The electronic medical record MargheritaTre was created for intensive care units.

These are among the most “critical” wards in which the quality of care and patient assistance acquire great importance, if we consider that the results are considered in terms of mortality.

The twofold objective of MargheritaTre project is, on the one hand, to promote the improvement of the quality of care in the critical patient, going towards a significant reduction in mortality rates and economic costs, through the improvement of results and reduction of errors; on the other hand, a systematic collection of data about the ICU admissions is made possible, so that it can allow a continuous evaluation of treatments and performances of ICUs.

MargheritaTre has also been realized in collaboration with researchers, intensivists and critical area nurses, within a research project funded by the Ministry of Health. Currently, the software is installed in 63 hospitals throughout the country, for a total of 77 intensive care units managed with the MargheritaTre software, with a rate of patients treated increasing by more than 1400 each year.

All intensive care units that are members of GiViTI can decide to use the electronic medical record MargheritaTre.

MargheritaTre allows management of all phases of intensive care hospitalization. The main areas of functionality are as follows:

• Ward plan: display of all the beds in the ward with an indication of bedridden patients
• Management of admissions: display of the complete list of admitted patients and registration of new admissions; by selecting a patient, access to his or her medical record
• Entrance: dedicated modules for recording all the patient’s personal and clinical data on entry to the ICU (diagnosis and objective examination);
• Inpatient: dedicated modules for planning, recording and monitoring nursing diagnoses for care needs, recording injuries, management of surgical drains, garrisons, diagnostic-therapeutic procedures, specialist consultations and complications arising;
• Therapy: modules built for planning and recording of prescriptions, administration management and therapy approvals;
• Clinical diary: module dedicated to collecting information about the clinical course;
• Parameters: modules dedicated to importing vital parameters (including haemogas) and laboratory test results, and a module dedicated to displaying them in graphs.
• Discharge/Transfer: module allowing complete management of the patient’s discharge with the information of date, time and outcome.

Software components:

• Internal modules
• Services

MargheritaTre has a ‘Client-Server’ computer architecture. The server side of the programme has the task of processing, validating and saving data, as well as managing and answering queries from the various clients. The client side of MargheritaTre is equipped with a GUI (Graphics User Interface) and presents to the user the information requested from the server and provides the data entry forms.

The MargheritaTre server is made available and maintained by the hospital wishing to adopt MargheritaTre and can be virtualized. Hardware maintenance, machine backups, system installations, are operations delegated to the hospital’s IT staff. The MediaClinics staff install and maintain the MargheritaTre application server using VPN and RDP technologies.

The server hosts a PostgreSQL database where data is stored. It must therefore be reachable from the ward: medical staff operate on clients that connect to the server for reading and writing; the clients are installed on machines in the intensive care or resuscitation ward premises.
Every request or data transmission originating from the client is sent to the DAL (Data Access Layer) of MargheritaTre in the form of a SOAP (ver. 1.2) request using the HTTP protocol and the XML language. The DAL is made up of a properly developed XML Web Service that has the task of accepting the requests coming from the client, checking if these requests are legitimate through the authentication of the applicant and proceeding to their processing. The XML Web Service runs on a web server (Microsoft Internet Information Service or equivalent). The DAL is the only part of the programme that can query the MargheritaTre database.