Francesca Ambrogi

Survey results released at the 2008 Healthcare Information and Management Systems Society meeting show that the implementation of electronic medical record technology dominates priorities among healthcare IT professionals. 

 Hospitals are taking advantage of such technology designed to improve the quality of staff communication in the hope that patients will benefit and departmental workflow will become more efficient.

Members of the University of Pisa's diagnostic and interventional radiology department presented one EMR software solution at the 2007 RSNA meeting. The system displayed in Chicago has been developed to improve communication among specialists caring for oncology patients.

A common technological connection was required to link different oncologists and clinicians belonging to different hospital departments. The solution had to organize each step of a patient's clinical care, arrange multidisciplinary management, and determine rules for data sharing. These goals have been achieved with the Electronic Oncology Patient Folder, a patient-oriented data collection and storage system that creates a customized folder for each patient depending on clinicians' requirements.

The Electronic Oncology Patient Folder is a web-based, interactive system. Data can be accessed from all hospital network connection points via a common web browser. This allows clinicians and radiologists to insert data and images into the database remotely, so they can be shared with other specialists in different departments.

The application is based on a Microsoft Windows platform running an Apache Tomcat web server and an SQL Server database. It is based on HTML and has been developed to be intuitive and easy to use. Clients do not require special hardware or advanced informatics skills.

Clinicians and radiologists can log on to the Electronic Oncology Patient Folder using Internet Explorer. They can then manage the system and visualize, insert, or modify patient data and associated images.

Level of access will depend on users' privilege status. Each doctor has customized access with different privilege levels. The system traces every new insertion or change in the database.

When a clinician needs to insert a new patient in the database, he or she must complete a form concerning the personal details of that patient. A new patient folder is then created automatically in the database. This folder is divided into many sections, one for each specialty included in the project.

Clinicians fill in their relevant section. They may also be able to modify or delete existing data. Newly inserted data are displayed in a table, which provides a short summary and links to open and view the details. By viewing the complete collection of data and images associated with a specific patient, doctors can gain an overview of that patient's clinical history (see figure).

The system also allows clinicians to request follow-up appointments and diagnostic examinations. Once the clinician has inserted the booking request, a summary table shows the pending request. An operator can fix the date of the appointment and record this in the database.

The web interface lets clinicians and radiologists search for patients stored previously in the database. Searches can be filtered by name or patient identifier. Patient folders can be viewed and filled during the oncology path with treatment and follow-up data. At the end of the oncology path, a patient folder can be archived and made available for further analysis. It is also possible to use the same filtering methods to browse the archive. This can be useful to extract statistics for both clinical and didactic purposes.

The Electronic Oncology Patient Folder provides radiologists and clinicians with a cooperative work tool, supporting oncology patient management among different departments. This system can replace the "paper exchange” communication that is currently in use, allowing better consultation, management, and data archiving.

The Electronic Oncology Patient Folder can also be regarded as a RIS add-on module, allowing follow-up appointments to be scheduled. The electronic folder contains a complete clinical history for each patient, with images and references between individual treatments. This may help support decision making and treatment planning.

This system was introduced at the University Hospital in Pisa in July 2007 for breast cancer patients. In its first year of operation, data were collected on approximately 1500 patients. Soon the concept will be extended to colon cancer patients.

Full integration of RIS/PACS and the Electronic Oncology Patient Folder to include references between the systems and searchable field functions should enhance the quality of care delivered to oncology patients still further.

Francesca Ambrogi

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