The Regional Health Innovation Landascape

Transcription

1 N.1 The Regional Health Innovation Landascape in Basilicata Region Giovanni De Costanzo, Carla Di Lorenzo, Giuseppina Giuzio Basilicata Region Department of Health, Emergency and Social policy Innovation Workshop, 30 May 1 June 2007, Potsdam

2 Basilicata - Brief Regional Profile N.2 Indicators Basilicata Italy Basilicata/I taly Population ,03% Surface 9,90 301,4 3,28% Population density 60,1 191,9 31,35% <5,000 20,001-65,000 5,000-20,000 65, ,000 >100,000 Totale Municipalities Potenza Age classes Male Female Total % total Matera tot age ,46% Population (absolute values) age More than 65 age ,61% 19,93% Potenza Matera tot 166,542 31, , , , , ,075 57,075 69, , , , ,727

3 The National Health System N.3 Italian National Health Service (SSN) is a public system that guarantees the medical assistance to all the citizens without distinctions of gender, residence, age, income, job and religion. The health services is managed at different government levels Central Level Regional Level Financing The National Health Service is funded mainly through tax payers. Moreover, the ASLs (local authority health services) obtain funding from patients contributions and from some of the non-free services they offer. The Basilicata Region Health Fund for year 2007, is ca 949,573,646 which represents 1,12% of the National Health Fund.

4 The Regional Health System N.4 Regional health care institutions: 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 Workers: about including personnel employed directly by the regional HS and the national health service. Economic importance The regional healthy system covers the 5,9% of the Gross Domestic Product (it s the seven sector for contribution). A.S. USL 2 Potenza inhabitants A.S. USL 1 Venosa inhabitants A.S. USL 4 Matera inhabitants A.S. USL 5 Montalbano J inhabitants A.S. USL 3 Lagonegro inhabitants

5 Basilicata Health Innovation N.5 Main Innovations of the Basilicata Region Health Service The innovation components of regional health system could be divided ided in two lines: 1. 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 This has changed the way with which the National Health fund is shared. 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 percentage rate of FSN for Essential Levels od Assistence (LEA) 44% 5% 51% territory Prevention Hospital

6 Basilicata Health Innovation N.6 Main Innovations of the Basilicata Region Health Service The innovation components of regional health system could be divided ided in two lines: 1. 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 It Has changed the way with which the National Health fund is shared. 2. The technological innovation which drivers are: New Technological factors; Integration of health information systems (EHR/PHR); e-health services; Telemedicine & e-care. e They often interacts between them

7 Basilicata Health Innovation N.7 Organizational innovation The National Health model migration from a Concentrated Hospital System to a Distributed Territorial System Through the introduction of innovating structures and services as: a ADI - Integrated Assistance at Home Health Places Regional Net of Palliative Care

8 Basilicata Health Innovation N.8 Organizational innovation The displacement of the sanitary assistance Hospital Territory a strong use of ICT In Order to shift the sanitary assistance and to guarantee the connection between Hospital and Territory, Basilicata Region is carrying out the so called Telemedicine project. The project aims to promote the dialogue between specialist doctors and the first aid team which is in charge of the caring of the patients at home. In order to support the correct management of this new service and a organisational model, a new software has been developed. This facilitates the activities technology management and points out important indicators which help Basilicata Region to better program its future implementations

9 Innovation connected with ICT Basilicata Health Innovation N.9 Infrastructural context Basilicata WAN (Wide Area Networks) Link in optical fiber between regional Hospitals

10 Basilicata Health Innovation N.10 Innovation connected with ICT Infrastructural context The Basilicata region s health information system MMG Radiology Accesso Servizi Refertazione Pronto Soccorso Laboratorio Gestore Repository Amministrativo Repository Amministrativo Hospital reports pharmacy Utente CUP Reparto Sistema di reporting Visita Specialistica terapy Cassa ADT (Accettazione) Fascicolo clinico ADT (Dimissione / Trasferimento) Gestore Repository Clinico Repository Clinico Hospital

11 Basilicata Health Innovation N.11 Innovation connected with ICT Infrastructural context The Basilicata region s health information system E-health A B Centro Ospedaliero di eccellenza GPRS MMG, Guardia Medica e ADI Ospedale Periferico Rete Regionale Casa Paziente C Telemedicine Services of e-health on the Basilicata Region web site

