Italian Plans for ehealth Interoperability Fabrizio Pizzo Marcello Melgara Lombardia Informatica S.p.A.

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1 Italian Plans for ehealth Interoperability Fabrizio Pizzo Marcello Melgara Lombardia Informatica S.p.A. 1

2 The Italian Roadmap Deadlines c.d. Decreto Fare Decree 21 June 2013 n. 69 transformed into L. 98/2013 (GU n. 194) Adoption of the Minsterial Decree to rule the validity of medication prescription all over Italy (ex art. 13, comma 2 del DL Crescita 2.0); Adoption of the Regulation for the Public Health Registries (mortality, cancer and other pathologies); Adoption of the Decree to rule the electronic transmission of illness certificates, to allow parents to get sick leave as father or mother; Adoption of Mininsterial Decrees to rule the the Electronic Health Record (Fascicolo Sanitario Elettronico: FSE) and the Medication Record (ex art. 12, comma 7 del DL Crescita 2.0) Deadline for the emission of the Guidelines to implement the FSE, drawn by the Agency for the Digital Italy (AGID) and by the Mininstry of Health (DL 179/2013 art. 15 bis) The Regions submit to AGID and to the MoH the plans to implement of the EHR s (FSE), based on the Guidelines (DL 179/2013 art. 15-bis) The EHR s are established by the Regions and Autonomus Provinces, in line with the Mininsterial Decrees (DL 179/2013 art. 2) AGID takes care of the desing and implementation of the National infrastructures needed to guarantee the EHR interoperability (DL 179/2013 art. 15- quinquies) AGID and MoH. Evaluate and approve within 60 daysi 2

3 Italian Approach to the EHR: Federated FSE In Italy EHR s are Regional The interoperability is assured through a FEDERATED ARCHITECTURE The Regional Nodes, which host the National Infrastructure and the Regional EHR co-operate among them. The Region of Affiliation (Regione Di Assistenza - RDA) of a citizen has the task to maintain the links to the documents even if they are generated and stored in other Regions. Lombardy participates to the pilot of the National Federated FSE with Emilia Romagna and Veneto. During epsos, IPSE project piloted the connection between the Italian NCPeH and the FSE s Italian PS is compliant to the EC PS Guideliines, although a limited data elements are coded epsos NCPeH National FSE Federated Architecture FSE Lombardia FSE Veneto FSE Emilia Romagna 3 3

4 Italian Approach to the eprescription In all Regions, epresciption was operational mainly for administrative purposes. In Lombardy about 7 million ep/month were managed The National ep system is based on a Central Repository, in which all ep/ed are stored. Some Regions also operate Regional repositories, connected to the Central one. All the Regions have now activated the ep pilot service also for dispensation An ep for cross border, compliant to the epsos ep specification, can be derived from the so called Red Prescription. By transforming the National Registration Code / Group of equivalence into the structured info requested by the specifications, with all the limitation of describing medicinal products with ATC/INN (see epsos and openmedicine projects) During epsos, the NCPeH was connected to the Lombardy ep system. In future the NCPeH could be connected to the Central em National ep Architecture epsos NCPeH Regional Regional Central Regional 4 Regional 4

5 Lombardy Region FSE: Sistema Informativo Socio Sanitario - SISS Regione Lombardia General Directorate for Health is responsible for healthcare policy design and implementation, for healthcare service provision to its 10 million citizens, being data controller for healthcare data. The General Directorate for Health holds the regulatory and administrative competencies in the healthcare domain, including planning and supplying, quality monitoring and control, appropriateness and efficiency of services. LISPA, in application of the policies and the strategies set by Regione Lombardia, develops and operate the ICT ehealth system (SISS: Sistema Informativo Socio Sanitario), the associated security infrastructure and the Electronic Health Records, under the legal responsibility of Regione Lombardia. Since epsos, LISPA operates the National Contact Point for ehealth (NCPeH), in application of the adopted Framework Agreement among Regione Lombardia, HealthCare Institutions and LISPA. 5 5

6 Fascicolo Sanitario Elettronico (FSE): Lombardy: Sistema Informativo Socio Sanitario Citizen Health Professionals consented upon National Health System Public Health Care Providers FSE Pharmacists Health Professionals working within the National Health System Discharge letters Laboratory tests res. eprescription Clinical Encounter reports Patient Summary Private Health Care Providers 6

7 Lombardy epsos Pilot, upon MoH Mandate PS Country A/B, ep Country A 11 Emergency Wards for foreigners: Milano EXPO 2015 and Garda Lake areas: Patient Summary Country B 3 Pilot Sites (about 40 GPs) for Patient Summary / eprescription Country A April Luxembourg 7 7

8 ehn Subgroup to restart ehealth Services Italian Ministry of Health joined the ehn- SG for Upkeep with the will of restarting ehealth Cross-border Services Italy will sign the TLA, delegating Lombardy to restart PS/eP ehealth Cross-border Services, waiting for a wider deployment 11 Emergency Wards for foreigners: Milano EXPO 2015 and Garda Lake areas: Patient Summary Country B 3 Pilot Sites (about 40 GPs) for Patient Summary / eprescription Country A April LuxembourgEXPAND WS 8 8

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