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and for partners who use the EHR platform;
- Experimental phase: real RIDC activities carried
out with the identified technological partner;
- Portal access given to physicians specializing in
ID and professionals of other departments
(appropriately selected by the Board of Medical
Directors) for the evaluation of real clinical cases;
- Check and audit: periodically audits were made
during the period of use of the platform, required by
the medical staff involved (ID physicians and
colleagues who demand online consultations) for the
adaptation of the operational processes useful to
improve the efficiency and quality of the
consultations, the learning process and the training
of medical staff with respect to the changes from
time to time set up;
- Final assessment (November, 2014) will
encompass: analysis of the consistency of the
product implemented and fulfillment of initial
requirements, the ergonomics of the product, level of
achievement of the objectives.
- Further new developments: possible new
developments and any changes to be made for a
possible extension of the consultation service from
the operational units involved during the
experimental stage to other departments of the same
hospital or, in the eventuality, other external
hospitals.
The outcome measures to evaluate efficacy and
efficiency of the web-platform developed for this
purposes are:
- The satisfaction of specialists involved (measure
of efficacy). This parameter will be evaluated
through the analysis of the customer satisfaction
form filled both by the ID specialists and by the
hearth surgeons at the end of each consultation;
- The number of RIDC performed compared to
historical data of bed-side consultation process
(measure of efficacy);
- The number of bed-side consultancies needed for
the insufficiency of web-based data (measure of
efficiency);
- The time spared in staff movement avoiding
(measure of efficiency). This measure will be
evaluated simulating several distances between the
ID specialist’ hospital and the hospital which asks
for the ID consultation.
Any consultation can be used as teaching
material to analyze the diagnostic work-flow
process, the choice of empirical treatment pending
cultures, the evaluation of the susceptibility test
performed on isolated microorganisms and the
following guided treatment, the timing of dose-
delivery methods for antibiotic / antifungal /
antiviral drugs, for the monitoring of treatment
outcome, for the side and untoward effects, for the
dose adjustments, etc.
2.3 Technological Key Elements
The originality and the strength of this prospective
work is its building process. This is based on the
interaction of technicians and physicians who give
their contribution from different points of view to
identify the most appropriate tool able to reach these
objectives.
Many Italian hospitals are equipped (and many
others are going to equip) with healthcare
information systems oriented to the management of
clinical events.
In particular, in the Lombardy Region, various
Hospital Information Systems (HIS) are evolving
according to the guidelines of SISS (acronym of
“Sistema Informativo Socio Sanitario”, the
Lombardy Healthcare Information System)
(Barbarito, 2012).
SISS can be defined as the set of IT applications
and infrastructures in the Lombardy Region (IT
systems for pharmacies, doctors, hospitals,
Lombardy Region offices, etc.) that contribute to the
provision of healthcare services within the Region.
SISS today consists of a number of systems that
are gradually evolving, according to a specific IT
strategy in e-health matters, in order to put into
practice more widespread and pervasive Information
and Communication Technologies (ICT) for
innovation purposes.
In addition to these considerations, the ID
department protagonist of this paper wanted to add
more value to the EHR currently in use and enforced
its functionalities.
This platform, already capable of managing the
entire care process in a paperless way and of
improving the clinical risk management procedures
compliantly (to Joint Commission International
standards and Italian Legislation), was integrated
with further features that could allow the exchange
of medical and scientific expertise, based on real
clinical cases, with an eye to provide continuing
online education to physicians.
From a technological point of view, a careful
examination of various type of healthcare, scientific
and documentary aspects has led to the
implementation of a real clinical tool accessible via
the web on any terminal or device with a browser
(PC, Tablet-PC, etc.). Connectivity is achieved
regardless of the operating system and functionality
enables doctors and nurses to perform all the tasks
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