**3. Operating room theatre**

Development of HIS at GPH started with the set up of the Anesthesia Information Management system (Taddei et al., 2000) for documentation of anesthesia procedure during cardiac surgery operations. Commercial software (OTIS by Dedalus Inc.) for anesthesia data entry with on-line acquisition from OR equipment was adapted and integrated with HIS. Three phases were distinguished: preoperative patient identification and characterization, importing data from ARCA repository; intra-operative data entry (drugs, events, notes) and automatic data capture from OR equipment; post-operative ICU ordering, anesthesia record printing and data exporting to ARCA repository. Material data entry system was developed for resource management during operations. For each anesthesia record a surgery record was created automatically (by trigger on intervention start) in order to facilitate reporting by operators and to achieve OR register.

Fig. 5. Anesthesia Information System integrated with Hospital Information System

Recently a new Anesthesia Information Management System has been developed at the Heart Hospital in Massa (Cossu et al., 2011). It was specialized for recording anesthesiarelated perioperative patient data during cardiac surgery on either adult or pediatric patients. The system was aimed at integrating patient data (clinical, instrumental and administrative) partly filled in by operator (anesthetist or anesthesia technician) through the Graphical User Interface, partly SQL-retrieved from Hospital Information System (Oracle), repository of patient electronic medical records, and partly gathered, by HL7, from Operating Room instrumentation (monitors, anesthetic machine and blood gas analyzer). Software was created in Java, achieving reliability and cross-platform capability. First, it was crucial to define requirements by interaction with anesthetists and later by cycles of test, revising and correction. GUI, designed to better ergonomics, was divided into modules, each for a corresponding task or phase of anesthesia. Specific forms are provided for documentation of induction phase, for recording staff, drug administrations (bolus or drip),

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

Development of HIS at GPH started with the set up of the Anesthesia Information Management system (Taddei et al., 2000) for documentation of anesthesia procedure during cardiac surgery operations. Commercial software (OTIS by Dedalus Inc.) for anesthesia data entry with on-line acquisition from OR equipment was adapted and integrated with HIS. Three phases were distinguished: preoperative patient identification and characterization, importing data from ARCA repository; intra-operative data entry (drugs, events, notes) and automatic data capture from OR equipment; post-operative ICU ordering, anesthesia record printing and data exporting to ARCA repository. Material data entry system was developed for resource management during operations. For each anesthesia record a surgery record was created automatically (by trigger on intervention start) in order to facilitate reporting by

Fig. 5. Anesthesia Information System integrated with Hospital Information System

Recently a new Anesthesia Information Management System has been developed at the Heart Hospital in Massa (Cossu et al., 2011). It was specialized for recording anesthesiarelated perioperative patient data during cardiac surgery on either adult or pediatric patients. The system was aimed at integrating patient data (clinical, instrumental and administrative) partly filled in by operator (anesthetist or anesthesia technician) through the Graphical User Interface, partly SQL-retrieved from Hospital Information System (Oracle), repository of patient electronic medical records, and partly gathered, by HL7, from Operating Room instrumentation (monitors, anesthetic machine and blood gas analyzer). Software was created in Java, achieving reliability and cross-platform capability. First, it was crucial to define requirements by interaction with anesthetists and later by cycles of test, revising and correction. GUI, designed to better ergonomics, was divided into modules, each for a corresponding task or phase of anesthesia. Specific forms are provided for documentation of induction phase, for recording staff, drug administrations (bolus or drip),

cardiac departments to allow use of mobile EMR workstations at patient bed.

**3. Operating room theatre** 

operators and to achieve OR register.


Fig. 6a. The main GUI of the new Anesthesia Information System: the diary (middle), the event counters (right), the tags for access to data views (top), the diary filters (bottom)

Fig. 6b. Data entry and printing


Fig. 7. Recording bolo/drip drug administrations and computing dosages and quantities


Fig. 8. Printout of anesthesia record

Fig. 7. Recording bolo/drip drug administrations and computing dosages and quantities

Fig. 8. Printout of anesthesia record

Fig. 9. From test ordering in the wards to laboratory processing and EMR reporting

fluid or blood administrations or losses, and any event of interest, for displaying physiological parameters, for echocardiography reporting. List of anesthesia-related information, fluid balance, lists or trends of physiologic, blood, ventilation, coagulation or monitoring parameters are represented. Counters for timing of main phases (e.g. anesthesia, surgery, ECC) are provided. Operation reports for surgeon's convenience are automatically 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 cardiac interventions.
