**1. Introduction**

Today information and communication technology is widely applied in health care. A variety of Information Systems for management of both administrative, government and clinical tasks have been developed and largely implemented in hospitals. Cardiac surgery setting is peculiar in terms of complexity of health-care information management, involving in addition to general tasks related to hospital patient care (ADT, DRG billing, cost evaluation, multimodality diagnostic examinations, laboratory tests, ward and nursing care, anesthesia and surgical interventions, follow-up) specific procedures for cardiac function evaluation and care (cath-lab, radiology), heart surgery (from minimal invasive to open heart operations with assisted circulation), intensive care unit monitoring.

Given the huge amount of different heterogeneous sources of patient data, both administrative and clinical, integration is crucial to allow comprehensive medical decision making, effective care planning and proper resource control. Actually few systems achieve this objective even if interoperability in health care has been promoted by many international initiatives (HL7, ANSI, CEN, DICOM).

Aim of this paper is to report our experience in developing an integration system to manage health care in its technological, administrative and clinical aspects, in respect of high quality care and cost-effectiveness evaluation.

Almost 15 years ago the Hospital Information System (HIS) was first developed at National Research Council (CNR), Institute of Clinical Physiology (IFC), in Pisa by the SPERIGEST project (supported by Italian National Health Ministry, 1995-98) (Macerata, 1995) for the integration of resources in Cardiology. Later, extension of HIS at G.Pasquinucci Heart Hospital (GPH), IFC-CNR's section in Massa, 60 kilometers from Pisa, specialized in Cardiology and Cardiac Surgery (both adult and pediatric), required both adaptation and development. In 2007 IFC-CNR health-care activities converged into the "G.Monasterio Foundation" (FGM) by the joint effort of CNR, Tuscany Region and Universities.

A networked computer-based information systems was implemented, based on three levels of data archiving (administration, clinical system and functional units, i.e. diagnostic laboratories, care units, Operating Rooms) and on two modalities for data exchange

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

(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 hospital Intranet and also outside by Extranet.

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

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

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 effective access to patient data, archived in the ARCA repository located in Pisa (SQL IBM DB2/2, recently migrated into Oracle DB).
