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Roll out in Romania

Health OptimumHealthcare delivery Optimization through TelemedicinePSC 4 – June 25, 2008

Cristina Racoceanu

Marketing & Business Development

INFO WORLD

Romania

Summary

• Progress report in Romania• Health Optimum services in Romania• Technical Architecture• Functional workflow – Tele-counseling for

Neurosurgery• Business Model• National health authorities and Health

Optimum• Dissemination • Conclusions

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Progress report in Romania

• Technical Interoperability between SCJUT and Treviso Treviso connects with the communication hub provided by Info

World and not directly to SCJUT, in order to minimize the additional infrastructure costs for the future deployment of telemedicine services

furthermore, this approach will ensure a smooth integration of the EHR services in SCJUT, planned for October 1, 2008, with the possibility of sharing medical data with other hospitals in the region

• Preparations for next services in August SolInfo will conduct XDS tests between 15th- 30th of July for a

complete integration with the Info World services in place in Timisoara

Discussions and tests will be conducted this period between Info World, SCJUT and SMUT (Electronic referral for Cardiology service) and between Info World, SolInfo and SCJUT (Tele-counseling for Radiology service)

• Preparations for the extension of services in SMUT and IBCV (December 2008-February 2009) A test has been successfully completed on June 13 in Timisoara

between SCJUT and SMUT

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Health Optimum services in Romania

• Services between SCJUT and Treviso: Tele-counseling for Neurosurgery – June 1, 2008

(launched) Tele-counseling for Radiology – August 1, 2008

 • Services between SCJUT and SMUT:

Electronic referral for Cardiology – August 1, 2008 Tele-counseling for Neurosurgery – December 1, 2008 Tele-counseling for Radiology – January 1, 2009 Tele-counseling for Oncology – February 1, 2009

• Services between SCJUT and IBCV: Electronic referral for Cardiology – February 1, 2009

• EHR Services will be available on October 1, 2008

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Technical ArchitectureRomanian site architecture

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Technical ArchitectureRomanian site architecture

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Technical ArchitectureTechnical services

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• Secure Mail Service - hosted in Romanian Hub for asynchronous tele-counseling services

• Conference Service - hosted in Romanian Hub for interactive tele-counseling services, unified communication and point-to-point AV-conference solution

• Call Center - subcontracted to Alcatel-Lucent, offers services to patients and medical staff (information, support, etc)

• Portal Services - hosted in Romanian Hub– www.MediPedia.ro – medical portal – patients store their

personal health records and give access to it to the physicians of choice

• PACS Services - hosted in Romanian Hub– PACS solution for radiological images and

communication with PACS currently in place in Treviso Hospital

• EHR Services – full deployed on 1st Oct, XDS testing with Treviso from 15 July– architecture backbone components for Romanian Hub

Business ModelGeneral Assumptions

• The business model is based on the cost of resources and savings acquired by use of telemedicine services

• In Romania the following healthcare structure and healthcare professionals will be involved in the Initial Deployment of HEALTH OPTIMUM

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Tertiary Hospitals (hubs) Primary Care Centres (spokes) Professionals

Treviso Hospital

County Hospital of Timisoara

Municipal Hospital of Timisoara

County Hospital of Timisoara

Municipal Hospital of Timisoara

Hospitals from Arad (County or/and Municipal)

Hospitals from Deva (County or/and Municipal)

Hospitals from Resita (County or/and Municipal)

City Hospital Petrosani

Municipal Hospital Lugoj

City Hospital Jimbolia

Initial Market Deployment

2 hospitals

247 Physicians

513 nurses

4 technicians

2 clinical secretaries

678.000 patients Full Market Deployment

45 hospitals 2.475 Physicians

4.500 nurses

1.975.000 patients

Business ModelGeneral Assumptions

• Apart from extrapolating the experience of Treviso about avoidable transportation of the patient with neurological conditions, the first-hand experience of the County Hospital is that:– > almost 50% of the patients transferred to the

County Hospital from other hospitals in the Region which do not have neurosurgery specialists either do not need neurosurgery at all are terminal patients who are not operable anymore

