DAFNE Consortium. July Dr. Marco Alpini DAFNE CONSORTIUM Hospital Project Coordinator. Dr. Rodolfo Caloni DAFNE CONSORTIUM Managing Director

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1 DAFNE Consortium July 2013 Dr. Rodolfo Caloni DAFNE CONSORTIUM Managing Director Dr. Marco Alpini DAFNE CONSORTIUM Hospital Project Coordinator

2 Drugs Distribution System in Italy (Year 2012) Pharmaceutical Companies abt. 200 (Farmindustria associated) abt. 50% from abroad 55% to abroad DEPOTS/Dealers abt. 130 >96% 8% 14% 74% abt. 120 Wholesalers (abt.35 Chemists Coop.) abt. 80 Headquarters abt. 230 Warehouses Pharmacies abt abt Private Public abt Paraph.+Corner 73% Turnover Public Price ~ 1,8 bill./unit ~ 23,0 bill. Euro Turnover Public + Private Hospital ~ 950 mill./unit 1% abt. 300 Local Health Units (ESTAV + ASL + AO (incl Public Hospitals) - abt Private Clinics and nursing home reliable or operating within public health service ~ 5,5 bill. Euro

3 DAFNE Consortium Supply Chain Consortium, established in 1991 by six Pharmaceutical Companies, progressively involving from 1992 Wholesalers as Members or Users, and later Depots / Dealers as Partners and Public and private Hospitals as Users. PharmaceuVcal Companies + Depots/Dealers Wholesalers Public Hospitals DAFNE: 1991/92 DAFNE: 2005/06 Total Turnover abt. 25 billions /year Member Partner Member User User 69 Ph. Companies M.S. > 96% 42 Depots / Dealers 40 Wholesalers M.S. > 99% 70 Wholesalers Pharmacies Para- Pharmacies and GDO Corners 110 ESTAV, ASL, AO with 850 Hospitals for a market share > 50% constantly expanding

4 69 Pharmaceutical Companies Members Abbott AbbVie ABC Farmaceutici Aboca Actavis Alcon Allergan Amgen Dompè Angelini Artsana Astellas Astra Zeneca Avantgarde Baxter Bayer B.Braun Beiersdorf Biofotura Boehringer Ingel. Bracco Bristol M.S Bruno farmaceutici Chiesi Co.Di.Fi * *(Menarini, Malesci, Guidotti, Lusofarmaco, Firma) Coloplast Convatec Cosmetique Act.e CSL Behring Daiichi Sankyo Eli Lilly EG-Crinos Euritalia FederFarmaco Ferring Fidia Ge Healthcare GlaxoS.K. (+Viiv) Grunenthal/Formenti Guna Inneov Johnson&Johnson Lab. Boiron Lab. SVR Medtronic Mellin Merck.S &.D. (July 2013) Novartis Nutricia Pensa Plada Pfizer Pierre Fabre Promefarm Ranbaxy Recordati. ReckittBenck Roche Ratiopharm Rottapharm Sandoz Sanofi-Aventis Schaer Sigma Tau Sixtus Skills in farm. Teva 40 Wholesalers Members AFM (BO) Farvima AllianceHealthcare FCR (RE) Al-Pharma Felletti & Spadazzi Confarma Galenitalia Cedifar Galeno C.E.F. Guacci Cofarmit. Lemarfarma Comifar Nord Est Farma Coofarma Salento Ravenna Farmacie Corofar Re Roberto Co.Si.Far. Riccobono Cotifa Safar Difar Sofarmamorra DM Barone Unico Farcopa Unione Farm.Liguri Farla soc.coop. Unioneffe Farmaca Cannone Unifarm Farmacentro S & L Unifarma Farmadistribuzione V.I.M. FarmAlvarion Farmintesa Logistica Merck Serono Blue = involved also in the Hospitals Project Mylan Named 42 Partners (Depots/Dealers, Medical Device Companies, Carriers) + 70 Wholesalers Users for a total M.S. > 99% DHL S.C. - Dimaf/Ceva - Chiapparoli - Fiege/Farmanova - Ferlito - Pieffe/UPS - Phardis - Monico - Profarco - Neologistica - Sidis - Ruoppolo - Jacopetti - Farmos - Cabassi&Giuriati - Profarma - Columbus - De Salute - Tonacci - Pharmidea - STM - Viprof - Welc.Pharma - Demas - Alloga - CPS - Felpharma - Sanifarma - Depofarma - Pluripharma - Fagit - CD Pharma - Salvia Farm. - Puleo - Gramma - Pasquali - Mazzoleni Benessere - Eurodifarm - Cesareo Farmacosm - J&J Medical - Logisan - CIAM > 110 Regional o Local Health Units for abt. 850 operavve or in test Hospitals/Storages

