C. Carpeggiani

Development of an electronic medical record for patient care in cardiology

An electronic medical record system has been designed and developed with the aim of supporting patient care in the department of cardiology. A clinical information system was implemented to integrate the different heterogeneous sources of patient information. All the clinically relevant patient data were gathered in a timely way and stored in the clinical database. A viewer/editor of patient medical records was designed, addressing friendliness, flexibility and communication. The basic function for consultation is the time-oriented (weekly or daily) representation of patient parameters, care events and examinations. World Wide Web technology has been applied to implement the medical record. The system is currently under clinical evaluation.

Medical record system for cardiology and cardiac surgery

Describes the electronic medical record (EMR) the authors have developed for use in their health care institution, mainly dealing with diagnosis and treatment of cardiovascular pathologies. This activity was part of the project SPERIGEST, supported by Health Ministry of Italy, for the management (clinical and administrative) of health care delivery. A networked information infrastructure was realized to integrate the different sources of patient information. Both clinical and administrative relevant data are collected from the various systems and stored into a central database. The EMR system was realised using World Wide Web (WWW) technology. The system is currently evaluated in one of the clinical departments of the authors institute.

Use of an electronic medical record in a department of cardiology

A computer-network infrastructure was realized to integrate the different remote cardiovascular diagnostic laboratories with the data derived from CCU and the administrative information. A variety of heterogeneous data, texts, signals, images is gathered from each peripheral unit, stored into a relational database (ARCA), processed and presented to health-care personnel by network-connected clinical workstations. From August 1999 to August 2000 the Electronic Medical Records (EMR) of 754 patients hospitalized in a Cardiological department were collected; 7808 procedures were digitally integrated and for each patient was possible to calculate the number of tests performed during hospitalization and the quantity of drugs assumed. The use of EMR allowed to obtain rapidly a clinical data integration, to access to patient data from any clinical lab; to collect information to obtain patient cost definition.

Electronic medical records in a cardiological outpatient clinic

In an outpatient clinic, a huge amount of information, administrative, clinical and instrumental, has to be handled every day for patient care. A computerized method has been developed in our Institute that is able to track the patient from administrative admission up to discharge. For the purpose of obtaining electronic medical records in the patient who undergoes clinical and instrumental examinations, even on the same day, each clinical laboratory is provided by networked computers and results from instrumental data can be obtained on-line. The system is based on a relational database with clinical and administrative information and is integrated with a large hospital information system where the system covers the role of a functional island. Use of Java language, with its multiplatform capabilities, allows extensive installation in the clinical environment and full integration with other subsystems. A protected Web front-end allows remote consultation of data. For follow up purposes, all the data collected from 1999 to the present day during hospital admission of in- or out-patients can be collected, retrieved and updated. At present 4600 cardiological outpatients have been treated by this system with substantial clinical achievements, time saving, and better follow up organization.

On-line integration and analysis of cardiological data to support medical decision making

A Web application was built to support cardiologists medical decision-making. Main components are: 1. a 3D-dynamic virtual heart, integrating the single patients cardiac and coronary abnormalities. 2. Estimation of patients outcome on the basis of historical data analysis on the subpopulation/s with the closest similarity to the patients risk profile. 3. Same derived from published clinical controlled trials. 4. External web links to international guidelines, risk charts and epidemiological surveys. Each patient is characterized by over one-hundred parameters belonging to anamnesis, test results, final diagnosis, therapy and follow-up. Historical data were retrieved from the Institutes cardiology database-containing more than 11,000 patients hospitalized in the last 30 years and systematically followed up for 10 years - and were graphically rendered. Cardiologists have expressed appreciation toward the project as it gives easy access to a wide range of data, precious for medical decision-making and important for research protocols and clinical and administrative patient management.

Heart rate variability modified by altitude exposure

To study the influence of altitude exposure on heart rate variability (HRV) and the possible detection of apnea by ECG 11 male climbers performed 24-hour ECG and respiratory signal monitoring during an expedition to the Everest. Recordings were done as soon as they reached the altitude (=>5000 m, P1), after at least 15 days of acclimatization (P2) and at sea level (before and after the expedition, B1, B2). HRV indices were computed on the RR time series, and their mean hourly values were fitted by a harmonic regression model to quantify the circadian periodic structure. Significant changes of HPV indices were detected after altitude exposure: altitude distress induces tachycardia, reduces HRV indices and blunts circadian heart rate variability. Respiratory pattern greatly interferes with RR interval time series.