The consequences are: a lot of money is wasted on ambulance transportations,

since some patients can be referred to the County Hospitals from peripheral hospitals as far as 200 Km;

the scarce and costly beds in the Neurosurgery Department are occupied by non-surgical patient (45% of the Department inpatients in 2007)

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Business ModelFinancial Simulation

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• Taking into account the operating costs of the HEALTH OPTIMUM service for personnel and equipment, the projected savings, costs, and net financial benefit are shown in the table below:

Summary of savingsYear 1 Year 2 Year 3 Year 4 Year 5

Romania without patient savings Savings 20.588 € 99.343 € 258.923 € 496.900 € 761.395 €Costs 118.477 € 127.413 € 145.326 € 162.489 € 203.120 €Difference -97.888 € -28.069 € 113.597 € 334.411 € 558.275 €

Romania with patient savings Savings 21.687 € 102.598 € 265.986 € 509.540 € 782.959 €Costs 118.477 € 127.413 € 145.326 € 162.489 € 203.120 €Difference -96.789 € -24.815 € 120.660 € 347.051 € 579.839 €

Business ModelFinancial Simulation

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National health authorities and Health Optimum

• Mrs. Ioana Pertache, Deputy Director NCOAHIS (National Centre for Organizing and Assuring the Health Information System) of the Ministry of Public Health of Romania and Mr. Dan Farcas, Chief of Office Strategies and Projects of the Ministry of Public Health of Romania sent a common letter to Andrea Halmos.

• The letter confirms the support of the Ministry of Public Health for the development of the telemedicine services in Romania and states that HEALTH OPTIMUM fits the future evolution of the Romanian Health System.

• The President of the Timis County Council is already aware of the Project and is fully supportive since during the project representatives from SCJUT kept him informed about the activities carried out during the project HEALTH OPTIMUM and the Near to Needs project which preceded it.

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Dissemination

• Dr. Mihai Ionac participated in the regional TV-News at AnalogTV in a special edition regarding HEALTH OPTIMUM on April 29, 2008

• Dr. Mihai Ionac presented "HEALTH OPTIMUM - The Europe telemedicine experience applied in Romania" during NEST Partnering Day, May 7, 2008

• Attending the Radiology Conference Tg Jiu, Romania – prints and conference, May 22, 2008

• Publishing the release of the HEALTH OPTIMUM services on Info World’s website

• Flyers distributed inside SCJUT disseminating information about the new services released – June 6, 2008

• Advertorials and PR releases in Medical Life Magazine (Viata Medicala) – not scheduled yet

• Publishing banners and articles on www.pulsmedia.ro (related with the printed magazine at the previous point) – starting from October 1, 2008

• Publishing banners and articles on www.medipedia.ro – starting from August 1, 2008

• Publishing of articles in the “Timisoara Medical Journal” – not scheduled yet

• RoCS 2008 – Romanian Computer Show, Healthcare Section – November 2008

• Final Press Conference in Timisoara – not scheduled yet, 2009• Journal of Experimental and Medical Surgical Research– not scheduled yet

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Conclusions (1)

• The scenario for the deployment of the HEALTH OPTIMUM services in Romania shows a far higher level of complexity than in the other countries because it is an unexplored one due to the fact that no Market Validation phase was carried out in this country

• The deployment of the HEALTH OPTIMUM services is strategically important for Romania because it can foster the establishment of a legal and economic framework for telemedicine in the country

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Conclusions (2)

• Telemedicine services are seen extremely valuable by doctors within the hospitals in the different Romanian regions as they could cut costs in terms of resources (money and time)

• Telemedicine reduces the number of referrals without substantially increasing the duration of consultations by Secondary Care specialists or GPs;

• Tele-referral s and tele-counselling constitute an on-the-job training for Secondary Care specialists or GPs;

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Conclusions (3)

• The HEALTH OPTIMUM telemedicine platform is also suitable to build commercial services on top of it

• Elimination of radiological plates reduces pollution and gives important savings ;

• Telemedicine can improve quality of care, satisfy growing demand for clinical services while containing healthcare expenditure.

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