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ACTIVITY REPORT

2018

ACTIVITY REPORT

2018

ATIH Headquarters117, bd Vivier Merle69329 Lyon cedex 03Tél. : 04 37 91 33 10Fax : 04 37 91 33 67

ATIH Paris Branch13, rue Moreau 75012 ParisTél. 01 40 02 75 63Fax : 01 40 02 75 64

www.atih.sante.fr

ACTIVITYreport

2018

Technical Agency for Information on Hospital Care

RAPPORT D’ACTIVITÉ2017

Agence techniquede l’informationsur l’hospitalisation

EDITORIAL

2018 was a full, rich year for the Technical Agency for Information on Hospital Care (ATIH), marked by the great work undertaken on adapting the data collection and restitution forms to the requirements of the General Data Protection Regulation (GDPR). In particular, a re-examination of restitution methods is underway in view of these requirements. This work will be continued in 2019 to cover all of our mechanisms.

This year, the relationships with our users have been further enhanced, to improve data access and use.The Regional Health Agencies (Agences régionales de santé - ARS) were mobilised to optimise use of information about the platform of access to hospital data managed by the Agency.The Agency focused more on healthcare institutions, with the organisation of several conferences on the restitution of hospital data (ScanSanté), a meeting with personnel from medical information departments (départements d’information médicale - DIM) on 2019 current affairs in medical information and the hospital data day. All these key moments have further increased the visibility of the missions of the Agency, its teams and its work.

2018 ACTIVITY REPORT

Finally, the ATIH user satisfaction measurement processes were further enhanced. Today, we have a regular and complete vision of users’ priority expectations and we have taken targeted actions to meet them.

The healthcare system transformation strategy (stratégie de transformation du système de santé - STSS) and experimenting with innovative funding have led the Agency to adapt to meet these new guidelines.This funding reform carried out in this context will require a reassessment of all of our technical tools: data collection, cost measurement, classification of medical activities and technical funding methods (consideration of quality, larger flat-rate sums, grouped funding, etc.). Thus, new challenges await the Agency in 2019, which will have a lasting impact on our work methods.

Housseyni Holla ATIH Managing Director


PRODUCING INDICATORS TO BETTER UNDERSTAND HEALTHCARE SERVICES ...............................

• Creating new indicators .................................................• Promoting knowledge of ScanSanté data ..............................................................

promoting THE AGENCY, ITS TEAMS AND ITS WORK.........................................................

• Building lasting connections with partners in the field .............................................• Meeting and interfacing with institutions ..................................................................• Evaluating the Agency’s audience satisfaction .............................................................................

GLOSSARY ...................................................................

ATIH: A CENTRE OF MULTIPLE EXPERTISE .............................

SOME SOME KEY FIGURES FOR HOSPITAL CARE .....................................................

ACCESSING HOSPITAL AND MEDICO-SOCIAL DATA ........................

• Securing and facilitating access to data ..............• Improving access to the hospital data platform .....................................• Developing access to data ............................................• Performing on-demand data processing ....................................................................

A WORD FROM USERS OF THE HOSPITAL DATA PLATFORM ...................................................

FUNDING HOSPITAL AND MEDICO-SOCIAL ACTIVITIES ..................................................................

• Joining the healthcare system reform .................• Experimenting with new forms of funding .............................................................• Adapting classifications to better fund institutions ..............................................................• Measuring costs in healthcare and medico-social sectors ......................................

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25

27

31

32

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37

41

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46

49

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52

56

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6 ATIH: A CENTRE OF MULTIPLE EXPERTISE


ATIH:A CENTRE OF MULTIPLE EXPERTISE

Founded in 2000, the Technical Agency for Information on Hospital Care (ATIH) is a public administrative institution overseen by the Ministers for Health and Social Security. The headquarters of the Agency are located in Lyon with a branch based in Paris.

The Agency’s strategic guidelines are dictated by a Board of Directors, a steering committee and a scientific council. The head of the Board of Directors is appointed by the Ministers for Health, Social Affairs and Social Security.

ATIH is in charge of:

- collection, hosting, restitution and analysis of data from healthcare institutions

- technical management of institutional funding mechanisms- conducting cost studies for healthcare and medico-social

institutions- development and maintenance of health nomenclatures


State services

Companies

Teachers, researchers

Healthcare and medico-social

institutions

National organisations

Hospital federations

Regional Health

Agencies (ARS)

National Health

Insurance

Court of Audit

General Directorate of Health Services (DGOS),General Directorate of Social Cohesion (DGCS),General Directorate of Public Finance (DGFIP),Directorate of Social Security (DSS),Directorate for Research, Studies, Evaluation and Statistics (DREES),General Inspectorate of Social Affairs (IGAS),General Secretariat of the Ministriesfor Social Affairs, etc.

Study and consulting firms, the media, etc.

Biomedicine Agency (ABM),National Support Agency for the Performance of Healthcare Institutions (ANAP),National Management Centre (CNG),National Solidarity Fund for Autonomy (CNSA), French National Authority for Health (HAS),National Cancer Institute (INCA), etc.

AUDIENCE


Management

- External communication- Partnerships mission- Data restitution mission (ScanSanté)

General secretariat

- Quality- Legal affairs and deals- Budget, accounting, management- Human resources and internal communication management- Secretariat

Architecture and IT production

- Web information system- Medical information collection systems- Software for healthcare institutions- System and network

Classifications, medical information and funding models

- Medicine, surgery, obstetrics and dentistry (Médecine, chirurgie, obstétrique et odontologie - MCO) / hospitalisation at home (hospitalisation à domicile - HAD)- Post-acute care and rehabilitation (Soins de suite et de réadaptation - SSR) / Psychiatry- Health nomenclatures- Medical statistics

National cost studies

- Healthcare: MCO, HAD, SSR, Psychiatry- Medico-social: Residential care

institutions for dependent elderly people (etablissements d’hébergement pour personnes âgées dépendantes - EHPAD), people with disabilities (personnes handicapées - PH), home nursing care services (Services de soins infirmiers à domicile - SSIAD)/multidisciplinary home aid and care services (services polyvalents d'aide et de soins à domicile - SPASAD)

Funding and economic analysis

- Analysis of activity and healthcare services- Cost analysis- Technical management of the funding

mechanism- Monitoring of the financial situation and the hospital National Objective for Health Care Spending (Objectifs nationaux de dépenses d’assurance maladie - ONDAM)

Responses to outside requests

- Data access- Processing requests

INTERNAL ORGANISATION OF THE AGENCY

In a constant effort to improve its internal performance, in 2018 ATIH conducted

work on the governance of its professions, including the planning of cross-functional

activities. The Agency also created a “working well together” charter to

improve internal interactions.


teams

As of 31 December 2018, the Agency employed 123 employees on a contractual basis and civil servants on secondment or provision.

StatisticiansPhysicians

Comptrollers

Administrative Positions

IT specialists

Others

37%11%

7%

15%

25%

5%


2018 AGENCY BUDGET

ATIH’s expenses amounted to €33,781,000 and its revenue was €33,825,000.

