Prof. Patrice Degoulet

Hôpital Européen Georges Pompidou (HEGP)

Faculté de Médecine René Descartes, Université Paris 5

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

Barcelona, March 17, 2010

• The context

– The scope

– The barriers

• The need for global IT infrastructures

• The HEGP case

• Key issues

eHealth Governance

eHealth Governance

• Quality management

• Population follow-up

• Clinical Investigation

• Intervention studies

• Data management

- Electronic Health Records (EHR)

- Clinical Data Warehouses (CDW)

- Biobanks management (BBM)

• Information management

- Biostatistics, bioinformatics

- Decision support systems

• Knowledge management

- Ontology management

- Data mining

IT Tools

Research

The scope

• Patient management

• Disease management

• Education

Care

• The context

– The scope

– The barriers

• The need for global IT infrastructures

• The HEGP case

• Key issues

eHealth Governance

• 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)

Barriers Technical

Healthcare units

Fu

nct

ion

s

…

Lab Rx PharmICU

…

Emerg

POE

Appt.

EHR

Auth,

POE

EHR

Auth,

Med

POE

Appt.

EHR

Auth,

Surgery

POE

Appt.

EHR

Auth,

Appt.

EHR

Auth,

POE

EHR

Auth,

EHR

Auth,

Appt.

HIS : A multitude of vertical

applicationsBarriers

Pathology

Genomics

• 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)

Barriers Organizational & political

• The context

• The need for global IT infrastructures

• The HEGP case

• Key issues

eHealth Governance

IT & clinical research

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

Five Directions

Ohmann C & Kuchinke W. Methods Inf Med 2009; 48: 45-54.

Research

eHealth Governance

Clinical Data

Warehouse

(CDW)Analytical

processing (OLAP),

Data Mining (OLAM)

3

Diagnostic,

predictive,

therapeutic

models

Knowledge bases

EBM sources

Decision

support systems5

Disease-oriented

Databases

Registries

Clinical Trials

Databases

4

Healthcare

Professionals

Patients

Dossier

patient

informatisé

Dossier

patient

informatisé

Electronic

Health Record

(EHR)

Heterogeneous

data integration

16

2

Care

Semantic

interoperability

platform

Global IT framework

eHealth Governance Organization of IT human resources

Bernstam EV et al. Academic Med 2009; 84 (7): 964-70.

Discipline Production Research

IT (Computation IT support Basic computer science& Technology) - Networks

- ServersResearch 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

• The context

• The need for global IT infrastructures

• The HEGP case

• Key issues

eHealth Governance

Hôpital Laennec (1634) Hôpital Boucicaut Hôpital Broussais

HEGP Background A large restructuring effort (July 2000-)

Main figures (2009)

NoNumber 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

HEGP Background

Budget (2008)HEGP Background

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 %

HEGP Background Shared BioBank (2008-)

HEGP BackgroundHEGP Cardiovascular

Research Center (September 2009-)

HEGP Background IT Governance (2010)

HEGP Executive Board(20 members)

IT Executive Board(General Director, Medical Director,

Finance Director, IT Director)

IT Committee(20 members)

Hospital Governance

IT Governance

Ad hoc Committee

User representation

User representation

HEGP Background

Clinical

epidemiology(Pr Chatellier)

IT &

Informatics(Pr Degoulet)

IT Organization (2010)

Biostatistics

& DRG

Management(Dr Heudes)

Epidemiology

&

Evaluation(Dr Durieux)

Clinical

Research(Pr Chatellier)

Informatics & Public Health Department(Pr Degoulet, coordinator)

Knowledge

engineering & eHealth(Dr Jaulent)

Clinical

Investigation

Center

(6 beds)(Pr Azizi)

Biomedical

Investigation(Dr Daniel)

CIS components

Actcomponent (AC)

Healthcare components

Application portal

Institution-relatedterminologies

structuresresources protocols

Patient-relatedidentityclinical

biologicalimages

documents

Client

Generic componentsSecurity

Manager (Sec)

Document Processor (DP)

Reference Manager (RM)

Identification device

Data/ information repositories

Communication Manager (Com)

Health record(HR)

Patientcomponent (PC)

Resourcecomponent (RC)

SessionManager

Decision SS (DSS)

Context Manager (CM)

A component-based architecture

EHR Concept dictionary 2000 -

• Concepts are

declared once and

only once

• They can be reused

(e.g. structured data

entry, report

generation)

EHR Concept dictionary + SNOMED

• 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, )

12/2009 -

HEGP CDW EHR/CDW integration : concept dimension

CIS Reference manager I2B2 Concept dimensionETL tools

HEGP CDW EHR/CDW integration

EHR :

Operational

Database

(ODS)

EHR :

Mirrored

Database

Production environment Evaluation/Research environment

ETL suite (Talend Open Studio)

Clinical Data

Warehouse

(CDW)

I2B2 DW

External

Databases

Data Analysis

Data Mining

R, SAS

Cognos PowerHouse,

I2B2 Client

Business Object

Ilog Rules

Real time requests

HEGP IT platform Quality management

Clinical Data

Warehouse

(CDW)

Analytical processing (OLAP),

Data Mining (OLAM)

3

Diagnostic,

predictive,

therapeutic

models

Knowledge bases

EBM sources

Decision

support systems5

Disease-oriented

Databases

Registries

Clinical Trials

Databases

4

Healthcare

Professionals

Patients

Electronic

Health Record

(EHR)

Heterogeneous

data integration

16

2 Semantic

interoperability

platform

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

Quality Management

HEGP IT platform External Registries

Clinical Data

Warehouse

(CDW)Analytical

processing (OLAP),

Data Mining (OLAM)

3

Diagnostic,

predictive,

therapeutic

models

Knowledge bases

EBM sources

Decision

support systems5

Disease-oriented

Databases

Registries

Clinical Trials

Databases

4

Healthcare

Professionals

Patients

Electronic

Health Record

(EHR)

Heterogeneous

data integration

16

2 Semantic

interoperability

platform

HEGP IT platform Clinical Research : Trials,

evaluation studies

Clinical Data

Warehouse

(CDW)Analytical

processing (OLAP),

Data Mining (OLAM)

3

Diagnostic,

predictive,

therapeutic

models

Knowledge bases

EBM sources

Decision

support systems5

Disease-oriented

Databases

Registries

Clinical Trials

Databases

4

Healthcare

Professionals

Patients

Electronic

Health Record

(EHR)

Heterogeneous

data integration

16

2 Semantic

interoperability

platform

Clinical Research IntegrationeCRF & EHR : inclusion criteria

Arcadia Project

Clinical Research Integration eCRF & EHR : clinical data capture

• The context

• The need for global IT infrastructures

• The HEGP case

• Key issues

eHealth Governance

– 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

eHealth Governance Key Issues

Acknowledgments

IECR

Michel Azizi

Gilles Chatellier

Christel Daniel

Thierry Dart

Pierre Durieux

Didier Heudes

Eric Zapletal

Pharmacy

Brigitte Sabatier

Patrice Prognonpatrice.degoulet@egp.aphhp.fr

Lise Marin

Bruno Frandji

Marie-Christine Jaulent