The case reported deals with a new e-government service, that co-operatively links welfare and public health areas. This service consists of the electronic compilation on-line of the sickness certificates of workers by the family doctors and their direct submission to INPS (National Social Security Institute), allowing also for the creation of a large historical data bank on epidemiology, that will be available to the medical community and the interested Institutions.
INPS, the largest public welfare institution in Italy, has the institutional duty of paying a variety of benefits, among which the sickness indemnity of workers, on the basis of the certificates released to the ill workers by the family doctors.
Before the introduction of this web application, the process of payment of sickness benefit had several preliminary manual steps: compilation and release of the sickness certificate in paper format by the family doctors, submission to INPS by mail by the workers, management of the paper flow by INPS (reception, grouping, storage, acquisition on the information system). These activities were highly expensive and resource-consuming, given the size of the certificate paper flow: more than 12 million certificates nation-wide per year.
The Celine project (Certificates on-line) aimed at providing a suitable solution to this problem, eliminating the paper flow and the related management activities through the electronic compilation and submission of the certificates directly to the INPS information system.
Furthermore, the parallel creation of a new data bank on epidemiology with Data Warehouse capabilities will represent a major advance for the epidemiological analysis. The importance of this data bank is given also by the fact that it contains the sickness data of the major part of workers in Italy, nearly all the employed and self-employed workers of the private sector and a part of the public sector.
The project is being carried out by INPS and operates in strict collaboration with the Ministry of Health, the Local Health Agency (ASL) and is regulated by a specific state law.
Main results, benefits and impacts
The impact of the Celine application is significant from several points of view, bringing public administration much closer to the citizens need: indeed one of its goals is to relieve the citizen-worker from a task that becomes quite onerous due to the condition of illness in which the task itself has to be accomplished: the submission of the sickness certificate to INPS. The application enables INPS to perform the acquisition of the sickness certificates of workers automatically, eliminating a huge paper flow that was requiring several manual steps, very expensive and resource consuming. The impact of the case in terms of benefits on the process of acquisition of the sickness certificates and its costs can be summarised as follows: - the whole process of payment of the sickness indemnity becomes fully automated, with a sharp increase in the efficiency and efficacy of the process (benefits both INPS and workers - a more efficient process results in a faster payment of the indemnity); - the risk of errors and misspelling in the certificate data, resulting in annoying operations of re-cycle and consequent delay in payments, is almost totally eliminated; - the reduction of cost is very impressive: as already mentioned, the management of one electronic certificate has an estimated cost of only about 6% of the correspondent paper certificate. This reduction (about 94%) will decrease the yearly process costs from ? 52.80 million to ? 3.36 million; - the total automation of the process allows also for a constant monitoring of the acquired sickness indemnity certificates and to control the costs deriving from the payment of the related indemnity. Moreover, other aspects can be considered: - it represents a significant example of a cooperative application linking two different areas: social protection and public health system. In this view, the direct flow created between those administrations relieve the citizen from the duty of bridging them at his/her own charge. - The nosological information contained in the certificates, joined with those related to the working history of the citizen, will provide a basis for the creation of an epidemiological Data Warehouse. This will allow studies and analyses of several type to be carried out, especially concerning the incidence of work environmental conditions on the occurrence of specific diseases. This kind of data bank does not exist in Italy yet (not even in Europe, to our knowledge), and it may be considered as an extraordinary achievement for massive epidemiological analysis and studies and for planning programs on preventive medicine. The application is currently in phase of increasing diffusion and its use became compulsory by law starting from 1.06.2005. In total, about 50.000 family doctors nation-wide are the target users of this application. The level of use and satisfaction survey shows a very positive doctor response and satisfaction, who especially appreciate the design and simplicity.Return on investment
Return on investment: Not applicable / Not availableLessons learnt
Several conclusions may be drawn from the present project: - the cooperation among administrations appears to be an important factor of success, also from an image point of view. The figure of "walking citizen", meaning a citizen that walks to bring information from one administration to another one, is to be replaced by a citizen that is enabled to interact with the whole administration at all levels, from local to national and even to over-national (e.g. European), by a variety of communication tools and virtually from his/her home. This responds to the concept of Information Society, where information can be obtained or provided very easily, getting over the potential barriers. - A simplification of the interaction between citizen and administration is also very useful for the administration: the inter-administration communication improves the efficiency of the process and reduces it costs. - The importance of a full exploitation of the ICT technologies: the current technological level, which is also continuously advancing, ensures a fast development of the Information Society. A considerable advance may be obtained by exploiting ICT at the current level. From the technical point of view, other issues have to be tackled when several administrations interact: information systems compatibility, interoperability, standardisation, data homogenisation. - The importance of the right environment. As it has been often stressed out, the advance in e-Government has to be accompanied by a parallel re-organisation of the related processes (back-office). The case shows that when the administration is ready for these changes, or is flexible enough to adapt quickly to the new process, the results are very positive. - The cooperation among administrations, beside improving the processes and reducing their cost, offers new opportunities, like the creation of an epidemiological Data Warehouse reported in the present case. The importance of these new products may, in some cases, be even greater than the benefits brought about in the processes. - The attention paid to the direct users of the application (the family doctors) in all the phases of the project, starting from the application design, which has been done in strict collaboration with a team constituted by doctors, to the implementation and test phases, and to a final survey to monitor their satisfaction in using the application has proved to be essential for the success. Problems like digital divide, which could affect the fraction of senior doctors, that are most likely to be less familiar with the use of computer and ICT in general, have been taken into proper account, organising training courses and assistance help desk. A final consideration - the success of this application encompasses technical, organisational and human factors: the information society is the society where information is a key value, but of course it has to combined with all the human values of a modern and civil society.
Login or create an account to comment.