D I G I TA L
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Nine million residents of Lombardy have received new electronic “citizen cards” that offer a range of benefits, especially for visits to the doctor. Now that there’s less administrative work to deal with, doctors have more time for healing. It’s virtually impossible to issue the wrong prescriptions, confidential patient data is more secure, and costs are decreasing.
The health card. For Angela Turcatti and her fellow citizens, it saves a lot of traveling back and forth — and it gives doctors like Claudio Negrini (left) more time for their patients.
Nine Million Trump Cards
a here’s no way Dr. Claudio Negrini can v o i d h a v i n g a q u i c k e s p r e s s o a f t e r h e T has left his office in Grosotto and started walking down the narrow streets of this mountain village. His patients call out greet- ings, and many consider it an honor to treat him to refreshments. The people of Grosotto trust their doctor — and one another. When Dr. Negrini makes a house call, he often does- n’t even lock the office door behind him. His patient files, in the form of huge stacks of pa- per, are stored in a cupboard that is secured by only a small padlock. His long-standing cus- tom is to write out his prescriptions by hand. He hasn’t had any need for a computer so far.
But all that will change fairly soon. And there’s little, according to Negrini, to be sorry about. In fact, Negrini is looking forward to the new era that’s about to begin for him and his patients. In April 2005, all nine million in- habitants of the Lombardy region in northern Italy received their personal electronic “citizen cards.” These cards will bring them benefits, especially when they visit their doctors. For example, the cards can be used to write digi- tal prescriptions, which can be processed much faster than the ones scribbled on red paper that are currently used in Italy. What’s more, in the future it will be nearly impossible to forge a prescription. Pharmacists will be
able to call up prescriptions directly from the server where they are stored, and nobody will have to despair over doctors’ illegible hand- writing anymore.
In a few weeks, Dr. Negrini intends to buy a computer and invest in a high-speed DSL link to the health care server in Milan so that he and his patients can benefit as soon as possible from the “citizen card.” One of these patients is former kiosk owner Angela Tur- catti. Although it’s hard for her to get from place to place, in the past she has had to make some unavoidable trips, for example to make appointments in person for examina- tions by medical specialists. To do this, she
has had to go to the local health service coor- dination center, the “Azienda Sanitaria Locale” (ASL) in the provincial capital, Sondrio. “I’m looking forward to the time when my doctor is hooked up to the network,” she says. “Then I can use my citizen card in Dottore Negrini’s office to make an appointment for my next examination at the hospital, without running around and then having to wait.”
Digital Prescriptions and Transfers. In Lecco, a province north of Milan, this conven- ience is already a reality. The card system that will soon be used throughout Lombardy has been tested here since 2003. Local doctors and patients have been benefiting from digi- tal prescriptions and transfers to specialists, online transmission of medical data, and quick paper-free billing.
Maurizio Tedeschi was one of the first doc- tors to use the new system. “The amount of
time I need for paperwork has decreased sig- nificantly, and most procedures go faster now,” he says. “I now have more time for my patients. Most of them have no idea how so- phisticated the technology is that’s backing me up.” Word of the system’s success is spreading, and other Italian regions such as Sicily are interested in the pilot project.
When patients visit Dr. Tedeschi’s office, the first thing they do is to hand over their new citizen cards so that he can slide them into a reading device. Using his own card — his health care professional’s ID — he then logs in via a second reading device. Programs on the cards’ chips identify the doctor and the patient and register both of them together at Lombardy’s health care servers. Within sec- onds, a secure data link is activated to trans- mit the patient’s medical data, including his or her age and address, previous illnesses,
Patients can use a code number to release confidential medical information
or choose to keep it to themselves.
medications being taken, and the results of previous examinations.
If the patient then enters his or her PIN, Dr. Tedeschi can also access confidential data such as a current hepatitis infection. In Italy, a strict data protection law allows patients to withhold sensitive information of this type even from their doctors. That’s why the new citizen cards enable them to keep their health data to themselves if they wish. After all, an optometrist testing a patient’s vision doesn’t need to know whether he or she is HIV-posi- tive. “So far, none of my patients have denied me access to their medical information,” says Dr. Tedeschi. “That’s probably because our re-
herself with a health care professional’s ID and a PIN. Even prison chaplains in Lombardy have health care professionals’ IDs so that their services can be billed electronically.
“The important thing is that the access rights are clearly regulated,” explains Carlo Leonardi, the project manager responsible for the card project at Lombardia Informatica, the company that coordinates the services of the various companies working on this complex IT project. Siemens Informatica, a joint ven- ture between Siemens AG (51%) and Telecom Italia (49%), developed the Smart Cards, whose chips use an operating system that not only meets high security standards but also
Dr. Maurizio Tedeschi explains the advantages of the health card — including how secure the data is on servers in Milan (right).
lationship is based on trust. It’s ultimately the patient who benefits the most from increased transparency.”
guarantees compatibility with all the inter- faces involved. Siemens Informatica was also commissioned to produce and distribute the cards. Finally, the company ensures that the card management system runs smoothly, in- cluding the call centers that are available to all of Lombardy’s residents.
As soon as Dr. Tedeschi enters his own PIN, he can order further examinations or write an electronic prescription. The system then auto- matically checks for possible negative interac- tions between the prescribed medicine and other medications the patient is taking. As a result, there is virtually no risk of doctors in- advertently prescribing medicines that could endanger their patients’ health. When the pa- tient visits a nearby pharmacy, the prescrip- tion is once again checked online in real time. The pharmacist also has to identify himself or
Data Bunkers. “Nine million people have al- ready received their new citizen cards,” says Leonardi. “An additional 145,000 personal IDs have been distributed to health care profes- sionals. But not everyone who has such an ID has access to all of a patient’s data. For exam- ple, nurses will have access to only as much patient data as they need.” He proudly ges- tures to one of the server rooms at Lombardia Informatica, which is located in an industrial park on the outskirts of Milan. Computer spe- cialist Andrea Zino can open the door of this
Pictures of the Future | Fall 2005