An application of self-organising maps for a knowledge base for use in cardiac domain

The conception, project realisation and updating of hospital information systems (HISs) rely on specific standardisation procedures. Particularly important is the momentum that technology is giving to the production of computer-assisted clinical documentation. Developing such a task, which includes issues like specific diagnostic reports as well as a total clinical record, requires making explicit the syntactic and semantic relationships among the data that describe the patients health. Our study tackles the realisation of a knowledge-based clinical record designed as a combination of modules depending on a set of main medical concepts. We have heuristically defined the knowledge bases content, which has a frame-based structure, through the self-organising map (SOM) technique. We have used the SOM approach for its intrinsic capability of grouping the words of a text according to the semantic categorisations of the natural language. A set of 30 reports, referring to patients afflicted with cardiac diseases and written in the Italian language, gives us the experimental setting that we have used to train the SOM and to obtain the knowledge base. The lists of words which activate the different nodes of the SOM are assumed as frames of the required knowledge base. Performance evaluation shows that this method gives us a representation of the medical knowledge that is efficient for producing meaningful clinical sentences. Moreover, this approach is of general interest: in fact, it works independently of the language used for writing clinical documents.

Electronic medical records optimize clinical data management in the outpatient cardiological clinic

A system based on a relational database with administrative and clinical information and integrated with an information system, where the system covers the role of a functional island, is routinely used in our Institution. To analyze how electronic medical records (EMR) may help physicians in organizing and reducing time waste in a busy outpatient clinic, a sample of 1000 reports were evaluated for system performance. The time needed for building new clinical histories or modifying the already acquired ones, to create physical examination and biochemical and instrumental exams reports, was assessed. Cardio-pulmonary tests, basal, dynamic and effort EKG, chest X-ray, echo Doppler studies, nuclear medicine procedures, invasive techniques, were collected. Clinical management was integrated with the administrative system (ADT), to correctly identify each patient. This system provided not only easy retrieving of stored data such as clinical history, physical examination, instrumental exams reports but also the results of new exams performed in the same day of patient visit with a time lapse of 1 to 20. Graphical interface structure contained preformatted fields which allowed selection or modifications of data/text models without additional waste of time. EMR represents an important tool for organization and synergy of different laboratories in an outpatient clinic, optimizing the time needed for data entry and leading to an overall better quality of care.

On-line integration of cardiological data to support medical decision making in patients with ischemic heart disease

We have developed a system that integrates, through a virtual 3D-dynamic heart model, all the pertinent clinical and instrumental information obtained for patients hospitalized for suspected or documented ischemic heart disease (IHD). In the present study we retrospectively compared the diagnosis formulated by the cardiologist in the discharge record with that automatically provided by the system. Divergences were found in 27% of the 110 patients studied and classified into four types: I) inability of the system to provide the correct diagnosis because of the lack of pertinent diagnostic parameters in the model (3%), a cardiologists diagnosis which was either II) not supported by objective data (3%), III) in conflict with the available information (10%), or IV) incomplete (11%). An experimental trial has been started in which the cardiologist in charge of the patient uses the automatic system during the diagnostic process and compilation of the discharge report.

Altitude distress influence on cardiac function

To study the influence of altitude exposure on heart rate variability (HRV) and cardiac ventricular function, 11 male climbers performed 24-hour ECG and echocardiographic evaluation during an expedition to Mount Everest. Recordings were done as soon as they reached the altitude of 5000 m, after at least 15 days of acclimatization and at sea level (both before and after the expedition). HRV indices were computed (in the time and frequency domains) on the RR time series, and major cardiac measures were calculated from the best echocardiographic view. Significant changes in HRV and other cardiac indices were detected after altitude exposure. Altitude distress induced tachycardia and reduced some HRV indices. The respiratory pattern was used to document sleep apnea, which greatly interferes with RR-interval time series. It was concluded that altitude distress modifies the cardiac function, whose interference with the heart-rate reflex could explain the HRV changes.