MargheritaTre

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:

  • increase the comprehensibility of clinical documentation
  • clarify shared care processes
  • optimize the use of resources
  • continuously evaluate the quality of care by comparing the different centers
  • standardize clinical and diagnostic procedures in Intensive Care Units
  • collect data for clinical research projects

An electronic medical record for intensive care units

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.

Advantages

H24 assistance 7/7

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.

No license

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.

designed by medical staff

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.

Continuous improvement

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.

Electronic Medical Record

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.

Data collection and analysis

The data collected within the MargheritaTre software can be sent to the Mario Negri Institute for clinical and epidemiological analyses.