Computerising healthcare facilities and the lack of standardisation

These days, a consensus is emerging about the possibilities opened up by Information and Communication Technology (ICT), which is growing in the health sector. It enables the information to be used so it can be stored, converted, managed, transmitted and analysed. In the medical field, information technology made its appearance in the 1980s to make sharing information easier – as important for each individual patient’s treatment as the way the health system is run overall. The first step was to computerise the entire administrative and financial parts, then to go deeper into the process by implementing a decision-making and analytical-accounting IT system (PMSI). Then, at the end of the 1990s came the component dedicated to computerising the production of treatments (patient health records, speciality files, PACS, RIS, etc.)

These different functions are managed by various different software vendors. If we take the French example, in 2011 the first repository on the French healthcare market was built by software vendors and integrators: the Base RELIMS. By referring to the latest figures, we can see more than 200 vendors, 22% of which offer a single software for a specific medical activity. Just as much software for the hospital teams to manage.

An assessment is emerging from this industrial landscape: many different variants of norms, protocols or exchange formats coexist. For Computerised Patient Records (CPRs) alone, 27 different applications have been identified on average. Knowing that apart from the CPRs, physicians have to manage speciality files by department at the same time: maternity, surgery, emergency… (4). Normally, these business applications aren’t able to communicate with each other and automatically receive data without needing to adapt it. To overcome these initial difficulties, software solutions exist to enable business application interoperability (5) – which certain IT teams already use. Nearly 40% of healthcare facilities now have this type of central application.(6)

Initially, to enable different software to communicate, peer-to-peer software connection was made a priority: for example, a maternity file could send data directly to the patient record if (and only if) each software vendor used and included the same formats and norms. But with the enormous increase of software being used in healthcare facilities, this solution is no longer thought to be durable: the supervision is complex and lacks stability depending on how new software versions evolve. As a result more global interoperability solutions called integration engines, or EAIs, have emerged and tend to be standardised these days.

“Medical data processing is at the heart of the company’s IT strategy in different forms:

The ability to put a patient file together completely electronically from start to finish

Ensuring the data is always correct

Ensuring that the systems are both internally and externally interoperable so they can communicate with doctors, hospitals and patients.

The care continuum concept must be considered above all else in order to make the data accessible”.

Yannick Michel, Organisation and IT Systems Director, Nouvelles Cliniques Nantaises (Groupe Confluent)

DIFFICULTIES TO REMEMBER

Incomplete electronic patient records

Different vendors, different interfaces: difficult for physicians to manage multiple functionalities from different vendors

“For me, computerising health systems is only done from an administrative point of view. The existing tools respect the regulations and certifications more than they respect the eventual user”.

Yannick Michel, Organisation and IT Systems Director, Nouvelles Cliniques Nantaises (Groupe Confluent)

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