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The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. The CEN ENV 12967-1 'Healthcare Information Systems Architecture'(HISA) standard defines an architectural approach based on a middleware of business-specific common services, enabling all parts of the local and geographical system to operate on the common information heritage of the organisation and on exploiting a set of common business-oriented functionality. After an overview on the key aspects of HISA, this paper discusses the positioning of the authorization and security aspects in the overall architecture. A global security framework is finally proposed.

The integration and evolution of existing systems represents one of the most urgent problems facing those responsible for healthcare information systems so that the needs of the whole organisation are addressed. The management of the healthcare record represents one of the major requirements in the overall process, however it is also necessary to ensure that the healthcare record and other healthcare information is integrated within the context of an overall healthcare information system. The CEN ENV 12967-1 'Healthcare Information Systems Architecture' standard defines a holistic architectural approach where the various, organisational, clinical, administrative and managerial requirements co-exist and cooperate, relying on a common heritage of information and services. This paper reviews the middleware-based approach adopted by CEN ENV 12967-1 and the specialisation necessary for the healthcare record based on CEN ENV 12265 'Electronic Healthcare Record Architecture'.

The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system. Such architecture has been already formalised through the European standard, defined by the CEN/TC251 prENV 12967-1 'Architecture for Health care Information Systems' (CEN prENV 12967-1 'Health care Information Systems Architecture'). Thanks to the availability of industrial products conforming to the standard, the effectiveness and the validity of this approach has been already demonstrated in practice. For example, through the Hansa collaboration hospitals and industries from countries of the Western and Eastern Europe, as well as of the Middle East use the same industrial middleware (i.e. 'The DHE middleware-Information view'-SPRI, 1998, 'The DHE middleware-Functional view'-SPRI, 1998) for integrating existing systems as well as for developing new applications.

The integration and evolution of existing systems represents one of the most urgent priorities of healthcare information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common healthcare-specific services not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system. Such architecture has been already formalised through the proposed European preStandard, defined by the CEN/TC251/PT1-013 "Standard Architecture for Healthcare Information Systems" [1]. Through the utilisation of the DHE middleware, the effectiveness and validity of this approach is also being demonstrated in practice by several hospitals and healthcare industries from 13 European countries, which collaborate in the Hansa project, presently running under the Telematics Application Programme of the Commission of the European Communities.

Main objectives and characteristics of computerized radiological image handling in a radiology department, homogeneously integrated with other information typologies, are discussed. The extension of the present DREAM system to image handling functionalities is in progress. The activities are based on the collaboration between the "Università Cattolica del Sacro Cuore (UCSC), Istituto di Radiologia". Hopital Cantonal Universitaire de Genève-Centre d'Informatique Hospitalier (HCUG) and Gesi aiming at the integration of "Osiris", image handling information system implemented by HCUG with DHE middleware implemented by Gesi and UCSC which represents the functional and information core of the entire information system. The initiative is part of "Synapses" project, partially supported by the European Union DG XIII within the program of information technology applications in health care.

In last years, requirements for health information systems have markedly increased. From essentially sectorial requirements limited to the single operational units, the need has emerged for the interaction and integration of the various components of the health care structure, within the service and over the territory. A major role in this evolutionary process is played by the architectural features of the information system. They must respond to precise requirements of standardization, modularity and openness so as to allow the integration and interaction of different, even if preexisting, applications and of different suppliers. In this article, some fundamental aspects of the architecture of health information systems are discussed based on actual experiences as well as on results of the principal approaches to standardization in Italy and Europe.

This paper provides a summary of the approach adopted by EDITH for the definition and management of the security aspects within a generic healthcare information system, organised according to a common architecture based on characteristics of modularity, openness and federation of the individual healthcare organisations and healthcare information systems. The specification and actual development of the Authorisation Server, shortly described in this paper, is the result of the joining of the activities carried out by GESI in the frame of the NUCLEUS (AIM 2025) and EDITH-Italy (ESPRIT 7058) projects.