Breakdown of expenses

Personnel

Support grants for healthcare institutions

Operating

Investment

26%

39%

29%

6%

Private resources

National Solidarity Fund for Autonomy (CNSA)

Other extraordinary income

5%

Health insurance28%

16%

Funds for modernisation of public and private healthcare organisations (FMESPP)

49%

2%

€

!"#$%&$'"%()%*+,(%-&+,.)/$ &

Personnel

Support grants for healthcare institutions

Operating

Investment

26%

39%

29%

6%

Private resources

National Solidarity Fund for Autonomy (CNSA)

Other extraordinary income

5%

Health insurance28%

16%

Funds for modernisation of public and private healthcare organisations (FMESPP)

49%

2%

€

!"#$%&$'"%()%*+,(%-&+,.)/$ &

Breakdown of revenue

12 SOME KEY FIGURES FOR 2017 HOSPITAL CARE

2018 ACTIVITY REPORT 13

SOMEKEY FIGURES FOR 2017 HOSPITAL CARE

3,308HEALTHCARE INSTITUTIONS

7,3 Mpatients hospitalised in public institutions

5,4 Mpatients hospitalisedin private commercial institutions

1,5 Mpatients hospitalisedin private institutions of public interest

736,000births

358,000in-hospital deaths

12,7 MPATIENTS HOSPITALISED IN FRANCE

2017 data from the Programme for Medicalisation of Information Systems (programme de médicalisation des systèmes d’information - PMSI), rounded to the nearest thousand


7,3 MPATIENTS TREATED IN FULL HOSPITALISATION

6,1 MPATIENTS HOSPITALISED AS OUTPATIENTS

1,5 Mpatients hospitalised for endoscopy

1,3 Mpatients hospitalised for cardiovascular disease

1,1 Mcancer patients hospitalised

580,000patients having undergone cataract surgery

165,000elective abortions performed at institutions

154,000patients for palliative care

142,000patients having undergone a total hip replacement

120,000patients treated for a stroke

12,2 MPATIENTS IN MEDICINE, SURGERY, OBSTETRICS AND DENTISTRY (MCO)

93,000patients hospitalised after prosthesis fitting due to arthritis of the hip or knee

53,000patients in post-stroke rehabilitation

35,000patients for palliative care830,000

PATIENTS UNDER FULL-TIME TREATMENT

1 MPATIENTS IN POST-ACUTE CARE AND REHABILITATION (SSR)

MCO

SSR


135,000patients with mood disorders

96,000patients with schizophrenia and delusional disorders

17,000patients with pervasive developmental disorders (autistic)

420,000PATIENTS IN PSYCHIATRY

35,000patients for palliative care

25,000patients for complex dressings and specific care

6,300patients for intensive nursing care

5,2 M DAYS

116,000PATIENTS IN HOSPITALISATION AT HOME (HAD)

341,000PATIENTS UNDER FULL-TIME TREATMENT

81,000PATIENTS HOSPITALISED WITHOUT CONSENT

PSYCHIATRY

HAD


2018 NATIONAL OBJECTIVEFOR HEALTH CARE SPENDING (ONDAM)

SOME EXAMPLES OF AVERAGE COSTS

for 2018 hospital ONDAM

60,5 funding of MCO-HAD activity

10 funding of psychiatry activity

8,5 funding of SSR activity

BILLION EUROS

BILLION EUROS

BILLION EUROS

81

195 BILLION EUROS

BILLION EUROS

MCO SSR HAD

€210per day and up to

€560per day for management of anticancer chemotherapy

€1,400outpatient cataract surgery

€2,700delivery with no complications for 1st child

€200 / dayStroke with hemiplegia in part-time hospitalisation (somewhat physically dependent persons)

€5,400 / stayheart failure (physically dependent persons)

IN PUBLIC INSTITUTIONSAND PRIVATE INSTITUTIONSOF PUBLIC INTEREST

IN PRIVATE COMMERCIALINSTITUTIONS

IN ALLINSTITUTIONS


≈602 INTERNET /INTRANET PLATFORMS

55 PHYSICAL SERVERS to manage 405 virtual servers

SECURE ACCESS575 users

209 users per month (on average) for 2,572 sessions and over 4,370 hours of connection

USER ACCOUNTS 56,100 in the healthcare sector

46,600 in the medico-social sector

157,800 DATA TRANSMISSIONSfor all MCO, HAD, SSR and psychiatry fields

THE AGENCY’S 2018 IT DATASTORAGE, FLOW AND PROCESSING

VISITS OF MAIN WEBSITES

PAYMENT ORDERS

ATIH

10,100 occurred in MCO

1,700occurred in HAD

E-PMSI

SCANSANTÉ

ANCREfunding data platform

570,000 visits for 2,160,000 views

VIA THE E-PMSI PLATFORM,allowing payment of activity of institutions for an amount exceeding 40 billion euros




TOTAL VOLUME used160Tb

ACCESSING HOSPITAL AND MEDICO-SOCIAL DATA18


ACCESSING HOSPITAL ANDMEDICO-SOCIAL DATA


The Agency undertakes various actions to secure and facilitate access to hospital and medico-social data.

Approving the secure access server

Following the completion of a risk analysis on the scope of the ATIH secure access platform and the organisation of a commission in the presence of the deputy senior defence official of the social ministries, the ATIH Managing Director decided to approve the secure access in September 2018, for a duration of 18 months. Thus integrating the residual risks, he validated the compliance of this platform with the security policy of the National Health Data System (système national des données de santé - SNDS).

Guaranteeing the protection of personal data

As part of the application of the General Data Protection Regulation (GDPR)1, ATIH designated a data protection officer to assist its various departments in the analysis and implementation of GDPR requirements.

Several actions were carried out:- formalisation of the record of personal data

processing activities carried out by ATIH- notification of persons about the conditions

of use of their data as well as their rights under the GDPR

- strengthening the security of data collection and distribution mechanisms

- planning of a formalised analysis of residual risks to privacy

- integration of clauses related to personal data protection in contracts and agreements with our partners

- definition of data storage periods.

Securing and facilitating access to data

Healthcare institution data repositories

Following the announcement by the President of the Republic on the creation of a Health Data Hub, in June 2018 the Minister of Health and Solidarity launched a mission for prefiguration of this platform for use of health data. This mission audited ATIH as part of the drafting of a report released in October.The Agency also met with the team responsible for the health data repository of the CHU de Rennes [Rennes University Hospital Centre] in order to determine ATIH’s potential contributions to the objectives for making health data available.

Simplifying by dematerialising access to the platform

The authentication token for access to the platform is valid for 3 years. In the first half of 2018, ATIH created a dematerialised procedure based on electronic signature of the items required for a token renewal. Thus, it was able to very quickly renew 300 tokens that expired at the end of the summer.

1. Regulation of the European Union constituting the reference text for the personal data protection since 25 May 2018. It strengthens and unifies data protection for individuals within the European Union.


Accessing PMSI data with a simplified CNIL procedure

In July 2018, to facilitate access to ATIH data, the French Data Protection Authority (Commission nationale de l’informatique et des libertés - CNIL) simplified the authorisation procedure for access to national PMSI data for two categories of users:- healthcare institutions and hospital

federations- manufacturers of medicinal products and

implantable medical devices (IMDs).

For healthcare institutions and hospital federations

The CNIL approved a reference methodology (MR005) to carry out research, study and evaluation work within the field of health or planning and assessment of healthcare services in the following areas:- comparative evaluation of healthcare

services: spatial analyses, strategic analyses- evolution of care practices, incidence of

certain factors in hospitalisations, temporal analyses

- comparative analyses of care activities, studies of patient trajectories, recruitment pool, future of patients

- description and analysis of diseases and care pathways of patients within healthcare institutions

- analysis of the health territory, territorial hospital groups (groupements hospitaliers de territoire - GHT), collaboration studies between institutions of a defined area

- continuous analysis of comparative assessments, better adaptation of healthcare services, optimisation, assessment of stays, creation of steering indicators, strategy

- modelling, simulation, planning, hospital logistics, operational research

- epidemiological studies- medico-economic studies.

The data controllers are authorised to carry out processing if it meets the conditions set forth by the provisions of the methodology. On the ATIH platform, they access data from the 4 PMSI fields with no geographical restriction over a rolling 9-year period plus the current year, and data from A&E care summaries (résumés de passages aux urgences - RPU).All institutions and federations are invited to fill in, on the CNIL website, a commitment to compliance with the selected reference methodology. In return, the CNIL automatically sends a receipt with the commitment to compliance number to ATIH.

575 users on the server

346 in 133 healthcare institutions

72 in national agencies

93 at ARS

37 at the Ministry of Health and Solidarity, including 27 at the Directorate for Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l’évaluation et des statistiques - DREES)

15 in hospital federations

Improving access to the hospital data platform


The data controller must ask a consulting firm to carry out the processing and ensure that it has submitted a commitment to compliance with the CNIL in accordance with the provisions of the Decree of 17 July 2017 on the reference determining the criteria of confidentiality, expertise and independence for research companies and consulting firms.

