The Regional Health Innovation Landascape · The Regional Health Innovation Landascape “Innovation” Workshop, 30 May–1 June 2007,Potsdam ... Pronto Soccorso CUP ADT (Accettazione)

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in Basilicata RegionGiovanni De Costanzo, Carla Di Lorenzo, Giuseppina Giuzio

Basilicata Region

Department of Health, Emergency and Social policy

The The RegionalRegional

HealthHealth

InnovationInnovation

LandascapeLandascape

“Innovation” Workshop, 30 May – 1 June 2007, Potsdam

N.2Basilicata - Brief Regional Profile

595,727069,29557,075270,839198,518tot

203,0630057,075114,01231,976Matera

392,664069,2950156,827166,542Potenza

Population (absolute values)

1310113297tot

310011317Matera

1000101980Potenza

Municipalities

Totale>100,00065,001-100,000

20,001-65,000

5,000-20,000

<5,000

595,727069,29557,075270,839198,518tot

203,0630057,075114,01231,976Matera

392,664069,2950156,827166,542Potenza

Population (absolute values)

1310113297tot

310011317Matera

1000101980Potenza

Municipalities

Totale>100,00065,001-100,000

20,001-65,000

5,000-20,000

<5,000

31,35%191,960,1Population

density

3,28%301,49,90Surface

1,03%57.851.000595.727Population

Basilicata/Italy

ItalyBasilicataIndicators

31,35%191,960,1Population

density

3,28%301,49,90Surface

1,03%57.851.000595.727Population

Basilicata/Italy

ItalyBasilicataIndicators

19,93%118.40466.64951.755More than 65 age

65,61%389.781194.196195.58515-64 age

14,46%85.90141.59044.3110-14 age

% totalTotal FemaleMaleAge classes

19,93%118.40466.64951.755More than 65 age

65,61%389.781194.196195.58515-64 age

14,46%85.90141.59044.3110-14 age

% totalTotal FemaleMaleAge classes

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�� Italian National Health Service (SSN)Italian National Health Service (SSN) is a public system that is a public system that

guarantees the medical guarantees the medical assistance assistance to all the citizens without to all the citizens without

distinctions of gender, residence, age, income, job and religiondistinctions of gender, residence, age, income, job and religion..

�� The health services is managed at different government levels The health services is managed at different government levels

–– Central LevelCentral Level

–– Regional LevelRegional Level

�� FinancingFinancingTThe National Health Service is funded mainly through tax payers. he National Health Service is funded mainly through tax payers.

Moreover, the Moreover, the ASLsASLs (local authority health services) obtain funding (local authority health services) obtain funding

from patients’ contributions and from some of the nonfrom patients’ contributions and from some of the non--free services free services

they offer.they offer.

The Basilicata Region Health Fund for year 2007, The Basilicata Region Health Fund for year 2007,

is ca is ca €€ 949,573,646 which represents 1,12% of 949,573,646 which represents 1,12% of

the National Health Fund.the National Health Fund.

The National Health System

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�� RegionalRegional healthhealth care care institutionsinstitutions::

– 5 AUSL, 2 A.O., 7 public hospitals and 1 private hospital with a total number of

2,272 beds for acute recoveries (15% DH) and with total number of hospitalized

patients 112,352 (34% DH) in 2006.

�� WorkersWorkers::

– about 10.000 including personnel employed directly by the regional HS and

the national health service.

�� Economic importanceEconomic importance

–– The regional healthy system covers the The regional healthy system covers the 5,9% of the Gross Domestic Product5,9% of the Gross Domestic Product (it’s (it’s

the seven sector for contribution).the seven sector for contribution).

A.S. USL 5 Montalbano J.

