11

Project TitleProject Title::

Development of Interoperability Development of Interoperability EnvironmentEnvironment: a) between Social Security : a) between Social Security Organizations and HealthCare Services, Organizations and HealthCare Services, to control HealthCare expenses, and b) to control HealthCare expenses, and b) Electronic transactions between Social Electronic transactions between Social Security Organizations and Banks (GSecurity Organizations and Banks (G--toto--

G and GG and G--toto––B)B)DateDate:: 9/9/1010/2008/2008 EU registration No.EU registration No.:: 8688186881

22

General Information about the projectGeneral Information about the project

••

Project Leader: Project Leader: Information Society S.A. (KtP SA)Information Society S.A. (KtP SA)

••

Client and beneficiary: Hellenic Ministry of Employment and SociClient and beneficiary: Hellenic Ministry of Employment and Social al Protection Protection -- General Secretariat Of Social Security (GGKA)General Secretariat Of Social Security (GGKA)

••

Project ContractorProject Contractor::––

IntracomIntracom IT Services S.A. and KPMG S.A.IT Services S.A. and KPMG S.A.––

Subcontractor Planning S.A.Subcontractor Planning S.A.

••

Technical Support: Technical Support: Planet S.A.Planet S.A.

••

Project Director (GGKA): Ms. Project Director (GGKA): Ms. KousoulouKousoulou FotiniFotini

••

Project Manager (KtP SA)Project Manager (KtP SA):: Del Toro GeorgeDel Toro George

••

Steering and Acceptance CommitteeSteering and Acceptance Committee: : Del Del torotoro G. (chairman) , G. (chairman) , MrMr LoudarosLoudaros A. A. , , Mr. Mr. IatridisIatridis N. N. , , Mr. Mr. KardarasKardaras G. G. , , Mr. Mr. MavromatisMavromatis P.P.

33

Proposed BudgetProposed Budget: 1.500.000: 1.500.000€€ ((1.220.0001.220.000€€ + + 200.000200.000€€ + 80.000+ 80.000€€))

EU ClassificationEU Classification:: 2.12.1Financial supportFinancial support: : EuropeanEuropean RegionalRegional DevelopmentDevelopment FundFund

Operating Unit: General Secretariat Of Social Security (GGKA)Operating Unit: General Secretariat Of Social Security (GGKA)

Social Security Organizations that take part in the Project:Social Security Organizations that take part in the Project:••

OGA (Farmers Insurance Organization of Greece)OGA (Farmers Insurance Organization of Greece),,

••

OAEE (Freelance workers Insurance Organization of Greece)OAEE (Freelance workers Insurance Organization of Greece),,••

OAPOAP--DEI (Power and Light Corp. of Greece DEI (Power and Light Corp. of Greece –– DEI, Workers DEI, Workers Insurance Organization)Insurance Organization)

HealthCareHealthCare Organizations that take part in the project:Organizations that take part in the project:••

General Hospital of AthensGeneral Hospital of Athens ««GG.. GennimatasGennimatas»»,,

••

Four Four (4) (4) private diagnostic centersprivate diagnostic centers,,••

And FSA (the PAnd FSA (the Pharmaceuticalharmaceutical Federation of Athens)Federation of Athens)

General Information about the projectGeneral Information about the project

44

Contract InformationContract Information

Contracts Contract No.

Contract award (€) (+ VAT)

(after the bid)

Contractor

1. Technical support 409 139.914,25€ PLANET

2. Development of Interoperability Environment: a) between Social Security Organizations and HealthCare Services, to control HealthCare expenses, and b) Electronic transactions between Social Security Organizations and Banks (G-to-G and G-to–B).

404 880.6ΟΟ,ΟΟ€ INTRACOM -KPMG

55

••

Interconnection of Social security with Interconnection of Social security with healthcare serviceshealthcare services: : –– Transfer of healthcare bills to social Transfer of healthcare bills to social

security,security,–– Control of expenditures (clearing Control of expenditures (clearing

house),house),••

Electronic transactions between Social Electronic transactions between Social security and Banks (payments),security and Banks (payments),

••

MIS and Business IntelligenceMIS and Business Intelligence

Main design goalsMain design goals

66

Project AimProject AimTo create an interoperability environmentTo create an interoperability environment: : aa) ) Between the Social security system an the Healthcare systems Between the Social security system an the Healthcare systems

organizations for controlling (health) expenses by creating an organizations for controlling (health) expenses by creating an electronic clearing house, and,electronic clearing house, and,

bb) ) Electronic transactions Between the Social security system and tElectronic transactions Between the Social security system and the he banks by using electronic payments for the Healthcare organizatibanks by using electronic payments for the Healthcare organizations ons ((governmentgovernment--toto--government and governmentgovernment and government--toto--businessbusiness))

