Presented by Baxter, with the participation of Telemedicine Observatory by ALTEMS (Università Cattolica del Sacro Cuore, Rome). Stefano Collatina, Country Head Baxter Italy Prof. Fabrizio Ferrara, Universita Cattolica del Sacro Cuore Simone Naso, Digital Health Specialist, Baxter Italy Health care delivery in Italy represents a number of challenges, including the regulatory requirements and the regional differences. Telemedicine has the potential to provide more cost-effective care, especially for vulnerable populations such as the elderly. In this webinar the unique needs of Italy will be discussed and how they can be addressed by standards-based process automation.

1. Trisotech.com
Process Automation in Telemedicine:
The Italian Perspective
Stefano Collatina
Country Lead, Baxter Italy
Integrated Care Solutions Head, Southern
Europe
stefano_collatina@baxter.com
Simone Naso
Digital Health Specialist, Baxter
Italy
simone_naso@baxter.com
Presented by
With the participation of
Fabrizio Massimo Ferrara
Director, Healthcare Information Systems
Lab
ALTEMS, Università Cattolica del Sacro
Cuore
fabriziomassimo.ferrara@unicatt.it

2. Trisotech.com
Introduction

3. Trisotech.com
TelemedicineSeriesRecap
In Webinar 1 of the series, we discussed Efficiency Improvements in Telemedicine
o Introduced some telemedicine concepts
o Introduced the BPM+ Health open standards
o Presented and demoed a model of Nurse Teletriage of the Ill-Appearing Infant
o Introduced Attended Tasks: Not giving up control for the sake of efficiency
In Webinar 2 of the series, we discussed Patient Care Improvements in Telemedicine
o Introduced some classifications of telemedicine
o Introduced how BPM+ Health complements the exsiting HL7 standards
o Presented and demoed a model of home parenteral nutritional support (TPN)
o Introduced Knowledge Entity Models: Providing disambiguation of terminology using
Vocabularies, Concept Maps and Rules
 In Webinar 3 of the series, we discussed Reducing Risks in Telemedicine
o Identified various Risks inherent to Telemedicine and how IT can mitigate them
o Introduced the International Patient Summary (IPS)
o Presented and demoed automated detection of warning signs (“red flags”) to identify a high-risk
patient using a Dyspepsia example
o Introduced the FHIR Accelerator: Combining HL7 Standards with BPM+ Health standards
PROCESS AUTOMATION IN TELEMEDICINE
Recordings and slides of the Webinars are available here: https://www.trisotech.com/webinars/

4. Trisotech.com
Todaywewantto discuss how Telemedicinecould be boostedby BPM+ in the Italianscenario
PROCESS AUTOMATION IN TELEMEDICINE: THE ITALIAN PERSPECTIVE

5. Fabrizio Massimo Ferrara
Current scenario and the need for a Clinical
Data Repository

6. 6
Current scenario
Different applications variously interconnected, with proprietary and
non-accessible databases
In the Hospital Over the territory
Patient /
Caregiver
Hospital
HC Association
Social services
Insurance
GP Pharmacy
Hospice, Nursing Home
Local Primary Care (Casa della salute)
Outpatient clinic
Regional PHR
(FSE)
?
?
Where is the "good" data?
Where is the data that ”is needed now"?
How difficult is it to get the data (vendor lock-in)?
Management control
Clinical risk
Clinical history
Process optimization
Protection and security
Appropriateness
and safety of care
Cooperation
Prevention
Research
?
?

