Reuse of Clinical Information: Integrating Primary Care and Clinical Research through a Bidirectional Standard Interface

Nowadays, most healthcare providers archive and manage patients\u2019 information in electronic format. The reuse of such Clinical Information is essential from both a scientific and financial perspective, and for the integration of Primary Care and Clinical Research; which has become a principal goal. The solution proposed aims at integrating data between a web platform, developed for research purposes, and Hospital In-formation Systems. Information is shared through a Bidirec-tional Standard Interface, which adopts biomedical controlled vocabularies and ontologies (LOINC, ICD and SNOMED), and HL7 messaging (CDA V3 R2) for data exchanging. Such an interface allows the importation of data from Hospital In-formation Systems to a web platform, and the exportation of information from the platform to Hospital Information Sys-tems. Currently, this project has been implemented in the Infectious Diseases context, and complete data integration and semantic interoperability has been obtained between the \u201cLi-gurian HIV Clinical Network\u201d and the Infectious Diseases Department of the San Paolo Hospital (Savona, Italy)

SILAM: Integrating Laboratory Information System within the Liguria Region Electronic Health Record

In the last few years a significant challenge has been faced in the healthcare world, after the development of the LOINC (Logical Observation Identifiers Names And Codes) and the HL7 (Health level 7) standards; in order to provide systems of interoperable platforms, interconnected and utilizing standard language for the processing, communication and treatment of data. The aim of this paper is to demonstrate how a small local laboratory can easily communicate with a central data repository using these standards. This was realized by creating: a database with laboratory observations codified in LOINC, a web server that represents the general repository of data and by using two clients that directly link to the Web Service (WS) and which also allows clinicians and laboratory biologists to communicate with each other. The results clearly demonstrate that these standards are able to realize interoperability among heterogeneous systems. A future development should consist in testing this reality at a national level, with a national data repository

A semi-automatic web based tool for the selection of research projects reviewers

The correct evaluation of research proposals continues today to be problematic, and in many cases, grants and fellowships are subjected to this type of assessment. A web based semi-automatic tool to help in the selection of reviewers was developed. The core of the proposed system is the matching of the MeSH Descriptors of the publications submitted by the reviewers (for their accreditation) and the Descriptor linked to the research keywords which were selected. Moreover, a citation related index was further calculated and adopted in order to discard not suitable reviewers. This tool was used as a support in a web site for the evaluation of candidates applying for a fellowship in the oncology fiel

Red blood cell alloimmunisation in transfusion-dependent thalassaemia: A systematic review

Background. Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. Materials and methods. We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. Results. The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). Discussion. Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%

The Ligurian Human Immunodeficiency Virus Clinical Network: A Web Tool to Manage Patients With Human Immunodeficiency Virus in Primary Care and Multicenter Clinical Trials

Background: In recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the Human Immunodeficiency Virus (HIV) life-cycle and the disease is now considered chronic. Consequently, a longitudinal and complex follow-up is now required for HIV positive patients during their lifetime. Moreover, patients often encounter various complications due to comorbidities, related to the immunodeficiency state and HAARTs\u2019 side effects. Thus, HIV positive patients are involved in multicenter clinical trials (MCTs) to improve treatments and discover a preventive vaccine. Therefore, physicians require proper instruments to access comprehensive patient data for managing patients during follow-ups, and tools for data collection and analysis in MCTs. Objective: The Ligurian HIV Clinical Network aims to provide physicians with a Web-tool to administrate HIV positive patients\u2019 data within primary-care and to reuse the collected clinical information to perform MCTs in Northern Italy. Methods: The key aspect of the system is a relational database which allows the storage of various types of clinical information (eg, related to HIV, cardiovascular, or hepatic diseases) in multiple formats. The modular design of the database permits a rapid insertion of new parameters without requiring any changes in the database structure. Furthermore, codes from biomedical ontologies controlled vocabularies (\u201cLogical Observation Identifier Names and Codes\u201d, and \u201cInternational Classification of Diseases 9\u201d) and ontologies (\u201cSystematized Nomenclature of Medicine Clinical Terms\u201d), units and normality ranges used by all partners participating in the project were collected to achieve a complete semantic interoperability. Accordingly, data can be automatically normalized through the z score formula and physicians can extract and correctly compare information with external statistical tools. Moreover, to respect patients\u2019 privacy and legal issues, a local identifier, determined through an HASH cryptography algorithm, is assigned to each patient during the registration process. The database is managed by a user-friendly Web-platform which allows quick access to information during medical examinations and the reusing of the collected data for present and future MCTs. Furthermore, a bidirectional middleware was created in order to import/export information through HL7 messaging. Hence, data can be manually entered by physicians or automatically collected within HL7-compliant Hospital Information systems. Results: Presently, the direct storage of patients\u2019 information from the San Paolo Hospital (Savona, Italy), and San Martino and Galliera hospitals in Genoa is in a test phase. Currently, 8 centers of Infectious Diseases (located in Liguria and Piedmont) are participating in the project and almost 400 HIV positive patients have been recorded in the system. Patient data has been used for primary care and research purposes. Currently, there are 4 on-going MCTs and preliminary results have already been presented at International HIV congresses. Conclusions: The Web-platform allows effective management, sharing and reuse of information within primary care and clinical research. In the future it is planned to share the clinical information from this network with other HL7-compliant workgroups and to extend the platform to other infective diseases (eg, hepatitis)