A.S. USL 4 MateraA.S. USL 2 Potenza

98.779 inhabitants

212.057 inhabitants 123.313 inhabitants

85.672 inhabitants

A.S. USL 1 Venosa

76.143 inhabitantsA.S. USL 3 Lagonegro

The Regional Health System

N.5Basilicata – Health Innovation

The innovation components of regional health system could be divThe innovation components of regional health system could be divided ided

in two lines:in two lines:

1.1. organisational innovation whose drivers are:organisational innovation whose drivers are:

– Problem-oriented: the most significant include the increase in chronic diseases, long-term conditions and ageing populations;

– Political push: in response to the rise of chronic illness and ageing populations, the sanitary attendance has been moved from the hospital to the territory. All regions have been asked to reduce their beds for acute illness to 3.5 X 1000. This has changed the way with which the National Health fund is shared.

percentage rate of FSN for Essential Levels od Assistence (LEA)

51%

44%

5%

territory Prevention Hospital

The percentage rate of the National Health Fund assigned for services offered by the hospitals, has been reduced from 55% of 2000 to 44% of 2007.

MainMain InnovationsInnovations of the Basilicata of the Basilicata RegionRegion HealthHealth ServiceService


The innovation components of regional health system could be divThe innovation components of regional health system could be divided ided

in two lines:in two lines:

1.1. organisational innovation whose drivers are:organisational innovation whose drivers are:

– Problem-oriented: the most significant include the increase in chronic diseases, long-term conditions and ageing populations;

– Political push: in response to the rise of chronic illness and ageing populations, the sanitary attendance has been moved from the hospital to the territory. All the regions have being asked to reduce their beds for acute illness to 3,5 X 1000. It Has changed the way with which the National Health fund is shared.

2. The technological innovation which drivers are:2. The technological innovation which drivers are:

�� New Technological factors;New Technological factors;

�� Integration of health information systems (EHR/PHR);Integration of health information systems (EHR/PHR);

�� ee--health services;health services;

�� Telemedicine & eTelemedicine & e--care. care.

They often interacts between themThey often interacts between them

MainMain InnovationsInnovations of the Basilicata of the Basilicata RegionRegion HealthHealth ServiceService

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Organizational innovationOrganizational innovation

The National Health model migration from a Concentrated HospitalThe National Health model migration from a Concentrated Hospital System System

to a Distributed Territorial Systemto a Distributed Territorial System

Through the introduction of innovating structures and services aThrough the introduction of innovating structures and services as:s:

� ADI - Integrated Assistance at Home

� Health Places

� Regional Net of Palliative Care

Basilicata – Health Innovation

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The displacement of the sanitary The displacement of the sanitary assistanceassistance

Hospital

Territory


a strong a strong useuse of ICTof ICT

In Order to shift the In Order to shift the sanitary sanitary assistance assistance and to guarantee the connection between and to guarantee the connection between

Hospital and Territory, Basilicata Region is carrying out the soHospital and Territory, Basilicata Region is carrying out the so called called TelemedicineTelemedicine

project. The project aims to promote the dialogue between speciaproject. The project aims to promote the dialogue between specialist doctors and the list doctors and the

first aid team which is in charge of the caring of the patients first aid team which is in charge of the caring of the patients at home. at home.

In order to support the correct management of this new service aIn order to support the correct management of this new service and organisational nd organisational

model, a model, a new software new software has been developed. This facilitates the activities technology has been developed. This facilitates the activities technology

management and points out important indicators which help Basilimanagement and points out important indicators which help Basilicata Region to cata Region to

better program its future implementationsbetter program its future implementations

OrganizationalOrganizational innovationinnovation


� Infrastructural context

InnovationInnovation connectedconnected withwith ICTICT

Basilicata WANBasilicata WAN

((Wide Area Networks)Wide Area Networks)

LinkLink in in opticaloptical fiberfiber

betweenbetween

regionalregional HospitalsHospitals

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MMGRadiology

reports

terapy

Visita Specialistica

pharmacyHospital

Hospital


Servizi

Refertazione

Laboratorio

Reparto

Accesso

Utente

Pronto Soccorso

CUP

ADT(Accettazione)

