EHTO Trends in Health Telematics in the European Union


	Updated: Dec 6, 96
ITALY

To understand Italian national healthcare strategies, specifically telematic applications, the current changes in Italian healthcare economic policy need to be taken into account. This has resulted in delays in developing a true national healthcare telematic plan and reflect recently increased activity in this area. The G7 healthcare telematic projects coordinated by the Italian Healthcare Ministry, starting in 1995, are also relevant.

The general political stance is to reduce national healthcare expenditure whilst maintaining the quality of the service provided.

In Italy today we see a progressive convergence between applied research and the implementation of healthcare policy initiatives through pilot projects, focused on organisational and technological aspects and addressing the cost to benefit ratio in healthcare services. This means a real change of emphasis from a research-driven to an implementation-driven scenario.

Political action is needed to take full account of the potential offered by telematics in healthcare, and also to stimulate private investment. It is also necessary to involve the telecommunications operators and financial and industrial interests. Infrastructure funding and support for added-value telematic services are not in themselves sufficient, while there is a need for some substantial reorganisation of healthcare service delivery and - more generally - to the overall functioning of the healthcare system.

In developing a healthcare telematics plan it will be necessary to overcome several obstacles, mainly financial, due to the limited resources available and other competing interests within the healthcare sector, not least the conservatism of the medical profession. A financial strategy covering both the public and private sectors which includes an information and training phase is thus of primary importance.

Users and telecom operators must have a clear understanding of the special needs of the healthcare sector. Hesitation by industry investing in this field could be also the result of too many systems only partially accepted by the market: such systems were in fact developed without coherent guidelines or without taking into account the specific needs of the healthcare sector. Too much effort has been put into developing local solutions without regard to interoperability. Adherence to the European Commission standards and guidelines, with interoperability, could create an enlarged international market, which could attract the interest of Italian industry. For the citizen, it is essential to have confidence that telematic healthcare systems and services are secure and reliable, and operate without any data confidentiality risks.

The establishment of a primary care network is a major policy issue. This gives the general practitioner (GP) the role of "gatekeeper" for the healthcare system, and providing the patient preventive information. The GP becomes the manager and coordinator of all the healthcare services provided for the patient, with access to the resources and services of the whole of the health service. The GP's decisions will be taken in consultation with the patient, to whom all information will be available, thus reflecting specific needs and personal preferences, but taking account of budget limits, of particular importance a public contribution is involved. This policy assist in containing the costs of the health service.

Development of the emergency services is also a strategic issue: emergency telemedicine involves the creation of regional networks for control of the "118" service, with a linked maritime system.

Cards (smartcards) are also considered as an important support to healthcare system integration and also as access key to the healthcare telematic network, to guarantee data security and confidentiality. They will be used as a tool to control healthcare administrative costs.

The National Telemedicine Research Plan covers the extension of telematic services to healthcare, funded by the Ministry of University and of Scientific and Technological Research.

Some consideration has been given to the coordination of Italian healthcare telematics policy and current EU activity. Italian expectations from the present Healthcare Telematics Programme are:

to receive as available validated and interoperable pilots ready to be transferred to the various local, regional or national scenarios;
to receive convergent guidelines as defined at EU level (mainly obtained through implementation mechanisms at the technological level).

Therefore, it is suggested that EU public healthcare research activity is structured to answer the healthcare policy objectives expressed by the competent authorities in the Member States. In this way, the results, once properly validated, could be quickly implemented in a coordinated manner in the various countries. It is worth mentioning in this context the role that properly evaluated pilot initiatives could have in proving in real life the economic and organisational impact of certain solutions.

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