The USL4 Health Company

1. The USL4 Health Company • The USL 4 health company is equipped of public legal personality, of organizational, administrative, patrimonial, book keeping, managerial and technical autonomy; • It supplies to assure the previewed level of assistance from the National Health Plan and from Regional One, in the within of: • collective prevention activities • territorial assistance for medical cures and rehabilitation • hospital assistance • The territorial within of USL 4 company is constituted of the Province of Prato, including the following 7 Municipalities: Cantagallo, Carmignano, Montemurlo, Poggio a Caiano, Prato, Vaiano and Vernio; • The USL 4 company has an hospital citizen with about 600 clinical bed and provide for ambulatorial district in any municipality, in order to serve about 247.000 inhabitants; • The USL 4 has about 2300 employees Eugenio Ruggieri

2. CUP: the reservation software system • The CUP system is a software used by the health structures in order to allow the citizen to reserve medical performances: • Management of the Patient Identifying and Archiving • Planning appointments of single and cyclical performances in agreement with the availabilities of the medical outpatients' departments • Management of ambulatory Agendas for Reservation (distribution points) • Generation and Visualization of the Calendar for ambulatory availabilities • Management of confirmations, movements, cancellations of appointments • Printing of labels and memorandum patients for examinations and payments • External ticket payment of performances: T-SERVE, Mail, Bank, Automated teller machines Eugenio Ruggieri

3. The USL4 CUP Distribution Service • The CUP service for the reservation of the medical performances is distributed as following: • N° 10 territorial medical district of USL4 company on the territory of the province of Prato; • The USL4 public hospital of Prato; • N° 12 private territorial medical district operating within the national health service for the USL4 company; • N° 7 family doctor’s offices; • Total amount of USL4 CUP operators is about 400 Eugenio Ruggieri

4. The Bonus-Malus Mechanism • CUP software is a basic tool for the monitoring of the health distribution points and for the management of the times of wait for the citizen • The time of wait is the time that elapses between the date of reservation and the first availability of the performance in the agendas of CUP service • The Tuscany regional law introduces in 2006 the Bonus- Malus mechanism: • refund (bonus) of 25 € to the citizen in the event of times of wait grater than 15 days for the specialistic visits (i.e. cardiological) • payment (malus) of ticket (the proportional quota for the cost of performance) from the citizen to the USL4 in case that the citizen is not presentating and in absence of cancellation of the reservation • In the course of the 2007 bonus-malus mechanism will be extended also for the performances of diagnostic instrumental • Need to optimize the reservation agendas recovering the “holes of reservation” and need a timely memorandum for the citizen that has a CUP reservation; Eugenio Ruggieri

5. The CRM Model for USL4 company • CARMEN project has the objective to improve relationships between citizens, businesses and Local Authorities using new multi-media channels as well as traditional access methods.  • It use the Customer Relations Model (CRM) strategy and supported by appropriate technologies: use of SMS mobile communication; • Started in October 2006 the experimental integration of SMS Carmen service with CUP software of USL4 • Send SMS memorandum to the citizens who have reserved medical performances by mean the USL4 CUP service Eugenio Ruggieri

6. SMS-CUP Memorandum Service USL4 CUP Service SMSCUP Database Daily Extraction Reservation File CARMEN - SMS WEB Service Eugenio Ruggieri

7. SMS-CUP Alghoritm • Every night the reservations of the third next day are extracted from the CUP Database and saved on a “reservation” text file; • SMSCUP software daily load the reservation file , generated from CUP Service, and parse the number phone in order to guarantee its correctness; • SMSCUP SW prepare SMS string and send it (actually via CGI Interface) to PRATO CARMEN SMS Service and log it; • The SMS CUP message is directly send to citizen in order to remember the reservation of the medical performance reservation; • In the SMS the citizen is ask to cancel the reservation in the case that is disabled to receive the medical performance; • Actually the citizen call a telephone number in order to cancel the reservation Eugenio Ruggieri

8. Analysis of SMS service SMS Volumes • The SMS-CUP service is started in October 2006 for specialistic medical examination only • Beginning from 1 December 2006 it has been extended to the fully medical performances • Problem: Very low percentage of citizen that correctly leaves cellular phone number at the reservation time: about 40% Eugenio Ruggieri

9. Analysis of SMS service • Reservation Cancelled with SMS received (violet) is increased of 5-10% • It not seems that the same effect for the presence of citizen to the medical department • The answer of the citizens meaningfully seems positive Eugenio Ruggieri

10. Conclusions • We attendeed following results: • Decreasing the number of citizens that are disabled to receive the medical performance • Optimizing the reservation cancelled in order to minimize the “hole of reservation” Future Developments • Use the reservation code number in the SMS message in order to allow with CUP operator to cancel directly CUP reservation • Implent a deletion system with SMS automatic reply by the citizen mobile phone Eugenio Ruggieri