Paolo Fraccaro*, Centre for Health Informatics (City University London); Department of Informatics, Bioengineering, Robotics and System Engineering (University of Genoa), London, United Kingdom Valeria Pupella, Department of Informatics, Bioengineering, Robotics and System Engineering (University of Genoa), Genoa, Italy Roberta Gazzarata, Department of Informatics, Bioengineering, Robotics and System Engineering (University of Genoa), Genoa, Italy Chiara Dentone, Department of Infectious Diseases (Sanremo Hospital) ; CEBR (University of Genoa), Sanremo, Italy Giovanni Cenderello, Department of Infectious Diseases (Galliera Hospital), Genoa, Italy Pasqualina De Leo, Department of Infectious Diseases (San Paolo Hospital), Genoa, Italy Federica Bozzano, CEBR (University of Genoa), Genoa, Italy Giorgetta Casalino Finocchio, Department of Infectious Diseases (Pietra Ligure Hospital), Pietra Ligure, Italy Andrea De Maria, CEBR (University of Genoa), Genoa, Italy Daniela Fenoglio, CEBR (University of Genoa), Genoa, Italy Gilberto Filaci, CEBR (University of Genoa), Genoa, Italy Michele Guerra, Department of Infectious Diseases (La Spezia Hospital), La Spezia, Italy Antonio Di Biagio, Department of Infectious Diseases (San Martino Hospital), Genoa, Italy Eugenio Mantia, Department of Infectious Diseases (Alessandria Hospital), Alessandria, Italy Giancarlo Orofino, Department of Infectious Diseases (Torino Hospital), Torino, Italy Giuseppe Ferrea, Department of Infectious Diseases (Sanremo Hospital), Sanremo, Italy Claudio Viscoli, Department of Infectious Diseases (San Martino Hospital), Genoa, Italy Mauro Giacomini, Department of Informatics, Bioengineering, Robotics and System Engineering (University of Genoa), Genoa, Italy Track: Practice Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Rapid-Fire Presentation Submission Type: Single Presentation Building: Mermaid Room: Room 2 - Aldgate/Bishopsgate Date: 2013-09-23 04:00 PM – 06:00 PM Last modified: 2013-09-25 Free Full Paper

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Background: In recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the HIV life-cycle and the disease is now considered a chronic disease. Consequently, longitudinal and complex follow-up is now required for HIV+ patients who need to be regularly monitored during their lifetime. Moreover, they often encounter various complications due to comorbidities, related to the state of immunodeficiency, and side effects caused by HAARTS. For this reason, HIV+ patients are involved in many Multicentre Clinical Trials (MCTs) to improve treatments and to discover a preventive vaccine. Therefore, physicians require proper instruments that allow access to comprehensive patient data to manage HIV+ patients during their follow-up and also tools for data analysis to be used in MCTs. The solution proposed, “The Ligurian HIV Clinical Network”, allows the administration of patient data within primary-care and the utilization of collected clinical information to perform MCTs in Northern Italy.
Methods: The key aspect of the system is a relational database which allows the storage of various types of clinical data (e.g. related to cardiovascular, hepatic or infectious disease aspects) in multiple formats. The modular design of the database permits rapid insertion of new parameters without the need for any changes to the database structure. Furthermore, special arrangements were developed in order to achieve a complete semantic interoperability. Particularly, codes from biomedical ontologies (e.g. Logical Observation Identifiers Names and Codes and International Classification of Diseases), units and normality ranges used by all partners participating in the project were collected. Accordingly, data can be automatically normalized through the Z-score formula and physicians can extract and correctly compare information within statistical analysis tools. Moreover, all the collected data respects patients’ privacy and legal issues since 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 patients' information during medical examinations and to carry out simultaneous MCTs within 8 Departments of Infectious Diseases in the Liguria and Piedmont Regions. Once the data is present in the database, it can be reused for MCTs when required. Furthermore, a bidirectional middleware was created in order to import and export information through the HL7 Version 3 “Clinical Document Architecture Release 2” structure. Accordingly, data can be manually entered by physicians or automatically collected within Hospital Information Systems which are HL7-compliant.
Results: Presently, patients’ information is directly recorded from the San Paolo Hospital (Savona, Italy) and the same infrastructure is being developed for two other hospitals in Genoa. Currently, almost 400 HIV+ patients have been recorded in the system and their data has been used for primary care and research purposes; there are 4 ongoing MCTs and preliminary results have been already presented at International HIV congresses.
Conclusion: The web-platform allows to effectively manage and share information within primary care and clinical research. For the future it is planned to share the clinical information from this network with other HL7-compliant workgroups and to extend the platform to other infective diseases (e.g. Hepatitis).