Electronic signature in daily eHealth activities (TeleMed-ESCAPE)

A health care unit issues hundreds of documents as a daily outcome of its procedures. Usually, these documents are processed with the use of PC, then printed, signed by the Physician and paper managed. The purpose of TeleMed ESCAPE is to eliminate the use of printed documents within the Health Care Unit. The project has developed a completely digital system to sign, transmit, extract/deliver and store clinical documents, preserving the privacy and the security of healthcare data. This system has progressively replaced the paper management. It also permits to avoid unnecessary accesses to the Hospital by sending electronically results to the final users, keeping the full legal validity and security of paper documents. The report is sent to a repository and from this to the wards or to General Practitioners, to PEIE (a special post mail service) and to citizens through an Internet connection to a dedicated webpage. Due to the new organisational model, a complete reengineering process was necessary to review all the procedures within the organization, because the new digital system has altered the traditional use of information.

Main results, benefits and impacts

The project has started in 2003 and ended in July 2005, but it is already re-used in different other contexts. Currently the Services of the involved Health Care Units digitally sign reports, send them to all inner units, and to covenanted General Practitioners, where they are extracted. Furthermore the report delivery through the PEIE service and the extraction through an Internet connected PC have been set up. In Treviso Hospital, where the digital services has already been implemented, we can notice an improvement of the quality of care provided to the citizens, eliminating unnecessary accesses to the health structures. In fact the patient flow to the structure is reduced thanks to the new different delivery channels: usually 30% of citizens read the test results on the Internet, 14% of citizens receive the reports at home by PEIE mail, and General Practitioners can display their patient reports on their PC and insert them in the Patient EHR. That allows patients to save more than ?500.000 and 100.000 hours for avoided travels. The medical report is available a few minutes after its validation. In this way the pharmacological treatment can start earlier and the request for urgent exams is reduced up to 20%: that means improvement of economy and efficiency, for a better quality of care. The new system has increased patient security and privacy: the information flows can be monitored at all times and responsibilities may be easily stated. The patient clinical data are handled only by the validating personnel and by the final users. The reports' losses have almost disappeared. All medical tests and results are validated and transmitted as soon as they are issued, reducing waiting time. The secretarial and the auxiliary staff in the issuing services can be reduced up to 10 units, therefore this precious resource can be used for activities of greater added value. TeleMed-ESCAPE locations include 4 different regions (Veneto, Lombardy, Friuli Venezia Giulia and Umbria) and 11 Health Care Units: it covers about 3.000.000 citizens.

Return on investment

Return on investment: Not applicable / Not available

Lessons learnt

TeleMed-ESCAPE is producing new and more efficient solutions to management problems within a hospital. All these solutions can be exported to other administrations, because the software can be easily integrated with the departmental software already present in every health care service, aiming at becoming an instrument for the Region Administrations to start up innovative technology uses, promoting common initiatives to build new IT infrastructures and applicative cooperation services. The XML language allows integrating the TeleMed-ESCAPE standards with the different applicative instruments to create digital documents and an Electronic Patient Record and ease data exchange for medical use. Furthermore, the 'standard scheme' of medical reports, distributed among the involved Health Care Units, can represent an important instrument to exchange information among different laboratories. Health Care Organizations and other public administration can learn from the TeleMed-ESCAPE experiences in order to implement a secure digital system to manage their documents. The digital signature can have multiple application areas: for instance, the Treviso Health Care Unit will re-use this experience to test e-prescription, electronically sent from the General Practitioner to the chemistry. The standardisation of code systems and report schemes can be spread to other health care services, improving the interoperability among health care structures and professionals for a better quality of care. The coordinating team is ready to support all the interested administrations, providing guidelines and, if necessary, training on the field with actual demonstration on how to proceed. They are ready to hold an 'Open doors' day. If selected to do so, the team will present the case, demonstrate it at an exhibition and contribute to the workshop.