Characteristics of interestCharacteristics of interest::aa) ) Pilot project (proof of concept)Pilot project (proof of concept),,bb) ) to study existing processes for control and payment of healthcarto study existing processes for control and payment of healthcare e

expenditures from healthcare organizations to the social securiexpenditures from healthcare organizations to the social security ty system system ((government Hospitals, pharmacies, private Hospitals, government Hospitals, pharmacies, private Hospitals, diagnostics centers, etc)diagnostics centers, etc) and to study electronic payments between and to study electronic payments between social security and healthcaresocial security and healthcare,,

cc) ) creation of electronic processescreation of electronic processes,,dd) ) without changing legislature (constrain)without changing legislature (constrain),,ee)) MIS MIS –– Business IntelligenceBusiness Intelligence

Project AIM and CharacterProject AIM and Character

77

Operational CoverageOperational Coverage

•• HealthCare expenditures Control by using information systems tecHealthCare expenditures Control by using information systems technology,hnology,

••

To To ““ironiron--outout”” the complexity of the Healthcare payments system (study and the complexity of the Healthcare payments system (study and propose),propose),

•• To create electronic transactions (expenditures and payments),To create electronic transactions (expenditures and payments),

••

to create Onto create On--line transaction processing and batch processing (large scale line transaction processing and batch processing (large scale processing)processing)

•• to create targeted onto create targeted on--line reporting and business intelligence line reporting and business intelligence

•• to create the needed computing infrastructureto create the needed computing infrastructure

88

OutcomesOutcomes

Expected outcomes:Expected outcomes:

••Improve organizational processesImprove organizational processes,,

••

Improve the internal structures and procedures of the social secImprove the internal structures and procedures of the social security systemurity system,, thus thus improving the services for the improving the services for the

•• to keep healthcare expenditures in control (how low can we go)to keep healthcare expenditures in control (how low can we go),,

•• creation of creation of ““globalglobal”” controlling mechanismscontrolling mechanisms,,

•• Improve and enhance decision making abilityImprove and enhance decision making ability,,

•• Increase the skills of human resources involvedIncrease the skills of human resources involved

BeneficiariesBeneficiaries::••

immediate beneficiaries: the healthcare system (pharmacies, hospimmediate beneficiaries: the healthcare system (pharmacies, hospitals, diagnostic itals, diagnostic centers etc)centers etc),, and and •• The Social security system,The Social security system,•• Other beneficiaries: the Greek citizensOther beneficiaries: the Greek citizens,,

99

Basic success factorsBasic success factors

- Swift and decisive Swift and decisive ““movesmoves”” from:from:-- from the parties involvedfrom the parties involved ((social security and healthcaresocial security and healthcare),),-- from all external parties (banks registries)from all external parties (banks registries)

-- the synchronization of all parties involved,the synchronization of all parties involved,

-- Make the users part of the systemMake the users part of the system

1010

Technical details Technical details –– network / hardwarenetwork / hardware

Network used: «SYZEYXIS»

internal government network

Systems and components:Database Servers:

two (2) database servers HP ProLiant

DL580 Generation 2 on clusters

Application Servers: two (2) application servers HP ProLiant

DL560 with load balancing

Web Servers: two (2) web servers HP ProLiant

ML350 Generation 4 with Load Balancing

Oracle Infrastructure / LDAP server: One (1) server HP ProLiant

ML350 Generation 4

Backup console/Antivirus/Administration Workstation: one (1) workstation HP Compaq Business Desktop dc7100 series

Back-up system: HP StorageWorks

Enterprise Virtual Array 3000

Backbone: 2Gb Fiber Channel “end to end”.

other: Net Backup, 11 PC’s

1111

Technical details Technical details -- softwaresoftware

Operating Systems:•Windows 2003 (Server)•Windows XP (Client)

Development tools:•Oracle 10g JDeveloper•Oracle 10g Forms Builder•Oracle Discoverer

10g•Oracle Warehouse Builder 10g

Type of Exchanged files:•Ascii

semicolon delimited (circa 1970)

•Xml (circa 1990)

1212

Technical details Technical details –– software subsystemssoftware subsystems

Interoperability subsystems

Data entry system Electronic data exchange

Data entry system

Payment system

Payments system

MIS and BI

Security System control

Administration and Security

User profile

Control and clearing system

Expenditures control and clearing

Bank reconciliation

BIMIS

Payment control

1313

Technical details Technical details -- softwaresoftware

Data entry system

Payment system

Expenses control subsystem

Basic Interoperability System Functions

Payment subsystem

Electronic data exchange

MIS

System control and definition

Local administration and security

Administration and security

B. I.

Bank reconciliation

HelathCare

General Secretariat for Social Security

Social security

1414

Technical details Technical details –– final architecturefinal architecture

H o s p i t a lP h a r m a c y f e d e r a t i o n D i a g n o s t i c

c e n t e r

H e a l t h C a r e

I n t e r o p e r a b i l i t y

S o c i a l S e c u r i t y

O A E E O G A O A P - D E I

A D S L

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V L A N

VLAN

S t o r a g e A r r a y

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L B

S A N

A d m i n i s t r a t i o n a n d s e c u r i t y

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V L A N

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I P I n f r a s t r u c t u r e & S e c u r i t y R o u t e r

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1515

StatusStatus

Status (today):Status (today):

FinishedFinished::•• ““Minimum set of dataMinimum set of data”” study,study,•• Project application study (project documentation)Project application study (project documentation),,•• Software creationSoftware creation,,•• DATA CENTERDATA CENTER InstallationInstallation,,•• Users and administrators TrainingUsers and administrators Training,,•• Pilot testingPilot testing,,•• Final application study (project documentation)Final application study (project documentation),,•• Connection to the Connection to the ““SYZEYXISSYZEYXIS”” network,network,•• Final Operational integration and testing of systemFinal Operational integration and testing of system..

to beto be: : •• six (6) month Service Level Agreementsix (6) month Service Level Agreement..

