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

1. eHealth Governance in a Local Organisation:
IT for Managing Care and Fostering Research at HEGP
Prof. Patrice Degoulet
Hôpital Européen Georges Pompidou (HEGP)
Faculté de Médecine René Descartes, Université Paris 5
Barcelona, March 17, 2010

2. eHealth Governance
• The context
– The scope
– The barriers
• The need for global IT infrastructures
• The HEGP case
• Key issues

3. eHealth Governance
The scope
IT Tools
Care
• Data management • Patient management
- Electronic Health Records (EHR) • Disease management
- Clinical Data Warehouses (CDW) • Education
- Biobanks management (BBM)
• Information management Research
- Biostatistics, bioinformatics
• Quality management
- Decision support systems
• Population follow-up
• Knowledge management
- Ontology management • Clinical Investigation
- Data mining • Intervention studies

4. eHealth Governance
• The context
– The scope
– The barriers
• The need for global IT infrastructures
• The HEGP case
• Key issues

5. Barriers Technical
• Technical (interoperability issues)
–Architectures based on heterogeneous vertical applications
–Syntax : coexistence of different message standards & versions
(DICOM, Edifact-HL7-CDISC)
–Semantics : coexistence of versions of international standards (e.g.
ICD9CM/ ICD10, SNOMED 3.5 /CT and local terminologies (e.g.,
procedures, drugs)
–Lack of security/confidentiality measures (precondition to
interoperability)

6. Barriers HIS : A multitude of vertical
applications
Emerg ICU Med Surgery Lab Rx Pharm
Functions
Auth, Auth, Auth, Auth, Auth, Auth, Auth,
EHR EHR EHR EHR
… EHR EHR EHR …
POE POE POE POE POE
Appt. Appt. Appt. Appt. Appt.
Pathology
Genomics
Healthcare units

7. Barriers Organizational & political
• Organizational
–Lack of coordination and governance bodies (e.g. administrative vs.
biomedical informatics, biomedical vs. bioinformatics, etc.)
• Political
–Short term vs. long term strategies
–Financing repartition (hospitals vs. universities vs. research
organizations)

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

9. IT & clinical research Five Directions
1. Necessity for a general IT conception
2. Support for an open source/open community approach
3. Acceptance of eSource in clinical research (eCRF) in place of
paper CRF
4. Interoperability of EHR and electronic data capture (EDC)
5. Harmonization and bridging of standards for technical and
semantic interoperability
Ohmann C & Kuchinke W. Methods Inf Med 2009; 48: 45-54.

10. Global IT framework C
eHealth Governance a
r
e
Healthcare Decision
Dossier
Dossier 6 5
Professionals Electronic
patient support systems
1 patient
Health Record
informatisé
informatisé
(EHR)
Patients
2 Semantic Knowledge bases
interoperability EBM sources
platform
Disease-oriented
R Databases 4
e Registries
s
e Diagnostic,
a Clinical Data predictive,
3 therapeutic
r Warehouse
(CDW) models
c Clinical Trials Analytical
h Databases Heterogeneous processing (OLAP),
data integration Data Mining (OLAM)

11. eHealth Governance Organization of IT human resources
Discipline Production Research
IT (Computation IT support Basic computer science
& Technology) - Networks
- Servers
Research IT
- Setting research databases
- Supporting research software
Informatics Data/information/knowledge New data/information/
management knowledge methods
- Requirement analysis - Ontology design methods
- Data warehouse design - Bioclinical integration
- Interoperable system design - NLP
- New algorithms
Bernstam EV et al. Academic Med 2009; 84 (7): 964-70.

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

13. HEGP Background A large restructuring effort (July 2000-)
Hôpital Laennec (1634) Hôpital Boucicaut Hôpital Broussais

14. HEGP Background Main figures (2009)
No
Number of active beds (Inpatient + One day care) 890
Total number of employees 3 200
- Nb. of physicians (FTE) 400
Mean number of inpatient admissions/month 4 700
One day hospital care (% of admissions) 49%
Number outpatients visits/month 18 000
Nb. visits at the emergency department/day 110
Nb. PC/light terminals 3 000
Nb. wireless portables computers 250
Nb. simultaneous users (at 11:00 am) 1 200

