**2. Electronic medical record**

2 Perioperative Considerations in Cardiac Surgery

Fig. 1. Gabriele Monasterio CNR / Tuscany Region Foundation, Pisa and Massa, Italy

hospital Intranet and also outside by Extranet.

Fig. 2. The clinical information system: patient data flows

(middleware data integration into the central clinical database ARCA and Web distribution of health care information over the HIS network). PACS was set up using Open Source DICOM utilities. The computer-network infrastructure, interconnecting GPH with the head institution in Pisa, allows achieving full access to patient information from any workstation. Secure Web technology was applied for distribution of health care information within

The project of the information system was aimed at collecting, archiving and integrating all data related to patient care, from the visit in ambulatory to hospital admission, diagnostic procedures, cardiac surgery intervention and finally discharge and follow-up. The different

sources of patient information were integrated by middleware into the central hospital database (ARCA) which represents the clinical repository. Network connection between GPH and IFC is currently fast enough (8 Mb/s and recently up to 200 Mb/s) to guarantee Transition from conventional paper-based towards electronic medical record (EMR) required, first, to set up regular and comprehensive patient information flow from health care units into ARCA repository (Taddei et al., 2003). Each diagnostic or care unit (ECG, echocardiography, cath lab, chemical lab, nursing system) as well as the Operating Room Theatre and the Intensive Care Unit were provided with computer-based systems for recording patient data and transferring reports into EMR. Structured data entry was generally implemented in addition to free text. Standard ICD9-CM codes of diagnoses and

Fig. 3. The main GUI of the Electronic Medical Record

Fig. 4. Accessing the medical record in the ward by Wi-Fi connected laptop

procedures were applied for filling in DRG forms. EMR user interface was set up extending the model already used in Cardiology departments of IFC-CNR in Pisa (Carpeggiani et al., 2000). Use of Java language allowed to deploy EMR on any platforms (MS-Windows, Mac, Linux). Safe wireless networks were installed in the wards of both adult and pediatric cardiac departments to allow use of mobile EMR workstations at patient bed.