The processing is carried out on the server of the service provider selected by ATIH: Secure Data Access Centre (centre d’accès sécurisé aux données - CASD) from 2018 to 2020 or on a secure server put in place by the consulting firm.

For studies that fall outside the framework of reference methodologies, the data controllers fall under the standard procedure. They must file with the National Health Data Institute (Institut national des données de santé - INDS) for review by the Expert Committee for Health Research, Studies and Evaluations (Comité d’expertise pour les recherches, les études et les évaluations dans le domaine de la santé - CEREES), obtain an authorisation from the CNIL and then send their file to ATIH.

For manufacturers of medicinal products and IMDs

The CNIL approved a reference methodology (MR006) for processing of study data for the following purposes:- preparation of discussion and meeting

files with competent committees and authorities (e.g. annual meetings of the Foresight Committee for Innovative Medicinal Products [comité de prospective des innovations médicamenteuses - CPIM], Economic Committee for Healthcare Products [comité économique des produits de santé - CEPS], etc.)

- completion of studies in real conditions of use at the request of the authorities

- targeting of sites and/or carrying out of feasibility studies in the context of research involving or not involving human subjects

- completion of studies in the context of post-marketing surveillance and vigilance.

27 consulting firms or research companies, accessing data on the CASD server

consulting firms that installed their own secure “bubble” for data processing, grouping

89 users

16 users

2


Developing access to data

Coordination of collection systemsATIH continued automatic supply of activity information from the annual statistics of institutions (statistique annuelle des établissements - SAE), managed by DREES, with data from the PMSI and added data on outpatient procedures and consultations in 2018. When institutions complete the SAE survey, they see their pre-filled PMSI data, which eases their collection burden and improves consistency between the two tools.In 2018, the work of supplying activity data in psychiatry started with a comparison of the lists of institutions of the two collection systems: SAE and collection of medical information in psychiatry (recueil d’information médicale en psychiatrie - Rim-P).

By expanding the scope of collection

Outpatient satisfaction surveySince 2015, the French National Authority for Health (Haute Autorité de Santé - HAS) has managed the national satisfaction measurement system, e-Satis. This survey was initially carried out for hospitalisations exceeding 48 hours in MCO. To supplement the satisfaction assessment, in 2018, HAS expanded it to outpatient surgery. As the project manager of e-Satis, the Agency had to change the platform to integrate this new field.Between the months of May and October 2018, 765 institutions participated, i.e. 82.5% of the total expected. 495,000 emails were sent plus 470,000 reminder emails. Ultimately, 160,000 patients responded.

By simplifying user management

Redesign of the user management platformA new version of the ATIH applications user management platform (Plage) was put online in October 2018.The platform was reviewed in its entirety, in particular with simplification of the creation of user accounts and grouping multiple accounts of a single user under a unique account. 105,531 user accounts were thus grouped into 68,871 unique accounts, with 102,822 institution profiles.

By integrating and simplifying reporting devices

Unified and integrated healthcare institution data reporting deviceThrough satisfaction surveys, the DIM reported that the monthly regulatory reporting of PMSI data was a time-consuming task even though the process itself was simple: anonymisation and transmission of data.The obsolescence of the technical solutions on which the information transmission tools are based largely explains the faults reported by users: very long processing times, lack of automatic updating, etc. As a matter of fact, the tools used by the DIM for regulatory reporting of PMSI data have changed very little in the last 15 years.In a context in which the DIM are increasingly called upon, it is essential to find a way to optimise these tools and free up time for medical tasks.All of the work for this modernisation will be undertaken as part of a project for a unified and integrated healthcare institution data reporting device (dispositif de remontée unifié et intégré des données des établissements de santé - DRUIDES). In 2018, several communications were sent to the DIM and publishers of IT solutions.Moreover, technical work for the first version of DRUIDES made good progress in 2018, and delivery is expected in April 2019.


Management of reports on activities of general interestIn 2018, the platform for management of reports of activity on missions of general interest (pilotage des rapports d’activité d’intérêt général - PIRAMIG) was deployed for the new missions of general interest (missions d’intérêt général - MIG):- F08-Perinatal mortality- F10-Occupational disease resource centres

(Centres de ressources sur les maladies professionnelles - CRMP)

- F18-Multiple sclerosis research and resource centres (Centres de ressources et de recherche sur la sclérose en plaques - C2RSEP)

- H03-Centres for prevention of care-associated infections (Centres de prévention des infections associées aux soins - CPIAS)

- I01-Addictology liaison teams (Équipes de liaison en addictologie - ELSA)

- O05-Medico-psychological emergency units (Cellules d’urgences médicopsychologiques - CUMP)

- T03-Health units in prisons (MCO)- T03b-Health units in prisons (Mental health)- T02-Intra-regional secure hospital units- T02b-Specially arranged hospital units (Unités

hospitalières spécialement aménagée - UHSA) (Mental health).

The reports for CPIAS replace those provided by the coordination centres of committees for the control of nosocomial infections (centres de coordination des comités de lutte contre les infections nosocomiales - CCLIN) and regional branches for the control of nosocomial infections (antennes régionales de lutte contre les infections nosocomiales - ARLIN).

In the 2017 campaign (collection carried out in 2018), 1,670 structures out of a total of 2,032, dependent on 236 legal institutions, provided their MIG report with a fill rate higher than 80%.

Management of calls for projects on health research and innovationThis year, the Agency carried out a complete redesign of the platform for management of calls for projects on health research and innovation, Innovarc, which will be used as part of the 2019 campaign, with an opening planned for February. This secure platform collects all health research and innovation projects, managed by the Ministry of Health:- national hospital clinical research programme

(programme hospitalier de recherche clinique national - PHRCN)

- medico-eoconomic research programme (programme de recherche médico-économique - PRME)

- care system performanc research programme (programme de recherche sur la performance du système des soins - PREPS)

- hospital nurse and paramedical research programme (programme hospitalier de recherche infirmière et paramédicale - PHRIP).

This platform ensures the management of the entire project filing campaign, until the delivery of the results, as well as the follow-up of selected projects.

In the 2017 campaign (collection carried out in 2018), 1,670 structures out of a total of 2,032, dependent on 236 legal institutions, provided their MIG report with a fill rate higher than 80%.

2018 ACTIVITY REPORT 25Cour des comptes

Comité économique des produits de santé (CEPS)

DSS

Autres

9

18

HAS17

25

6Igas5

DGOS

77

52

traitements pour l’agence, à la suite de

demandes externes dans le cadre des

travaux sur le finance-ment des établisse-

ments dont les destinataires sont

souvent le ministère chargé de la santé ou les

corps de contrôle (Cour des comptes, Igas, Igf). D’autres demandes sont

effectuées directement par l’externe :

Court of Audit

Economic Committee for Healthcare Products (CEPS)

DSS

Other

9

18

HAS17

25

6IGAS

5

DGOS

77

52

processings forthe Agency, following external requests as part of work on the funding of institutions whose recipients are often the Ministry of Health or control bodies (Court of Audit, IGAS, IGF).

Other requests are made directly by external

In 2018, the Agency performed

209 data processings

Performing on-demand data processing

A WORD FROM USERS26


How has the secure access changed your day-to-day access to hospital data?

For the DREES, the transformation into SAS table is no longer done. Compilation of the description of the tables into a single folder is a plus compared to the annual files.The speed of the processing times of the platform is significant and it facilitates detailed exploration of the data. Direct export of the results to Excel saves valuable time.

How many hours per month would you say you and your team spend on the platform?

It is difficult to assess, because the research managers are also working on other sources.

What do you think are the main advantages of the data access system?

With this platform, more data is available: reference tables (Joint Classification of Medical Procedures [Classification Commune des Actes Medicaux - CCAM], ICD), various groupings of GHM, institution files, etc.Specific uses are taken into account: loading of SAE tables, possibility of work sharing, and loading your own documentation. The change of platform has not required us to change the way we work.

