eHealth Governance in a Local Organisation:
 IT for Managing Care and Fostering Research at HEGP


                   Prof...
eHealth Governance


• The context
   – The scope
   – The barriers
• The need for global IT infrastructures
• The HEGP ca...
eHealth Governance
                                          The scope
            IT Tools
                              ...
eHealth Governance


• The context
   – The scope
   – The barriers
• The need for global IT infrastructures
• The HEGP ca...
Barriers                                      Technical


• Technical (interoperability issues)
  –Architectures based on ...
Barriers                             HIS : A multitude of vertical
                                                       ...
Barriers                        Organizational & political


• Organizational
  –Lack of coordination and governance bodie...
eHealth Governance


•   The context
•   The need for global IT infrastructures
•   The HEGP case
•   Key issues
IT & clinical research                  Five Directions


1. Necessity for a general IT conception
2. Support for an open ...
Global IT framework                     C
     eHealth Governance                                                         ...
eHealth Governance                 Organization of IT human resources

Discipline        Production                       ...
eHealth Governance



•   The context
•   The need for global IT infrastructures
•   The HEGP case
•   Key issues
HEGP Background             A large restructuring effort (July 2000-)




Hôpital Laennec (1634)   Hôpital Boucicaut   Hôp...
HEGP Background                   Main figures (2009)

                                                         No
Number ...
HEGP Background                   Budget (2008)

                             Expenses (M€)
     Non medical personnel    ...
HEGP Background   Shared BioBank (2008-)
HEGP Cardiovascular
HEGP Background   Research Center (September 2009-)
HEGP Background                            IT Governance (2010)

       HEGP Executive Board                   Hospital Go...
HEGP Background                                     IT Organization (2010)

                                  Informatics ...
A component-based architecture                  CIS components


                     Healthcare components               ...
EHR Concept dictionary   2000 -



• Concepts are
declared once and
only once
• They can be reused
(e.g. structured data
e...
EHR Concept dictionary + SNOMED   12/2009 -


• Concepts within the concept
dictionary are associated with
SNOMED entries
...
HEGP CDW           EHR/CDW integration : concept dimension

                        ETL tools
CIS Reference manager       ...
HEGP CDW                                 EHR/CDW integration

Production environment               Evaluation/Research env...
HEGP IT platform                                  Quality management


 Healthcare                                        ...
Quality Management               EHCR quality indicators with I2B2 & BO
  Rate of clinical reports production by hospital...
HEGP IT platform                                  External Registries


 Healthcare                                       ...
HEGP IT platform                               Clinical Research : Trials,
                                               ...
eCRF & EHR : inclusion criteria
Clinical Research Integration
                                      Arcadia Project
Clinical Research Integration   eCRF & EHR : clinical data capture
eHealth Governance


•   The context
•   The need for global IT infrastructures
•   The HEGP case
•   Key issues
eHealth Governance                    Key Issues


 – Define an organization to foster collaboration between the care and
...
Acknowledgments




IECR
                               Marie-Christine Jaulent
    Michel Azizi
    Gilles Chatellier
   ...
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eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital

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eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital

