Purpose: This paper reports on the authors' experience with the implementation of an internal network with open structure model (extranet) inside a private healthcare institution.
Materials and methods: An integrated clinical-administrative internal network was set up within a private orthopaedic hospital with about 90 beds. The system consists of a DICOM-based HIS-RIS network connected to the radiological department PACS, and is implemented through an internal web-server over a mixed wired-wireless network. The strengths of the system are: the use of an open-structure model allowing external access; the inclusion of a wireless component of the network, which extends access to mobile workstations; the possibility of conducting the quality assurance procedures directly from outside the hospital.
Results: The system allows the diagnostic images generated by the various equipment (Rx, CT, NMR, etc.) to be filed in compliance with the AIPA (Italian Authority for Information Technology in Public Administration) regulations; the images and electronic clinical records are made available to the departments by means of an internal web server. The use of the wireless component of the network has several additional advantages: for example, it enables healthcare personnel to view clinical records and diagnostic images on their laptop monitors from any department or hospital room, and it makes every change or addition readily available to the healthcare personnel. In this way the laptops represent an evolution of the traditional paper-based clinical record. Moreover, a direct connection was set up with the University Department of Image Processing with a view to increasing the hospital's efficiency and productivity. This connection allows adequate quality assurance procedures to be carried out on the radiological department equipment without requiring the physical presence of specialised staff, and therefore reducing costs and machine idle time. A second phase of the project is currently being tested. This consists in the collaboration of a pilot group of twenty family doctors to test system functionality during telebooking, teleconsulting and information exchange with specialists, as well as the possibility of keeping track of the patients' diagnostic work-up and clinical therapy.
Discussion and conclusions: In the context of the Italian healthcare system, the creation of adequate hospital information systems (HIS) and their integration with PACS was at first a prerogative of a few large hospitals. Recently, however, more and more patients have started to approach the healthcare world directly through the Internet, at first to request only information (leading to the diffusion of specialised web sites, or portals) and later also e-services. This new demand led us to create a Hospital Information System able to organise the internal activity of the hospital and offer several external services such as telebooking and teleconsulting, and therefore increase the hospital's efficiency and productivity. a method of choice for following patients after interventional procedures or as a mass-screening tool to select patients to be referred for coronary angiography.