Legnano Hospital

Story Details

Legnano Hospital is a 1,500-bed hospital in Milan, Italy. The hospital consists of four main sites and a dozen annexes. All of these locations are interconnected via a data network, with each site containing its own local network that connects administrative, technical, and clinical-medical departments. There are 1,200 desktop clients on the overall network, used by about 4,500 hospital staff members. Based on the administrative and diagnostic information produced in all of the hospital's clinics, there is a vast amount of data that needs to be managed, organized, and stored.

Because it needed to improve its overall IT security and create an online services portal for employees and the general public alike, Legnano hospital turned to Sun Microsystems. In early 2007, the hospital worked with Sun on a wide-ranging solution implementation that impacted all of the hospital's sites. The initiative, which took about five months to complete, encompassed four technological areas: virtualization and consolidation of servers and desktops; development of an online services portal; centralized access control through Single Sign On (SSO); and testing the use of a Caregiver Mobility solution, via RFID technology, to support Clinical Risk Management and administration of patient logistics.

“The project is the culmination of a five-year development and review process of the information system,” explains Claudio Caccia, chief information officer of Legnano Hospital. “In particular, by deploying this new technology, we're enhancing the overall performance and security of the system. At the same time, the Sun portal has given employees and the general public 24 x 7 access to online services.”

New Portal Provides Flexibility and Security for Online Services
The project began with a complete re-architecture of the hospital’s data centers, with the goal of installing an IT infrastructure capable of delivering the new services with maximum efficiency. This re-architecture occurred at two physically separate data centers, so the hospital could maintain effective disaster-recovery and business-continuity policies.

During this phase, the hospital's servers were grouped into clusters, using the features in the new Sun Fire v490 servers. The new servers, based on the Solaris 10 Operating System, were configured to host all of the hospital's applications. The hospital also is testing Sun Virtual Desktop Infrastructure Software, Sun Ray virtual display clients and VMware technology for its desktop virtualization needs.

The hospital's online services were then made accessible through a newly developed portal system based on the Sun Java System Portal Server. This solution provides a portal through which employees can collaborate and access medical information. Using identity-based access and management, the Portal Server personalizes content for employees. Legnano Hospital professionals can authenticate and log onto the portal using a smart card created by the regional project Charter Regional Services - Information System Social and Health (CRS SISS). Once authenticated through Single Sign On (SSO), each hospital employee's portal experience is customized to their resource access on the database.

Using the Sun Java Composite Application Platform Suite (JavaCAPS), Legnano Hospital was also able to integrate its Sun products with the existing Electronic Medical Record (EMR) system. JavaCAPS provides a common development, management, and monitoring environment for all integration components within the suite. The solution's integrated application and infrastructure products are supported by a set of graphical tools that support standards-based collaboration and business process execution.

Through the integration of Sun products and the hospital's EMR system, tested and proven international standard technologies can communicate between different applications associated with emergency, reception, laboratory work, pathology, radiology, and the operating rooms. As a result, the hospital's medical and nursing staff members can access the EMR via the new services portal to check diagnostic services, consult reports, and record any information about a patient while making that information immediately available to every department in the hospital.

Secure Single Sign-On Through Smart Cards
In order to improve security, to comply with privacy laws, and simplify access to information, the hospital also implemented a SSO system using Java Card-enabled smart cards.

The solution provides centralized management of hospital user access and profiles directly through the hospital’s online services portal.

Java Card technology, which is compatible with existing smart card standards, allows small Java-based applications to be run securely on smart cards.

The SSO system allows for centralized management and profiling of hospital employees through the new portal. User authentication takes place through an ActiveIdentity solution, which consists of three software elements: the agent client, the central Active Directory or LDAP archive services, and the IT administrator's console. Using their smart cards, hospital employees can consult their own clinical data, such as reports, laboratory tests, and images. In addition, hospital's smart cards can be also used to access online services via Internet through Virtual Private Network (VPN) and a series of authentication codes. External users can access three areas: an information area, an online services area for the general public, and a restricted area for healthcare professionals.

“For the smart card, we used a special regional version of the smart card from CRS SISS that is intended for healthcare professionals,” says Caccia. “The card was configured with differentiated access policies, and was given to our medical and paramedical staff as well as to our external consultants.” The hospital-issued smart cards are used for secure sign-on and also as tools to help the hospital identify staff access and attendance.

Through this project, now in its final stages of development, Legnano Hospital will be issuing more than 4,500 smart cards.

RFID Technology to Support Clinical Risk Management Additionally, the hospital has started to deploy an innovative Caregiver Mobility solution that addresses Clinical Risk Management processes through the use of passive radio frequency identification (RFID) technology, which identifies patients during all stages of treatment. Legnano Hospital patients wear an RFID-enabled bracelet, which holds detailed information about drug prescription and administration.

The Caregiver Mobility project aims to concretely assess the potential economic, organizational, and financial advantages and disadvantages of investing in RFID technology. The project also seeks to determine if RFID might help reduce errors made through written prescriptions and diagnoses, as well as mistaken patient identification.

"The RFID project is evolving towards two uses,” explains Caccia. “The first concerns the patient cycle, where we aim to use this technology to track all patient activity. The second area of use concerns the supply cycle, to areas such as management of blood, drugs, clothing, and medical personnel. These applications have different requirements, for which are evaluating different technologies in order to minimize the technological impact the implementation will have on medical and nursing activities.”

In particular, the need for remote control in the management of certain patient activities will involve the deployment of UHF transmission technology, which allows a user to take readings remotely and easily from a distance of a few meters.

By mid-2008, the new project was expected to begin in pilot form. It is expected to go into production in the second half of the year.

Disaster Recovery For a New Way of Working
In collaboration with Sun, the hospital improved its disaster recovery capabilities by implementing the Solaris Cluster 3.1, a multi-system server cluster solution that manages the availability of applications, services, and data across the hospital's separate datacenters. The hospital is also creating a backup system based on Sun StorageTek technology and database encryption through dedicated hardware systems.

Legnano Hospital is also considering adopting the Sun Modular Datacenter S20 (originally known as Project Blackbox), which involves housing an entire datacenter inside a standard container. Implementing this technology would optimize the hospital's investment and free up physical space that could be devoted to patient needs.

In the future, the hospital also plans to bring its EMR system directly to the patient's bedside. By doing so, the medical staff would be able to view X-rays and other medical information in digital format, with the patient nearby. Within 12-18 months, staff members operating inside the 105 wards of Legnano Hospital will gradually be able to abandon paper documents in favor of a paperless and wireless environment.

"The Hospital of Legnano is initiating an innovative process that envisions changing the way we work in order to be more efficient and effective,” concludes Caccia. “The realization of these projects and goals is made possible by research and the ability to protect these variables: technology, the review process, and organization and awareness of all the people involved. In all of this, a close collaboration with Sun was very important, as was the establishment of a partnership with all suppliers who have shared the objectives of the project and the phases of this achievement. "