DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sotto l’Alto Patronato del Capo dello Stato ,Presidenza della Repubblica Italiana

PATRONAGES SPONSORS SUPPORTING PARTNER MEDIA PARTNER

SharingSharing information betweeninformation between 72 000 health care 72 000 health care

professionals across 37 professionals across 37 public university hospitals : a public university hospitals : a

review of APreview of AP--HP experiencesHP experiences

E.Lepage, E. Sultan, M.Dumont, Ph Letoumelin, J.Pontou

EPR Direction, Assistance Publique – Hôpitaux de Paris

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Pitié-Salpétrière

CochinHEGP

A. Paré

R. Poincaré A. Trousseau

St Antoine

Tenon

St Louis

Lariboisière

BeaujonAvicenne

93 Bobigny92 Clichy²

jvrJ. Verdier93 Bondy

Ch. Foix – J. Rostand94 Ivry

92 Garches

92 Boulogne

Bicêtre91 Kremlin-Bicêtre

P. Brousse94 Villejuif

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• 12 Hospitals Group• 39 University Hospitals• 22 500 beds• 12 500 acute beds• 1 680 ambulatory places

• 90 000 employees

• 72 000 users

21 000 physicians

48 000 nursing staff

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Robert Debrérdb

Antoine Béclèreabc

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Louis Mourierlmr

Henri Mondorhmn

94 Créteil92 Clamart

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• 4 M Outpatient visit• 1 M Hospitalizations• 1 M Emergencies• 32% parisians• 58% Paris sub urb• 10% Others

AP-HP : The University Hospital of Ile de France

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

The AP-HP HIS

37 home made HIS

constellation of applications devoted to each process

Partial functional coverAbsence of integration At best interfacing between applications (mainly administrative data)

No information sharing across the Hospitals or even medical unitsAccess to as many (too many) applications as processesResulting high expenditure for maintenance fees of applications

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Evolution of AP-HP HIS

ChimiothérapieRCP (Dossier Cancer)

AgendaGIP/Gilda

LIS AlphaSLIS Infolam

Anatomo-pathology ApixLIS Synergie

Anatomo-pathology InfologicLIS LMX

Osisris

LIS MolisLIS Netlab Multilab

LIS Lab 400LIS HPX

LIS Dx LabLIS Hexaflux

SAMU AppligosUrgences

SAGPMSI (OR et Simpa)

IpopRados

Stare- Stade/SandraMediweb

Dx Care (HEGP, Beaujon, Pitié)Actipidos

Medical Archives

Anatomo-pathology

Radiotherapy (Variant)

Emergency medical service

PACS (Carestream)

Laboratory Information System (GLIMS)

Clinical information system Orbis

14 medical applications

10 Laboratory Information System (LIS)

Local applications

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Patient Information System Project : Objectives

The magic words : information sharing

One shared HIS, opened towards the “outside”

One integrated HIS providing access to all processes (“one access to all”)

Uniqueness of each information

Optimization of medical activity thanks to one single information system

One information system in the service of a strategy of healthcareReorganization of of AP-HP in Hospitals Groups and birth of regional health territory Communication with private hospitals and practices Transmission of electronic medical records to national healthcare professionals

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing Information in Health

Key points :

Difficulties are not only technical

One common vocabulary based on international nomenclatures is mandatory

Set up a real culture for changeEvolution of organizationsNormalization of the medical and nursing practices

Strong political will

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : the means

Set up one common terminology : Semantic interoperability

Laboratory Information System : LOINC terminologyClinical Information System :

Medical terminology : SNOMEDNursing terminology : Nanda, NIC, NOC

Medical decision making : Arden Syntax

Standards of Interoperability

HL7 protocol for medical and laboratory systemDICOM protocol for the PACS

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : the LIS ProjectObtain acceptance by biologists of

a common terminology

Component Kind of Property Time System Scale MethodDosage Units Limits

Evolution of practices one leader by specialty

a centralization of the project

Loss of specificityLoss of autonomy collaboration with laboratory referentsRules of accreditation : (habilitation)Strong reactivity of the hot line

