STS harmonizes and standardizes the following regional informations:
Patients registry
Doctors registry
Pharmacies registry
Hospitals and laboratories registry
Paper recipies registry
System users registry
Exemption codes registry
Prescription codes registry
At the beginning of STS System:
4 Regions already had their own IT health system
8 Regions started to buid their own IT health system
9 Regions do not have any own IT health system
Regional, digital and organisational divide
national registry

7. “Tessera Sanitaria” System
Patient identification (tax code)
E-prescription and medical e-certificates
EHR
Ticket control
Private health expenditure
Electronic Health Record

8. “Tessera Sanitaria” System
Initial phase of the system (from 2003)
Registry (facilities, coding, prescriptions, etc), based on NSIS standards
Alignment of the citizen registry with the national fiscal code registry
«Tessera Sanitaria» (electronic health card) is given to each citizen (access to online services) and provides unique identification
Pharmaceutical and specialistic prescription (from 2009)
Precise verification of the exemption for income (from 2011)
Electronic prescription (from 2012)
dematerialisation of paper prescription (from 2013)

9. “Tessera Sanitaria”: patient identification
on-line service access
TEAM (european insurance card)
100% population
60mln
CF – unique code
ANPR
ANA
national registry

10. E-prescription: Actors involved (1/3)
Since 2009!!!
prescription
(100% prescribers)
Drugs and medical
services supply
(100% pharmacies
health facilities)
800 millions prescriptions/yr
regions
ASL
Local health authorities
Ministry of health (NSIS)
AIFA – Italian drug agency
national registry

11. 4 – E-prescription: why is it an innovative service?
Since 2016
+ Control strengthening heath expenditure
+ Prescriptive appropriateness
national registry

12. E- Prescription (3/3) Pharmaceutical: 92% paperless prescription
Specialistic:
50% paperless prescription
Nearing completion
From march 1st 2016
Italian patients can spend pharmaceutical prescription nationwide
national registry

13. Income exemption control (ticket)
Patient
ASL
Ticket recovery
control
march
Self-certified exemption
Income exemption patient registry
ASL DOCTOR
PRESCRIPTION WITH EXEMPTION
national registry

14. Private health expenditure
Since 2015!!!
doctors
Drugs and medical services
Electronic precompiled tax record
Since 2017 Patient checks on-line his own private health expenditures !!!!!
national registry

15. E-Health record (EHR) – Italian Interoperability Infrastructure
The 2017 Budget Act provides for the acceleration of the realization of the FSE (National EHR).
HOW: entrusting MEF the realization of the National Interoperability Infrastructure (INI) between the regional FSE
using the existing infrastructure of the Tessera Sanitaria System (TS System)

16. FSE – National Interoperability Infrastructure (INI)
1/3
FSE interoperability
INI
FSE-INI regional subsidiarity
TS system infrastructure
national registry

17. FSE – National Interoperability Infrastructure (INI)
2/3
FSE
region
FSE
region
FSE-UE
Interoperability
Interoperability
Consent
Interoperability
INI
Metadata insert
Metadata search
Metadata retrieval
Patient Identification and consent verification
Consent - revocation registry
death TS
System
ANA
national registry

18. FSE – National Interoperability Infrastructure (INI) subsidiarity
3/3
FSE-INI
region
Interoperability
FSE-INI
region
Interoperability
Within
31/3/2017
FSE-INI
region
Interoperability
FSE-INI
region
Interoperability
FSE-INI
region
Interoperability
Interoperability
INI
FSE nationwide
By 2017
national registry

19. Thank You
Antonietta Cavallo