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Information
technology will definitely play an important role and is actually constituting
a series of great opportunity for the management of healthcare structures
also in Italy.
The
role of information technology with reference to health (but “wellness
or “well being” could be a more appropriate wording) can
be foreseen as a catalyzing and support element for the entire
Italian healthcare system, as a support element for the professional
activity of the healthcare operator, but, more important as an enabling
factor for the citizens to take a more active participation in front
of the aforementioned domain.
As generally in Europe, also
in Italy the penetration level of the healthcare telematics systems
is low with respect to other sectors (e.g. banking, transport), but
the estimate for the next decade is for a potentially growing market.
Nevertheless,
today, such market is highly fragmented and difficult to be accessed.
In Italy, this fact is mainly
due to a limited knowledge of the potential benefits of it (which in
turns can be related to a general informatics illiteracy) and also to
the inability - at any level - of expressing a coherent demand.
The market in Italy can be
structured according to four layers model:
1) telecommunication infrastructure, available, largely
diffused and managed by the telecom operators;
2) generic added value services (e.g. e-mail, Internet,
remote databases, security), available from other sectors;
3) special purpose added value services (e.g. regional
databases, certified third parties), partially available;
4) interoperable applications, available only in small
percentage.
Obviously the focus from all the participating actors
(users, citizens, industry, providers) is on the last two levels of
the model, i.e. 3 and 4.
The main goal that the progressive introduction in
Italy of healthcare telematics system should achieve can be considered
as the realization of the continuity of care principle.
This
means a twofold task, following, so to say, to orthogonal lines, i.e.
the interconnection of the territorial points of care on a geographical
basis, giving therefore a greater spectrum of opportunities to isolated
areas or situations, such as rural zones, sea and air, and the district
integration among the different levels of care (i.e. continuity among
primary care, secondary care, home-care etc.).
The
achievement of such goal will allow a reduction of duplication and therefore
optimization of the efforts, reaching quality basically through the
development of interoperable applications.
Healthcare
telematics is going to be perceived in Italy as an important enabling
factor for the citizen quality of life. In fact, there are growing expectations
on what healthcare services can and must yield to the citizen (e.g.
TV programmes devoted to health, Internet): the citizen has a greater
consciousness and direct responsability of his own body (performance
levels) and of his own wellness (longer life expectancy, higher education,
higher mobility).
In
this sense, healthcare telematics is going to give a strong contribution
to perform an informed choice of care and carers, on the basis of objective
indexes of quality of the service needed, by allowing transparency and
inducing competition also at international level among the healthcare
provider institutions which can in turns improve their rationalization
strategies, better addressing their specialties.
Generally
speaking, the introduction of healthcare telematics in Italy can be
considered as an evolution tool for the classical health paradigma,
moving the attention baricenter from care during acute phase to a vision
including wellness promotion and disease prevention, from an health
system centered on hospitals to a distributed health system involving
all levels of care (from general practitioner to home-care), from the
attitude of citizen to an almost blind and exclusive mandate of his
health to the medical doctor to a more direct responsibility of his
own body and wellness.
The
final result will be the leveraging of the healthcare institution of
excellence on an international scale, and therefore, paradoxically the
healthcare system could loose controllablity at national and regional
level.
In
order to understand the status of healthcare telematics in Italy and
its degree of penetration among the various potential interested actors,
it is necessary to briefly outline the model of healthcare system adopted
in the country. The model is essentially a public one, where the guide-lines
and the control activities are handled by the central government (the
Ministry of Health) and related institutions (Istituto Superiore di
Sanita') but the actual management and spending is under the control
of the regional authorities, with a large degree of autonomy (Assessorati
alla Sanita'). Private actors are also allowed according to accrediation
procedures and mainly through a private system of integrative insurance,
but actually they account for a small amount of the total spending for
health.
Just to have some reference figure, the Italian health
system accounted in 1998 for a total spending of approximately 150000
billion ITL (accounting for approximately 7-8% of the Italian GNP).
Despite the prevalent public approach to health, it
has to be pointed out that about 30% of such figure is coming out directly
from the pocket of the Italian citizens. This fact is due to several
reasons and firstly to a large degree of disorganization of the competent
structures for managing health and health expenditure, but not least
to the lack and delay in the introduction of telematics related technology
into the system, at any level. As in the analysis of many other sectors
of the society, also for the healthcare domain a layered approach
can be followed, recognizing easily three levels of intervention:
1) the human resources (degree of competence and committment);
2) the organizational level (both clinical and administrative);
3) the technological level.
In the present situation, in Italy, levels 2 and 3
deserve the highest degree of attention from both central and regional
competent authorities.
It should be noted that levels 2 and 3 need concerted
strategies and actions, since the it is well know how disruptive - beside
useless - for the system could be the injection of advanced technologies
upon badly organized flows of information and working processes.
The
Italian healthcare system requires in this sense a true synergic intervention,
to avoid unuseful efforts and waste of resources. From such a picture,
it is undestandable that the degree of penetration of healthcare telematics
into the Italian health system is quite (and someone could say fortunately!)
limited and it followed in any case a buttom-up approach. In fact, no
national healthcare telematics plan exists and only some regions have
started only recently the exercise to build feasibility studies in limited
compartments, such as, for example, healthcare emergency (see the various
“118” regional system, 118 being the toll-free telephone
number for emergency) or the area of access to healthcare from the citizens
(“CUP”, Centro Unico di Prenotazione, see the regione Emilia-Romagna
and Liguria cases).
The lack of plans (nation or regional wide) more specifically
means the lack of guidelines, which basically prevent the real planning
and potential investments (both public and private) related to healthcare
telematics.
This happens despite the recognition of a potential
Italian market in this domain from several industrial actors and despite
the birth of related industrial enterprises.
The
Italian “Confindustria” (the association of the private
Italian industrialists) is - since years - aware of the problem, but
it encouters difficulties given the lack of guidelines and rules in
the field. For example, it is clear to several biomedical equipment
Italian manufacturers the shift towards the tendency of selling to the
healthcare providers (or even to the citizens, via the general practitioners)
no more equipments “per se”, but the full telematic service
(i.e. including the informatics and the telecommunication components).
Explanation to this status for health in Italy (as well probably in
other European countries) can be given by taking into account the complexity
of the healthcare system. It can be compared to a mosaic, where
each piece deals with the interest and point of view of a given category:
the medical doctors (they don't want to give up their power in front
of the patients), the industrialist (they would like to sell systems
and services as much as possible), the nurses (they are the ones which
really deal daily with the patients), and the citizens (they are the
payers, indirectly (through taxes) and directly). Definitely, none has
the key to find the “optimal” solution.
Perhaps,
it could be concluded that the problem of properly introducing healthcare
telematics in Italy will be enforced by larger societal changes such
as those induced by the advent of Internet in each Italian citizen home.
The
cultural shift brought-in by the information society will at the end
cover health as well.
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