“Houston, we have a problem,” is the memorable famous quote from the Apollo 13 space flight which resonated with Marco Foracchia CIO of Reggio Emilia Local Health Authority when the COVID-19 pandemic hit Italy.
The former biomedical engineer is a man who likes a plan, but 13 years after joining the public healthcare authority he had to become flexible to the challenges posed by the pandemic which ripped through the Emilia-Romagna region. But like the astronauts, who triumphed over adversity, Foracchia led his ICT team with a vision and the help of a data-driven approach.
Foracchia compared the IT challenge faced by Reggio Emilia Local Health Authority, to the ‘square peg in a round hole’ scene from the Apollo 13 movie. Like the astronauts, his team focused on the problem in hand to reach their life or death goal. Foracchia stretched the intended use of most software systems to adapt to the pandemic scenario in order to properly manage the new types of data, gather and distribute all the information necessary for the top management to fight COVID-19. A winning choice was the adoption of population analytics to monitor the spread of COVID-19 among the one million population and treat people at home via telemedicine.
“Our ICT team focused on solving the issue at any cost, even though the tools we have are not really built for this kind of unexpected event - just like the astronauts on Apollo 13 who had to adapt what they had to survive and safely return to Earth,” said Foracchia.
“We had to be flexible, we had to be creative - which can be hard for us engineers who like a plan - and look for the best possible solution. I believe this is an attitude that is now embedded in our ICT team and will help with any future emergencies. I'm very proud of how my team reacted to the pandemic,” said Foracchia who pointed out the vaccine roll out was now easing the pressures.
The health authority is now focusing more than ever on using telemedicine and virtual consultations to treat people at home, which is vital in a region which stretches from the Apennine Mountains to the Po Valley and is largely made up of an elderly population.
Reggio Emilia Local Health Authority - IRCCS, was born from the merger between the current Ausl and the Arcispedale Santa Maria Nuova hospital in the year 2017. The reorganisation now provides a single hospital unit, called the Santa Maria Nuova Provincial Hospital, divided into six establishments which includes an oncology research institute and hundreds of public health services:
- Archispedale S. Maria Nuova of Reggio Emilia
- S. Anna Hospital of Castelnovo ne 'Monti
- San Sebastiano Hospital in Correggio
- Guastalla Civil Hospital
- Ercole Franchini Hospital in Montecchio
- Cesare Magati Hospital in Scandiano
Data-driven analytics and management
After many years working around the world as a biomedical engineer, Foracchia is relishing the fact he has returned home to focus on a healthcare system which is driven by data analytics. “Suddenly my job to take care of my grandparents and my community is now the focus of my everyday job, which is great,” he said.
“As I have an international perspective I am able to bring new ideas and connections from the outside to a local level, so I always try to keep my eyes open. I'm really interested in technologies that analyse data and population analytics which really showed its power during the pandemic. It was impressive to have the capability of analysing data as soon as it was produced and watching the time and geographic distribution of new cases.”
The health authority has always been data driven but this was accelerated during the pandemic due to the speed at which it spread. “They had to rely on the numbers that I gave them to make decisions on the management of hospital beds. It was now like landing a plane in fog: you have to rely and trust your data,” said Foracchia.
“This change brought up the importance of technologies. Suddenly the Electronic Medical Record (EMR) for counting and tracking the evolution of COVID-19 infections became the most useful tool and the health authority was demanding more from their ICT managers.”
“This was not about trend technology like Artificial Intelligence, it was about using simple technology to analyse big numbers and using it seriously. We also used technology for getting in touch with patients and sent more than a million SMS messages during the pandemic.
“This proved to be extremely effective in terms of keeping in touch, especially as we had a very simple link that anybody on a smartphone could open up and then interact with us on the website or through an app.
“It is all about making existing technology configurable and flexible and if this technology is used properly and widely it gives me hope for the evolution of e-health.”
Roots of telemedicine
Telemedicine started within the health authority 15 years ago to ensure patients have access to information. “If a patient is in the mountains and has diabetes we don’t want them to come down to the hospital every month - this is an example of the basic roots of our telemedicine approach as we want to keep them comfortable and away from the central hospital. This was especially true during the pandemic,” commented Foracchia.
“Today, we have moved towards a more sophisticated form of telemedicine, which has been accelerated due to the pandemic, but the philosophy is still there,” said Foracchia, who pointed out once COVID-19 hit all information about the pandemic was centralised at Santa Maria Nuova Provincial Hospital.
“Telemedicine allowed us to follow the progress of COVID-19 patients at home rather than admit them to hospital. Their condition would have been stable and we were able to monitor them and contact them frequently. But not only the patients, their families, their contacts, every person that had been in contact was put in quarantine and we had to keep in touch with them.
“We have the technology to have virtual consultations with patients at home and patients with implanted cardiac devices can share information with our cardiologists at the hospital. We also have patients who require ECG information that are visited at home by nurses or general practitioners.