What would you suggest as potential changes?

The documentation could be supplemented with the addition of a glossary of the modalities of variables and their history (e.g. movement codes).Changes made to source files during the creation of SAS tables should be documented (e.g. line with cancellation of RSFA files).Moreover, the simplicity of the export of the results should be preserved.

Engin YilmazAssistant Department Manager, Healthcare InstitutionsDREES

A WORD FROM USERS OF THE HOSPITAL DATA PLATFORM

A WORD FROM USERS28


Access to hospital data is now fast and simplified. We no longer need to control the databases, take the time to “cut/paste” before finally being able to use them.I also appreciate the availability and rapid updating of data.Finally, the SAS Enterprise Guide is easy to use and lets you make simple queries, with just a few clicks, to create “customised” programmes for more “expert” users.


For me, the time spent on the platform varies and greatly depends on the projects I am working on. It may be 2 hours per month for just updating data from already created queries, or several hours (around 3-4 days per month) when it comes to creating new queries (in particular for queries that require chaining stays).


The main advantages are the structuring of the data and the updating of the data.Another significant fact, related to the implementation of the access system: the ARS/ATIH monitoring committees that allow for regular exchange, in a very constructive manner, and also let us ask questions, including requests for changes to the tool.


Somewhat more complete documentation, because the description of variables of the different tables could be more in depth.For example, for the procedure table, there is no specification about the modalities of the variable “modificateurs – acte_modif”; for the fixed table, there is no specification on the variable “top_uhcd”.A more comprehensive explanation of modalities or comments in the glossaries would be appreciated and would sometimes prevent the need to look for information elsewhere.

Sarah Neqqache, PMSI Administrator,Care Organisation OfficeBourgogne-Franche-Comté Regional Health Agency



It has saved us a considerable amount of time in the regulator area thanks to the simplified procedure (MR005) as well as in performing data processing on different levels: minimised processing times and ability to continue work during processing with access to a remote SAS server, and temporal provision of data closer to reality.And we no longer need storage space on our machines.


About 50 hours.


For us, it is the updating of data, the speed of processing, the reactivity of user support, the diversity of data available and the simplicity of access compared to other devices.


You could add other data/classifications/descriptions such as, for example, data from the national cost study (étude nationales de coûts - ENC) or socioeconomic data, ATC classification or descriptions of CCAM grouping codes. The addition of a Python (programming language) interface would be a plus.

Stéphanie Polazzi, Antoine Duclos Health Data Department Team -Hospices Civils de Lyon [Lyon Civil Hospices]

FUNDING HOSPITAL AND MEDICO-SOCIAL ACTIVITIES30


FUNDING

HOSPITAL AND MEDICO-SOCIAL ACTIVITIES


In 2018, the government announced its ambition to transform the healthcare system to better meet the expectations of patients and to better decompartmentalise care, particularly between the community and the hospital.

The Ministry identified 5 priority focus areas:

1. territorial organisation2. quality and relevance of procedures3. modes of funding and regulation4. human resources and training5. digital technology.

Article 51 of the 2018 LFSS opens up the option of exploring innovative organisations that need to deviate from current funding mechanisms to promote the transversal and collective care of patients.Among these experiments, two models more specifically concerned healthcare institutions: the care episode (épisode de soins - EDS) funding model and the shared care incentive (incitation à la prise en charge partagée - IPEP) model.For these projects, calls for expressions of interest were launched by the Ministry in May 2018 in order to invite parties to participate in a process of co-development of the mechanisms.

Joining the healthcare system transformation strategy

Experimenting with new forms of funding

A specific mechanism has been set up to lead the discussion with the parties involved and to establish actions related to the national health strategy. Several projects mobilise the skills of the Agency, which has integrated and invested around the new guidelines. In particular, 2018 was marked by the start of projects on healthcare institution funding. Some of them, such as funding of chronic diseases or the quality incentive, resulted in measures in the 2019 social security funding law (loi de financement de la sécurité sociale - LFSS). Others are more long term, such as psychiatric funding, and are including more globally in the “Ma santé 2022” [My Health 2022] project.

Care episode (EDS)

As of September 2018, for three identified diseases: colon, total hip replacement and total knee replacement, the Agency analysed the pathway on a 2013-2016 cohort of patients. To do this, a data analysis and processing methodology was applied. It was first necessary to structure the data (of different natures) before proposing descriptive analyses and then predictive modelling of the pathways. This work was presented to parties during technical groups run by the National Health Insurance Fund (Caisse nationale d’assurance maladie des - CNAM) and the General Directorate of Health Services (Direction générale de l’offre de soin - DGOS). The results showed the ability to select patient characteristics predictive of the pathway.


These techniques will be used in 2019 to construct the EDS funding model, which will include a risk adjustment.

Shared care incentive (IPEP)

The Agency provided its expertise and support for the development of the funding model and integration of quality indicators into the mechanism.

For emergency departments, an experiment should be ready in 2019

to test new services, such as patient reorientation flat rates or the emergency

department coordination flat rates.

Participating in funding reform

More generally in the health field, the “Task Force” team, established at the Ministry, started the reflection on the entire funding model. This reflection focused primarily on emergency departments, quality funding, relevance and funding of chronic diseases.

For emergency departments, an experiment should be ready in 2019 to test new services, such as patient reorientation flat rates or the emergency department coordination flat rates. This experiment will affect the emergency department activity valuation for the institutions involved. The Agency was mobilised to provide data from the PMSI to measure all of the services currently billed for emergency care. Regarding relevance, the Task Force discussed solutions based on territorial indicators qualifying the use of care and the production of care. At this stage, these discussions were not conclusive. However, the decision was made to create a link between funding and authorisations in 2019. Thus, the Agency will create activity tracking tables based on authorisations granted to institutions.

In terms of quality funding, the Ministry’s goal is to simplify the model to make it more readable and comprehensible for the parties involved. This simplification will also be accompanied by a significant progress in the funding envelope, which may reach €300 million. In connection with HAS and the DGOS, the Agency provided data and proposed methodologies to create the quality credit allocation model.

Finally, the Ministry started work to establish flat rates for funding of chronic diseases, targeting two conditions: diabetes and patients in pre-replacement therapy stage 4 and 5 chronic renal failure. In 2019, the proposals will lead to flat rate funding for patients.

Since 2018, work has led to the development, with all parties involved, of specifications describing the expectations in terms of care and organisation. The Agency thinks about methods for collection of information from a patient who will require, in the longer term, the creation of specific collection devices. More specifically for MCO activities, as part of the global outpatient development policy, the Agency is mobilised to appraise rate solutions, such as the elimination of low limits and the creation of unique rates. The 2019 rate campaign will include all or part of these solutions.


Further refining classification in SSR

Classification projects

During the 2018 campaign, several projects were carried out on classification in medico-economic groups (groupes médicoéconomiques - GME). The nosological groups of the major category “Diseases and Disorders of the Circulatory System” (CM05) were reviewed, in association with professionals (learned society): the current classification consists of groupings of diseases that have a real clinical meaning, so it is not necessary to modify them. The work will be continued in 2019, and studies will be conducted for a possible qualitative consideration of the procedures of the specific catalogue of rehabilitation procedures (atalogue spécifique des actes de rééducation et réadaptation - CSARR) in CM05. Work was carried out on the diversity of rehabilitation. This work showed that the diversity of parties involved is more related to the medical unit and the institution at which the patients receive care than to the characteristics of the stay (GME, rehabilitation score). Therefore, it does not seem relevant to introduce the diversity of the parties involved into the classification. If needed, other methods can be explored to incorporate this parameter.To raise awareness of ATIH’s work on classification, various support materials have been produced (brochures, video, etc.) and presented during events: Emois days, Regional Technical Medical Information Committee, ARS meetings, etc.