GestoreRepository

Amministrativo

GestoreRepository

Clinico

Fascicolo clinico

ADT(Dimissione /

Trasferimento)

Repository Clinico

Cassa

Repository Amministrativo

Sistema di reporting

�� Infrastructural contextInfrastructural context

� The Basilicata region’s health information system


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�� Infrastructural contextInfrastructural context

�� The Basilicata region’s health information system The Basilicata region’s health information system

� E-health

Ospedale Periferico

MMG, Guardia Medica e ADI

Centro Ospedaliero di eccellenza

ReteRegionale

Casa Paziente

GPRS

Ospedale Periferico

MMG, Guardia Medica e ADIMMG, Guardia Medica e ADI

Centro Ospedaliero di eccellenza

ReteRegionale

Casa Paziente

GPRS

A B

C

TelemedicineServices of e-health on the Basilicata Region web site



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CASE STUDYCASE STUDY

BASILICATA REGIONBASILICATA REGION

Telemedicine Telemedicine forfor IMAIMA

Basilicata – Case study

RealizationsRealizations ICTICT

Technological innovation

technologicaltechnological componentcomponent ICT + ICT + organizationalorganizational componentcomponent

RealizationsRealizations

executivelyexecutively““Connection territoryConnection territory--hospital for hospital for

management of the management of the cardiologicalcardiological emergencyemergency

in course of acute infarct of the myocardiumin course of acute infarct of the myocardium””

HCN-InnovationPotsdam

30 may 2007

BASILICATA REGION

N.13CASE STUDY – BASILICATA REGION: Telemedicine for IMA

The Case study has connected to the application of the The Case study has connected to the application of the

Telemedicine within the “coronary emergency”Telemedicine within the “coronary emergency”

the cardiovascular diseases represent the first cause of death ithe cardiovascular diseases represent the first cause of death in the western n the western

world (every year in Italy around 150.000 persons are struck by world (every year in Italy around 150.000 persons are struck by myocardial myocardial

attack attack –– IMA. IMA.

In Basilicata this number is around 700 and the 50% around, of pIn Basilicata this number is around 700 and the 50% around, of patients atients

stroked by IMA dies before reaching the hospital structure.stroked by IMA dies before reaching the hospital structure.

ObjectivesObjectives

“ “ Connection between Territory/Hospital for the management of the Connection between Territory/Hospital for the management of the

cardiologicalcardiological emergencies in progress of acute myocardial attackemergencies in progress of acute myocardial attack””

•• To reduce, with the help of the ICT technologies and with the inTo reduce, with the help of the ICT technologies and with the introduction troduction

of new organizational models on the territory, this percentage tof new organizational models on the territory, this percentage through hrough

the implementation of the diagnosis before reaching the hospitalthe implementation of the diagnosis before reaching the hospital..

•• To offer to the patient, struck by acute myocardial attack, a pTo offer to the patient, struck by acute myocardial attack, a prompt and rompt and

efficient treatment related to the characteristics of the patienefficient treatment related to the characteristics of the patient and the t and the

place in which the event is verified.place in which the event is verified.

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Organizational innovationOrganizational innovation

From an organizational point of view it needs:From an organizational point of view it needs:to coordinate the Coronary Care Unit (CCU) located on the territto coordinate the Coronary Care Unit (CCU) located on the territory with the ory with the

main operational unit of emergency urgency main operational unit of emergency urgency

Model HUBModel HUB--SPOKESPOKE

CASE STUDY – BASILICATA REGION: Telemedicine for IMA

regional network of coronary emergency founded on a model HUBregional network of coronary emergency founded on a model HUB--SPOKESPOKE

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From an technological point of view it needs:From an technological point of view it needs:to use the broadband connection, already present in the hospitalto use the broadband connection, already present in the hospital structures structures

and 118 (emergency service), for the transmission of the layout and 118 (emergency service), for the transmission of the layout ECG ECG

(Electrocardiogram) and for its clinical rapport (Figure 1).(Electrocardiogram) and for its clinical rapport (Figure 1).