5 DAFNE Consortium A B2B community, whose mission is to develop a partnership with all the subjects of the supply chain to optimize the distribution processes and its related administrative management. Goals: quality service and savings Integration among partners is enabled by developing telematic connection projects, using EDI standard and Internet, promoting dematerialisation of documents in the order cycle. «Telematic trasmission and dematerialisation» throughout the entire order cycle (order and order confirmation, delivery note, invoice, payment/collection) allow to reduce/eliminate: Clericals errors Credit notes Time and transmission costs Waste of paper and lack of space Time and management costs due to the manual filing system and document reconciliation and also to consider the proper service level by the tracking order (from its transmission to the client s delivery report)

6 DAFNE Consortium: The Main Projects! already operavve Project Leaders and GOALS «on stand by» Hospital Collaborative Logistics Electronic Invoice Electronic Order Template RFId Marco Alpini Rodolfo Caloni Claudio Caloi Rodolfo Caloni Rodolfo Caloni From the positive and steady experience between Ph. Companies and Wholesalers to the electronic transmission of all Logistics and Adm. documents between Ph. Companies and Hospitals. Collaboration example between public and private The Logistics doc. elect. transmission (delivery note with unit, batch nr. and expiry date) before the goods delivery allows a better management of the purchases and the warehouse stock. By the document certifying the goods delivery, you get information on delivery time and service quality Digitalisation of the entire invoicing process: from the electronic invoice to the electronic filing of documents. Financial services with added value: advanced invoice transmission, automatic research of documents, payments and collections Electronic transmission (by PEC) among Supplier-Client- Health M. of the 3 copies of the order template for narcotic and psychotic drugs through the DAFNE portal Collaboration example among Dafne, Assoram and Ministry of Health «Benzodiazepin no more included «DAFNE, with Comifar and some Depots, has tested RFId technology, used for automatic parcels identification. These data, compared with those present on delivery notes, have shown good results. Collaboration between Public Hospitals and Private Companies Delivery note and Received delivery notification Agrrement between ISP Bank and Dafne Collaboration AssoRam/Dafne/H. M. May it be the future! Decisive role of Depots/Dealers

7 !! DAFNE Consortium Mission: electronic documents exchange throughout the envre order cycle Order, Order confirmation, Delivery note, Invoice, Payment & Collection! Delivery note sent by the service provider Delivery note/received delivery notification reconciliation by the provider Client s payment Filing of bank documents Order Delivery & Ship note Invoicing Payment & Collection Documents already available Order placement Order/delivery note reconciliation by the client Invoice issueing Dematerialisation

8 DAFNE Consortium: formats All documents (except Reconciliation ) available in EDIFACT94B Standard implemented at Consortium foundation in 1992 Used by 40% of Pharma Co.s and important Logistics Providers EasyDafne Flat - txt format implemented for Internet channel since 1998 Used by Wholesalers and some Health Customers (ASL) XMLDafne Xml format implemented for Web Services channel recently and mainly used by Health Customers (Region, A.Vaste, ASL) Invoice and Reconciliation documents available also in CBI2 (Bank Network Standard)! A result of our partnership with IntesaSanpaolo Bank"

9 DAFNE Consortium: applied technologies NaVonal Healthcare System XML Provider GXS Translator XML Ph. Companies Depots/Dealers Wholeselers FLAT FLY EASY EDI Each supplier and each client has its own mail box for elettronic documents storage and downloading (same standard file format): order, delivery note, invoice, payment Signed agreement Dafne ISP Bank for document management service (transmission / digitalised storage, electr. invoicing, active and passive cycle, account books, etc.)

