A guideline-based co-operative work framework integrating medical knowledge management services for heart failure care delivery

Information and communication technology (ICT) represents a significant change agent in the medical community. The development and the integration of innovative ICT tools to effectively manage the Medical Knowledge (MK) is one of the more relevant challenges for near future. The development of innovative information technology tools can support the process of creating, sharing, disseminating and exploiting the MK among the different health care organisations. Guidelines (GLs) are one of the methods that try to solve the issue of transferring the results of the bio-medical research into the clinical practice, providing a series of recommendations based on scientific evidence that would constitute the best practice. However, the development of good GLs doesn’t ensure their use in practice. Several studies have shown that the compliance with the GL can be improved when GLs are integrated with an Electronic Medical Record so that patient-specific advices can be delivered at the right time and place, improving clinical performance. Moreover, it has been shown that organizational constraints, whose communication among hospital Health Care Professionals (HCPs) and between hospital specialists and General Practitioners (GPs) represents one of the more relevant aspects, can impair the implementation of GLs. The co-ordinated action of HCPs in patient care delivery is a key factor for an healthcare organization. Therefore, not only computerised GLs (establishing “what to do”), but also organisational aspects (establishing “how, by whom, and by what”) have to be taken in consideration. Workflow management systems could be a suitable tool to address organisational issue

A non-photochemical route to synthesize simple benzo[1,2-b:4,3-b′]dithiophenes: FeCl3-mediated cyclization of dithienyl ethenes

The FeCl3-mediated cyclization of a,a0-disubstituted Z-alkenes 1 is reported as a general and non-photochemical route to synthesize benzo[1,2-b:4,3-b0]dithiophene (BDT) derivatives 2, achievable in good yields starting from cheap and easily available materials. The influence of the temperature and the nature of the substituents on the scope and limitations of this methodology is also reported

Design and implementation of a regional tele-oncology project: design and initial implementation phase

In 1997 two tele-oncology projects started in the north of Italy (Province of Trento). The common aim of the projects concerns the design and the implementation of a non-surgical tele-oncology system intended to provide a suitable and flexible computing environment for a joint management of oncology patient on a WAN. The network designed for the first project (funded by Italian Health Ministry) links 5 rural hospitals of the province -lacking of oncology specialists on site- to the central one, where clinical oncology (CO) and radiotherapy services are provided. The specific purpose of the tele-oncology system is to support the rural hospitals oncology care by providing continuos expert remote advice from central site oncology specialists in formulating treatment plans and conducting follow-up sessions. The second project (funded by EC Adapt-bis Programme) is devoted to facilitate the communication between general practitioners (GPs) and the medical staff at the CO department of Trento through a computer network, allowing GPs and hospital specialists to share medical data. To satisfy the overall needs of the two projects an intranet-based OTCS was implemented. The basic component of the system is the multimedia digital medical record. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser. The system incorporates Web-based applications (native and custom) such as synchronized navigation on medical records, image-sharing, audio-conferencing, white-boarding, local notepad, chat and e-mail service. The system provides a synchronous mode for real-time cooperative working between hospital specialists and an asynchronous mode for sharing clinical data between GPs and hospital specialists. Users acceptance during the prototype implementation periods and the training phase was high. Since summer 1999 the OTCS has been deployed in hospital and GPs setting and it is going to be tested in the hospital routin

Design and implementation of an intranet-based system for real-time tele-consultation in oncology

This study describes a tele-consultation system (TCS) developed to provide a computing environment over a Wide Area Network (WAN) in North Italy (Province of Trento), that can be used by two or more physicians to share medical data and to work co-operatively on medical records. A pilot study has been carried out in oncology to assess the effectiveness of the system. The aim of this project is to facilitate the management of oncological patients by improving communication among the specialists of central and district hospitals. Methods and Results: The TCS is an intranet-based solution. The intranet is based on a PC WAN with Windows NT Server, Microsoft SQL Server, and Internet Information Server. TCS is composed of native and custom applications developed in the Microsoft Windows (9x and NT) environment. The basic component of the system is the multimedia digital medical record, structured as a collection of HTML and ASP pages. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser via the Web Server. The medical data to be stored and the presentation architecture of the clinical record had been determined in close collaboration with the clinicians involved in the project. TCS will allow a multi-point tele-consultation (TC) among two or more participants on remote computers, providing synchronized surfing through the clinical report. A set of collaborative and personal tools, whiteboard with drawing tools, point-to-point digital audio-conference, chat, local notepad, e-mail service, are integrated in the system to provide an user friendly environment. TCS has been developed as a client-server architecture. The client part of the system is based on the Microsoft Web Browser control and provides the user interface and the tools described above. The server part, running all the time on a dedicated computer, accepts connection requests and manages the connections among the participants in a TC, allowing multiple TC to run simultaneously. TCS has been developed in Visual C++ environment using MFC library and COM technology; ActiveX controls have been written in Visual Basic to perform dedicated tasks from the inside of the HTML clinical report. Before deploying the system in the hospital departments involved in the project, TCS has been tested in our laboratory by clinicians involved in the project to evaluate the usability of the system Discussion: The TCS has the potential to support a “multi-disciplinary distributed virtual oncological meeting”. The specialists of different departments and of different hospitals can attend “virtual meetings” and interactively discuss on medical data. An expected benefit of the “virtual meeting” should be the possibility to provide expert remote advice from oncologists to peripheral cancer units in formulating treatment plans, conducting follow-up sessions and supporting clinical researche

An evaluation of the users' satisfaction and the use of a tele-consultation system in oncology practice

A three year oncology teleconsulting project was concluded in November 2000. During a six-month study period, 38 clinical physicians and 47 nurses used the system. A total of 617 electronic patient records were created in te oncology department, 297 in dermatology and 24 in gynaecology. There were 45 synchronous teleconsultations involving various participants, lasting a total of 708 min. We conducted surveys of the attitudes of the users to the teleconsulting system both before and after its implementation. There were no significant differences between the two surveys and the results showed that users had a positive reaction to the system and high expectations to its future utilizatio

Evaluation of a tele-oncology service for rural hospitals

A web-based telemedicine system was established in the province of Trento (italy) to provide rural hospitals with a telemedicine consultation service to support treatment plans and follow-up session for cancer patients. The system is based on a multimedia digital oncology patient record available throughout the network via a dedicated Web browser. Embedded applications are integrated to duscuss the cases and to share clinical information in `virtual oncology meetings`. To evaluate the impact of the telemedicine system a questionnaire was distributed to all health professionals involved in the project (26 clinicians, 31 nurses). The questionnaire, based on open and closed response questions, investigates the use of the system users` attitudes towards the digital clinical record and teleconsultation, personal benefits perceived from the system, major problems encountered during the experimentation, system future use expectation, etc. The quantitative and qualitative results reveal benefits in communication and informagion sharing and point out mainly organizational limits rather than usage or technical performance