BackgroundIn recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the Human Immunodeficiency Virus (HIV) life-cycle and the disease is now considered chronic. Consequently, a longitudinal and complex follow-up is now required for HIV positive patients during their lifetime. Moreover, patients often encounter various complications due to comorbidities, related to the immunodeficiency state and HAARTs’ side effects. Thus, HIV positive patients are involved in multicenter clinical trials (MCTs) to improve treatments and discover a preventive vaccine. Therefore, physicians require proper instruments to access comprehensive patient data for managing patients during follow-ups, and tools for data collection and analysis in MCTs.ObjectiveThe Ligurian HIV Clinical Network aims to provide physicians with a Web-tool to administrate HIV positive patients’ data within primary-care and to reuse the collected clinical information to perform MCTs in Northern Italy.MethodsThe key aspect of the system is a relational database which allows the storage of various types of clinical information (eg, related to HIV, cardiovascular, or hepatic diseases) in multiple formats. The modular design of the database permits a rapid insertion of new parameters without requiring any changes in the database structure. Furthermore, codes from biomedical ontologies controlled vocabularies (“Logical Observation Identifier Names and Codes”, and “International Classification of Diseases 9”) and ontologies (“Systematized Nomenclature of Medicine Clinical Terms”), units and normality ranges used by all partners participating in the project were collected to achieve a complete semantic interoperability. Accordingly, data can be automatically normalized through the z score formula and physicians can extract and correctly compare information with external statistical tools. Moreover, to respect patients’ privacy and legal issues, a local identifier, determined through an HASH cryptography algorithm, is assigned to each patient during the registration process. The database is managed by a user-friendly Web-platform which allows quick access to information during medical examinations and the reusing of the collected data for present and future MCTs. Furthermore, a bidirectional middleware was created in order to import/export information through HL7 messaging. Hence, data can be manually entered by physicians or automatically collected within HL7-compliant Hospital Information systems.ResultsPresently, the direct storage of patients’ information from the San Paolo Hospital (Savona, Italy), and San Martino and Galliera hospitals in Genoa is in a test phase. Currently, 8 centers of Infectious Diseases (located in Liguria and Piedmont) are participating in the project and almost 400 HIV positive patients have been recorded in the system. Patient data has been used for primary care and research purposes. Currently, there are 4 on-going MCTs and preliminary results have already been presented at International HIV congresses.ConclusionsThe ...

This paper presents the architectural solutions and the first implementation results of a terminology service that aims to support Italian health institutions in the deployment of their clinical data in a semantically standardized format while main-taining their internal coding habits unchanged. As a first ex-ample of this general idea, an implementation structure of a translation system in LOINC for laboratory tests is presented. The first prototype of this system is at a testing stage within some clinical institutions of the Ligurian region. In this paper, the workflow of collaboration between the staff of a medical informatics academic laboratory and some hospital analysis laboratories is presented. With this system more than 400 rec-ords relative to clinical tests were coded with the appropriate LOINC code and these translations were inserted into a Com-mon Terminology Services 2 (CTS2) based tool to support fu-ture cooperative maintenance of the coding system. A compari-son with similar implementations in other English and non-English speaking countries is present. The authors thinks that the present example could be easily adopted both at a regional and at a national level in order to form an interconnected la-boratory network towards real semantic interoperabilit

Nowadays, most healthcare providers archive and manage patients’ information in electronic format. The reuse of such Clinical Information is essential from both a scientific and financial perspective, and for the integration of Primary Care and Clinical Research; which has become a principal goal. The solution proposed aims at integrating data between a web platform, developed for research purposes, and Hospital In-formation Systems. Information is shared through a Bidirec-tional Standard Interface, which adopts biomedical controlled vocabularies and ontologies (LOINC, ICD and SNOMED), and HL7 messaging (CDA V3 R2) for data exchanging. Such an interface allows the importation of data from Hospital In-formation Systems to a web platform, and the exportation of information from the platform to Hospital Information Sys-tems. Currently, this project has been implemented in the Infectious Diseases context, and complete data integration and semantic interoperability has been obtained between the “Li-gurian HIV Clinical Network” and the Infectious Diseases Department of the San Paolo Hospital (Savona, Italy)

In the last few years a significant challenge has been faced in the healthcare world, after the development of the LOINC (Logical Observation Identifiers Names And Codes) and the HL7 (Health level 7) standards; in order to provide systems of interoperable platforms, interconnected and utilizing standard language for the processing, communication and treatment of data. The aim of this paper is to demonstrate how a small local laboratory can easily communicate with a central data repository using these standards. This was realized by creating: a database with laboratory observations codified in LOINC, a web server that represents the general repository of data and by using two clients that directly link to the Web Service (WS) and which also allows clinicians and laboratory biologists to communicate with each other. The results clearly demonstrate that these standards are able to realize interoperability among heterogeneous systems. A future development should consist in testing this reality at a national level, with a national data repository

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