Customer Case Study
Puglia and AGFA HealthCare
lead the way to Italy’s first
region-wide RIS/PACS network
InnovaPuglia – Puglia Region
The SIRDImm (Regional Information System for Diagnostic Imaging) project, run by InnovaPuglia, delivers a fully integrated, secure and scalable imaging infrastructure, connecting hospitals and clinics across the Puglia region through AGFA HealthCare’s Enterprise Imaging Platform.
With the SIRDImm project, the Puglia Region has become one of the first in Italy to implement a truly region-wide, centralized RIS/PACS solution for public healthcare. By creating a shared infrastructure, built on AGFA HealthCare’s Enterprise Imaging platform, the project has made it possible to securely streamline the exchange of imaging data across a large and diverse network of healthcare facilities, each with their own systems and requirements.
Clinicians now experience a highly reliable, unified platform, regardless of where they are working, including full automation of workflow processes from exam booking to image viewing. Just as importantly, the integration with electronic medical record (EMR) systems allows them to access images directly within the patient file.
With this powerful example, the Puglia Region has shown a path forward — one that other regions can look to as they navigate their own digital transformations in healthcare.
Laying the foundation for regional imaging
The SIRDImm project was launched in 2014 as part of Puglia’s Regional Plan for Healthcare Digitization, and in 2015 InnovaPuglia, the region’s ICT provider, was given the responsibility for implementation. The goal of the project was to set up a single, regional RIS/PACS that would be integrated with all the major regional systems, including EMRs, order management solutions, the Regional Health Portal, etc. It would enable full digitization of imaging workflows, and provide secure, centralized image storing and sharing for all the public healthcare organizations across the region.
In 2020, InnovaPuglia chose a consortium led by AGFA HealthCare, and comprising other companies including Medas, Lutech, GPI and KPMG Advisory, to carry out the project.
“This project is unique in Italy — not just for its geographical scale,
but also for how deeply it’s integrated with the public healthcare ecosystem.
AGFA HealthCare played a key role in making that a reality.”
“We were looking for world-leading companies with proven experience in digital healthcare, specifically in imaging diagnostics projects. We then gave them the freedom to determine the best possible architecture that would ensure maximum efficiency and 24/7 operation without any service interruption. This level of resilience is essential for a regional network of this size,” explains engineer Ludovico Genco, Executive Director of the project.
The consortium developed a robust technical architecture built upon AGFA HealthCare’s Enterprise Imaging platform, with multi-tier storage and a high-reliability design with redundancy and disaster recovery. The solution includes Enterprise Imaging for Radiology, the Vendor Neutral Archive (VNA), XERO® Universal Viewer and Elefante.NET®, AGFA HealthCare’s RIS developed specifically for Italy.
“Our vision was clear: unify and digitize diagnostic imaging workflows across the region,” says Dr. Concetta Ladalardo, CIO of the Puglia Region.
“We needed a robust, secure system that could evolve with us. AGFA HealthCare delivered exactly that. With six public healthcare organizations (‘Aziende Sanitarie Pubbliche’) now integrated in the solution, with another three to be added by 2026, this project is unique in Italy for its scale, integration and impact.”
Ing. Ludovico Genco
Executive Director of the SIRDImm project
Ing. Ludovico Genco
Executive Director of the SIRDImm project
AGFA HealthCare’s solution:
A unified radiology platform that enables radiologists to work at the top of their craft, with near-real-time access to images, powerful diagnostic tools, shared workflows across sites, and enhanced collaboration.
Elefante Radiology Information System (RIS)
Offering full functionality and ease of use, integrated with key regional systems such as the health registry, centralized appointment scheduling, and clinical repositories.
A three-tiered central data archive ensuring consistent image storage and fast, reliable image availability across all of the Puglia region’s sites.
Intuitive viewer enabling clinicians to view images directly in the EMR and allowing patients to view images on the Regional Health Portal.
A coordinated rollout, grounded in expertise
“AGFA HealthCare combined its expertise in diagnostic imaging with its extensive experience from its numerous installations across Italy to organize the preparatory activities and deployment with great efficiency and precision. Each site had its own detailed and customized timelines. Additionally, AGFA HealthCare took the initiative to coordinate activities directly with the various third-party suppliers at each healthcare organization,” Ludovico Genco continues.
