Title: The eHealth National Plan: interoperability in practice Department for Innovation and Technologies P
1The eHealth National Plan interoperability in
practiceDepartment for Innovation and
TechnologiesPresidency of the Council of
MinistersPaolo DonzelliDirector General,
Research and digital innovation projects
2Department for innovation and technologies
- The Minister for Reforms and Innovation of the
Public Administration is delegated by the Prime
Minister with the responsibility of coordinating
and encouraging governmental policies in
innovation and ICT - The Department for Innovation and Technologies of
the Presidency of the Council of Ministers has
been established in 2001 to implement the
Ministers innovation policy
3Outline
- The context
- The eHealth National Plan
- A new governance for eHealth
- Regional eHealth projects
- Focus on two main projects
4The Context
- Regional governments (21!) are responsible for
healthcare services delivery - Central government must ensure standard quality
levels and interoperability of solutions
5The eHealth National Plan
- In 2005, the Department for Innovation and
Technologies and the Ministry of Health launched
the eHealth National Plan, with - An initial budget (2005-2007) of 110 Million
- (70 M Central Government 30 M Regions)
- The creation of a new governance for eHealth with
the introduction of a Permanent National Board
for eHealth focussing on ICT harmonization
6The eHealth National Plan basic principles
- The Plan evolves around two main lines of action
- Establish a close central - local cooperation
- by introducing a new governance model to ensure a
strong political commitment and foster
interoperability - Inject innovation within healthcare services
- by focussing on organizational innovation
- by launching innovative regional projects with
high commonality, interoperability and
reusability of solutions
drive
learn
7The new Governance for eHealth - overview
The new entity!
National Health Steering Board
Permanent National Board for eHealth
Department for Innovation and Technologies
(Coordination)
Ministry of Health (Coordination)
Regions Local Authorities representatives
Semantic Interoperability Working Groups
Technical Interoperability Working Groups
- Focus on
- Harmonization of ICT solutions for achieving
interoperability and cooperation - www.sanitaelettronica.gov.it
- Focus on
- Harmonization of semantic encoding for a better
management of the National Health Information
System
8The eHealth Infrastructure architecture
- In March 2006, the Permanent National Board for
eHealth released the Architectural strategy for
e-Health, defining the architecture for the
National eHealth Infrastructure. - The overall system is based on
- A federated structure built on top of the
eGovernment network - A distributed knowledge mechanism to handle
citizens clinical history
9Regional eHealth Projects overview
Oncology Excellence Centers Network
Home care solutions
eSkills for health operators
CIP-LSP eHealth
Health operators e-signature
E-booking systems
Online services for GPs (V-EHR)
eGovernment Network
10Regional Projects - geographical distribution
- e-Signature
- Oncology excellence centers network
- GPs Network
- eLearning
- e-Signature
- e-Signature
- EHR
- GPs Network
- GPs Network
- e-Signature
- Oncology excellence centers network
- GPs Network
- e-Signature
- Oncology excellence centers network
- GPs Network
- e-Signature
- eLearning
11Brief overview of two of the main projects
Oncology Excellence Centers Network
Home care solutions
eSkills for health operators
CIP-LSP eHealth
Health operators e-signature
E-booking systems
Online services for GPs (V-EHR)
eGovernment Network
- They provide examples of different mix of
bottom-up/top-down implementation strategies - to capture needs, experiences, knowledge of local
territories (users, industry, local authorities) - to ensure economies of scale and interoperability
12Online services for GPs goals and scope
- Project Goals
- increase knowledge sharing among healthcare
operators - increase efficiency of service delivery
- create a national electronic health record
(V-EHR) - Scope
- 7 regions more than 50.000 GPs and 15 millions
citizens - Key services and components
- E-prescription (medication/ examination)
- E-booking
- Electronic Diagnostic orders and reports
- Electronic Hospital discharge summaries
- V-EHR (Emergency Data Set - Patient summary -
Medication record)
13Online services for GPs example scenario
14Online services for GPs implementation strategy
Project replicated over different regions to
support local innovation capabilities, while
ensuring exchange of solutions and
interoperability
- Main requirements, high-level architecture and
standards defined at central level - Procurement procedures and implementation managed
at local level (involving local healthcare
providers and IT vendors) - Centralized support to compare and harmonize
emerging solutions - fix errors, improve implementations
- extract reusable components
- V-EHR as an Open Source component (community
provided by developers and users) - Library of service models
OSS competence center within the eGov National
Authority
15V-EHR general framework (1)
- The V-EHR is based on IBIS Health data
info-broker - IBIS is a distributed registry, based on ebXML
metamodel v. 3.0 (ebRIM) to guarantee high
flexibility and extensibility - IBIS allows retrieval of digitally signed
clinical documents to - citizens
- authorized healthcare operators (GPs, ER)
- IBIS is placed on top of the eGov network (web
services based Italian Public Administration
network)
16V-EHR general framework (2)
17V-EHR e-prescription creation and registration
- Document Loading A specialist generates an
e-prescription in his production system and loads
it in the repository of his clinic
(loadDocument). - Document Registration the repository sends a
notification (registerDocument) to the Access
Gateway (and to IBIS) about the generated
e-prescription that will be included in IBIS. - Clinical document notification IBIS via the
Access Gateway, through a publishsubscribe
mechanism, notifies (notifyNewDocument) the
authorized users (subscriber, e.g. GP) about the
generation of the e-prescription by providing a
reference to the event - Document selection the GP, who received a
notification through his clinical records
software or through a web interface, selects the
notified document (selectDocument). - Document request retrieval the GP asks the
repository for the document (getDocument) and
retrieves the document from the repository
(retrieveDocument).
18eBooking goals and scope
- Project Goals
- allow for an efficient use of healthcare
resources - reduce waiting lists
- feed the central local government DSS
- Scope
- 5 regions more than 8 millions citizens
- Key services and components
- Inter-regional e-booking system
- Intra-regional e-booking system
- Mobility and waiting time data collection system
19e-Booking main services
E-booking
Feels sick and has an e-prescription
Business rules
E-booking
E-Booking orchestrator system
Region1 Local e-booking system
Region2 Local e-booking system
20E-Booking implementation strategy
The project is a joint effort of five regions,
each of which develops a piece of the puzzle.
Main steps
- Main requirements, high-level architecture and
project plan defined at central level - Each region is responsible for a part of the
project requirements analysis data warehouse
structure low-level architecture local
e-booking implementation orchestrator
implementation. - Procurement procedures and development managed at
local level (involving local healthcare providers
and IT vendors) - Centralized support to extract reusable
components - Local e-booking system as an Open Source
component (community provided by developers and
users)
21Conclusions
- The eHealth National Plan has been designed to
- Create of a new high governance for eHealth
- Adopt a balanced combination of bottom-up and
top-down implementation strategies - Improve quality of demand (by aggregation and
cooperation) - Enhance quality of ICT industry offer (drive
towards innovation)