The Ligurian HIV network: How medical informatics standards can help clinical research

open11noIntegrating evidence from systematic research in daily clinical practice is one of the pillars of evidence-based medicine. Electronic data capture tools simplify data collection from different centers and supports the management of multicenter clinical trials. The Ligurian HIV Network (LHN) is one such tool, originating from a regional effort to integrate clinical trial capabilities for HIV and other chronic infectious diseases. In order to manually collect a complete report of all clinical tests on patients enrolled in a trial, a strenuous human effort and the allocation of great resources would be necessary. Moreover, the risk of error in a manual system is very high. The proposed system automatically extracts clinical data from the EHR of three hospitals of the LHN in a standardized way, and enhance their re-use in clinical trials. Through dedicated questionnaires, physicians reported a strongly positive feedback about the efficacy of the platform in supporting clinical research.openGiannini B.; Mora S.; Gazzarata R.; Di Biagio A; Cenderello G.; Dentone C.; Setti M.; Fenoglio D.; Cassola G.; Viscoli C.; Giacomini M.Giannini, B.; Mora, S.; Gazzarata, R.; Di Biagio, A; Cenderello, G.; Dentone, C.; Setti, M.; Fenoglio, D.; Cassola, G.; Viscoli, C.; Giacomini, M

A modular multipurpose, parameter centered electronic health record architecture

Health Information Technology is playing a key role in healthcare. Specifically, the use of electronic health records has been found to bring about most significant improvements in healthcare quality, mainly as relates to patient management, healthcare delivery and research support. Health record systems adoption has been promoted in many countries to support efficient, high quality integrated healthcare. The objective of this work is the implementation of an Electronic Health Record system based on a relational database. The system architecture is modular and based on the concentration of specific pathology related parameters in one module, therefore the system can be easily applied to different pathologies. Several examples of its application are described. It is intended to extend the system integrating genomic data

A Standardized SOA for Clinical Data Interchange in a Cardiac Telemonitoring Environment

Care of chronic cardiac patients requires information interchange between patients\u2019 homes, clinical environments and the Electronic Health Record (EHR). Standards are emerging to support clinical information collection, exchange and management and to overcome information fragmentation and actors delocalization. Heterogeneity of information sources at patients\u2019 homes calls for open solutions to collect and accommodate multi-domain information, including environmental data. Based on the experience gained in a European Research Program, this paper presents an integrated and open approach for clinical data interchange in cardiac telemonitoring applications. This interchange is supported by the use of standards following the indications provided by the national authorities of the countries involved. Taking into account the requirements provided by the medical staff involved in the project the authors designed and implemented a prototypal middleware, based on a Service Oriented Architecture (SOA) approach, to give a structured and robust tool to CHF (Congestive Heart Failure) patients for their personalized telemonitoring. The middleware is represented by a Health Record Management Service (HRMS), whose interface is compliant to the HSSP (Healthcare Services Specification Project) RLUS (Retrieve, Locate and Update Service) standard (Level 0), which allows communication between the agents involved through the exchange of CDA R2 (Clinical Document Architecture Release 2) documents. Three performance tests were carried out and showed that the prototype completely fulfilled all requirements indicated by the medical staff, however certain aspects, such as authentication, security and scalability, should be deeply analyzed within a future engineering phase