The main technical challenge facing the project teams was outdated infrastructure in some of the hospitals; particularly the server rooms and data networks. The need to modernize the infrastructure extended the planned implementation time, and the issues were overcome thanks to the strong commitment of all the players.
But as Dr. Ladalardo and Mr. Genco make clear, the human challenges were just as important: introducing a new regional platform meant rethinking old habits. “Initially, some staff were skeptical about the changes in the way of working,” recalls Mr. Genco. “To address this reluctance, we highlighted how we were building something unique in Italy — beneficial to both clinicians and patients.”
“The users were able to work with the system right away, with maximum efficiency from the start,” says Dr. Ladalardo. “AGFA HealthCare adapted the training to the specific roles of each user. Combined with the intuitive interface, this made all the difference.”
The first step towards regional imaging
Policlinico Riuniti – Azienda Ospedaliera Universitaria di Foggia was chosen as a pilot site for the Enterprise Imaging solution. “We were opening a new Emergency Department, which involved bringing in a lot of new equipment. It was clear we needed to upgrade our RIS/PACS to Enterprise Imaging, a cutting-edge solution that could meet the demands of emergency care.
This Enterprise Imaging solution is now seamlessly integrated with our enterprise and regional applications, ensuring all patient information is immediately accessible, while its reliable and robust data protection gives us confidence that this sensitive data is always secure,” comments Dr. Egidio Guerra, Head of Emergency Radiology Department, Policlinico Riuniti – Azienda Ospedaliera Universitaria di Foggia.
Dr. Egidio Guerra
Head of Emergency Radiology Department,
Policlinico Riuniti – Azienda Ospedaliera
Universitaria di Foggia
A unified experience, region-wide
The Enterprise Imaging solution now offers a single, seamless experience, both technically and for users, thanks to the transparent synchronization of geographically distributed archives, which ensures fast, consistent image access.
Full integration with enterprise and regional systems — including medical records, order management systems for inpatients, outpatients and emergency patients, as well as clinical repositories — is driving greater efficiency and reducing manual workload across all facilities.
“Even though data is distributed geographically, the user experience the solution as a unified system, regardless of the location at which they are working. That’s a major achievement,” says Dr. Ladalardo. “Furthermore, Enterprise Imaging has been fully and efficiently integrated with the various EMRs, enabling full automation of workflow processes from exam booking to image viewing. This ensures greater efficiency and security of activities for healthcare professionals.”
Scalability, security and continuity
The architecture of the solution has created a highly resilient, user-friendly and interoperable imaging environment, built not just to support current needs, but to scale with the future of regional healthcare in Puglia.
All data is exchanged over RUPAR, the region’s private network infrastructure, fully isolated from public internet access. The system is tightly integrated with Active Directory-based user authentication and is reachable only through internal network connections or VPN, adding another layer of protection.
“The system is designed with three hierarchical levels, allowing access to applications and data even should two levels be unavailable,” explains Ludovico Genco. “There are two redundant instances of the system at the regional data center, with a third currently being implemented to serve as the Disaster Recovery solution.”
AGFA HealthCare unites strong technical expertise with a real understanding of healthcare, to deliver reliable, robust and comprehensive solutions. Combined with their proactive support and flexibility, this has made them a valuable partner throughout our project.
Looking ahead, we believe that our experience offers a valuable model — one that could be successfully replicated by other regions aiming to achieve the same goals.
Service and collaboration
To support this key regional project, AGFA HealthCare set up a dedicated service team, with staff embedded at each healthcare organization. They ensure continuous support coverage for both planned activities and emergencies. Outside normal service hours, technicians are available on-call.
In addition AGFA provides proactive monitoring applications, Open Ticket Request Systems (OTRS) and comprehensive maintenance covering both routine and emergency interventions on hardware and software systems throughout the entire contract period.
A benchmark for regional transformations
“This project is unique in Italy — not just for its geographical scale, but also for how deeply it’s integrated with the public healthcare ecosystem,” says Ludovico Genco. “This integration enables more efficient, faster and safer workflows, as well as significant cost savings from optimization of our investments. AGFA played a key role in making that vision a reality.” “AGFA unites strong technical expertise with a real understanding of healthcare, to deliver reliable, robust and comprehensive solutions. Combined with their proactive support and flexibility, this has made them a valuable partner throughout our project. Looking ahead, we believe that our experience offers a valuable model — one that could be successfully replicated by other regions aiming to achieve the same goals,” Dr. Concetta Ladalardo concludes.