Liberté Egalité Pataquès

More and more French hospitals are using data to improve patient outcomes, notably in medication prescription and administration, and to boost communication between patients and caregivers.

By
Mélisande
Rouger

Powerful initiatives are multiplying in every field of healthcare, but without proper oversight from the competent bodies the potential value of these solutions will remain stifled.

Nicolas Houdre, Chief Medical Information Officer at Valenciennes University Hospital Centre (CHU) in North-East France, presented impacting results in automated medication administration during a session in HIMSS Liège, Belgium, in March.

Houdre and his team have been using a medication management and dispensing solution to manage elderly patients for the past two years. The benefits to patient care have been spectacular, according to the physician.

"We’ve had a very impressive drop in medication errors. We report 53% fewer medication dispensing errors and 97% fewer errors in medication administration.

"Having a robot prepare medication also represents a phenomenal gain of time for nurses and shortens hospital stay," he added.

Other French institutions have switched to automated validation of medication administration, including university hospitals in Tours, Lyon, Meaux and Rouen. An increasing number of hospitals are also working with data based solutions to facilitate or improve patient management and communication with the patient. Valenciennes CHU, for example, uses an appointment recall system through text messages, and emails hospitalisation correspondence directly to the attending physician.

The hospital has other projects underway in connected biology and radiology, to enable patients and doctors to consult their imaging or biopsy results from home, and it is currently designing a web portal, in which patients will access their examination results.

Messy patchwork

But overall, hospital initiatives remain too isolated to truly impact patient care and France offers a patchwork of isolated projects without any link between themselves and, sometimes, reality, according to Yves Morvan, Account Manager at Ipsos Healthcare. "Multiple initiatives pop out everywhere for diabetes, vaccination, etc. regardless of use or unity. There are a lot of scattered projects without any centralised organisation. Physicians and institutions develop solutions on their own, depending on their level of maturity," he said.

The failed attempt to deploy the personalised medical record (DMP) across the country perfectly exemplifies this state of affairs. "The system hasn’t been able to implement the DMP yet, even though we’ve been talking about it for 15 years and invested millions in it," Morvan said.

In 2014 an internal report by the French council for the quality and co-ordination of care revealed that about €500m had been invested over a decade in the creation of just 400,000 DMPs, instead of €5m originally planned. The report echoed earlier concerns by the Court of Auditors, who had criticised the "missing leadership" of the project.

To share data, some institutions have adopted another, similar solution: the computerised patient record (DPI). Valenciennes CHU, a reference hospital for two million patients, has fully deployed the DPI and plans to share it with 14 institutions in the Haina

Morvan identifies three difficulties at the core of France’s problem. The first is the absence of a common interface. "We have a big problem of interoperability in France. Solutions are not successfully distributed because they don’t work on a technical point of view. Unlike the mobile phone industry, which developed a unique system to read SIM cards years ago, the healthcare sector hasn’t been able to agree on a common strategy," he said.

Another drawback in his opinion is that most projects are not created from necessity but instead reflect the creator or CIO’s personal interests. "Ground-breaking solutions are not used because we haven’t thought of who is going to use them and which added value they will bring. There are a lot of expectations from patients, so it’s a missed opportunity. We create without thinking of reality. However if a service does not answer clinical needs it will never work," Morvan said.

Imposing medical prescription software led to "permanent fighting" with hospital physicians, Morvan recalled. Houdre also evoked "a lot of resistance" in his hospital when automated prescription was deployed. "It was a revolution to have pharmacists validate medical prescriptions. Physicians were reluctant at first. They don’t like it when someone else is looking into the way they manage patients," he said.

ut Cambrésis regional hospital group by the end of the year. "We think this will ease data sharing when a patient must be hospitalised somewhere else in the region," Houdre said

A missed opportunity

Morvan identifies three difficulties at the core of France’s problem. The first is the absence of a common interface. "We have a big problem of interoperability in France. Solutions are not successfully distributed because they don’t work on a technical point of view. Unlike the mobile phone industry, which developed a unique system to read SIM cards years ago, the healthcare sector hasn’t been able to agree on a common strategy," he said.

Another drawback in his opinion is that most projects are not created from necessity but instead reflect the creator or CIO’s personal interests. "Ground-breaking solutions are not used because we haven’t thought of who is going to use them and which added value they will bring. There are a lot of expectations from patients, so it’s a missed opportunity. We create without thinking of reality. However if a service does not answer clinical needs it will never work," Morvan said.

Imposing medical prescription software led to "permanent fighting" with hospital physicians, Morvan recalled. Houdre also evoked "a lot of resistance" in his hospital when automated prescription was deployed. "It was a revolution to have pharmacists validate medical prescriptions. Physicians were reluctant at first. They don’t like it when someone else is looking into the way they manage patients," he said.

The DPI also generated frustration, but things have changed. "I think we’ve overcome this rejection and doctors cannot work without the DPI anymore," he said.

Physicians and labs tend to overprotect themselves and there’s a myth around patient data manipulation from insurance companies," Morvan said

Among the benefits of using automated prescription, Houdre mentioned a tremendous reduction of side effects, medication incompatibilities and allergies. The system also gives out alerts and triggers a chain of control, to check appropriateness and avoid bacterial resistance in case an antibiotic is prescribed. "Our prescriptions are much more secure than a few years ago," Houdre said.

Data protection is also a concern. The national commission for computerisation and freedom (CNIL), France’s regulatory body, has accompanied the expansion of data projects in healthcare. In 2016 the CNIL notably authorised 697 projects both for research and evaluation. "They’ve had a benevolent approach. It’s the actors themselves who self-censored. Physicians and labs tend to overprotect themselves and there’s a myth around patient data manipulation from insurance companies," Morvan said.

Technical solutions exist and everything is ready in the ecosystem. All that is needed now is a conductor. "We have a problem of harmonisation. We need a conductor to co-ordinate the pharmaceutical industry, institutions, and all these actors who have a different level of maturity, statuses and interests. This is what the agency for the shared healthcare information systems should do. That’s why they’ve been created 15 years ago," Morvan said.

France is also lagging behind in the use of remote monitoring devices. In a study conducted in 23 countries, Ipsos Healthcare found that 7% of the French are using or have already used a remotely connected device to manage their health, a "ridiculously low" figure compared with the US (21%), India (26%) and China (28%).

Things could improve if the government decided to reimburse 10% of the devices’ costs, Morvan believes. "That would boost the market within two years. If we keep on looking at what’s happening, nothing’s going to happen."

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Mélisande Rouger

is a journalist with a keen interest in healthcare, IT and medical technology. She has been writing and talking about health for the past ten years and enjoys learning and updating her skills constantly.

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