  1. 1. eHealth Governance in a Local Organisation: IT for Managing Care and Fostering Research at HEGP Prof. Patrice Degoulet Hôpital Européen Georges Pompidou (HEGP) Faculté de Médecine René Descartes, Université Paris 5 Barcelona, March 17, 2010
  2. 2. eHealth Governance • The context – The scope – The barriers • The need for global IT infrastructures • The HEGP case • Key issues
  3. 3. eHealth Governance The scope IT Tools Care • Data management • Patient management - Electronic Health Records (EHR) • Disease management - Clinical Data Warehouses (CDW) • Education - Biobanks management (BBM) • Information management Research - Biostatistics, bioinformatics • Quality management - Decision support systems • Population follow-up • Knowledge management - Ontology management • Clinical Investigation - Data mining • Intervention studies
  4. 4. eHealth Governance • The context – The scope – The barriers • The need for global IT infrastructures • The HEGP case • Key issues
  5. 5. Barriers Technical • Technical (interoperability issues) –Architectures based on heterogeneous vertical applications –Syntax : coexistence of different message standards & versions (DICOM, Edifact-HL7-CDISC) –Semantics : coexistence of versions of international standards (e.g. ICD9CM/ ICD10, SNOMED 3.5 /CT and local terminologies (e.g., procedures, drugs) –Lack of security/confidentiality measures (precondition to interoperability)
  6. 6. Barriers HIS : A multitude of vertical applications Emerg ICU Med Surgery Lab Rx Pharm Functions Auth, Auth, Auth, Auth, Auth, Auth, Auth, EHR EHR EHR EHR … EHR EHR EHR … POE POE POE POE POE Appt. Appt. Appt. Appt. Appt. Pathology Genomics Healthcare units
  7. 7. Barriers Organizational & political • Organizational –Lack of coordination and governance bodies (e.g. administrative vs. biomedical informatics, biomedical vs. bioinformatics, etc.) • Political –Short term vs. long term strategies –Financing repartition (hospitals vs. universities vs. research organizations)
  8. 8. eHealth Governance • The context • The need for global IT infrastructures • The HEGP case • Key issues
  9. 9. IT & clinical research Five Directions 1. Necessity for a general IT conception 2. Support for an open source/open community approach 3. Acceptance of eSource in clinical research (eCRF) in place of paper CRF 4. Interoperability of EHR and electronic data capture (EDC) 5. Harmonization and bridging of standards for technical and semantic interoperability Ohmann C & Kuchinke W. Methods Inf Med 2009; 48: 45-54.
  10. 10. Global IT framework C eHealth Governance a r e Healthcare Decision Dossier Dossier 6 5 Professionals Electronic patient support systems 1 patient Health Record informatisé informatisé (EHR) Patients 2 Semantic Knowledge bases interoperability EBM sources platform Disease-oriented R Databases 4 e Registries s e Diagnostic, a Clinical Data predictive, 3 therapeutic r Warehouse (CDW) models c Clinical Trials Analytical h Databases Heterogeneous processing (OLAP), data integration Data Mining (OLAM)
  11. 11. eHealth Governance Organization of IT human resources Discipline Production Research IT (Computation IT support Basic computer science & Technology) - Networks - Servers Research IT - Setting research databases - Supporting research software Informatics Data/information/knowledge New data/information/ management knowledge methods - Requirement analysis - Ontology design methods - Data warehouse design - Bioclinical integration - Interoperable system design - NLP - New algorithms Bernstam EV et al. Academic Med 2009; 84 (7): 964-70.
  12. 12. eHealth Governance • The context • The need for global IT infrastructures • The HEGP case • Key issues
  13. 13. HEGP Background A large restructuring effort (July 2000-) Hôpital Laennec (1634) Hôpital Boucicaut Hôpital Broussais
  14. 14. HEGP Background Main figures (2009) No Number of active beds (Inpatient + One day care) 890 Total number of employees 3 200 - Nb. of physicians (FTE) 400 Mean number of inpatient admissions/month 4 700 One day hospital care (% of admissions) 49% Number outpatients visits/month 18 000 Nb. visits at the emergency department/day 110 Nb. PC/light terminals 3 000 Nb. wireless portables computers 250 Nb. simultaneous users (at 11:00 am) 1 200
  15. 15. HEGP Background Budget (2008) Expenses (M€) Non medical personnel 122.1 46.3 % Medical personnel 45.5 17.2 % Other expenses 96.3 36.5 % Total 263.9 100.0 % Incomes (M€) DRG activities 157.0 61,1 % Other activities 47.0 18,3 % Education & research 53.1 20.6% Total 257.1 100.0 %
  16. 16. HEGP Background Shared BioBank (2008-)
  17. 17. HEGP Cardiovascular HEGP Background Research Center (September 2009-)
