**9. Conclusion**

While information systems for reporting diagnostic, clinical and cardiac surgery activities have been in use at GPH for more than ten years, since 2005, EMR is daily used on all the patients admitted in the clinical departments (Cardiology, Cardiac Surgery and ICU). In order to assure confidentiality, EMR access is allowed only to authorized health care personnel using a personal password to login.

So far at GPH in Massa more than 30000 inpatient and 240000 outpatient records were processed and archived, including up to 12000 cardiac surgery reports (adult and pediatric).

The HIS, developed by the efforts of interdisciplinary teams of IFC-CNR and GPH during the last fifteen years, despite initial difficulties, mainly due to adoption of new technology, was finally effective for both clinical and administrative management (Carpeggiani et al., 2008). Data integration and archiving allowed hospital personnel (physicians, nurses, secretary and administration officers, director) to access clinical records easily and reliably with benefits to overall health-care process. Particularly EMR in the ward promoted staff inter-communication and comprehensive documentation of patient care during hospitalization. Actually a series of technical measures, continuously updated, were needed for assuring data security, confidentiality and integrity, given the continuous exposure to intrusion risks on networks. Technical services were organized to provide 24-hour assistance and support.

Currently medical records need to be printed out after patient discharge and signed by the responsible of department, just achieving a legal value. Application (under development) of both electronic signature and official clinical data storage systems, according to regulatory laws, will allow to authenticate electronic documents achieving a real paperless medical record. Policies for data access, backup and storage will be revised and updated.

Adoption of standard dataset for the characterization of cardiac patients was crucial to achieve comprehensive registers allowing to benchmark surgeons' practice by making prospective prediction of patient outcome according to multicenter risk stratification models. Uploading pediatric cardiac surgery records on international EACTS database it was possible to qualify the GPH centre as one of the best ones in terms of outcome during the last years.

Actually revision of both database architectures (Oracle DBMS) and clinical applications according to health-care data exchange standards (HL7 v3, IHE) (HL7 standard) is currently under development aimed at improving performance of information systems, safeguarding their security and also to assure multicenter interoperability.

#### **10. Acknowledgment**

We thank the information technology teams of both Heart Hospital in Massa (Andrea Gori, Emiliano Rocca, Giacomo Piccini and Tiziano Carducci) and of Hospital section in Pisa (Alessio Ciregia, Mario Cossu, Mauro Raciti, Cristina Salvatori, Andrea Trabucco, Fabrizio Conforti, Giuseppe Di Guglielmo, Gavino Marras) for help, suggestions and advice in setting up applications. Moreover our appreciation for collaborative efforts and suggestions to the clinical staff involved in cardiology, cardiac surgery, anesthesia and radiology (particularly Bruno Murzi, Nadia Assanta, Sergio Berti, Paolo Del Sarto, Mattia Glauber, Dante Chiappino, Pierantonio Furfori and Umberto Paradossi).

### **11. References**

12 Perioperative Considerations in Cardiac Surgery

Tele-echocardiography was initially implemented in pediatric centers of Banja Luka and Rijeka and Gynecology University Hospital in Tirana, using videoconferencing equipment for transmitting on-line over Internet sequences of diagnostic images. Limitations in terms of functionality, versatility, scalability and cost/effectiveness suggested exploitation of Open-Source technology to set up low-cost devices implementing both live and store-and-

These devices are generally prone to promote collaborative health-care in various medical

While information systems for reporting diagnostic, clinical and cardiac surgery activities have been in use at GPH for more than ten years, since 2005, EMR is daily used on all the patients admitted in the clinical departments (Cardiology, Cardiac Surgery and ICU). In order to assure confidentiality, EMR access is allowed only to authorized health care

So far at GPH in Massa more than 30000 inpatient and 240000 outpatient records were processed and archived, including up to 12000 cardiac surgery reports (adult and pediatric). The HIS, developed by the efforts of interdisciplinary teams of IFC-CNR and GPH during the last fifteen years, despite initial difficulties, mainly due to adoption of new technology, was finally effective for both clinical and administrative management (Carpeggiani et al., 2008). Data integration and archiving allowed hospital personnel (physicians, nurses, secretary and administration officers, director) to access clinical records easily and reliably with benefits to overall health-care process. Particularly EMR in the ward promoted staff inter-communication and comprehensive documentation of patient care during hospitalization. Actually a series of technical measures, continuously updated, were needed for assuring data security, confidentiality and integrity, given the continuous exposure to intrusion risks on networks.

Currently medical records need to be printed out after patient discharge and signed by the responsible of department, just achieving a legal value. Application (under development) of both electronic signature and official clinical data storage systems, according to regulatory laws, will allow to authenticate electronic documents achieving a real paperless medical

Adoption of standard dataset for the characterization of cardiac patients was crucial to achieve comprehensive registers allowing to benchmark surgeons' practice by making prospective prediction of patient outcome according to multicenter risk stratification models. Uploading pediatric cardiac surgery records on international EACTS database it was possible to qualify

Actually revision of both database architectures (Oracle DBMS) and clinical applications according to health-care data exchange standards (HL7 v3, IHE) (HL7 standard) is currently under development aimed at improving performance of information systems, safeguarding

We thank the information technology teams of both Heart Hospital in Massa (Andrea Gori, Emiliano Rocca, Giacomo Piccini and Tiziano Carducci) and of Hospital section in Pisa

forward teleconsulting as well as videoconference and image storage/management.

fields even in remote Countries not able to acquire expensive medical technology.

Technical services were organized to provide 24-hour assistance and support.

record. Policies for data access, backup and storage will be revised and updated.

the GPH centre as one of the best ones in terms of outcome during the last years.

their security and also to assure multicenter interoperability.

**10. Acknowledgment** 

**9. Conclusion** 

personnel using a personal password to login.


http://www.dcm4che.org/

EACTS database. Available from:

http://www.eactscongenitaldb.org/


http://www.osirix-viewer.com/

SICCH Database. Available from:

http://www.sicch.org/ sections/Database\_Nazionale/index.html

Taddei, A.; Dalmiani, S.; Piccini, G.; Vellani, A.; Carducci, T.; Buffa, M.; Scebba , L.; Glauber, M.; Murzi, B.; Biagini, A. & Macerata, A. (2003). Data integration in cardiac surgery and resource management. In: *Computers in Cardiology*, vol.30, pp. 279-282, IEEE


http://www.escardio.org/communities/councils/ccp/e-

journal/volume9/Pages/telemedicine-open-source-technology-congenital-heartdisease-foetus-newborn-Alessandro-Taddei.aspx