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e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : LIS Project (2)

LIS project : the resultsAcceptance by the biologists

Strong listening of the userPass to the stage of participative actorMonthly meeting with the referents

Implementation across more than 80 laboratory departments including

Maintenance of a common terminology associating biologists

Integration with the Clinical Information System

Publication of the first national referential of interoperability by the national agency

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : PACS Project

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : PACS project (2)

Deployment across the 37 AP-HP’s hospitalsRadiology departmentClinical Units

Integration into medical recordSharing pictures between multiple AP-HP’s hospitals and from outsideExchange pictures between AP-HP and non-APHP hospitals

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Sharing information : PACS Project (3)

Facilitate usage while protecting confidentiality

Identifying the right patient via ID number and the targeted medical record via record numberTaking action on patient’s medical record while keeping responsibility with his physician

Design organization in view of sharing access to pictures

Warranty right conditions of pictures process and access to Guidance defined by college of radiology

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

The Clinical Information SystemThe Clinical Information System

One Patient record, whole and integrated for all the 37 hospitalOne Patient record, whole and integrated for all the 37 hospitalss

Open 24/24 and 7/7Open 24/24 and 7/7shared and opened towards the outsideshared and opened towards the outside

Quality of care optimization by integration of decision making sQuality of care optimization by integration of decision making systemystem

Contribution towards the strategic challenges of APContribution towards the strategic challenges of AP--HPHPConstitution of Hospital GroupsConstitution of Hospital GroupsOne unique Patient record for the APOne unique Patient record for the AP--HP GroupHP Group

Response to regional and national prioritiesResponse to regional and national prioritiesRegional level for secured medical data exchanges between practiRegional level for secured medical data exchanges between practitionerstionersNational level for access to the patients’ electronic health recNational level for access to the patients’ electronic health record (DMP)ord (DMP)

Selection of Orbis software from AgfaSelection of Orbis software from Agfa

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e-Health ConferenceMay 29, 2013Rome, Italy

Step 1 Administrative functions including uniqueness of Patient ID across AP-HP

Step 2 Patient e-record including exchange with the national medical recordDemands/results of exams with direct, integrated, access to pictures (PACS)Medico-economic management

Step 3Drugs management workflow : from order to administration of medicationSchedule of appointments and resourcesMedico-economic management (additional)

Transversal SecurityConcepts dictionary Medical decision making Treatment of information Research and teaching tool

Orbis Project

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e-Health ConferenceMay 29, 2013Rome, Italy

Patient e-record

Principles Same workflow as practical trajectory of careOne terminology : SNOMEDEngagement of all colleges of specialtyIn the service of the medical community

Difficulties

Dictionary of conceptsTime consuming development Broadness of the field to be coveredAcceptance by physicians

Absolute necessity to collaborate with others hospitals

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e-Health ConferenceMay 29, 2013Rome, Italy

Deployment step 1 and 2

June 2011-June 2012

Deployment on a first hospital (500 beds)

October 2012- December 2013

Deployment of 2 other pilot sites (800 and 600 beds)

June 2013- December 2016

Generalization on the 34 other hospitals Deployment in parallel of 8 hospitals

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Deployment step 1 and 2 : first results

Medical and secretarial department reorganization

Increase of hospitalization report

Decrease of hospitalization report deadline

Optimization of DRG coding

Collaborative trial on HIS impact

DIRECTION DE LA POLITIQUE MEDICALE

e-Health ConferenceMay 29, 2013Rome, Italy

Projet Patient : Conclusion

An objective : shared HIS open towards outside dedicated to the patient and supporting the health strategy

Importance of the semantic Interoperability

Development of a patient recordNeed of a national and European collaborative processIntegration of decision making tool

Importance of driving the changeShow pragmatism while keeping in mind the target

Strong commitment of the medical and administrative governance