by Luciano Fassari
Both the technical indications and a decree indicating the targets to be reached in order to obtain the resources (in total 610 million) arrive on the table of the Regions. But the new ESF will not only be useful for citizens: doctors will be able to access and use the clinical data of patients and share information and consult with other professionals. Pharmacists will be able to consult the information sheet of the therapy in real time and check the therapy delivered to the patient. But also the nurses and the other Health Professionals will be able to access the clinical data of the following patients. THE GUIDELINES – THE RESOURCES DECREE
15 APR –
Consult your clinical data, book and pay for services, access Telemedicine services, receive information on your pathology on the treatment path to follow. These are some of the services that Italian citizens will be able to find in their electronic health record. The new national guidelines drawn up by the Ministry of Health in conjunction with the Ministry for Technological Innovation and Digital Transition and the Ministry of Economy and Finance outline the path that must be completed by 2026.
The new ESF will not only be useful for citizens. For example, family doctors, pediatricians and specialists will be able to access and use the clinical data of patients under treatment and also share information and consult with other professionals.
In the ESF also the pharmacists will then be able, among other things, to consult the information sheet of the therapy in real time and check the therapy delivered to the patient. But also the nurses and the other Health Professionals will be able to access the clinical data of the patients to the extent of relevance.
But the ESF will also be useful to institutions for the analysis and monitoring of demand and planning of the supply of services.
The project falls within the scope of the Pnrr for which approximately 610 million have been allocated as foreseen by another ministerial decree that binds the allocation of resources to the presentation by the Regions of operational plans (within three months) which will be monitored by the competent ministries with the support of Agenas who will be able to replace the Regions in case of default.
The Regions will now have to express themselves on the two measures.
But let’s go back to the guidelines that for the Government “intend to summarize and amend all the previous recommendations and become the basis for implementation in the period 2022-2026”
For the document, the ESF must become “the single and exclusive point of access for citizens to the services of the NHS, an ecosystem of data-based services for health professionals for the diagnosis and treatment of their patients and for ever more personalized patient care , a tool for health structures and institutions that will be able to use the clinical information of the ESF to carry out analyzes of clinical data and improve the provision of health services “.
To date, in fact, the Electronic Health Record (FSE) “does not yet provide an accurate representation of the health conditions of the patient, of the social and health context and of the social welfare plans. Furthermore, it is not fed equally in all Regions, greatly limiting its usability as a tool for diagnosis, treatment and prevention ”.
To strengthen it, the Guidelines define 4 lines of action to strengthen the ESF:
– guaranteeing homogeneous and uniform digital health services
– standardize the contents in terms of data and codes adopted
– strengthen the architecture to improve the interoperability of the ESF
– strengthen the governance of the implementation rules of the new ESF.
For each of the 4 dimensions (services, content, architecture and governance), on which the guidelines of action outlined by the Guidelines act, the mandatory and recommended requirements to be implemented in the short, medium and long term to pursue the objectives outlined are defined.
The mandatory requirements to be implemented in the short term, to (i) standardize the existing ESF services for citizens and health professionals at national level, (ii) extend the minimum core of mandatory ESF documents and improve their standardization together with that of the supplementary documents already implemented by the Regions, (iii ) evolve the ESF interoperability infrastructure through the creation of a national index, a national register of patients and a component for the acquisition of data and documents from their producer systems, (iv) adopt a system for the control and monitoring the quality of clinical information that feeds the ESF institutionalize and govern standardization processes at national level of the different dimensions of the ESF
The mandatory requirements to be implemented within the duration of the PNRR, to (i) evolve towards services for access to clinical data (no longer just documents) by citizens and health professionals, for their use in the prevention and treatment activities carried out by GPs / PLS and specialist doctors, for their use by pharmacists to perform their respective functions of verifying adherence to therapies and possible adverse reactions, for their use by health institutions for health planning and prevention, (ii) feed the ESF with standardized clinical data through the use of coding systems and dictionaries, acquired in the prevention, diagnosis and treatment activities conducted by health professionals on the patients, including patient summaries produced by GPs / PLS according to PNRR targets, telemedicine data, independently generated data from patients and imaging, (iii) implement a new ESF architecture, complete with a central clinical data repository in standard HL7 FHIR (optionally reuse also at a local level) and enhanced by new interoperability components capable of reaching and connecting all information-producing healthcare facilities, (iv) adopting Advanced Analytics tools, also based on Artificial Intelligence techniques for the processing of clinical data of the ESF, (v) to make clinical data available for research, (vi) to institutionalize at national level a continuous and systematic process of verifying the information needs and standardization of documents and clinical data to be merged into the ESF in addition to those originally planned.
The recommended requirements to (i) create services based on clinical data, further extended to omic, genetic and epigenetic data, for an increasingly personalized care on the client, (ii) make available to Health Institutions for government purposes, (iii) extend the data available for research on omic, genetic and epigenetic data.
How the ESF will work for citizens, health professionals and institutions
Citizens
– Consultation of clinical data
– Management of proxies to informal caregivers
– Access to health services: – Reservation and payment of services, – Drug delivery, – Telemedicine, – Emergency-urgency
– Empowerment in care: – Information on the pathology – Information on the treatment path – Tools to make the patient an active part in the treatment
Services for GP / PLS and Medical Specialists
– Access and use of clinical data of patients under treatment
– Dynamic and intelligent ESF summary sheet of the assisted person
– Sharing of information and consultation between professionals in the provision of care
– Reservation of services
– Support for the application of the principles of prescriptive appropriateness in the care process
– Taking charge and monitoring adherence to patient care
– Primary and Secondary Prevention
Services for Pharmacists:
– Reservation of health services;
– Real-time consultation of the information sheet of the therapy and verification of the therapy delivered to the patient
– Registration of allergies and adverse drug reactions
– Support for the evaluation of therapeutic adherence
Services for Nurses and other Healthcare Professionals
– Access to patients’ clinical data as far as pertinent
Health Institutions
– Health Planning: analysis and monitoring of demand and planning of the supply of services
– Access to data and analysis tools to support the Prevention Services of Research Institutes
Extraction, pseudo-anonymization / anonymization and preparation of administrative and clinical data of the ESF for:
– Advanced analytics for data exploration and identification of hidden patterns
– Training of AI / ML models
– Predictive models for the study of pathologies and therapies
Luciano Fassari
April 15, 2022
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