S. Dalmiani

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.

New standards for cardiology report and data communication: an experience with HL7 CDA release 2 and EbXML

The diffusion of health standards, connected to technological infrastructure, finally opens the road to a new way of interconnecting and integrating different clinical solutions. New standards coming from established Organizations such as HL7 and DICOM, are going to be integrated with Communication Organization to build the Health environment Info-structure of the next decade. The purpose of this work is to show how this is possible, using simple and affordable methods: The recently approved HL7 Clinical Document Architecture Release 2 standard for message packaging and the newly approved ebXML 3.0 specifications. These promising standards can be used in conjunction with Web-Services and Web Service Description Language (WSDL) technology. This type of solution allows to be totally independent from the development platform, from the programming language and the operating system used. EbXML is an XML framework for business-to-business (B2B) environment developed by the ebXML Initiative

HL7 clinical document architecture to share cardiological images and structured data in next generation infrastructure

In medicine and in cardiology different standards are used for treatment of clinical and iconographic information. Among the most relevant there are HL7 for clinical data and DICOM for images and signals. The advent of electronic health record systems (EHR) and the request for data integration coming from different imaging modalities and diagnostic instrumentation, offer us a technological panorama difficult to manage. There is an increasing demand to select the most meaningful information in a simple and effective way, without the duty and the necessity to create from scratch new ways of data communication and sharing. Hence an agreement, in order to be able to feed a new multidisciplinary information databases, is necessary. To reach this goal, we used the emergent development of HL7 in the field of the structure of clinical document architecture (CDA).

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.

An informative system for structured data management to build a cardiological multidimensional database

To collect clinical data generated during patient care in a multidisciplinary environment an informative system should manage each clinical aspect of involved disciplines. In this project we developed an application of what we call a Dynamic Dataset Definition (D/sup 3/) that allows rapid system deployment due to its capability of building a graphical interface directly related to a definition of collectable data. It is sufficient to initialize the system with a minimal data-set, not yet completely established, and let to successive steps to refine detailed information with current clinical use, where annotations are followed by an immediate program changes. Moreover, in a multidisciplinary clinical environment, information is shared providing a partial view on the common defined dataset, in order to inherit data definitions of shared parameters and let them to be displayed and/or entered by several physicians. At last, the physician will retrieve information based on his personal choice or by a common scheme or calculated indexes, with a final generation of a WEB based report. This system has been implemented in a network environment to guarantee an effortless data sharing between physicians, and tested in a Cardiology and Cardiac Surgery departments at our institute. Presently, 12 clinical subsystems are based on this model and more than 270,000 parameters have been collected on 1200 patients since August 2001 to August 2002.

Intelligent data retrieval system as a decision support in cardiology in an Intranet environment

Wide availability of computing resources encourages archiving clinical data to a large extent, thus making difficult an effective and easy data retrieval approach. The solution the authors present is aimed at helping the physician in retrieving discriminant parameters for a particular subject, both for initial diagnosis and therapeutical control. Since the system has an active role in the process of decision making, the authors have called it Intelligent Data Retrieval System (IDR). It consists of an interactive front-end, carried out around four main features: handling the problem of dishomogeneous data, suggesting significant data through an heuristic approach and helping the user to apply dimension reduction procedures. Moreover the system allows a wide portability and the use of encryption algorithms as well. Portability and easy access to patient data has been further. Improved by implementing the system as an Intranet application.

ECG devices interoperability in hospital environment: clinical experience

The clinical use of information systems is now widely accepted in hospital departments. Among diagnostic instrumental examinations the electrocardiogram is the most popular diagnostic procedure in hospitals and outpatient points of care and its integration in Hospital Information System (HIS) is mandatory. We report our experience in integrating ECG devices in the clinical HIS of an advanced Health Care Center for.pulmonaty and cardiovascular disease. In the last five years the Electronic Medical Record was daily used and automatically filled, as much as possible, by diagnostic instrumentation. Electrocardiogram was the last diagnostic procedure to be integrated; this depended both by technical problems and by functional variables. Solutions adopted are the results of technical choices for an optimal integration of ECG devices into Electronic Medical Record and the guidelines and advices suggesied by doctors and nurses. One year validation takes into account the real bedside process of ECG acquisition in clinical ward or laboratories, following the instrumentation requirements as expected by the users. On the basis of our experience we conclude that the commercial ECG device integration is far to be reached and it is one of the most challenge problems in a hospital environment

Cardiac surgery and cardiological data integration between remote structures

Patient data exchange between remote cardiology and cardiac surgery may represent a real problem in everyday patient care. This study was aimed to assess database connectivity in a cardiology department with a remote cardiac surgery, to explore possibilities of technology standards and to establish a background for developments in teleconsulting. Digital imaging and communication protocol (DICOM) and HL7 standard were adopted. Data from cardiology were dispatched to surgeons by an Internet connection. For patients undergoing surgery, information coming from the surgical department could be reviewed by cardiologists for subsequent follow up. This approach allows rapid consultation and exchange of structured data and images between cardiologists and surgeons even in remote sites; this model improves clinical care by reducing geographical barriers between physicians practicing in distant structures.

EMR standards in cardiological outpatient management

From 1997 a hospital informative system (HIS) has been established in our institute for clinical data management and proprietary protocols have been adopted for data exchange. In the outpatient setting standardization for direct integration with other subsystems is mandatory due to huge clinical and administrative data amounts. Aim of this study was to standardize a common informative system using HL7-CDA rel.2 protocol as data interface exchange among different outpatient specialties. An interaction model was produced and compared with a draft version of HL7 CDA version 2; structured data were superimposed to the basic CDA skeleton. The structured body was extended with clinical information coded with LOINC and SNOMED dictionary. This system was able to set a CDA packet containing visit reports and relevant clinical information, sharing data with other specialties through a central repository.