1616

Outcomes Outcomes -- ProblemsProblems

YES it can be done, butYES it can be done, but::

•• definition and standardization of definition and standardization of nomenclaturesnomenclatures::••

adoption of international classification systems (ex. GMDN, andadoption of international classification systems (ex. GMDN, and

ICD 10),ICD 10),•• when not available, then choose a local one and standardize it,when not available, then choose a local one and standardize it,•• Implementation (registry and codification)Implementation (registry and codification)

The steering committee took decisions to make the system work.The steering committee took decisions to make the system work.They will need revisingThey will need revising..

••

Bank reimbursements for providing services to the project and tBank reimbursements for providing services to the project and the he social security system:social security system:

•• Banks are Banks are ““reluctantreluctant”” to a to a ““globalglobal”” agreement,agreement,•• ““agreementagreement”” case by case,case by case,•• a a ““politicalpolitical”” (strategic) agreement is needed(strategic) agreement is needed

1717

Interoperability project and HLInteroperability project and HL--7:7:•• HLHL--7 was optional7 was optional,,•• the contractor did not include HLthe contractor did not include HL--7 in the offer7 in the offer

Proposal (Design)Proposal (Design) vsvs projectproject::•• new requirements risen as the project was runningnew requirements risen as the project was running::

Interoperability with other existing systems Interoperability with other existing systems ((other social other social security systems security systems -- ex. social security registryex. social security registry),),

inclusion of other social security and healthcare inclusion of other social security and healthcare organizationsorganizations,,

Doctor diagnosis (?)Doctor diagnosis (?),,connection with the new connection with the new ““cardcard”” type system (s)type system (s),,analytic prescription, directly from the pharmacyanalytic prescription, directly from the pharmacy,,Private clinics and private hospitalsPrivate clinics and private hospitals,,connection with other EU systems (country interoperability)connection with other EU systems (country interoperability)

Open issuesOpen issues

1818

Project extensionProject extension

Project extension AIMProject extension AIM::

•• Include HLInclude HL--7 connectivity7 connectivity

••

Include new type of HealthCare organizations: Pharmacies and Include new type of HealthCare organizations: Pharmacies and privately owned clinicsprivately owned clinics..

With these two (2), will cover all major requirements of the syWith these two (2), will cover all major requirements of the system.stem.

1919

Project extensionProject extension

•• Include 5 to 10 pharmacies as proof of concept (analytic drug prInclude 5 to 10 pharmacies as proof of concept (analytic drug prescriptions)escriptions),,

•• Connect system to the internetConnect system to the internet,,

••

Include HLInclude HL--7 connective by adding the needed infrastructure of hardware and7 connective by adding the needed infrastructure of hardware and system software (and experience),system software (and experience),

•• Create the needed message HLCreate the needed message HL--7:7:Submit HealthCare Services Invoice (event E01) Submit HealthCare Services Invoice (event E01)

[FHS] Batch: [FHS] Batch: MessagesMessages EHC (EHC (This message is used to submit a This message is used to submit a HealthCare Services Invoice to a TPA/Payer for processing and HealthCare Services Invoice to a TPA/Payer for processing and payment)payment)

Cancel HealthCare Services Invoice (event E02) Cancel HealthCare Services Invoice (event E02) [FHS] Batch[FHS] Batch: Messages: Messages EHC (EHC (This message is used to cancel one This message is used to cancel one HealthCare Services Invoices or one Product/Service Group in an HealthCare Services Invoices or one Product/Service Group in an Invoice or one Product/Service Line Item in an Invoice that haveInvoice or one Product/Service Line Item in an Invoice that have previously been submitted to a TPA/Payer)previously been submitted to a TPA/Payer)

•• plus all other needed services (training, studies, software conplus all other needed services (training, studies, software construction, etc)struction, etc)

2020

Project extensionProject extension

Possible budgetPossible budget::

budget

(€) ContractorProject continuation 264.180,00 Intracom

–

KPMG

Technical support 41.959,40 Planet

Total 306.139,40

2121

The endThe end……??

On your computer nowOn your computer now, , HERAnetHERAnet

((www.heranet.gov.grwww.heranet.gov.gr))

HHealth ealth

EExpendituresxpenditures,,

RReimbursementseimbursements

&&

AAnalytics nalytics

ΝΕΤΝΕΤworkwork

Thank youThank you,,Del Toro Del Toro georgegeorge