10 DAFNE Consortium: main functions Each Dafne User has to - choose the appropriate set-up - develop the integration in house to create or read documents according to our standard formats - enter the network to upload or download documents GxS Provider deliver documents - mapping different formats for any-to-any Dafne user dialogue - mapping formats for Bank Platform connection - being linked with other VAN (EDI only)

11 DAFNE Consortium Electronic Documents exchange Final Balance - Ph. Companies Estav/ASL/AO (Hospitals) Wholesalers abt transferred documents:!! abt orders from NHS!! abt invoices!! (telematic + electronic dematerialised by Banca ISP)!! abt delivery notes!! abt received delivery notification!! orders confirmation!! more than item lines! ( from NHS)!! Depots/Dealers

12 Corresponding cost of the Costo order per cycle Ordine documents Equivalente [ /ordine] ,6 24,4 11,7 5,3 8,4 14,7 7,2 11,2 11,2 Saving 23,9 (31,5%) (67,1%) 2,8 7,2 12,9 2,2 1,2 6,8 1,5 1,5 Traditional Tradizionale system Intermediate Intermedio stage Full electronic Integratosystem Technological Scene Scenario Tecnologico Order Fase Ordine Invoice Fase Fatturazione Fase Delivery Consegna Fase Payment Pagamento/Incasso and Collection 2007 Report - Observatory on Electronic invoice and Dematerialisation School of Management - Polytechnic Institute of Milan

13 Costs and Savings for each subject of the supply chain / cycle Ph. Companies 35,6 24,4 11,7 18,7 Depots Wholesalers *Higher saving results are conceived for Public Healthcare Structures 11,2 saving 23,9. (31,5%) (67,1%) ,2 13, ,7 2,1 9,3 3,7 1,4 6,6 Traditional System Intermediate stage Full Electronic System 2007 Report - Observatory on Electronic invoice and Dematerialisation School of Management - Polytechnic Institute of Milan

14 DAFNE Consortium From our positive and steady experience with WHOLESALERS THE PROJECT DAFNE HOSPITALS in order to achieve and share mutual advantages between Public Hospitals and Private Companies

15 Ph. Companies involved in the DAFNE Hospitals Project (July 2013) Progetto Ospedali

16 Healthcare facilities and Hospitals in the DAFNE Hospitals Project (March 2013) AO Sondrio Trento Asl Belluno AO Como Asl Feltre (Piemonte) AO Seriate Asl P. Soligo AO Bergamo Asl Verona Asl Treviso OIRM Torino AO Treviglio Asl Asolo AO Mantova Asl e Ao Padova AO Orbassano Asl Alessandria Intercent E R. Asl CN 2 Asl 4 Lavagna AO Modena Asl 1 Imperia Estav N.O. Bolzano Estav Centro Estav S.E. Umbria Friuli V.G.! Friuli ASUR Marche Lazio (Lait)! Wide presence and continuous Market share growth confirms that Cooperation between public Hospitals and private Companies is possible. Asl Pescara Asl L Aquila Campania (Soresa) Basilicata Ares Puglia Asl Bari Policlinico Bari ASL Lecce Asl Palermo Asl Messina Asl Catania 110 Regional or Local Health Units (Estav - Aree Vaste ASL - AO) including abt. 850 operative or in test Hospitals/Storages for at least 1 out of 3 electronic documents with 50% and more Market share

17 IT Partners in the DAFNE Hospitals Project (March 2013) In order to favour free Hospitals subscriptions, DAFNE Consortium has endorsed an economic agreement with those Software houses which already manage ERP systems within Hospitals. Hospitals Project

18 The DAFNE Hospital Project TOP REGIONS / PROVINCES Contatti già avviati con vertici regionali e/o ASL/AO di: Calabria Puglia Umbria Lombardia Piemonte Signed agreement among DAFNE Consortium, several Regions and the most important Health Associations (Farmindustria,FIASO,FARE, SIFO)

19 Veneto Region Belluno Treviso Padova Rovigo Hospitals Project

20 Hospitals Project

21 Friuli Venezia Giulia Region A.s.s.6 Pordenone Hospitals Project

22 Tuscany Region Estav Centro Estav Nord Ovest Estav Sud Est ESTAV are the only three references for all Health facilities/ Hospitals in Tuscany Region: all documents are exchanged exclusively between Dafne Consortium and the three ESTAV Hospitals Project

