**6. Web data distribution**

Distribution of health care information over HIS network was achieved by the use of Web technology. HTTPS Web server was installed for secure access to clinical data recorded in ARCA repository. Web clinical site was developed for allowing authorized users, through password control, to browse into patient clinical data from any workstation over HIS network or even from Internet by VPN connection. First, CGI applications in C language

Fig. 10. From the clinical Web site: the list of cardiac surgery interventions.

and in NetData script (IBM) were realized and later Java servlets and PHP4 applications were developed. Tabular or graphic views were implemented for reporting medical records of in- and outpatients, discharge letters, lists of patients and diagnostic reports, cardiac surgery and anesthesia data. Data, downloaded from the web site, were further processed by statistical packages. Later a new web information systems (BMF) allowing deep user access control was developed; all administrative, clinical and government web applications were migrated and adapted (Mangione, 2006).

### **7. RIS-PACS**

8 Perioperative Considerations in Cardiac Surgery

created in the HIS medical record at start of surgery. HTML reports are created, retrieving data from anesthesia database (Oracle), and printed out: "the anesthesia report", i.e. the medical and legal document, and the "ICU report" addressed to personnel taking care of operated patient. AIMS was introduced in ORs since March 2011, using medical-grade computers close to patient bed. This system, adopting advanced IT solutions (Java, HL7, database relational), could be potentially deployed to other institutions, not limiting to

The LIS was integrated with the HIS to automate the testing process from clinical departments to laboratory and back into EMR (Taddei et al., 2005). Laboratory workflow consists of three parts: (a) test ordering by clinical staff, printing bar-coded ID labels and transmitting orders by network to laboratory; (b) processing test requests and controlling identified specimens by laboratory staff, providing work orders to analytical instruments

International reference data sets were adopted to characterize cardiac patients developing registers, aimed at both clinical research and outcome evaluation. An information model was created for structured data management to build clinical registers (Dalmiani et al., 2002). Registers were partially filled in automatically by data retrieved from EMR or from anesthesia record. EACTS congenital heart surgery dataset was adopted as reference for pediatric patients (EACTS database), while National Society of Cardiac Surgery dataset for adults undergoing cardiac surgery (SICCH database). Standard risk scores were derived

Distribution of health care information over HIS network was achieved by the use of Web technology. HTTPS Web server was installed for secure access to clinical data recorded in ARCA repository. Web clinical site was developed for allowing authorized users, through password control, to browse into patient clinical data from any workstation over HIS network or even from Internet by VPN connection. First, CGI applications in C language

and validation of results authorizing delivery into the hospital clinical repository.

from datasets (Euroscore for adult and Aristotle for pediatric cardiac surgery).

Fig. 10. From the clinical Web site: the list of cardiac surgery interventions.

cardiac interventions.

**5. Clinical registers** 

**6. Web data distribution** 

**4. Laboratory information system** 

Using Open-Source utilities (DCM4CHE), the PACS for different DICOM modalities (CR, CT, XA, US) was set up, while viewer/processing workstations (OSIRIX) were installed for both reporting and consultation (OSIRIX). According to conformance statement of DICOM server (DCM4CHE) and modality equipment Work-List service was implemented was applied to get patient lists from HIS, thus allowing to identify examinations. Radiology workflow include the following steps: examination reservations (1) (in-or outpatients); execution of examinations, identified by worklist and recorded on DICOM server (2a,b); examination reporting on review workstation (3b) or on conventional films (3a); report data entry and printing by EMR (Taddei et al., 2008). Data security was maintained by RAID architecture and using CD/DVD automated DICOM backup systems.

Fig. 11. The RIS structure

Fig. 12. The PACS

Fig. 13. Fetal tele-echocardiography