“The fact that a person can have a CT scan up in the mountains where we have few radiologists and the CT scan is read by a radiologist who is a 100 kilometers away
is a major breakthrough because it means that the person gets the same quality healthcare as everyone else without having to travel to the hospital.”
Benefit of the Electronic Health Record (EHR)
The EHR is the set of digital data and documents of a health and social health generated by present and past clinical events, also referring to services provided outside the National Health Service, which a patient can access through a PC or mobile device, with SPID, FedERa or smartcard credentials.
- Book specialist visits and exams online
- Modify or cancel appointments booked online
- Pay health tickets online and view payment receipts
- Change or revoke the family doctor
- Self-certify age and income exemptions
“The EHR makes all information available directly to the patient who can access their complete record of diagnostic procedures at any place in the region,” said Foracchia.
“As EHR was started 15 years ago it was very ahead of its time, now it's very common to have these personal health records. But for us having this mature type of technology proved very effective during the pandemic as we could communicate electronically with the patient. The availability of this channel of communication between a healthcare institution and a patient to share their personal health record was extremely effective.
“In the last 15 years we have worked to show clinicians that sharing information through technology was possible and it could help their everyday practice. And now they take for granted that a CT scan is available anywhere in the Province and a colleague on the end of the phone can take a look if they need a second opinion. They grew with the idea of sharing information. They grew with the idea that the patient could actually see the information they were putting in the system.”
Focus on value of technology
As Reggio Emilia Local Health Authority is a public body this means they have a set income based on the size of population covered. “Our advantage is we do not adopt technology for the sake of it, we adopt technology for the value behind it - so this must keep costs stable and improve the service. This approach creates a competitive advantage with respect to other healthcare institutions within the same region or at the national level.
“ICT in the company has evolved to focus on covering a broader number of patients. Italy is a very old country, therefore our main issues tend to revolve around the elderly and chronic diseases created with age and we also have an oncology institute which attracts patients from all over the region,” he said.
The IRCCS in Advanced Technologies and Models of Care in Oncology of Reggio Emilia is an oncology research centre incorporated into the Reggio Emilia Local Health Authority, which combines a very high level of quality of care with an orientation to translational research activity, clinical and health care in the oncology field.
As the birthplace of the Italian flag, Emilia-Romagna region looks set to emerge from one of the worst health crises in a century with the rollout of their vaccine program and continued focus on data analytics to drive future decisions for the health authority.
Partners that share information
Reggio Emilia Local Health Authority has a strict mandate for all partners within their ecosystem, to share information.
“When we acquire any new ICT systems, they have to fully integrate within the pre-existing ecosystem,” said Marco Foracchia, CIO of Reggio Emilia Local Health Authority.
“This approach guarantees that any new extension in terms of technologies within our institution is shared. This principle guides every procurement aspect. Every time we buy a new device or new system, we have that in mind. There's no way around it - even if it’s an excellent piece of technology - if it's not possible to integrate it, then we're not interested.”
Philips rose to the challenge of opening up and helping Reggio Emilia Local Health Authority manage residual ICT - such as ultrasounds, photographic images and video streams - which needed to be stored.
“We started the partnership with Philips about eight years ago and it was great to find a company open to the challenge of sharing information. It was visionary from their point of view. They had to go beyond their current technologies but they liked the idea of being open, ingesting several types of information data that no-one wants to manage and sharing it around the Province or to other systems.”
Quick fire questions
In the hot seat with Marco Foracchia, CIO of Reggio Emilia Local Health Authority:
What technology trend do you see revolutionising hospitals in the next few years?
“COVID-19 has broken the fear for a remote consultation that was in the medical field. We're now opening up to real telemedicine with the aim of keeping the patient at home as much as we can. I also think population and business analytics of medical information will have a big impact.”
What message would you like to share with other ICT teams?
“COVID forced us to focus on everyday survival. Do not forget to have the big picture and imagine your ICT systems 10 years from now. Stop once in a while and think about where you’re going - imagine what you’re building - and that will help with everyday decisions and motivate you and your team.”
Could you sum up how healthcare has changed since you started your career?
“We can now give answers to issues at speed as healthcare changes. In the past it was healthcare that was ahead and technology lagging behind but today technology is ahead of healthcare.”
Fallout of the pandemic
The COVID-19 pandemic claimed a total of 123,282 lives in Italy (as of May 11, 2021) with the peak of 993 deaths recorded on the single day of December 3, 2020.
The region with the highest number of deaths was Lombardy, which is also the region that registered the highest number of coronavirus cases and was the epicenter of the outbreak in the country. This lies only 220km from Emilia-Romagna Region.
Italy's death toll was one of the worst in the world. However, the country has started to see light at the end of the tunnel with the vaccination program which Reggio Emilia Local Health Authority is now rolling out to protect its one million population.