Recovery Plan, a healthcare mission (part 3)

Promoting the creation of a modern and digitally oriented Italian NHS, able to improve the quality of care and the response to the health needs of citizens.

Innovation, research and digitisation of the Italian National Health Service

The component "innovation, research and digitisation of the National Health Service" stems from the need to intervene in the process of transformation and renewal of the current Italian National Health Service (NHS), promoting the creation of a modern and digitally oriented proposal, able to improve the quality of care and the response to the health needs of citizens.

Made in cooperation with our partners from esanum.it

The COVID-19 emergency has highlighted some structural weaknesses of the Italian health system. The health system's response to the development of the pandemic was hampered by deficiencies in the provision of adequate medical and health devices, the availability of personnel, and the provision of technological and digital infrastructure and equipment.

Lessons learned during the COVID-19 emergency also show that it is necessary to find a new and appropriate way of coping with needs and contingencies in order to establish lasting, transparent and mutually beneficial relationships between public action and the action of private structures. All this is part of a sector that must be considered absolutely "strategic" and where central government guidance is essential.

Finally, the document highlights the importance of the Italian research sector, which needs more funding to ensure greater coordination and the updating of the supply of health services. Research is an essential element, as it ensures the improvement of patient care, as well as the development and evaluation of organisations.

In this context, the project contained in the draft “Recovery Plan” aims to respond to the following challenges:

• Overcoming issues related to the limited resources allocated to health research and digital health
• Develop a stronger link between research centres and companies, in an open innovation perspective and
• Make healthcare facilities safer and in line with current seismic safety standards
• Overcoming the critical issues linked to the limited and uneven spread of electronic medical records
• Overcoming the problem linked to ageing equipment/underuse of health technologies in hospitals
• Overcoming the limited diffusion of telemedicine tools and activities
• Aligning training plans in a manner consistent with the needs of the health sector

The objectives

The overall objective is to increase the effectiveness and efficiency of the health and care system, taking into account elements such as the ageing population and the limited investment in health infrastructure made in the past. In order to achieve this broader objective, this part of the project aims to strengthen innovation and digitisation in health facilities and to support research and training of health professionals.

The document identifies 3 priorities:

1. Secure access for citizens to their health data, including across borders, i.e. enabling citizens to access their health data across the EU
2. Personalised medicine through a shared European data infrastructure - enabling researchers and other professionals to pool resources (data, expertise, computing and storage capacity) across the EU
3. Increased focus on citizens, using digital tools to enable people to take care of their health, stimulate prevention and enable feedback and interaction between users and healthcare providers

Therefore, specific targets to be achieved by July 2026 include:

• Ensure the provision of updated technologies for healthcare equipment, replacing existing ones, and promote the digitisation of healthcare facilities in order to ensure a prompt and adequate response to any epidemic or pandemic events (the document envisages the purchase of 2,648 new medical devices and the improvement of the digitisation of 177 DEAs - 1st level Emergency Care Departments).
• Strengthening and expanding the NHS information system in terms of the evolution and modernisation of the infrastructure/systems for creating, collecting and analysing health and non-health data, by increasing the number of types of documents digitised in the Electronic Health Record.
• Supporting advanced innovation in health data management through AI (Artificial Intelligence), Big Data and Machine Learning and integrating information from administrative flows with clinical data collected to implement personalised and precision pathways.
• Ensure secure accessibility of health data in compliance with privacy regulations.
• Address and overcome the gaps between research and industry.
• Reorganise the network of Research, Hospitalisation and Care Institutes (IRCCS) to improve the quality and excellence of the NHS.
• Develop, through the funding of research programmes/projects focused on specific pathologies of high biomedical complexity, targeted therapies able to provide concrete answers to the health needs of citizens affected by rare diseases and tumours and strengthen the response capacity of centres of excellence in Italy.
• Guaranteeing structured and sustainable continuous training for health workers to meet current and future challenges, promoting the development of adequate managerial skills for staff with coordination and governance responsibilities in NHS bodies.