Adapting classifications to better describe and fund institutions

Medical information projects

Consdiering the difficulties in using the cognitive daily activities grid to improve the description of behavioural and cognitive disorders, the Agency studied the possibility of encouraging the description of these disorders through the use of ICD-10 codes. After consultation of the parties involved, the process did not lead to the expected coding instructions, due to the difficulty of use of the codes of the chapter of ICD-10 in question (Chapter V: Mental and behavioural disorders).Requests have been made from the field to change the collection of medical information, in particular to better describe the extension of the length of stay due to lack of support for admission into the SSR department (the patient cannot walk), as part of locomotor care, and to expand the scope of the variable date of surgical procedure.After medico-statistical analyses, these two proposals do not improve the description of the medical activity and do not simplify the collection, so they were rejected.

Funding model

During the 2018 campaign, the Agency made some adjustments to the temporary mechanism and updated all of the activity valuation parameters according to classification in medico-economic groups (GME).For the target mechanism for SSR activities funding, the Ministry initiated a review on the basis of activity-modulated allocation in order to refine its calculation methods, its scope, etc. Thus, ATIH has contracted to develop an economic model for calculating the base within the SSR economic model.The first phase took place in 2018 and resulted in an inventory of the parameters to be included in the funding, other than activity measured by the PMSI.


Moving toward a new HAD classification

Since 2016, funding reform has been under review by the DGOS and at the same time the new medico-economic classification is under development at ATIH. The objective is to move forward together so that the tool is finalised at the same time as the funding model.For development of the classification, a new variable called “nature of the stay”, which defines the patient’s treatment plan, will be collected by institutions starting in 2019. This concept, developed in 2018, will facilitate the progress of the development of the tool, which will be more in line with medical reasoning, since the main medical project (which mobilises most of the care effort) is determined under the responsibility of the coordinating physician during the patient's admission to HAD.

To characterise the care, eight modalities were defined:

1. small child2. antepartum3. postpartum4. one-time care (chemotherapy session, etc.)5. complex care for chronic diseases and/or disability (dressings, etc.)6. palliative care7. monitoring8. rehabilitation

In addition, the Task Force wants to see the topic of care pathways included in the reflection on the new funding model. The idea is to identify MCO/HAD pathways, which involves a more cross-sectional view in the logic of the reflection on classification.

15 to 21%

23 to27%

29 to32%

33 to35%

43 to44%

15 to 21%

23 to27%

29 to32%

33 to35%

43 to44%

15 to 21%

23 to27%

29 to32%

33 to35%

43 to44%

Improving MCO classification

ATIH has supported the best valuation of short stays, especially in medicine, by participating in the description of the existing classification. As part of the Outpatient Steering Committee, headed by the DGOS, ATIH has contributed

to the reflection, by producing indicators, also reported in map-based reporting. For outpatient medicine, ATIH has supported the DGOS in the inventory of the description of the existing classification.

Example: proportion of outpatient stays in medicine, by region

2017 ATIH data


Total mastectomy with complex reconstruction

Major proc. for breast TM

Major breast proc. other than TM

Other breast proc. other than TM

Other proc. for breast TM

A A

A

A

A

D

D

D

A

A

A

A

A

A

A

A A

DR A

A MDC09

TM BREAST

Isolated complex reconstruction

BREAST

RECONSTRUCTION

MEDICAL PROCEDURE

MASTECTOMY

Lymph node clearance

Proc. for involvement of nail, benign tumours, nevi, cysts

EXCISION AND GRAFT

Other proc. for excision or graft

Major proc. for excision or graft

Excision of soft tissue lesion

Intermediate proc. for excision or graft

Excision or graft for ulcer, phlegmon

Plastic surgery

Proc. for ano-genital wartsANAL REGION

Proc. on anal or perianal area

Superficial surgery of sensory orifices of the face

Other major proc. from MDC09

Other proc. from MDC09

OTHER

01_RECMAS

02_RECISOL

03_TMSEIN_MAJ

04_TMSEIN_INT

05_TMSEIN_AUT

06_HTMSEIN_MAJ

07_HTMSEIN_AUT

08_CURAGE

09_ONTBK

10_EXGRF_INFECT

11_EXGRF_MAJ

12_EXGRF_INT

13_EXGRF_FACE

14_EXGRF_AUT

15_PLASII

16_ANAL_COND

17_ANAL_ITV

18_FACE_ORI

19_AUT_MAJ

20_AUT_MDC

The review of Major Diagnostic Category (MDC) 09 was finalised in 2018 for the skin/grafts section, in order to take into account the burden of the procedures. The methodology put in place will be applied to other MDCs in 2019.

Work was carried out on associated comorbidities (comorbidités associées - CMA), which resulted in minor adjustments to the existing list; this is why it was not modified. The current methodology for review of CMA would need to be re-assessed. For example, it would be necessary to operate not with a single list of thousands of diagnostics, but with a list that can be modulated according to the MDC to which the CMA will apply.


393 HEALTHCARE 268 ENC 125 COST SURVEY

613

MED

ICO-

SOCI

AL

135 MCO

95 SSR

38 HAD

42 SCU

83 PSY

226 SSIAD

300 PH

97 EHPAD

135 MCO

95 SSR

38 HAD

42 SCU

83 PSY

226 SSIAD

300 PH

97 EHPAD

613 MÉDICO-SOCIAL

Measuring costs in healthcare and medico-social sectors

Sample of cost measurement

Number of institutions participating in cost surveys and studies in 2018

Producing cost frameworks

After each national cost study (étude nationales de coûts - ENC) campaign, ATIH publishes (online on ScanSanté) cost frameworks or national cost values, i.e. the average costs:- per stay, by homogeneous patient group

(groupe homogène des malades - GHM) in MCO

- per day, by medico-economic group (groupes médicoéconomiques - GME) in SSR

- per day, by homogeneous care group (groupe homogène de prise en charge - GHPC) in HAD

- per day, by resident group in EHPAD.

From these frameworks, institutions can compare their costs to the average national cost.

The Agency uses the results of the healthcare ENC for its work on medical classifications, evolution of funding models and for calculation of hospital rates.

The work units (unités d’oeuvre - UO) cost framework is calculated from national data from public and private non-profit institutions from the accounting adjustment (retraitement comptable - RTC).It provides work unit costs for care activities and support functions, including:- cost per day of clinical services for MCO,

HAD, SSR, psychiatry- cost of medical-technical facilities- cost of laundry and food service activities- cost of medical logistics.


Consolidating healthcare ENC

By improving the composition of the sample

Assessment of the 2nd year of application of the ENC decree

In application of Decree No. 2016-1273 of 28 September 2016 on the conduct of national cost studies, in addition to applications on a voluntary basis, 24 institutions were contacted by ATIH: 10 in MCO, 10 in SSR and 4 in HAD.All of the institutions responded to this request. Therefore, the funding penalty mechanism for non-response was not activated. Following discussions, 2 institutions from the MCO field were included in the 2019 sample.As a reminder, 2 institutions had already been selected in this context the year before, for the campaign on 2018 data.In summary, the MCO ENC sample thus included 4 institutions resulting from the implementation of the Decree.

By improving the methodology

Measuring the care load in MCO

A work group, comprised of experts from federations, institutions performing the ENC and “non-ENC” institutions involved in this type of process, was created by ATIH to discuss a relevant breakdown of healthcare personnel costs for MCO stays, based on measurement of care load.The work group suggested introducing into the MCO ENC methodology the measurement of the care load by nursing care individualised to the person receiving care (soins infirmiers individualisés à la personne soignée - SIIPS).This measurement makes it possible to determine a nursing care indicator that gives a global and overall assessment of care for a patient’s stay, from the care demand of the person receiving care. It is the most common in healthcare institutions and has a published database1, and has also been used in the SSR ENC since 2009.

1. "La méthode Siips : indicateurs de soins infirmiers”, 2nd edition, Éditions Lamarre

Meeting with participating institutions

The Agency participates in regular exchanges with the institutions involved in the ENC.