23 Marche Region Hospitals Project

24 Lazio Region Sole reference for all Health facilities - Hospitals in Lazio region: all documents are exchanged exclusively between Dafne Consortium and Lait (Lazio Innovative Technology Society) Hospitals Peoject

25 Campania Region Sole reference for all Health facilities/ Hospitals in Campania region: all documents are exchanged exclusively between Dafne Consortium and SoReSa (Health Care Regional Society) Hospitals Project

26 Puglia Region Policlinico Universitario Bari Asl Ba Bari Ares Puglia Bari Asl Provinciale Lecce Hospitals Project

27 Sicilia Region Asp Palermo Asp Messina AO Papardo Piemonte Messina Asp Catania AO Cannizzaro Catania AOU Policlinico Vittorio Emanuele Catania Asp Siracusa Hospitals Project

28 DAFNE Consortium and the Hospitals Project Goals Telematic transmission and dematerialisation throughout the entire order cycle (order, delivery note, invoice) allow to reduce/eliminate: Clerical errors Credit notes Time and Transmission cost Waste of paper and lack of space Time and management cost due to documents filing and reconciliation Electronic delivery note and received delivery notification (Collaborative Logistics Project) allow to: provide ahead of goods delivery with essential information (qty, batch number, expiry date) for a better Administration, Procurement and Inventory management (+ savings) help with order-delivery note reconciliation and payment terms complete the order tracking and check the service level improve the efficiency and efficacy of the Healthcare Supply Chain

29 News dalle Pubbliche Amministrazioni della Toscana centrale Dal sito della Regione Toscana DALLA CARTA AL DIGITALE: NEI PRIMI 9 MESI GIÀ RISPARMIATI EURO. I da' diffusi dalla Vicepresidente della Regione Toscana d.ssa Stella Targe: con delega all e- government - Internet Fes'val, Pisa FIRENZE Soltanto nell acquisto dei farmaci, la Regione Toscana ha conseguito risparmi, nei soli primi 9 mesi di questo 2012, per oltre 700 mila euro. Ciò è stato possibile grazie alla semplice dematerializzazione nel ciclo ordine-bolla-fattura («promossa in collaborazione con il Consorzio DAFNE»). In altri termini è bastato trasferire le procedure dal cartaceo al digitale per ottenere interessanti livelli di risparmio. I dati, elaborati dal Politecnico di Milano, derivano da un progetto (il Sirius ) utilizzato dai tre Estav toscani (gli enti per i servizi tecnico amministrativi, in area vasta, delle Asl) e sono stati diffusi da Stella Targetti, vicepresidente di Regione Toscana con delega all e-government, nel giorno inaugurale, a Pisa, di Internet Festival. (Mauro Bianchini, giovedì 4 ottobre 2012 alle 14:28 su sito Regione Toscana)

30 Conclusions Dematerialisation: from order to delivery note, from invoice to payment/collection, from digitalised storage to automatic reconciliation, it deals with a necessary and irreversible process for a modern, efficient and more and more qualifying Healtchcare Supply Chain management A process, hastened by specific and more frequent requests, as mentioned in the Chapter of Hospitals tenders and motivated by the need of a more efficient Public Administration The Council of State (meeting of Oct. 12, 2012) accepts the regulation schema identifying technical rules and guidelines for electronic invoices process management towards all Public Administration

31 At work without documents dematerialisation!

32 At work using innovative processes and documents dematerialisation More efficiency, less costs, less mistakes, a better service, clear spaces, less paper waste and more trees!

33 DAFNE Consortium Membership Fees for Ph. Companies: 7.230,40 one off (as a contribution to the Consortium Fund) Annual Contribution for traffic and services from abt on a basis of real lines/received orders; the fee is voted by Board Members according to preliminary balance sheet Annual Contribution (abt ) for each Member of the Hospitals Project on a basis of a specific balance sheet (voted by Board Members) for Wholesalers: 2.065,82 one-off (as a contribution to the Consortium Fund) As users without membership or fee/contribution, they are enabled only for order transmission and order confirmation for Public Healthcare Structures: Users without membership or fee/contribution enabled for all documents of the order cycle For Depots / Dealers / Carriers and others: Partners enabled for all documents of the order cycle by means of a specific economic agreement The DAFNE Consortium is a non-profit-making Organisation ww.consorziodafne.com