The digital upgrade of hospitals' technological equipment

Data published by the Ministry of Health show significant obsolescence and a gap in the availability of digital infrastructure and equipment to ensure that health services are effectively delivered nationwide:

• about 24% of CT machines are more than 10 years old
• about 27% of MRI machines are more than 10 years old
• about 31% of angiography machines are more than 10 years old
• about 74% of mammography machines are more than 10 years old
• about 50% of mechanical ventilators are more than 10 years old

In France, Denmark and Sweden, between 60 and 70% of equipment is at most 5 years old. In Italy, the newest equipment (considering those up to 5 years old, i.e. the most performing and hi-tech machines) are becoming fewer and fewer.

Improving the digitisation of healthcare facilities will help increase staff productivity, facilitate hospital operations, improve process quality, ensure patient safety and deliver high-quality services by integrating state-of-the-art technologies such as medical devices, intelligent information systems, facility control and automated transport systems, location-based services, sensors and digital communication tools into healthcare processes. Digital upgrading will make it possible to replace healthcare equipment with the most technologically advanced versions, also bringing benefits to clinical care processes.

Technological evolution will also equip companies and professionals with advanced analysis tools, capable of collecting data in real time, transforming it into information and interpreting it for simulations. The investment aims to purchase and test 2,648 pieces of equipment to replace obsolete and outdated technologies (more than 5 years old) and improve the digitisation of 177 healthcare facilities.

Towards a new, safe and sustainable hospital

The Ordinance of the President of the Council of Ministers no. 3274 of 20 March 2003 requires seismic vulnerability checks to be carried out on buildings of strategic interest. Among public buildings, hospitals play a strategic role in the event of disasters.

The hospital, one of the most exposed and sensitive sites because it is crowded with thousands of people with very different reactive capacities, must not only withstand the shock force of the earthquake, but also continue to offer sufficient levels of healthcare. This means that special attention must be paid not only to the load-bearing elements but also to the non-structural and plant elements.

The objective of the project within the Recovery Plan is to outline a path for structural improvement in the field of hospital safety. More specifically, the aim is to bring them into line with current seismic safety standards. To this end, the Ministry of Health has identified a total requirement of 675 interventions in 2020, distributed proportionally among the Regions.

Data collection, data processing, data analysis and simulation at central level

The Electronic Health Record (EHR) is a key tool that unlocks the potential of data analysis in healthcare. The EHR allows patients to have access to all their health records and enables practitioners to increase the quality and timeliness of care decisions to be made. The EHR needs to be uniformly adopted across the country and its security improved, with the aim of making it informationally complete and usable for both citizens and professionals.

The monitoring carried out by the Agency for Digital Italy (AgID) shows a substantial gap between the activation and the actual use of the EHR by citizens. In fact, as far as citizens are concerned, in 10 out of 20 Regions the level of activation is below 50%, and slightly above 1% in 6 Regions, while the use of the EHR is above 50% in only 4 Regions. The situation regarding activation and use of the EHR by physicians is also critical, resulting in a level of activation similar to that of citizens (in 9 Regions there is a rate of <50%) and a satisfactory level of use for only 3 Regions.

The investment aims to strengthen the technological infrastructure of the Ministry of Health responsible for the collection, processing, validation and analysis of health data, as well as the implementation of new health information flows and the integration of existing flows. In addition to creating a national platform for managing health registers and health surveillance systems and developing a national platform for telemedicine solutions.

The EHR, if fully and properly managed and used, also supports the governance of regional and national health systems based on 'real world' clinical data. The use and deployment of EHR is therefore essential for the digital transformation of health.

Developing the professional, digital and managerial skills of health professionals

Scientific progress and technological innovation require that health professionals are constantly updated and trained.

This part of the project aims to increase the number of scholarships for a specific course in general medicine, guaranteeing the completion of 3 three-year training cycles; to launch a training plan on safety in terms of hospital infections for all medical and non-medical managerial profiles of the NHS; to activate a training pathway for personnel with apex roles within the NHS bodies in order to make them acquire the necessary managerial skills and abilities to face current and future health challenges in an integrated, sustainable, innovative, flexible and result-oriented way.

Click on the image to download the Recovery Plan draft

Reference:
Draft Recovery Plan "Mission 6 - Healthcare. M6C1 - Proximity networks, facilities and telemedicine for territorial healthcare assistance. M6C2 - Innovation, research and digitalisation of national healthcare service".