The Covid emergency has increased the problems of the territorial health and care system, which had already been showing clear signs of difficulty in implementing the models that had been identified as strategic for more than a decade. In fact, many will remember the slogan “From curing to caring”, unfortunately still difficult to apply in some contexts.
To promote innovation of the entire territorial health and care system, Beta 80 Group has defined a specific operational management framework based on the application federation model, an Enterprise Architecture pattern that promotes interoperability and information sharing between applications, information systems and decentralised and autonomous organisational structures.
Healthcare cuts? Right to health at risk
The ordinary conditions of the pre-pandemic years made it possible, unfortunately, or fortunately, to compensate for these difficulties through the services intended for higher intensity care. The number of technically inappropriate admissions to the emergency room still constitutes an obstacle to the identification and access to the most appropriate services. The hospital, but above all the emergency room, represents the guarantee and certainty of receiving help for the citizen, who is often not only in need of care, but also lives in a condition of fragility.
Moreover, the streamlining of public spending has seen a progressive cut in hospital resources, as it is based on the incidence of pathologies that would require access and not on actual utilisation. This has led, for example, to the reduction of 33,000 hospital beds between 2010 and 2018, according to estimates presented by Istat (Italian national statistical institute) during a hearing at the House Budget Committee. The obvious consequences are manifold:
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long waiting times
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overcrowding of facilities
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patient dissatisfaction
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stress for staff.
Investing in health: what the NRRP states
To concretely relaunch the territorial health and care system reform, a share of the funds of the National Recovery and Resilience Plan (NRRP) has been allocated to this area. In particular, Mission 6 Health of the plan is focused on implementing proximity healthcare, widespread throughout the country, in order to guarantee primary and intermediate care, starting with the most fragile categories. The overall budget for this measure is more than 20 billion euro, mainly financed by the NRRP, with the integration of funding from the React Eu and the Complementary Plan. The implementation of these measures started with the registration of the Decree of 20 January 2022, with which a first tranche of funds of more than 8 billion euro is allocated among the regions.
The goal of territorial health and care system reform is a National Health Service that aims at healthcare closer to people and overcoming inequalities. This could be possible by building structures dedicated to intermediate care services throughout the country, thus reducing the use of hospitalisation and increasing the perceived quality of life.
To this end, the actions are aimed at:
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Defining a new organisational model for the primary care network, capable of identifying uniform structural, technological, and organisational standards throughout the national territory, in order to guarantee citizens and operators of the National Health Service compliance with the Essential Levels of Care.
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Facilitating the identification of intervention priorities with a view to proximity and integration between the territorial, hospital and specialist care networks.
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Promoting the continuity of care for those living in conditions of chronicity, fragility or disability, which entail the risk of non-self-sufficiency, also through integration between the social and health services.
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Designing a new institutional set-up for environmental and climate health prevention.
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Aligning with the quality standards of care in the leading European countries.
Key aspects of health care reform
The key aspects of the reform aim to redesign the healthcare geography, its functions and standards. The main elements are:
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Community Homes: a physical and easily identified place, open 24 hours a day, 7 days a week, which citizens can access for health and socio-health care needs. There are more than 1350 Community Homes spread throughout the country. They represent the organisational model of proximity assistance for the population, i.e. the preferred location for the planning and delivery of health and social integration interventions.
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116 117 Operations Centre: free telephone contact service for the entire population, active 24/7, which implements the Harmonised European Number for non-urgent medical treatment. It was created from the Continuity of Care Contact System and has evolved into a point of contact for all low-intensity health and sociomedical needs.
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Territorial Operations Centre: a multi-channel contact service for professionals in the health and socio-medical system; it coordinates the taking charge of the person and links the services and professionals involved in the various care settings. Newly established, it represents the central link between territorial, health and social-health, hospital and emergency-urgency network activities.
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Family and Community Nurse: it is the professional figure of reference who ensures nursing care, at different levels of complexity, in collaboration with all the professionals in the community in which he or she works. He/she not only takes care of patients, but also interacts with all the actors and resources present in the community to respond to current or potential needs.
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Electronic Health Record: it is the set of data and digital documents of a health and social-health nature generated by present and past clinical events concerning the patient. It was first established in 2012 with an activation deadline of 30 June 2015. However, the actual implementation encountered considerable organisational and technological problems, so that a new technological architecture was defined and new implementation guidelines were issued by the Minister for Technological Innovation and Digital Transition, which all the local health authorities of the Regions and Autonomous Provinces will have to adopt, gradually leading to the use of Electronic Health Record 2.0 by 2026.
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Continuity of care unit: it is a mobile district team for the management and support of the care of individuals or communities, which are in particularly complex clinical-assistance conditions, and which involve a proven operational difficulty.
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Community hospital: it is an in-patient health facility of the Territorial Assistance that performs an intermediate function between home and hospitalisation, to avoid improper hospital admissions or to favour protected discharges in more suitable places. It plays an essential role in the prevalence of sociomedical needs, clinical stabilisation, functional recovery, and autonomy.
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Telemedicine: it is a technology that is destined to become routinely used by healthcare professionals to provide services to patients or consultancy and support services to other professionals. It includes in a network of coordinated care and enables the provision of health services and performances at a distance, using digital devices, internet, software, and telecommunication networks.
Beta 80 Group: promoting the digital transition of national healthcare
The reform implies a profound change management process by Regions, Autonomous Provinces, local health authorities and all the bodies and professionals involved. In this scenario, Beta 80 Group has an important role as a partner for technological transition and reorganization, through the services of:
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Consulting: combining many years of expertise in health care processes with in-depth knowledge of the components of Mission 6 Health of the NRRP and the Electronic Health Record0 implementation guidelines.
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PSAPs Solution Specialist: offering both established and operational solutions and new ones, based on the common core application architecture of the Life 1st suite. All this is supported by an approach consolidated over many years of experience in multidisciplinary PSAPs.
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System Integrator: an essential element to achieve the objectives of cooperation and application federation, which is essential to implement the territorial health and care system reform.
Towards the application federation model
The changes to the application pool required to implement the territorial health and care system reform are numerous and depend on the organisational restructuring processes and the development of the technical and digital skills of the healthcare personnel. They also need to be coordinated with similar updates to the applications of the whole network of bodies, structures and professionals involved. To this end, Beta 80 Group has defined a specific operational management framework, incremental in nature and able to adapt to the specific needs and priorities of each territory. The framework is based on the application federation model, thanks to which application integration and cooperation are subject to the definition of a standard reference interchange model.
In this way, it is possible to:
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make the most of previous investments in tools, which reflect the peculiarities of the area and for which operators are familiar;
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minimise any strong technological interdependence, making a tool interchangeable with one intended for the same functional domain without any impact on the confederated application ecosystem.
This approach is reflected in the indications of the Department for Digital Transformation and the Agency for Digital Italy. The challenge is to bring a high level of maturity of the interchange standards, a prerequisite for application federation: from the commodity services of the enabling platforms, managed centrally, to the department- and process-specific tools, managed by local authorities and structures with their suppliers.
The second half of 2021 and the first half of 2022 represented a significant moment of discontinuity for the National Health Service, with the planning of various structural interventions to the territorial health and care system for the next three years, which will be implemented thanks to NRRP funds. The entire Italian population is the target of this reform, with particular attention to chronic or fragile subjects, with the aim of simplifying access to services and guaranteeing better adequacy and focus, without burdening the structures intended for emergency or high-intensity care.
As of the second half of 2021, but especially in 2022 and the next three years, this reform represents a great opportunity for Beta 80 Group to promote its catalogue of services and products, and to evolve the Life 1st suite.
