Background: General Director, Information Systems, Ministry of Health for Italy
Theme: Connecting health as a tool to improve care for chronic conditions

We need help to shift from hospital acute systems to community treatment. We have an increasing problem in the national health system because of the aging population and increased incidence of chronic pathologies - older people require a different mix of healthcare services to be developed.

So we have to move from hospital-centric services to community-centric services based on the patient. This is a long journey for us in Italy and going too slowly for us so far. The goal is to create an organizational model for chronic treatment which reduces admissions, bring people out of hospital quicker, and improve the assistance network.

We are trying to learn by doing. We believe in integrating clinical components with the organizational and management components of the care provided. This implies a paradigm shift in Health Information Systems, integrating around the citizen the information related to their health services and tracing them back to the supplier - improving the continuity of care and evaluating the capacity of the system to meet the health needs of the population.

We started with the government health information system which is based on monitoring the healthcare system. Now we are building a federated framework of local information systems and electronic health records, all of which facilitates homecare emergency, second opnions, and disease management. The problem though is creating interoperability through finding common languages and codification. We are taking incremental steps towards implementing the full EHR system starting with admissions, drugs, and death records.

Right now we manage on an individual basis: childbirth registry, inpatient services, which are both national and about 50% of outpatient services and pharmacutical events. Next steps are mortality registry and homecare procedures.

We are learning from the data where inefficiencies are occurring and where services are moving from treating chronic disease in an acute setting towards helping people at home and in the community.

We are working at a national level, but regional projects are going on too, building better EHRs and interoperability standards. In Lombardy, a large proportion of the population has cards and access to the system, now data is being shared on prescriptions, referrals and discharge letters. Elsewhere, networks are being built to help interface citizens and healthcare profesisonals.

There are two different levels: integrating different structures to help professionals use information, together with common languages to enable monitoring and evaluation.

Q: The regions are having a big influence - is this bottom up development?
A: We are looking for a middle ground between bottom up and top down. We want to point out that health expenditure is a problem and a priority to tackle for all.

Q: What role do you see for the private sector in italy
A: We have a national health system, but also an active private sector financed by public system. It varies between regions, but of course the private sector can be an innovator and a good partner in designing a new model.

Q: Will you go with a central database or federated model?
The central database will be an index a way of tracing events, keeping records in a federated system.

Q: Are there other countries whose model you are watching?
Of course the UK’s NHS - we always copy them - but also the Canadian system, which is similar to our approach.

Q: Are regional systems interoperable?
A: Each region started with their own method but now we are trying to find a common set of interoperabilities to maintain choice of method and technology, but to let them talk to each other, so we are driving that effort.

Q: How do you handle potential deficiencies and move from monitoring to action?
We don’t choose a centralistic approach, instead we try to put regions together - those who have developed innovation with those looking for solutions. We think this is the way to make things happen.

Q: Italy has the most aging population in europe - in the combination of social and health policy, is there anything being done to raise birth rate, for example?
We need to integrate the social and healthcare systems - municipalities now control social so there’s now a big effort to bring them together but it’s early days.