  18. 18. HEGP Background IT Governance (2010) HEGP Executive Board Hospital Governance (20 members) IT Executive Board (General Director, Medical Director, IT Governance Finance Director, IT Director) IT Committee (20 members) User representation Ad hoc Committee User representation
  19. 19. HEGP Background IT Organization (2010) Informatics & Public Health Department (Pr Degoulet, coordinator) IT & Biostatistics Epidemiology Biomedical Clinical Informatics & DRG & Investigation Research (Pr Degoulet) (Dr Daniel) Clinical Management Evaluation (Pr Chatellier) (Dr Heudes) (Dr Durieux) Investigation Center (6 beds) (Pr Azizi) Knowledge Clinical engineering & eHealth epidemiology (Dr Jaulent) (Pr Chatellier)
  20. 20. A component-based architecture CIS components Healthcare components Data/ Patient Health record information Client component (PC) (HR) repositories Act Resource Identification component (AC) component (RC) Patient-related device identity clinical Session Generic components biological Manager Context Security images Manager (CM) Manager (Sec) documents Application Reference Decision SS Institution-related portal Manager (RM) (DSS) terminologies structures Document Communication resources Processor (DP) Manager (Com) protocols
  21. 21. EHR Concept dictionary 2000 - • Concepts are declared once and only once • They can be reused (e.g. structured data entry, report generation)
  22. 22. EHR Concept dictionary + SNOMED 12/2009 - • Concepts within the concept dictionary are associated with SNOMED entries • Semantic links within SNOMED can be used to  facilitate EHR queries  provide reasoning capabilities  foster interoperability (other EHRs, EHR-CDW integration, knowledge coupling, )
  23. 23. HEGP CDW EHR/CDW integration : concept dimension ETL tools CIS Reference manager I2B2 Concept dimension
  24. 24. HEGP CDW EHR/CDW integration Production environment Evaluation/Research environment ETL suite (Talend Open Studio) EHR : External EHR : Clinical Data Operational Databases Mirrored Warehouse Database Database (CDW) (ODS) I2B2 DW R, SAS Real time requests Cognos PowerHouse, I2B2 Client Data Analysis Business Object Data Mining Ilog Rules
  25. 25. HEGP IT platform Quality management Healthcare Decision Professionals 6 5 1 Electronic support systems Health Record Patients (EHR) 2 Semantic Knowledge bases interoperability EBM sources platform Disease-oriented Databases 4 Registries Diagnostic, Clinical Data predictive, 3 therapeutic Warehouse Clinical Trials (CDW) models Databases Heterogeneous Analytical processing (OLAP), data integration Data Mining (OLAM)
  26. 26. Quality Management EHCR quality indicators with I2B2 & BO  Rate of clinical reports production by hospital unit – Nb. sej : number of stays (A) – Nb. sej avec CR : number of stays with a report (B) – Nb. sej sans CR : number of stays without a report – Taux : rate (B/A) – Nb. CRH : total number of clinical reports
  27. 27. HEGP IT platform External Registries Healthcare Decision Professionals 6 5 1 Electronic support systems Health Record Patients (EHR) 2 Semantic Knowledge bases interoperability EBM sources platform Disease-oriented Databases 4 Registries Diagnostic, Clinical Data predictive, 3 therapeutic Warehouse Clinical Trials (CDW) models Databases Analytical Heterogeneous processing (OLAP), data integration Data Mining (OLAM)
  28. 28. HEGP IT platform Clinical Research : Trials, evaluation studies Healthcare Decision Professionals 6 5 1 Electronic support systems Health Record Patients (EHR) Semantic Knowledge bases 2 interoperability EBM sources platform Disease-oriented Databases 4 Registries Diagnostic, Clinical Data predictive, 3 therapeutic Warehouse Clinical Trials (CDW) models Databases Analytical Heterogeneous processing (OLAP), data integration Data Mining (OLAM)
  29. 29. eCRF & EHR : inclusion criteria Clinical Research Integration Arcadia Project
  30. 30. Clinical Research Integration eCRF & EHR : clinical data capture
  31. 31. eHealth Governance • The context • The need for global IT infrastructures • The HEGP case • Key issues
  32. 32. eHealth Governance Key Issues – Define an organization to foster collaboration between the care and research actors – Define an IT staff organization to cover both the care and research activities – Promote sound IT infrastructures Design the EHR in a data warehouse perspective Promote architectures that foster (semantic) interoperability Security traceability policy
  33. 33. Acknowledgments IECR Marie-Christine Jaulent Michel Azizi Gilles Chatellier Christel Daniel Thierry Dart Pierre Durieux Didier Heudes Lise Marin Eric Zapletal Bruno Frandji Pharmacy Brigitte Sabatier Patrice Prognon patrice.degoulet@egp.aphhp.fr

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