7. 7
Objective scenario
Integrated and non-proprietary data
Built-in data
repositories
Patients Activities
Risorse Clinical Data
Costs
Episodes
Drugs
Multi-vendor APPS
Multi-vendor
devices
• Existing
systems
• Territory
• FSE
• …
continuità del percorso,
qualità, rischio clinico, ricerca,
analisi dei costi, protezione dei
dati ……
Common services
Specialized multi-vendor and business/clinical
intelligence applications
Standard ISO EN UNI 12967
“HISA: Health Informatics - Service Architecture”
Therapies
Messages
Reminder
Case
manager
Overall patient
clinical
dashboard
Measures
Compliance
Communications
An open environment can:
• integrate, protect and make
data available
• ensure stability over time
• allow the use of applications
from different vendors

8. 8
Clinical Data Repository (CDR)
A clinical data repository (CDR) is
an aggregation of granular patient-centric health data
usually collected from multiple-source IT systems
and
intended to support multiple uses.
https://www.gartner.com/it-glossary/cdr-clinical-data-repository
not only documents, complementary
NOT alternative to the FSE

9. 9
Technologies change ... data remains
We need a complete, well-
known and accessible
knowledge heritage, that
could be used quickly and
freely by HC companies for
different needs (and
emergencies)
European Interoperability Framework
Bruxelles, 23.3.2017 COM (2017) 134 (https://ec.europa.eu/isa2/eif_en )
2.3 Basic principle 2: Openness
The open data of public administrations .... refer to the idea that all public data should be freely
accessible for use and re-use by third parties, .....
2.6 Basic Principle 5: Technology Neutrality and Data Portability
...... Public administrations must make access to and re-use of their public services, and data
independent of any specific technology or product.
Patrimonio
informativo
Border
tables
HL7
Messages
Web-
service
Web-
API
IHE
Profiles
Import/
export
???
Knowledge
Heritage

10. 10
CDR implementation strategies
for the sectors and data
that are gradually
needed
incrementally building
integrated heritage
Gradually and
without changing
existing applications
similar to what is done for
administrative purposes with
the data warehouse
International standard ISO-CEN EN-12967
“HISA: Health Informatics Service Architecture”
Clinical data repository
non proprietary, integrated,
standard Authorizations
and protection
functions
Integration and normalization of data
Evolution:
pathways, clinical risk, clinical
governance, BI, telemedicine,
research, IoT, ...
Right of access and
of portability
Without changing
the existing
systems
Availability and protection
of ALL necessary data
Documentation of
Processed data
(registries)

11. The Baxter’s perspective
on Process Automation
for Telemedicine
Stefano Collatina
Simone Naso

12. 12
Working to bring smarter, more personalized care to the world
90 year heritage of
saving and
sustaining lives
STRONG
global business
with great people
ADVANCING
transformativ
e healthcare
innovation
ONE OF THE MOST
trusted brands
in medical products

13. 13
Advancing Healthcare: Our Businesses
Advanced Surgery
Enabling surgeons to act with precision and
speed to minimize complications and
increase efficiency
Clinical Nutrition
Leading nutrition solutions formulated to help
patients maintain or regain their health
Renal Care
Pioneering therapy options for people with
kidney disease, including peritoneal dialysis
and hemodialysis
Acute Therapies
Innovative products and therapies that treat
life-threatening conditions in the ICU
Medication Delivery
Advanced infusion systems and solutions
to help ensure the right treatment is
delivered safely and efficiently
Pharmaceuticals
Providing generic injectables and inhaled
anesthetics that are critical to patient care
across the globe
BioPharma Solutions
Providing scientific expertise, contract
manufacturing, parenteral delivery systems and
customized support services

14. Pharmaceutical Innovation: A Wide Choice Of Digital Solutions
Baxter Confidential — Do not distribute without prior approval | 14
Integrated system for the
continuous monitoring of home
patients in Automatic Peritoneal
Dialysis.
Homecare platform for
clinical management of
dialysis and parenteral
nutrition patients in the
hospital and
telemedicine for
outpatients.
Platform supporting
the journey from
hospital to homecare.
Infection surveillance specialized
platform, both in the hospital and on
the territory.
• Baxter has a lot of digital products, many of which are used in outpatients' management.
• This is causing challenges for healthcare providers to keep the governance, therefore Baxter
plans to improve the effectiveness of care through actual Telemedicine.

