A Measurement to Support the ehealth Regional Strategy Session 170 - March 7, 2018 Claudio Saccavini, CINO Giulia Pellizzon, Project Engineer Consortium Arsenàl.IT 1
Conflict of Interest Claudio Saccavini, Chief Innovation Officer Giulia Pellizzon, Project Engineer Have no real or apparent conflicts of interest to report 2
Agenda Background Our ecosystem The Five Ws and one H Handle with care: hints and suggestions Gimme the numbers Next stop? 3 Suggestions
Learning Objectives Describe the assessment model for the exchange of EHRs in the Veneto Region (Italy) Evaluate the assessment measure in use to support the ehealth strategy Analyze the Veneto case and its application to other contexts 4
Arsenàl.IT Who we are 5
Background Where we are Venice 6
Background Some features The Healthcare System One regional public health system Nine local health authorities (LHAs) Two hospital trusts (HTs) One oncology research center 7 Administrative Framework One regional authority Seven provinces (counties) 575 municipalities
Background Some features Health Expenditure and Comparison Public 70% Private 30% 49% 51% The Veneto Regional Health System Universal health coverage but 30% funded by households and... 86% of which is out-ofpocket Veneto Based on OECD data 2016 and 12 Health report Crea Sanità US 8
Our ecosystem One Army ~ 5,000,000 Citizens ~ 8,000 Hospital Specialists ~ 70,000 Overall Health Workers ~ 4,000 GPs ~ 1,500 Pharmacies 9
Our ecosystem One Mission Mission accomplished LHA Or HT Health Information Exchange system (HIEs) Starting point 10
Our ecosystem One Vision 2013 2019 ICT adoption Structured info TIME LINE VALUE LINE Exchange info Data at work 11
Our ecosystem The deployment Bees on the ground, but How do we track the progress? How do we improve our action plans? How does a solution solve actual conditions?? We need a measure 12
The five Ws and one H The assessment program WHO? Independent institution WHAT? WHERE? The entire Veneto Region Healthcare digitalization adoption 13
The five Ws and one H The assessment program When? Get the initial status and track the progress Survey I Survey II 2013 2016 14
The five Ws and one H The assessment program Why? (1 of 2) First, identify the digitization level of each LHA and HT Second, get the whole picture of the regional health system 15
The five Ws and one H The assessment program Why? (2 of 2) Third, measure the value of a new asset class: structured information RAW DATA MEANINGFUL DATA ICT deployment strategy Measure the value of information 16
The five Ws and one H The assessment program How? Identified HIMSS and its EMRAM methodology 0 stage All three ancillaries not installed 1 stage Lab, Rad, Pharmacy installed 2 stage HIE capable 3 stage Clinical documentation 4 stage CPOE; CDS 5 stage Full R-PACS 6 stage Full CDSS, CLMA 7 stage Complete EMR, data analytics 17
Handle with care Coding and meaning HIMSS EMRAM HIEs meaning 0 and 1 st stage There is no exchange of digital data 2 nd stage Presence of different digital data but limited exchange 18
Handle with care Coding and meaning HIMSS EMRAM HIEs meaning 3 rd stage Some documents are structured and exchanged 4 th stage Starting to work in a CDSS-mode 19
Handle with care Coding and meaning HIMSS EMRAM HIEs meaning 5 rd stage EHRs enable new delivery models 6 th stage Data analytics supports clinical strategy and programs 20
Handle with care Coding and meaning HIMSS EMRAM HIEs meaning 7 th stage AI at work 21
Gimme the numbers main results The Veneto Region EMRAM mean score 2013 2.9 2016 3.9 0 EMRAM score 1 2 3 4 5 6 7 No exchange Limited exchange Some docs are structured and exchanged 22 From CDSS to AI
Gimme the numbers STOCKS FLOWS Already available docs ~ 160M in 4 years 23 eprescription: ~ 40M/y ereferral: ~ 20M/y
-1 Variation 2016-2013 0 1 2 3 4 5 Gimme the numbers A map From 0.3 to 5.2 Good practices 1 2 3 4 HIMSS stages 2016 5 6 7 Pay attention Check & Maintain 24
Next stop? - A new measurement? How to complete the EMRAM score? How to assess the ability to deliver the continuity of care? 2013 2016 2017 EMRAM Regione Veneto Survey I EMRAM Regione Veneto Survey II CCMM on testing 25
Next stop? From hospital to primary and social care 26
Transferability APPROCH Bottom-up Engagement & Collaboration Strong commitment OBSTACLES Lack of vision Reduced credibility of strategy Undefined goals VALUES Standard and acknowledged methodology not case specific Self-feeding process One measure does not provide insight to the value 27
Any questions? mmm 28
Claudio Saccavini Technical Director Consorzio Arsenàl.IT csaccavini@consorzioarsenal.it @Consorz_Arsenal LinkedIn: Consorzio Arsenàl.IT - OFFICIAL Giulia Pellizzon Project Engineer Consorzio Arsenàl.IT gpellizzon@consorzioarsenal.it @Consorz_Arsenal LinkedIn: Consorzio Arsenàl.IT - OFFICIAL 29