In Italy, general principles on government contracts mandate that the provision of services to public administrations must be preceded by the issuing of a public tender allowing various companies to transparently compete for the job. This blog has recently discussed a couple of court decisions that in fact confirmed and further strengthened such principle.
However, a recent decision by the Consiglio di Stato, the higher court which is competent for administrative matters, seems to go in the opposite direction in a case regarding services linked to digital health.
The facts of the case relate to the Lecce health center, located in Puglia, Italy, which assigned to a certain firm the tasks of providing maintenance IT services in the fields of RIS (Radiology Information System) and PACS (Picture Archiving and Communication System). The same firm had previously provided IT maintenance in the RIS-PACS field, was the exclusive authorized reseller of the concerned systems and was in charge of the integration of other IT systems already in place the health center. Given such qualifications, the health center refrained from issuing a public tender and instead used the tool of the “negotiated process” with such IT firm only, which is allowed when, due to technical reasons, the supply contract can be assigned only to a single firm. The petitioner of the case, on the contrary, argued that any other qualified IT company was able to integrate and maintain the IT systems.
What is interesting to note is that the Court gives weight to the “special complexity” of the services constituted by the shift to a digital imaging system: under such view, e-Health is viewed as a field fraught with risks (on data, and ultimately on patients), thus allowing to recur to the exception constituted by the “negotiated process” rather than to rely on the rule of open tenders.
A new Agreement on Digital Health (“Patto sanità digitale”) prepared by the Ministry of Health has been submitted to the State and Region Conference in June 2015. The proposed agreement between regions and national government aims at setting forth a precise timetable for the implementation of e-health in Italy and envisages a steering committee in charge of monitoring the status of implementation of the plan.
Among the priorities of the new proposal, the Ministry of Health has indicated the adoption of effective solutions for patient workflow management and patient relationship management, to be achieved through the widespread use of electronic clinical records, telemedicine services and mobile health. According to the plan presented by the government, e-health solutions are key to a deeper overhaul of the national healthcare service in order to increase care outside of hospitals and find more efficient ways of bringing healthcare to patients.
Telemedicine solutions, including remote monitoring and diagnosis, would allow the national health service to bring services to patients in a more efficient way. While a specific piece of legislation addressed to telemedicine services has not yet been enacted, on February 20, 2014 the Italian Ministry of Health issued a set of official national guidelines on telemedicine, which set forth a useful regulatory and technical framework for healthcare authorities and private operators active in the provision of telemedicine services.
Unlike previous guidelines, however, the latest digital health plan also aims at restructuring the use of financial resources devoted to the development of telemedicine solutions, in order to convey funds only to more effective projects capable of fostering the widespread adoption of e-health instruments by other healthcare providers. The government also plans to increase the involvement of private actors in these development projects, through project financing and performance based service contracts.
While it is expected that patients will ultimately benefit from a more efficient model for the supply of healthcare, the government also hopes to rein in spending through a more efficient use of resources and a closer monitoring of test prescriptions and drug consumption, which the new e-health solutions will enable.