15. Confidenziale Baxter - Non distribuire senza previa autorizzazione | 15
GLBL/MG17/19-0031 Maggio 2019
COVID-19 pandemic has been a driver for Telemedicine
The COVID-19 pandemic has highlighted the need to strengthen health systems and to handle health
emergencies better. Modern digital technologies have made delivery of care to patients in their
homes feasible.
The movement of patients from hospitals to their homes would have a series of positive effects, such as
• a lower spread of infectious diseases in the environment
• a reduction in the risk of contracting infections on patients already weakened by chronic diseases
• a greater availability of clinical facilities for patients who necessarily need to be hospitalized and
• a reduction in costs.
Telemedicine must be enacted to support this transition.

16. Confidenziale Baxter - Non distribuire senza previa autorizzazione | 16
GLBL/MG17/19-0031 Maggio 2019
How to enable real Telemedicine?
• Telemedicine is not only video-visits.
• It consists also in providing coordinated healthcare supported by apposite software platforms.
• A common Clinical Data Repository can enable cooperation among different software platforms.
• Software platforms and a shared clinical data are necessary, but alone are insufficient to enable
real telemedicine that focuses on the patient.
Hospitals
Labs
Diagnostic Systems
Home Nurse Service
GP

17. Confidenziale Baxter - Non distribuire senza previa autorizzazione | 17
GLBL/MG17/19-0031 Maggio 2019
Obstacles to Telemedicine Implementation
Goverance
The high interdisciplinary nature and natural heterogeneity of information systems involved entails a
governance problem for telemedicine. How to now, for example:
• How to manage on aTelemedicine program patient with multi-morbidity?
• Are there patients locked waiting for a specific task to be performed?
• Who is slowing down the service delivery?
Performance monitoring
Performance monitoring is paramount to determine efficacy ofTelemedicine programs, but how to
measure it?
Adherence to a dynamic reality
The implementation ofTelemedicine programs is closely related to the local / hospital situation, which
is dynamic and constantly evolving.
A model designed today may no longer be suitable in a few months.

18. Confidenziale Baxter - Non distribuire senza previa autorizzazione | 18
GLBL/MG17/19-0031 Maggio 2019
Example of interdisciplinary processes

19. a robust and thriving community-of-practice of
healthcare institutions, professional societies, and
vendors established to foster the sharing and
promulgation of best-practices around modeling
and sharing:
• shareable pathways,
• clinical pathways,
• automatable clinical guidelines, and
• other healthcare knowledge
The fact that a process orientated approach is an emerging
need of the global healthcare market is supported by the recent
constitution of the BPM+ Health international community:
www.BPM-Plus.org
BPM+Health International Community

20. Data
Intelligent
Healthcare
Automation
Computable Data
Aggregated Data
Data Automation
Information Automation
Orchestration of knowledge
Workflow and Decision Automation
Data in clinical context
• EMR 1
• EMR 2
• Devices
• Wearables
• Diagnostics
• Claims
• Common schema
• Identity resolution
• Medical resources
• Metadata
• Context
• Events awareness
• Tasks and activities
• Roles and responsibilities
• Decisioning
• Case management
• Event orchestration
• AI and ML
BPM+ Value Add

21. Confidenziale Baxter - Non distribuire senza previa autorizzazione | 21
GLBL/MG17/19-0031 Maggio 2019
Solving Telemedicine implementation problems
Goverance
By focusing on processes orchestration, professionals and software platforms engaged inTelemedicine
can operate under control in a coordinated manner.
Performance monitoring
A side-effect of process coordination is that relevant activities can be tracked allowing the timely
measurement of performance.
Adherence to a dynamic reality
The use of executable models of processes seems promising: is sufficient to modify the model
according to any new situation and the orchestration of the processes will vary consistently, adapting
to the new circumstances.

22. • Baxter is always focused on innovation to continue
its mission to save and sustain human lives and
supports home care in various practices since many
decades.
• The current Italian healthcare scenario is
characterized by the need for real Telemedicine
solutions.
• This can’t be achieved without the adoption of new
technologies enabling both data and process
interoperability.
• The Clinical Data Repository proposed by ALTEMS,
and the Process Automation approach adopted by
BPM+ Health international community seems to be
promising innovation.
Conclusions

23. Thank you for watching!