Month Fields Type Number of registrations Method

July Healthcare Annual meeting 115 In-person

October EHPAD Annual meeting 44 In-person

July PH Annual meeting 126 In-person

April Healthcare Work group 61 In-person

September Healthcare Thematic workshop: Hospital hospitality 7 Web conference

November HealthcareThematic workshop: Measurement of care load

13 Web conference

366


The exploratory collection continues with the objective of collecting enough data to be able to carry out a comparative study between the two techniques of load distribution (days versus SIIPS points).

Assigning logistics and structure costs to analysis sections

In the discussions with parties involved, it was noted that the current methodology for allocation of general logistics and management (logistique et gestion générales - LGG) and structure expenses, overall by field, did not identify additional costs related to certain activities, such as intensive care.An exploratory change gives the institution the option to allocate LGG and structure charges more specifically over the sections. Impact analysis will be conducted in 2019.

Improving the quality of cost measurement

A study is being conducted over 18 months, in collaboration with an outside office, in order to carry out a quantitative and qualitative diagnosis on the allocation keys used and on the work units from the RTC and the ENC, and then to recommend and test changes.These changes will involve both the analytical tree and the scope of the various analysis sections, the definition and instructions concerning the breakdown keys, and the relevance and choice of work units.This study is being conducted within the framework of the ENC/RTC governance. It has already led to adjustments and clarifications of collection instructions for the 2018 and 2019 campaigns.

Refining measurement of medico-social costs

Continuation of EHPAD national cost studies

The results of the 2015 and 2016 campaigns have been published; the results of the 2017 campaign will be published in summer 2019.The 2017 and 2018 campaigns continued in 2018. Institutions participating in the 2017 campaign received their accounting data and institutions participating in the 2018 campaign carried out the four quarterly collections of their activity data: Pathos, autonomy, gerontology, iso-resources groups (grille de l’autonomie gérontologie groupes iso-ressources - AGGIR), complementary variables and minutes.

Start of Serafin-PH national cost studies

The General Directorate of Social Cohesion (Direction générale de la cohésion sociale - DGCS) and the National Solidarity Fund for Autonomy (Caisse nationale de solidarité pour l'autonomie - CNSA) have tasked ATIH with the technical execution of ENC in the field of structures for persons with disabilities.The first study was launched in 2018; it refined cost measurement following two cost surveys carried out on 2015 and 2016 accounting data. The renewal of a second study on 2019 data was confirmed.

Launch of the cost measurement campaign in SSIAD/SPASAD

The DGCS and CNSA tasked ATIH with conducting a cost measurement study on home nursing care services (SSIAD) and multidisciplinary home aid and care services (SPASAD).This study was conducted from activity data collected over two average weeks in 2018 and accounting data.

PRODUCING INDICATORS TO BETTER UNDERSTAND HEALTHCARE SERVICES40


PRODUCING INDICATORS TO BETTER UNDERSTAND HEALTHCARE SERVICES


Activity

Consumption-production of care

Rate of use and hospitalisation rateA new indicator, rate of use by number of patients per 1000 residents complements the rates of use in number of stays or days.Moreover, most regions have added new zoning on which these rates are calculated.

Market shares, all fieldsFrom now on, there are market shares for 4 fields: MCO, HAD, SSR and psychiatry.As a reminder, this restitution indicates the distribution of activity among the various institutions serving patients from a health territory, a region or a specific zone in a region (ARS-specific zoning). The activity may be represented by large group and type of hospitalisation based on the field studied.

Market shares and cross analyses for consumption-production of careCumulative data is now available for the current year and is updated each week.

Map for consumption-production of careA presentation of activity by territorial hospital group (GHT) was carried out for the 4 fields of activity of the PMSI. Moreover, socio-economic data from the National Institute of Statistics and Economic Studies (Institut national de la statistique et des études économiques - INSEE) were added to the list of indicators, as well as activity groups for children/adults for the psychiatry field.

Creating new indicatorsOnline on ScanSanté

Analysis of activity

Aggregated PMSI validation tablesSSR and Psychiatry - An aggregated presentation of activity is proposed: description of the activity, valuation and scores according to various geographical axes and by category of institutions. They were updated once a year and are now updated each week on the current year with a monthly and then quarterly display. MCO and HAD - The various presentations that distinguished institutions by funding sector (exDG or exOQN) were also groups and data quality tables were added.

Analyses of specific activities

Visualisation of surgical practicesIn order to support hospitals in the shift to outpatient care, ATIH and the National Health Insurance Fund (CNAM) have created a tool for visualisation of surgical practices, especially outpatient surgery, of healthcare institutions. Named Visuchir, this application, ergonomic and easy to use, can be freely accessed from ScanSanté.Carried out from the PMSI, Visuchir offers a detailed analysis of the surgical activities and methods of care of all public and private healthcare institutions within the territory (about 1000). The objective is to provide healthcare professionals and institutions with a set of indicators for steering and comparing their surgical practices, especially in an outpatient setting.


Coordination indicatorsTwo coordination indicators are proposed to help regional health agencies (ARS) carry out territorial diagnostics. Designed in partnership between the DGOS and ATIH, they are developed by geographic area (and not by healthcare institution) for medicine and surgery.

The readmission rate within 1 to 30 days (RH30) is obtained from the number of patients readmitted within 30 days compared to all patients hospitalised during the current year (excluding transfers and repeat stays).The rate of potentially avoidable hospitalisation (hospitalisations potentiellement évitables - HPE) is calculated in the form of a rate of use measuring the consumption of potentially avoidable hospital care of residents in a given geographic area, compared to the adult population residing in this area per 1000 residents.

Oncology - changesNew tables were added specifying the geographic origin of patients for the MCO set of indicators.

Medico-economic restitutions in psychiatry

Focuses were added to the “Data by institution” and “Aggregated data” restitutions to document involuntary treatment; they detail the number of days and patients according to the legal mode of care for each type of treatment: full-time, part-time and outpatient.

Care pathway

Flow between MCO institutionsIn order to improve the use of the institutions flow representation tool (outil de représentation de flux d’établissements - ORFEE), the activity description was refined with the addition of performance indices (based on the average duration of stay for transferred stays [SSR and HAD]), the concentration index and the addition of transfer rates in HAD and SSR by GHM.

Flow between HAD institutionsThe HAD ORFEE makes it possible to measure, compare and analyse information from chained MCO and HAD PMSI. Based on the 23 primary care modes, the tool provides a description of the activity of institutions, the concentration of activity, the flow of patients between MCO institution and HAD, etc.

Cost-funding

Cost analysis

EHPAD ENC cost frameworksRestitutions on the major data topic “Cost-funding” were enhanced with the integration of reference costs from the national cost study in EHPAD for the 2016 campaign. An Excel sheet presents the detailed results of costs by activity and by expense item for each group of residents. A note to the reader accompanies the introduction of this file.A data query form is being developed to facilitate the targeting of results: details of costs by activity, by cost item, by type of personnel. Selections by year and by group of residents will be proposed as of the first quarter 2019.


Financial analysis

Financial indicatorsThis new application provides financial tracking indicators developed from accounting information in order to establish an inventory of the financial situation of the institution, in both its main budget and overall. It also integrates elements on investments and debt. It is also possible to position the institution compared to other institutions, selected through criteria such as size, status, presence of certain equipment, etc. Thus, inclusion of the benchmark function gives access to additional information. Finally, each institution that is a member of a GHT can view all of the indicators individually.

Open data

Following national work on PMSI data accessible in open data, an initial file on the Joint Classification of Medical Procedures (CCAM) can be downloaded with data on procedures by institution, region and at the national level: number of procedures, mean duration of stays with the procedure, number of stays in outpatient care with the procedure.

Understanding purchasing and consumption of medicinal products at the hospital

This annual collection, carried out by ATIH since 2015, provides the total volume of medicinal products used by institutions, whether or not they are included on the “additional lists”.In 2018, the number of institutions that sent their 2017 data increased notably, going from 915 to 1,551. These institutions represent 73% of the 2017 overall hospital activity in number of days.In 2018, data restitutions from the years 2015 to 2017 were published on the ATIH website, in the form of a global analysis of results and ranking by field of activity and by region.