OrganizationalOrganizational innovationinnovation

Figure 1Figure 1


RESULTSRESULTS

Improving and making the net compact and effective.Improving and making the net compact and effective.

Diminish the negative impact represented by the peculiar Diminish the negative impact represented by the peculiar

geographical features of our Region (distances, road geographical features of our Region (distances, road

conditions, mountainous, etc.).conditions, mountainous, etc.).


How does it happen?How does it happen?

1. Ambulances ( 118 - service of emergency urgency) need to be equipped with an electrocardiogram system of transmission, ECG with 12 derivations useful to transmit the layout via infrastructure WLAN of the Region. Alternatively, where the signal doesn’t reach certain areas, GSM telephone can be used : the layout transmission will get in time to the Unit dept.

Structure of the Regional CCU into a Hub & Spoke model

Spoke Hospital

118 Operational Central

Hub Hospital118

… the best reperfusion treatment in the temporal,clinical and organizational context….

Guidelines AMI STE ACC/AHA 2004


2. The operator of the 118 Unit, on the basis of an operational protocol (Figure 3), joins in conversation through the video conference system (through broadband)with the CCU Cardiologist who will get the layout and will be able to propose the possible therapy on site.

- pre-Ospedaliero118 (Telemedicina)

Conferma ECGdi STEMI

calcolodel Rischio

Basso

PROTOCOLLO OPERATIVOPROTOCOLLO OPERATIVOcl. Killip > 1

PA < 100 mmHg,

FC > 100 b/min,

età > 75 anni

↑ST≥ 6 der.

tempi della PTCAEsordio <3h

PTCA in 60’

brevi (o C.I. alla th.lisi)Esordio >3h

PTCA in 90’

lunghi

Centro HubPTCA (+/- facilitata)

TROMBOLISI(entro 30’)

farmaci (ASA, UFE)trasporto direttocontenimento dei tempi

+/- prontamente

primo contatto medico:

Alto

Figure 3

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ADVANTAGESADVANTAGES

The project is going to be experimented to level of the whole regional system.


1. 1. reduction of mortality of patients affected by IMA;reduction of mortality of patients affected by IMA;

2. reduction of pre2. reduction of pre--hospital intervention time;hospital intervention time;

3. to diagnose IMA and to level patients correctly;3. to diagnose IMA and to level patients correctly;

4. reduction of patients’ numbers transported to the hospital 4. reduction of patients’ numbers transported to the hospital

5. take patients in a suitable 5. take patients in a suitable cardiologicalcardiological structurestructure. .

N.20Basilicata – The Innovation Landascape

Future Future needneed

1.1. Realization of new net TerritoryRealization of new net Territory--HospitalHospital

-- Health care homeHealth care home

-- Regional Regional oncologicaloncological netnet

-- heart failureheart failure net net

-- etc. etc.

The Basilicata regional innovation program forecasts these actioThe Basilicata regional innovation program forecasts these actions:ns:



2.2. new enew e--health services developmenthealth services development




3.3. new telemedicine services developmentnew telemedicine services development




4.4. Link, via Cooperative Applications Based on eLink, via Cooperative Applications Based on e--Services, with the other health Services, with the other health

regional information systems.regional information systems.




These 4 axes of development will be integrated with the aim to sThese 4 axes of development will be integrated with the aim to share citizens’ hare citizens’

clinical and administrative information. The aim is to create anclinical and administrative information. The aim is to create an Electronic Health Electronic Health

Record (EHR) & a Personal Health Record (EPR).Record (EHR) & a Personal Health Record (EPR).


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THE ENDTHE END

Documents

The Regional Health Innovation Landascape · The Regional Health Innovation Landascape “Innovation” Workshop, 30 May–1 June 2007,Potsdam ... Pronto Soccorso CUP ADT (Accettazione)