12 Basilicata Case study N.12 CASE STUDY BASILICATA REGION Telemedicine for IMA Technological innovation technological component ICT + organizational component Realizations ICT Realizations executively BASILICATA REGION Connection territory-hospital for management of the cardiological emergency in course of acute infarct of the myocardium HCN-Innovation Potsdam 30 may 2007

13 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.13 The Case study has connected to the application of the Telemedicine within the coronary emergency the cardiovascular diseases represent the first cause of death in the western world (every year in Italy around persons are struck by myocardial attack IMA. In Basilicata this number is around 700 and the 50% around, of patients p stroked by IMA dies before reaching the hospital structure. Objectives Connection between Territory/Hospital for the management of the cardiological emergencies in progress of acute myocardial attack To reduce, with the help of the ICT technologies and with the introduction of new organizational models on the territory, this percentage through t the implementation of the diagnosis before reaching the hospital. To offer to the patient, struck by acute myocardial attack, a prompt p and efficient treatment related to the characteristics of the patient t and the place in which the event is verified.

14 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.14 Organizational innovation From an organizational point of view it needs: to coordinate the Coronary Care Unit (CCU) located on the territory with the main operational unit of emergency urgency regional network of coronary emergency founded on a model HUB-SPOKE Model HUB-SPOKE

15 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.15 Organizational innovation From an technological point of view it needs: to use the broadband connection, already present in the hospital structures and 118 (emergency service), for the transmission of the layout ECG (Electrocardiogram) and for its clinical rapport (Figure 1). Figure 1

16 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.16 RESULTS Improving and making the net compact and effective. Diminish the negative impact represented by the peculiar geographical features of our Region (distances, road conditions, mountainous, etc.).

17 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.17 How does it happen? 1. Ambulances ( 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 118 Operational Central 118 Hub Hospital Spoke Hospital the best reperfusion treatment in the temporal, clinical and organizational context. Guidelines AMI STE ACC/AHA 2004

18 CASE STUDY BASILICATA REGION: Telemedicine for IMA N 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. primo contatto medico: PROTOCOLLO OPERATIVO - pre-ospedaliero 118 (Telemedicina) Conferma ECG di STEMI calcolo del Rischio cl. Killip > 1 PA < 100 mmhg, FC > 100 b/min, età > 75 anni ST 6 der. Alto Basso Esordio <3h PTCA in 60 Esordio >3h PTCA in 90 tempi della PTCA brevi (o C.I. alla th.lisi) farmaci (ASA, UFE) trasporto diretto contenimento dei tempi lunghi TROMBOLISI (entro 30 ) Centro Hub PTCA (+/- facilitata) +/- prontamente Figure 3

19 CASE STUDY BASILICATA REGION: Telemedicine for IMA N.19 ADVANTAGES 1. reduction of mortality of patients affected by IMA; 2. reduction of pre-hospital intervention time; 3. to diagnose IMA and to level patients correctly; 4. reduction of patients numbers transported to the hospital 5. take patients in a suitable cardiological structure. The project is going to be experimented to level of the whole regional system.

20 Future need Basilicata The Innovation Landascape N.20 The Basilicata regional innovation program forecasts these actions: 1. Realization of new net Territory-Hospital - Health care home - Regional oncological net - heart failure net - etc.

21 Future need Basilicata The Innovation Landascape N.21 The Basilicata regional innovation program forecasts these actions: 2. new e-health e services development

22 Future need Basilicata The Innovation Landascape N.22 The Basilicata regional innovation program forecasts these actions: 3. new telemedicine services development

23 Future need Basilicata The Innovation Landascape N.23 The Basilicata regional innovation program forecasts these actions: 4. Link, via Cooperative Applications Based on e-services, e with the other health regional information systems.

24 Future need Basilicata The Innovation Landascape N.24 The Basilicata regional innovation program forecasts these actions: These 4 axes of development will be integrated with the aim to share s citizens clinical and administrative information. The aim is to create an Electronic Health Record (EHR) & a Personal Health Record (EPR).

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