Online on the Agency’s website


ATC2* 2017 total quantity dispensed

ATC2 ATC2 DescriptionTotal amount

dispensed

N02 Analgesics 294,386,102

B05 Blood substitutes and perfusion solutions 174,443,151

N05 Psycholeptics 160,361,974

B01 Antithrombotic agents 78,572,062

J01 Antibacterials for systemic use 65,163,453

A02 Drugs for acid-related disorders 55,647,450

N03 Antiepileptics 49,981,370

A06 Drugs for constipation 47,307,108

A03 Drugs for functional gastrointestinal disorders 42,882,701

A12 Mineral supplements 41,834,552

N06 Psychoanaleptics 39,264,095

N01 Anaesthetics 37,147,999

C03 Diuretics 35,013,427

R03 Drugs for obstructive airway diseases 30,618,102

D08 Antiseptics and disinfectants 29,763,650

C07 Beta-blocking agents 29,098,265

C09 Agents acting on the renin-angiotensin system 26,608,450

H02 Corticosteroids for systemic use 26,527,087

S01 Ophthalmologicals 25,324,474

C08 Calcium channel blockers 25,251,844

ATC2 2017 total amount delivered

ATC2 ATC2 DescriptionAmount

dispensed

L01 Antineoplastic 2,023,770,000

L04 Immunosuppressants 654,170,225

N01 Anaesthetics 389,769,244

B02 Antihaemorrhagics 308,063,907

J05 Antivirals for systemic use 306,268,881

J06 Immune sera and immunoglobulins 296,576,573

B05 Blood substitutes and perfusion solutions 203,448,541

A16 Other digestive tract and metabolism products 187,157,077

B01 Antithrombotic agents 124,268,855

B03 Antianaemic preparations 105,626,958

J02 Antimycotics for systemic use 101,286,392

J01 Antibacterials for systemic use 99,971,862

N05 Psycholeptics 47,237,557

M03 Muscle relaxants 45,680,102

V03 All other therapeutic products 44,116,120

N02 Analgesics 36,150,700

C02 Antihypertensives 34,898,354

V08 Contrast media 32,424,496

R07 Other respiratory system products 29,711,848

A11 Vitamins 26,503,007

2017 medicinal products - Ranking of top 20 pharmaceutical classes by quantity and amount*

* All results presented were created from the “cleaned” 2017 database.Controls were carried out on prices and quantities to eliminate outliers.The quantities dispensed are in whole numbers of common dispensing units (unités communes de dispensation - UCD).The median price is calculated on a weighted average price including all taxes per UCD over the year.The amounts are the products of the prices by the quantities delivered.


Informing users

Information sessions

In order to better inform users about the content and query methods of the ScanSanté data restitution platform, ATIH organised 3 information sessions, attended by 115 participants (institutional, ARS and healthcare institutions).

In partnership with the School of Public Health (école des hautes études en santé publique - EHESP), ScanSanté user training sessions are still offered at healthcare institutions. These two-day sessions, included in the “Processing and combined use of various healthcare databases (ScanSanté, SNDS, etc.)” module, are based on practical cases and handling of the tool.Other informational activities were also conducted with users at institutions at the Adelf Emois days, at Paris Healthcare Week and at the Occitanie health data days in Montpellier and during the ATIH hospital data day in November.

Collecting user needs

ARS and institutions user group

In addition to the various work groups run by the Agency, two user groups were mobilised several times in 2018 to share their needs in terms of content and functionalities.

Coordination of tools by the ARS

In partnership with the General Secretariat of the Ministries for Social Affairs and the DREES, ATIH contributed to the coordinated implementation of tools for the ARS. Its active participation in work to harmonise indicators between ScanSanté and the Diamant tool of the Ile de France ARS, led by the General Secretariat, laid the foundation for an alignment of indicators in the field of MCO.

Moreover, ATIH participated in the indicator governing project,

managed by DREES and the General Secretariat of the Ministries

for Social Affairs. Work should continue in 2019.

Promoting knowledge of data

PROMOTING THE AGENCY IN ITS ENVIRONMENT48


PROMOTING THE AGENCY IN ITS ENVIRONMENT


Better meeting the needs of medical information departments (DIM)

Following the interviews conducted in 2017 with the DIM on their expectations from ATIH, a multi-year action plan was developed, that already includes in 2018:- strengthening of user support for medical information (Agora platform) with recruitment of three external DIM experts to help respond to users.- organisation of a day on 2019 PMSI news in order to help the DIM anticipate future changes in data collection.

Creating a unified and integrated healthcare institution data reporting mechanism (DRUIDES)

The objective is to simplify and secure activity data collection for medical information departments (DIM) on a unified platform.ATIH presented the principle of the mechanism in different instances (DIM panel, federation, CHU DIM, etc.) and the 2018 ATIH day on hospital data. This mechanism requires the initiation of an ongoing dialogue with the DIM to better adapt to their environment.

Implementation of DRUIDES is planned in 2020 for the MCO field. The first tests will be carried out in partnership with institutions in 2019.

Building lasting connections with partners in the field

Better meeting the needs of financial affairs departments (directions des affaires financières - DAF)

In 2018, a DAF mission was established on the same model as the meetings organised with the DIM, to collect their needs and identify improvements to make to ATIH tools and restitutions. In this context, the Agency met with three institutions in 2018 and will continue its travels in 2019 to define a targeted action plan for this category of users.

Enhancing access of Regional Health Agencies (ARS) to ATIH data

ATIH continues to organise a monitoring committee bringing together the ARS PMSI contact persons in the context of access to data, in order to learn their needs for changes to the services of the platform and to promote discussions between regions. This committee met three times in 2018.In addition to activity data, in 2018 ATIH provided the ARS with access to raw financial data from public and private non-profit institutions, in the general context of its mission of restitution of the data it collects.

Optimising discussions between ARS and ATIH

The Agency met with the Managing Director of the Provence-Alpes-Côte d’Azur Regional Health Agency, who expressed the needs of his teams in terms of tools (provision of indicator calculation programmes, etc.) and restitutions (regional activity indicators, etc.). Following this, a work group was created with three ARS to determine and prioritise the actions to be carried out.


Building relationships with the SOFIME and the DIM community

The partnership with the French-speaking Society of Medical Information (Société francophone de l'information médicale - SOFIME), started in 2017, continued in 2018, and an ATIH/SOFIME convention project was proposed at the end of the year.The DIM expert groups are structured in each field of activity. For example, in MCO, these experts were consulted about the feasibility of certain collections: conversion variable Day hospitalisations/full hospitalisation, collection of information related to transportation supplements, new codes related to perinatal care, DIM vision for collection of A&E care summaries (RPU), etc. In mid-November, an informational half-day about 2019 PMSI news was organised for the DIM; about 170 people participated.


Meeting and interfacing with institutions

The objective was to organise an exchange of ideas with institutions, to establish the position of the Agency and its scope of action and to promote its teams and its work.

Mardi 20 novembre 2018à Lyon

Journee atihdes données hospitalières

Établissements de santé, venez échanger autour des différentes étapes du cycle de la donnée hospitalière !

AGENCE TECHNIQUEDE L'INFORMATIONSUR L'HOSPITALISATION

On 20 November 2018, ATIH held the first “Hospital Data Day”, an event dedicated to healthcare institutions for discussion and sharing about the various steps for processing of hospital data.


10 participant workshops were offered:

Workshop 1 / PMSI data histories

Workshop 2 / Harmonising and facilitating the flow of funding campaigns and accounting adjustment (RTC)

Workshop 3 / Behind the scenes of a rate campaign

Workshop 4 / Analysing your territorial hospital group (GHT) with ScanSanté

Workshop 5 / Collected data: the potential of secure access

Workshop 6 / “What do I know?” about medico-economic classification

Workshop 7 / Toward a unified and integrated healthcare institution data reporting mechanism (DRUIDES)

Workshop 8 / Transmission of data on e-PMSI: control, validation and viewing

Workshop 9 / Understanding the community-hospital pathway to create integrated funding

Workshop 10 / Funding and expenses: situating your institution with ScanSanté


Experience centres were organised in the form of booths presenting data collection mapping, national cost studies and the ScanSanté data restitution platform.

