The Project

MobiDis was conceived as a study and prototype for a new generation of healthcare information systems, capable of supporting the patient's care process beyond the boundaries of a single institution. The basic idea was that modern care can no longer be organized exclusively inside the hospital: it unfolds over time, in several places, through the collaboration of diverse actors and in a framework where the patient themselves must be able to become an active participant.

In this perspective, the project aimed to describe the architecture of a system capable of connecting service consumers, service providers, registries and existing applications in a single virtual organization. The emphasis falls on continuity of care, on the possibility of access under mobility conditions and on the system's capacity to maintain coherent information produced in different points of the healthcare network.

MobiDis is therefore not just an attempt to digitize a clinical file cabinet, but a proposal to reorganize the informational infrastructure around the citizen, where collaboration, distributed access, interoperability and information synchronization become basic conditions for the act of care.

The Project Book

The project results were synthesized in the collective volume Il Progetto MobiDis, edited by Fabrizio L. Ricci and Luca Dan Șerbănați, published by Bagatto Libri, Rome, in 2008. The book is not a monograph written by two authors, but a project book proper: a collective volume that brings together 14 chapters and the contributions of 18 authors and collaborators.

Because of this, the volume's value is double. On one hand, it articulately fixes the concepts, architecture and prototypes developed within the project. On the other hand, it preserves the traces of an ample scientific collaboration, in which various teams worked on complementary components: general architecture, virtual clinical record, personal health record, pediatric scenarios, chronic disease, telemedicine and clinical trials.

For my website, this book has a special role: it allows presenting MobiDis not as a simple "work", but as a transition node between the conceptual formulation of the Virtual Healthcare Record and subsequent developments, especially those related to LuMiR and other territorial architectures of the virtualized medical record.

MobiDis Architecture

In my chapter Architettura MobiDis, I tried to give the project a clear architectural form. The starting point is the idea that the system must support a care process based on the collaboration of healthcare structures federated into a virtual structure. In this context, the architecture is not just technical infrastructure, but the expression of how cooperation between the involved actors is thought.

At the conceptual level, MobiDis is organized around a family of subsystems that must coexist and collaborate: components oriented toward data and business objects, procedural components and applications, common services, integration services, registries, repositories and communication mechanisms. From a logical point of view, the system assumes application servers, service servers, data servers and client applications of several types.

An important role is played by the choice of the service-oriented paradigm. MobiDis was thought of as a distributed system on several levels, based on Web services, capable of offering a rich environment for virtual patient records. This choice had two major advantages: it made possible the integration of heterogeneous applications and created the technical base for mobile access, geographical distribution and subsequent evolution of services.

Here, too, the interest in mobility appears. Access via desktop, laptop, PDA or other network-connected devices was not for us a secondary addition, but a structural requirement. Continuity of care implied that relevant information must be available in a timely manner, in different places and in sometimes unforeseen clinical contexts.

Cartella Clinica Virtuale and Libretto Sanitario Personale

The conceptual nucleus of the system is the Cartella Clinica Virtuale (CCV), i.e., the virtual clinical record of the patient. In my terminology from English texts, this corresponds to the Virtual Healthcare Record. The essential idea is that, for each citizen, there must be a unique, coherent and updatable structure that integrates relevant clinical information, even if it comes from multiple sources and is physically stored in different places.

In the chapter on architecture, I insist on the flexible and multidimensional character of the CCV. It is not just a data repository, but a concept structured by time, clinical data types, medical knowledge areas and disease classes. It is precisely this structuring that allows navigation, composition of views and reuse of clinical information within an interoperable framework.

The chapter Il Libretto Sanitario Personale, written together with Ricci, shows how this virtual record can also be designed from the patient's perspective. LSP is, basically, a specialized and adapted view of the CCV, intended for the citizen. It is not just a document to be consulted, but an active instrument: it can support communication with the doctor, monitoring therapies, access to explanatory information, reminders for prevention or monitoring activities and even simple forms of telemedicine.

The relationship between CCV, the general practitioner's record and LSP is one of the most fertile ideas of the project. The doctor, the healthcare structure and the patient do not operate on isolated copies, but on synchronized components of the same informational universe. This is, in fact, the technical and conceptual condition of truly continuous care.

My Contribution

In MobiDis, my role was multiple. I was the co-editor of the project volume and the direct author of some of its key chapters. The chapter Architettura MobiDis is entirely mine and expresses, probably most clearly, how I understood at that moment the transition from institutional information systems to territorial, federated and patient-centric systems.

I co-signed with Fabrizio L. Ricci the chapter Il Libretto Sanitario Personale, in which the patient's perspective explicitly becomes part of the architecture. There it is clearly seen that the patient is no longer treated as a simple passive beneficiary of the system, but as an actor who must have their own views, their own instruments and their own role in managing continuity of care.

But my participation in the project goes beyond these two chapters. The concept of VCR/VHR, which organizes an essential part of the architecture and of the way of thinking about clinical information integration, belongs to me and influenced other contributions in the volume. Therefore, even if MobiDis is a collective work, it bears to an important extent the stamp of my own research line.

Conceptual Heritage

Looking back, MobiDis is the point where several research threads begin to tie together. Here, for the first time in a coherent and applied framework, the central role of the virtual clinical record, interoperability, service orientation and the territorial organization of care is clarified.

At the same time, the project shows that the same conceptual infrastructure can feed different directions: the virtualized medical record, patient tools, home care and pediatric follow-up scenarios, but also the clinical trials component. MobiDis is not yet the mature regional system that will appear later, but it represents one of its roots.

For this reason, in the structure of my site, MobiDis must be viewed as a project page and as a transition point between the genesis of the VHR and subsequent developments in digital health. It explains better than a single article how a vision of digital health began to take shape, in which the patient, the clinical actors and the information infrastructure form a common system.

Essential Bibliography

• Ricci, F.L. and Serbanati, L.D. (eds.), Il Progetto MobiDis, Bagatto Libri, Rome, ISBN 978-88-78061-67-5, 2008 (in Italian).
• Ricci, F.L., Serbanati, L.D., MobiDis: Toward a Patient Centric Healthcare Information System, in Rolf Engelbrecht, Antoine Geissbühler, Christian Lovis, George I. Mihalas (eds.), Connecting Medical Informatics and Bio-Informatics – Proceedings of MIE 2005 – The XIXth International Congress of the European Federation for Medical Informatics, Geneva, Switzerland, vol. 116, Studies in Health Technology and Informatics, p. 557–562, IOS Press, 2005.
• Serbanati, L.D., Architettura MobiDis, in Il Progetto MobiDis, 2008.
• Ricci, F.L., Serbanati, L.D., Il Libretto Sanitario Personale, in Il Progetto MobiDis, 2008.

Links

• Medical Informatics – main theme page
• Virtual Healthcare Record
• LuMiR
• Clinical Trials