Transcript Diapositive 1
How French healthcare IT is progressively moving to international standards
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Year 2000: standard technologies are popping up in national standards
HPRIM
New message formats based on XML schemas, transport by secured email (S/MIME, ESMTP)
Intra-hospital medication workflow using DTD based XML messages
National Social Security network (Sésam-Vitale) uses secured email with a PKI for claims and reimbursements.
Each electronic invoice is signed by the care provider with his professional chip card (CPS) in conjunction with the patient insurance card.
The patient card (Vitale) delivers up-to-date insurance information.
HL7 UK 2005 – HL7 in France 2
2000 - 2003: Move to international standards
2001: Arrival in Europe of the IHE initiative (Integrating the Healthcare Enterprise)
Radiology intra-hospital workflow based on DICOM and HL7 v2
Strongly promoted in Europe by a French public body: GMSIH
New domains launched and driven by France: Clinical laboratory (2003), Pathology (2005)
IHE was the key that opened the door of French hospitals to HL7 standards
2001 - 2003: AFNOR (the official French standardization body) Gathered all the healthcare IT actors
Study of HL7 v3 published by AFNOR in 2002
Decision to build the HL7 France affiliate
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August 2004: Creation of HL7 France affiliate, based on the transformation of the HPRIM association
Why?
Thousands of operational links based on the HPRIM standards
HPRIM members had recognized the limits of national standards
How?
New name: HL7 France HPRIM
New bylaws: From a vendors association to an even representation between vendors and the other categories (users, consultants, general interest)
New policies and procedures (board election, ballots…)
Who joined in?
Public bodies: GMSIH, a university, many public hospitals
Professional societies: SFIL (clinical biologists), SFR (radiologists)
One professional trade union, some individual users
HL7 UK 2005 – HL7 in France 4
HL7 France H’: Two activities = Two TCs
HPRIM TC (low level activity):
Maintenance of the legacy HPRIM standards
Facilitate the migration to HL7 standards
HL7 France TC (high level activity):
Promotion of HL7 standards
Participation to 3 professional events in 2005, including conference in the “Sénat” for CIOs,in October 2005 Promotion of CDA R2 to the stake holders of national projects (Healthcare ministry, National Social Security)
Education and translations
Translation of the primer to V3 by Andrew Hinchley (1000 copies printed) 150 attendees to 8 one-day education sessions on V3: Introduction + CDA HL7 UK 2005 – HL7 in France 5
HL7 France TC activities (continued)
Support to initiatives using HL7 (IHE)
New IHE “Patient Administration Management” (PAM) profile based on HL7 V2.5 ADT.
Cooperation with other European HL7 affiliates
IHE PAM profile includes “Historic Movement Management” option, built in cooperation with HL7 Germany.
Support national projects (Production of CDA implementation guides)
“Dossier Communicant en Cancérologie” (DCC): A national project to organize multi-disciplinary cooperation around a cancer case
Dossier Médical Personnel (DMP): The national EHR.
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Le Dossier Médical Personnel (DMP) Legal framework
Legalization of digital signature (with X509 certificates + PKI)
Modernization of the national registry for all healthcare professionals. Personal chip card (CPS) encoding id, certificate, profession, specialty…
NIS: An upcoming national healthcare identifier for each French citizen.
A new chip card for each person registered to the National Social Security: “Vitale 2” is an insurance card containing the insurance information and the NIS.
“Le médecin traitant”: The primary physician for the patient (except for emergencies). The patient can delegate the management of his EHR to him.
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Le Dossier Médical Personnel (DMP) Major orientations
Document oriented: Sharing of electronic documents:
Human readable
Persistent
Considered as a whole (wholeness)
Authenticated
Manageable (stewardship)
Access rights potentially supervised by the patient
Access through the patient chip card Vitale 2
Possible delegation to the primary physician
Or explicit consent given by the patient for a care episode
Web based access and management (7 days, 24 hours)
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Le Dossier Médical Personnel (DMP) Schedule
Spring 2005: Constitution of the GIP DMP (the public instance managing the project)
July 2005: Tender for “1st experimentation”
October 2005: Selection of 6 industrial consortium
Nov 2005 – March 2006: 6 Pilot sites, period of evaluation
A local healthcare community: Hospital(s), clinics, labs, GPs, radiology centers…
5 000 real patient records each
March 2006: Tender for the national solution
One to 6 host sites
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DMP: Candidate tools and standards for infrastructure
IHE XDS profile
: Cross Enterprise Document Sharing A care provider or a care setting
Document Source Provide&Register Document Set One host Key to the patient folder: Patient NIS + Host id
A care provider or a care setting
Document Registry Query Documents Document Repository Retrieve Document Submission set:
Soap with MIME attachment Transport: http POST or SMTP HL7 UK 2005 – HL7 in France 10
DMP: Candidate standards for content
First documents required
Volet médical (= Care Record Summary for French Realm)
Hospital discharge letter
Laboratory report
Examination report
Structured
CDA R2
Unstructured
pdf, rtf, html
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HL7 France contributions to the DMP
Implementation guide for use of the CDA R2 header in the French realm, common to all electronic documents
How to represent all the participants to the document (author, legal authenticator, custodian, record target, patient…)
Identifiers for care providers, care settings, patients
Rules for document update (only replacement is authorized)
Localized vocabularies:
Acts are coded according to the French vocabulary “CCAM”) Care providers functions are coded according to the vocabulary of the professional chip card (CPS) HL7 UK 2005 – HL7 in France 12
CDA R2 implementation guide for the care record summary in the French
Section
Antécédents personnels Antécédents médicaux Antécédents chirurgicaux Antécédents psychiatriques Antécédents gynéco-obstétricaux Autres antécédents Antécédents familiaux Allergies et intolérances Liste des problèmes Traitements médicamenteux Autres traitements Autres facteurs médicaux Données biométriques Vaccinations Habitus Décès
realm
LOINC Code LOINC Name
11322-5 11348-0 10167-5 10165-9 11449-6 11329-0 10157-6 10155-0 11450-5 19009-0 29554-3 X-INFO 8716-3 11369-6 29762-2 31211-6 HISTORY OF GENERAL HEALTH HISTORY OF PAST ILLNESS HISTORY OF SURGICAL PROCEDURES HISTORY OF PSYCHIATRIC DISEASES PREGNANCY STATUS HISTORY GENERAL HISTORY OF FAMILY MEMBER DISEASES HISTORY OF ALLERGIES PROBLEM LIST MEDICATION.CURRENT
PROCEDURE OTHER MEDICAL INFORMATION PHYSICAL FINDINGS HISTORY OF IMMUNIZATION SOCIAL HISTORY DATE OF DEATH HL7 UK 2005 – HL7 in France 13
Next work items of HL7 France TC
Write CDA implementation guides for
Pathology reports (13 reports, one per organ)
needed by the national project DCC (specialized patient record for a cancer case)
Laboratory report in cooperation with IHE Laboratory committee
needed by both projects DMP and DCC
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Some “French connections”: HL7 France: IHE information from GMSIH: DMP:
www.hl7francehprim.org
www.gmsih.fr/ihe www.d-m-p.fr
Thank you for your attention Thanks to HL7 UK for its kind invitation
François Macary : GWI Medica, chair HL7 France HL7 UK 2005 – HL7 in France 15