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The eHealth National Plan: interoperability in practice Department for Innovation and Technologies P

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Title: The eHealth National Plan: interoperability in practice Department for Innovation and Technologies P


1
The eHealth National Plan interoperability in
practiceDepartment for Innovation and
TechnologiesPresidency of the Council of
MinistersPaolo DonzelliDirector General,
Research and digital innovation projects
2
Department 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

3
Outline
  • The context
  • The eHealth National Plan
  • A new governance for eHealth
  • Regional eHealth projects
  • Focus on two main projects

4
The Context
  • Regional governments (21!) are responsible for
    healthcare services delivery
  • Central government must ensure standard quality
    levels and interoperability of solutions

5
The 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

6
The 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
7
The 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

8
The 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

9
Regional 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
10
Regional Projects - geographical distribution
  • e-Booking
  • e-Signature
  • e-Signature
  • Oncology excellence centers network
  • e-Signature
  • e-Booking
  • e-Signature
  • e-Booking
  • e-Signature
  • e-Signature
  • GPs Network
  • eLearning
  • e-Signature
  • e-Signature
  • EHR
  • GPs Network
  • GPs Network
  • e-Signature
  • GPs Network
  • e-Signature
  • Oncology excellence centers network
  • GPs Network
  • e-Signature
  • GPs Network
  • e-Signature
  • Oncology excellence centers network
  • GPs Network
  • GPs Network
  • e-Signature
  • eLearning

11
Brief 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

12
Online 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)

13
Online services for GPs example scenario
14
Online 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
15
V-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)

16
V-EHR general framework (2)
17
V-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).

18
eBooking 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

19
e-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
20
E-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)

21
Conclusions
  • 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)
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