Paolo Locatelli

Health Care Information Systems: Architectural Models and Governance

The adoption of ICT within health care has been characterized by a series of phases evolving since the 1960s (Khoumbati et al., 2009). Health informatics adoption started mainly from financial systems, providing support to the organization’s billing, payroll, accounting and reporting systems. Clinical departments launched a major initiative during the 1970s that supported such internal activities as radiology, laboratory and pharmacy (Wickramasinghe & Geisler, 2008), where machinery could support high-volume operations with the implementation of standardized procedures. Financial systems once again became prominent in the 1980s, with major investments in cost accounting and materials management systems (Grimson, 2001). During the 1990s, attention turned towards enterprise-wide clinical systems, including clinical data repositories and visions of a fully computerized Electronic Medical Record (EMR) (Bates, 2005).

Open Source Clinical Portals: A Model for Healthcare Information Systems to Support Care Processes and Feed Clinical Research

Open source is a still unexploited chance for healthcare organizations and technology providers to answer to a growing demand for innovation and to join economical benefits with a new way of managing hospital information systems. This chapter will present the case of the web enterprise clinical portal developed in Italy by Niguarda Hospital in Milan with the support of Fondazione Politecnico di Milano, to enable a paperless environment for clinical and administrative activities in the ward. This represents also one rare case of open source technology and reuse in the healthcare sector, as the systems porting is now taking place at Besta Neurological Institute in Milan. This institute is customizing the portal to feed researchers with structured clinical data collected in its portals patient records, so that they can be analyzed, e.g., through business intelligence tools. Both organizational and clinical advantages are investigated, from process monitoring, to semantic data structuring, to recognition of common patterns in care processes.

Evicase: an evidence-based case structuring approach for personalized healthcare.

The personalized medicine era stresses a growing need to combine evidence-based medicine with case based reasoning in order to improve the care process. To address this need we suggest a framework to generate multi-tiered statistical structures we call Evicases. Evicase integrates established medical evidence together with patient cases from the bedside. It then uses machine learning algorithms to produce statistical results and aggregators, weighted predictions, and appropriate recommendations. Designed as a stand-alone structure, Evicase can be used for a range of decision support applications including guideline adherence monitoring and personalized prognostic predictions.

Effectively Introducing Mobile Solutions in Hospitals: The Importance of Process Perspective and KPIs

ICT enables improvement of healthcare processes, by increasing quality while simultaneously reducing costs. Among the different ICT-based solutions, mobile health is achieving an increasing importance: despite all potential benefits of mobile technologies, little attention has been put so far in their application within hospitals. As a result, any mobile solution introduction tends to not take into account organizational implications, with the result of limited or ineffective adoptions. Drawing on the experience of four successful implementations of mobile solutions in three Italian hospitals, this paper emphasizes the importance of two design factors: (i) the adoption of a process perspective, (ii) the continuous monitoring of a pre-determined sets of Key Performance Indicators (KPIs). Theoretical and managerial implications are proposed and discussed.

ICT and mobile health to improve clinical process delivery. a research project for therapy management process innovation.

The volume and the complexity of clinical and administrative information make Information and Communication Technologies (ICTs) essential for running and innovating healthcare. This paper tells about a project aimed to design, develop and implement a set of organizational models, acknowledged procedures and ICT tools (Mobile & Wireless solutions and Automatic Identification and Data Capture technologies) to improve actual support, safety, reliability and traceability of a specific therapy management (stem cells). The value of the project is to design a solution based on mobile and identification technology in tight collaboration with physicians and actors involved in the process to ensure usability and effectivenes in process management.

(Re-)Designing the Business Model of a Digital Ecosystem: An Example in the Socio-Care Context.

The advent of digital innovations is pushing many companies to re-design their Business Models (BMs). Amir and Zott (2015) described the process concerning the design of a new BM as constituted by elements, themes and antecedents. This research is based on a European project aimed at improving the independent living for elderly people affected by Mild Cognitive Impairment (MCI) or Mild Dementia (MD), through the definition of a new BM based on the adoption of digital innovations. Through a clinical inquiry approach, this research aims at analysing the interactions among antecedents and providing suggestions regarding the tools that could support BM re-design processes for an ecosystem of actors. Results highlighted alternation of antecedents that results in the continuous development of knowledge and increase of collected information. The increasing complexity should be limited thorough the integration of the collected information that allows the removal of not consistent information.

