MargheritaTre was born as a research project, started in 2004 and carried out by the Istituto di Ricerche Farmacologiche Mario Negri IRCCS in collaboration with GiViTI (Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva) in order to improve and make more effective the interventions in the Intensive Care Units (giviti.marionegri.it).
Beginning in November 2020, IMN has established a partnership with MediaClinics Italia, which has taken over technical support, evolutionary maintenance and will take care of future IT developments from January 2021.
The most innovative aspect of the project is to develop a tool that is useful for both clinical, medical and nursing practice, and to meet the needs of evaluative research.
The objective of MargheritaTre is to create an electronic medical record, shared by a large network of Italian Intensive Care Units, which will make it possible to:
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:
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.
The technical assistance and maintenance service can be activated 24 hours a day, 7 days a week. It enables the handling of requests that need to be resolved in the shortest possible time.
Use of MargheritaTre software is free of charge, and it doesn’t require a license purchase: the price for the use of the platform is only related to the technical support and maintenance service.
The MargheritaTre software has been developed in collaboration with intensivists and critical care nurses to support and improve clinical practice, with the aim of supporting and improving it.
The MargheritaTre patient record is under continuous development and improvement, thanks to the research activities carried on by GiViTi. Proposals and requests from doctors, nurses and researchers, regarding new developments and features, are examined and processed regularly.
The use of the Electronic Medical Record guarantees many advantages over analogical processes: reduction of human error, dissemination of standardized and shared best practices, traceability of information and data, performances analysis, optimisation of resource.
The data collected within the MargheritaTre software can be sent to the Mario Negri Institute for clinical and epidemiological analyses.