With nearly 290 participants and an overall satisfaction rate of more

than 90%, this day was a success.


The Agency uses this barometer to:

- obtain relevant and regular feedback about its activities

- adapt by undertaking actions targeted at the priority expectations of the users

- evaluate its efforts by observing the effects on satisfaction.

In particular, this barometer covers each data collection campaign (such as PMSI, ENC, financial account, etc.), each database distributed (such as PMSI, RTC, etc.), the Agency’s website, on-demand data processing and, since 2018, ScanSanté restitutions.

The questionnaires, usually short and online, let the audience participate in improving a service/product in a quick and easy way through a few questions. Individuals can also leave their contact details for additional contribution if the Agency wishes to further study a subject.

Evaluating user satisfaction

97% of respondents said they were satisfied or very satisfied with the PMSI databases and their access system

96% of respondents said they were satisfied or very satisfied with the mechanism

Users of the PMSI databases on the secure access portal

Participants in the ENC on healthcare fields

To measure and improve its performance, ATIH relies in particular on a satisfaction barometer. The Agency regularly asks its users to learn about their overall and detailed level of satisfaction according to some key criteria.








Participants in the collection and transmission of PMSI data

Participants in the EHPAD ENC

Participants in the SERAFIN-PH cost survey

Participants in the collection and transmission of RTC data

Participants in the collection and transmission of social assessment data

Participants in the collection and transmission of financial data

ARSAgence régionale de santé - Regional health agency

ARLINAntenne régionale de lutte contre les infections nosocomiales - Regional branches for the control of nosocomial infections

CASDCentre d’accès sécurisé aux données - Secure data access centre

CCAMClassification commune des actes médicaux - Joint Classification of Medical Procedures

CCLINCentre de coordination de la lutte contre les infections nosocomiales - Coordination centres for the control of nosocomial infections

CEPSComité économique des produits de santé - Economic Committee for Healthcare Products

CEREESComité d'expertise pour les recherches, études et évaluations en santé - Expert Committee for Health Research, Studies and Evaluations

CNAMCaisse nationale d’assurance maladie - National Health Insurance Fund

CNILCommission nationale de l'informatique et des libertés - French Data Protection Authority

DGFIPDirection générale des finances publiques - General Directorate of Public Finances

DGOSDirection générale de l’offre de soin - General Directorate of Health Services

DIMDépartement d’information médicale - Department of Medical Information

DMIDispositifs médicoimplantables - Implantable medical devices

DREESDirection de la recherche, des études, de l’évaluation et des statistiques - Directorate Research, Studies, Evaluation and Statistics

DRUIDESDispositif de remontée unifié et intégré des données des établissements de santé - Unified and integrated healthcare institution data reporting mechanism

DSSDirection de la sécurité sociale - Directorate of Social Security

EDSÉpisode de soins - Care episode

EHESPÉcole des hautes études en santé publique - School of Public Health

CNSACaisse nationale de solidarité pour l’autonomie - National Solidarity Fund for Autonomy

CMACo-morbidités associés - Associated comorbidities

CMDCatégorie majeure de diagnostic - Major category of diagnosis

COPContrat d’objectifs et de performance - Objectives and performance contract

CPIAS Centre de prévention des infections associées aux soins - Centre for prevention of care-associated infections

CPIMComité de prospective des innovations médicamenteuses - Foresight Committee for Innovative Medicinal Products

CSARRCatalogue spécifique des actes de rééducation et réadaptation - Specific Catalogue of Rehabilitation Procedures

DAFDirection des affaires financières - Financial affairs department

DGDotation globale - Global allocation

DGCSDirection générale de la cohésion sociale - General Directorate of Social Cohesion

EHPADÉtablissement d’hébergement pour personnes âgées dépendantes - Residential care institutions for dependent elderly people

ENCÉtude nationale de coûts - National cost study

GDRGestion du risque - Risk management

GHT- Groupe homogène de tarifs - Homogeneous rate group- Groupements hospitaliers de territoire - Territorial hospital groups

GHPCGroupe homogène de prise en charge - Homogeneous care group

GMEGroupe médicoéconomique - Medico-economic group

HADHospitalisation à domicile - Hospitalisation at home

HASHaute autorité de santé - French National Authority for Health

ICDInternational Classification of Diseases

IGFInspection générale des finances - General Inspectorate of Finances

INDSInstitut national des données de santé - National Health Data Institute

GLOSSARY

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INNOVARCGestion des appels à projet sur la recherche et l’innovation en santé - Management of calls for projects on health research and innovation

INSEEInstitut national de la statistique et des études économiques - National Institute of Statistics and Economic Studies

IPEPIncitation à la prise en charge partagée - Shared care incentive

LGGLogistique et gestion générales - General logistics and management

LFSSLoi de financement de la sécurité sociale - French Social Security Funding Law

MCOMédecine, chirurgie, obstétrique et odontologie - Medicine, surgery, obstetrics and dentistry

MIGMissions d'intérêt général - Missions of general interest

ONDAMObjectif national des dépenses d’assurance maladie - National Objective for Health Care Spending

OQNObjectif quantifié national - National quantified objective

PSSIEPolitique de sécurité des systèmes d'information de l’État - State information systems security policy

RIM-PRecueil d’information médicale en psychiatrie - Collection of medical information in psychiatry

RPURésumé des passages aux urgences - A&E care summaries

RTCRetraitement comptable - Accounting adjustment

SAEStatistique annuelle des établissements de santé - Annual statistics of healthcare institutions

SERAFIN-PHServices et établissements : réforme pour une adéquation des financements aux parcours des personnes handicapées - Services and institutions: reform to adapt funding to the pathways of people with disabilities

SIGAPSSystème d'interrogation, de gestion et d'analyse des publications scientifiques - System for Identification, Management and Analysis of Scientific Publications

SIGRECSystème d'information et de gestion de la recherche et des essais cliniques - Information and Management System for Research and Clinical Trials

ORFEEOutil de représentation des flux entre établissements - Flow between institutions representation tool

PIRAMIGPilotage des rapports d’activité sur les missions d’intérêt général - Management of reports of activity on missions of general interest

PHPersonnes handicapées - People with disabilities

PHRCNProgramme hospitalier de recherche clinique national - National hospital clinical research programme

PMSIProgramme de médicalisation des systèmes d’information - Programme for Medicalisation of Information Systems

PRMEProgramme de recherche médico-économique - Medico-eoconomic research programme

PREPSProgramme de recherche sur la performance du système des soins - Care system performance research programme

PHRIPProgramme hospitalier de recherche infirmière et paramédicale - Hospital nurse and paramedical research programme

SIIPSSoins infirmiers individualisés à la personne soignée - Nursing care individualised to the person receiving care

SNDSSystème national des données de santé - National Health Data System

SOFIMESociété francophone de l'Information médicale - French-speaking Society of Medical Information

SPASADService polyvalent d'aide et de soins à domicile - Multidisciplinary home aid and care services

SSIADService de soins infirmiers à domicile - Home nursing care services

SSRSoins de suite et de réadaptation - Post-acute care and rehabilitation

UOUnité d’œuvre - Work unit

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ACTIVITY REPORT

2018

ACTIVITY REPORT

2018

ATIH Headquarters117, bd Vivier Merle69329 Lyon cedex 03Tél. : 04 37 91 33 10Fax : 04 37 91 33 67

ATIH Paris Branch13, rue Moreau 75012 ParisTél. 01 40 02 75 63Fax : 01 40 02 75 64

www.atih.sante.fr

2018 - santé.fr · all these key moments have further increased the visibility of the missions of...

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