A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment

Ageing has significant impacts on the organization of healthcare systems and on social inclusion—especially for elderly people affected by Cognitive Impairment (CI). These people are significantly exposed to undeniable risks that can affect their health and wellbeing (falling, malnutrition, hygiene issues, etc.) – especially when living alone. This paper defines a Business Model (BM) allowing independent living for elderly people affected by CI. This BM include: (i) an up-to-date, modular, flexible and scalable organizational model describing the activities to be accomplished by regulators and service suppliers; and (ii) a digital platform based on innovative and easy-to-replicate information and communication technologies. The organic approach to the development of the BM is then focused in an Italian use case as a part of “DECI”, a “Horizon 2020” project with four pilot projects in Israel, Italy, Spain and Sweden.

Uso delle piattaforme ICT a supporto dei servizi socio-sanitari: il progetto Attiv@bili

Il presente lavoro si focalizza sul progetto Attiv@bili - Innovazione Sociale e Assistenza Digitale in Ambienti Controllati. Tale progetto, finanziato da Regione Lombardia, e finalizzato a disegnare un nuovo modello tecnologico per l’integrazione delle cure a supporto delle persone fragili (Integrated Care - IC) erogate presso il domicilio dell’assistito, per aumentarne l’empowerment e l’inclusione sociale. L’assistenza domiciliare integrata ai soggetti fragili prevede l’erogazione congiunta e coordinata di servizi sanitari e socio-assistenziali lungo tutte le fasi del processo di supporto. L’impiego di strumenti tecnologici, quali sistemi informativi e piattaforme di interoperabilita fra processi, nonche strumenti di supporto domotico, risulta indispensabile a garantire gli obiettivi sopra-descritti. Per questi motivi, il progetto Attiv@bili si e focalizzato sulla progettazione e lo sviluppo di una soluzione tecnologica focalizzata da una parte sull’integrazione dei processi di cura e dall’altra sul monitoraggio e supporto degli interventi erogati direttamente al domicilio dell’assistito. Questo lavoro descrive il risultato della fase di progettazione, inquadrando l’architettura logica prevista nello stato dell’arte in ambito Ambient Assisted Living ed evidenzia alcuni spunti utili per un riutilizzo del modello tecnologico in ambito sociosanitario.

An integrated approach to safety-driven and ICT-enabled process reengineering: methodological advice and a case study.

Patient safety is a central concern inside any healthcare environment. With the progress of Information and Communication Technologies (ICTs), new solutions have become available to support care and management processes. Analyzing process risks helps identifying areas of improvement and provides ICT-solutions design with indications on what portions of the process need primary interventions. Understanding the link between process reengineering, technology assessment of enabling technologies and risk management allows user acceptance and patient safety improvements. Fondazione IRCCS Istituto Nazionale dei Tumori (INT), offers a good example of process reengineering driven by the purpose of increasing patient safety, enabled by new technologies. A pillar of the evolution of ICT process support at INT is based on Radio Frequency Identification technologies, implemented to identify and trace items and people across processes. This paper will present an integrated approach, based on process reengineering methodologies and risk assessment studies, and methodological advice applied to a case of surgical kits management procedures.

Information and communication technologies enable a comprehensive governance of patient safety in chemotherapy. An Italian framework project

Therapy management is a critical clinical process in terms of patient safety, traceability, and accountability. Chemotherapy is even more challenging, because of different professionals working together, strict protocols, dangerous procedures, costs. Thus, process control, consolidated organizational knowledge and ICT supporting tools become essential for safety and management. Unfortunately, literature does not provide an integrated approach to these issues; national networks of innovation and research can provide better help. Fondazione IRCCS Istituto Nazionale dei Tumori in Milan leads “Towards a complete competence framework and an integrated solution for patient safety in chemotherapy”, a project funded by the Italian Ministry of Health now assessing guidelines, process configurations, risk levels and ICT solutions, in over 20 Italian healthcare organizations. Major results of organizational and technology assessments are here discussed, focusing on the Istituto as a major example of process reengineering and ICT, dealing with Pharmacy centralization, advanced automation, digitalization of drug management, also drawing interesting considerations about impacts and benefits.