HCN-Innovation BASILICATA with Notes

N.1

TheThe RegionalRegional HealthHealth InnovationInnovation LandascapeLandascape

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 Basilicata - Brief Regional Profile N.2

Basilicata/I Indicators Basilicata Italy taly Population 595.727 57.851.000 1,03%

Surface 9,90 301,4 3,28%

Population 60,1 191,9 31,35% density

5,000- 20,001- 65,001- <5,000 >100,000 Totale 20,000 65,000 100,000

Municipalities

Potenza 80 19 0 1 0 100

Matera 17 13 1 0 0 31 Age classes Male Female Total % total tot 97 32 1 1 0 131 0-14 age 44.311 41.590 85.901 14,46% Population (absolute values) Potenza 166,542 156,827 0 69,295 0 392,664 15-64 age 195.585 194.196 389.781 65,61% Matera 31,976 114,012 57,075 0 0 203,063 More than 65 age 51.755 66.649 118.404 19,93% tot 198,518 270,839 57,075 69,295 0 595,727 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. 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 2006.

Workers :

– about 10.000 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 1 Venosa 98.779 inhabitants A.S. USL 2 Potenza A.S. USL 4 Matera 212.057 inhabitants 123.313 inhabitants

A.S. USL 5 Montalbano J. 85.672 inhabitants

A.S. USL 3 Lagonegro 76.143 inhabitants Basilicata – Health Innovation N.5 Main Innovations of the Basilicata Region Health Service

The innovation components of regional health system could be div 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 1000. This has changed the way with which the National Health fund is shared.

percentage rate of FSN The percentage rate of the for Essential Levels od Assistence (LEA) National Health Fund assigned for services offered by the hospitals, has been 44% reduced from 55% of 2000 51% to 44% of 2007. 5%

territory Prevention Hospital Basilicata – Health Innovation N.6 Main Innovations of the Basilicata Region Health Service

The innovation components of regional health system could be div 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 1000. 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.

They often interacts between them 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 a s:

ADI - Integrated Assistance at Home

Health Places

Regional Net of Palliative Care 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 specia list 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 a nd organisational model, a new software has been developed. This facilitates the activities technology management and points out important indicators which help Basili cata Region to better program its future implementations Basilicata – Health Innovation N.9 Innovation connected with ICT

Infrastructural context

Basilicata WAN (Wide Area Networks)

Link in optical fiber between regional Hospitals Basilicata – Health Innovation N. 10

Innovation connected with ICT

Infrastructural context The Basilicata region’s health information system

Radiology MMG Servizi Accesso

Refertazione Pronto Soccorso Gestore Repository Laboratorio Amministrativo Repository Amministrativo

CUP reports pharmacy Utente Reparto Sistema di Hospital reporting

Cassa Fascicolo clinico Gestore Repository Clinico Repository Visita ADT Clinico (Dimissione / Specialistica Trasferimento) terapy ADT (Accettazione)

Hospital 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

Rete Regionale Ospedale Periferico Casa Paziente C

Telemedicine Services of e-health on the Basilicata Region web site Basilicata – Case study N. 12

CASE STUDY BASILICATA REGION

Telemedicine for IMA

Technological innovation technological component ICT + organizational component

Realizations ICT BASILICATA REGION Realizations executively “Connection territory -hospital for management of the cardiological emergency in course of acute infarct of the myocardium ”

HCN-Innovation Potsdam 30 may 2007 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 i n the western world (every year in Italy around 150.000 persons are struck by myocardial attack – IMA. In Basilicata this number is around 700 and the 50% around, of p atients 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 in troduction of new organizational models on the territory, this percentage t hrough the implementation of the diagnosis before reaching the hospital .

• To offer to the patient, struck by acute myocardial attack, a p rompt and efficient treatment related to the characteristics of the patien t and the place in which the event is verified. 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 territ ory with the main operational unit of emergency urgency

regional network of coronary emergency founded on a model HUB -SPOKE

Model HUB -SPOKE 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 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.). CASE STUDY – BASILICATA REGION: Telemedicine for IMA N. 17

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

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 CASE STUDY – BASILICATA REGION: Telemedicine for IMA N. 18

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.

PROTOCOLLO OPERATIVO cl.Killip >1 primo contatto medico: PA<100mmHg, FC>100b/min, - pre-Ospedaliero Conferma ECG calcolo età >75anni 118 (Telemedicina) di STEMI del Rischio ↑ST≥ 6der.

Alto Basso

Esordio<3h tempi della PTCA PTCAin60’ brevi (o C.I. alla th.lisi) lunghi TROMBOLISI Esordio>3h (entro 30’) PTCAin90’ farmaci (ASA, UFE) trasporto diretto contenimento dei tempi

Centro Hub PTCA (+/- facilitata) +/- prontamente

Figure 3 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. Basilicata – The Innovation Landascape N. 20 Future need