ICT and mobile health to improve clinical process delivery. a research project for therapy management process innovation.

The volume and the complexity of clinical and administrative information make Information and Communication Technologies (ICTs) essential for running and innovating healthcare. This paper tells about a project aimed to design, develop and implement a set of organizational models, acknowledged procedures and ICT tools (Mobile & Wireless solutions and Automatic Identification and Data Capture technologies) to improve actual support, safety, reliability and traceability of a specific therapy management (stem cells). The value of the project is to design a solution based on mobile and identification technology in tight collaboration with physicians and actors involved in the process to ensure usability and effectivenes in process management.

Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.

Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology.

Evicase: an evidence-based case structuring approach for personalized healthcare.

The personalized medicine era stresses a growing need to combine evidence-based medicine with case based reasoning in order to improve the care process. To address this need we suggest a framework to generate multi-tiered statistical structures we call Evicases. Evicase integrates established medical evidence together with patient cases from the bedside. It then uses machine learning algorithms to produce statistical results and aggregators, weighted predictions, and appropriate recommendations. Designed as a stand-alone structure, Evicase can be used for a range of decision support applications including guideline adherence monitoring and personalized prognostic predictions.

Open source clinical portals: a model for healthcare information systems to support care processes and feed clinical research. An Italian case of design, development, reuse, and exploitation.

Open source is a still unexploited chance for healthcare organizations and technology providers to answer to a growing demand for innovation and to join economical benefits with a new way of managing hospital information systems. This chapter will present the case of the web enterprise clinical portal developed in Italy by Niguarda Hospital in Milan with the support of Fondazione Politecnico di Milano, to enable a paperless environment for clinical and administrative activities in the ward. This represents also one rare case of open source technology and reuse in the healthcare sector, as the system's porting is now taking place at Besta Neurological Institute in Milan. This institute is customizing the portal to feed researchers with structured clinical data collected in its portal's patient records, so that they can be analyzed, e.g., through business intelligence tools. Both organizational and clinical advantages are investigated, from process monitoring, to semantic data structuring, to recognition of common patterns in care processes.

The evolution of hospital information systems and the role of electronic patient records: from the Italian scenario to a real case.

Health care organizations can gain great value from Information and Communication Technologies (ICT), yet, although there is growing awareness of the potential benefits associated with their use, results often fall far short of expectations. Each year, the "ICT in Health Care" Observatory--part of the Politecnico di Milano School of Management--outlines a profile of the role of ICT in the Italian health care industry, investigating current projects in terms of their impact on processes and organizations, implementation state of the art, governance models, and prospective pathways. The 2009 collaborative research process outlines the need for a change in the way health care CIOs approach technological and organizational evolutions. ICT departments lack vision, governance mechanisms, skilled resources, and top management commitment. This has led to a series of distortions in the innovation of Hospital Information Systems (HISs) and ICT departments themselves. Currently they are too concerned with day-to-day operations and delay comprehensive initiatives capable of leading to effective ICT-driven innovations. The paper points out the problems that health care organizations are tackling and how they are trying to solve them. The case of the Italian National Cancer Institute in Milan provides a valuable example of how a health care organization is developing its HIS.

How different technologies can fit nursing processes to empower staff and increase quality of care. An Italian case study.

The rapid evolution of healthcare and the need to contain costs, to decrease the time of patients' hospitalization, and to improve the quality of care has led the nursing profession to face new challenges. This paper describes the case study of A.O. Ospedale Niguarda in Milan (Italy), a public healthcare provider where the key role of Nursing is being recognized according to international common practice. Also considering the context of Italian healthcare, attention will be drawn to concrete actions carried out on the organizational side and also for what concerns IT tools supporting nursing activities. This was done aiming with success at rising nurses' knowledge level of the patient, support its activities, increase quality of care, in a precise managerial and methodological framework. We will describe four cases of projects (Intensive Care Unit patient record, First Aid Station care reporting, pressure ulcers management, transfusion traceability) carried out by Niguarda with the support of its partner Fondazione Politecnico di Milano, set up to support bedside nursing activities with the most suitable technology for the purpose.