15. HEGP Background Budget (2008)
Expenses (M€)
Non medical personnel 122.1 46.3 %
Medical personnel 45.5 17.2 %
Other expenses 96.3 36.5 %
Total 263.9 100.0 %
Incomes (M€)
DRG activities 157.0 61,1 %
Other activities 47.0 18,3 %
Education & research 53.1 20.6%
Total 257.1 100.0 %

16. HEGP Background Shared BioBank (2008-)

17. HEGP Cardiovascular
HEGP Background Research Center (September 2009-)

18. HEGP Background IT Governance (2010)
HEGP Executive Board Hospital Governance
(20 members)
IT Executive Board
(General Director, Medical Director, IT Governance
Finance Director, IT Director)
IT Committee
(20 members)
User representation
Ad hoc Committee User representation

19. HEGP Background IT Organization (2010)
Informatics & Public Health Department
(Pr Degoulet, coordinator)
IT & Biostatistics Epidemiology Biomedical Clinical
Informatics & DRG & Investigation Research
(Pr Degoulet) (Dr Daniel) Clinical
Management Evaluation (Pr Chatellier)
(Dr Heudes) (Dr Durieux) Investigation
Center
(6 beds)
(Pr Azizi)
Knowledge Clinical
engineering & eHealth epidemiology
(Dr Jaulent) (Pr Chatellier)

20. A component-based architecture CIS components
Healthcare components Data/
Patient Health record information
Client component (PC) (HR) repositories
Act Resource
Identification component (AC) component (RC) Patient-related
device identity
clinical
Session Generic components biological
Manager Context Security images
Manager (CM) Manager (Sec) documents
Application Reference Decision SS Institution-related
portal Manager (RM) (DSS) terminologies
structures
Document Communication resources
Processor (DP) Manager (Com) protocols

21. EHR Concept dictionary 2000 -
• Concepts are
declared once and
only once
• They can be reused
(e.g. structured data
entry, report
generation)

22. EHR Concept dictionary + SNOMED 12/2009 -
• Concepts within the concept
dictionary are associated with
SNOMED entries
• Semantic links within
SNOMED can be used to
 facilitate EHR queries
 provide reasoning capabilities
 foster interoperability (other
EHRs, EHR-CDW integration,
knowledge coupling, )

23. HEGP CDW EHR/CDW integration : concept dimension
ETL tools
CIS Reference manager I2B2 Concept dimension

24. HEGP CDW EHR/CDW integration
Production environment Evaluation/Research environment
ETL suite (Talend Open Studio)
EHR : External
EHR : Clinical Data
Operational Databases
Mirrored Warehouse
Database
Database (CDW)
(ODS)
I2B2 DW
R, SAS
Real time requests Cognos PowerHouse,
I2B2 Client
Data Analysis Business Object
Data Mining Ilog Rules

25. HEGP IT platform Quality management
Healthcare Decision
Professionals 6 5
1 Electronic support systems
Health Record
Patients (EHR)
2 Semantic Knowledge bases
interoperability EBM sources
platform
Disease-oriented
Databases 4
Registries
Diagnostic,
Clinical Data predictive,
3 therapeutic
Warehouse
Clinical Trials (CDW) models
Databases
Heterogeneous Analytical processing (OLAP),
data integration Data Mining (OLAM)

26. Quality Management EHCR quality indicators with I2B2 & BO
 Rate of clinical reports production by hospital unit
– Nb. sej : number of stays (A)
– Nb. sej avec CR : number of stays with a report (B)
– Nb. sej sans CR : number of stays without a report
– Taux : rate (B/A)
– Nb. CRH : total number of clinical reports

27. HEGP IT platform External Registries
Healthcare Decision
Professionals 6 5
1 Electronic support systems
Health Record
Patients (EHR)
2 Semantic Knowledge bases
interoperability EBM sources
platform
Disease-oriented
Databases 4
Registries
Diagnostic,
Clinical Data predictive,
3 therapeutic
Warehouse
Clinical Trials (CDW) models
Databases Analytical
Heterogeneous processing (OLAP),
data integration Data Mining (OLAM)

28. HEGP IT platform Clinical Research : Trials,
evaluation studies
Healthcare Decision
Professionals 6 5
1 Electronic support systems
Health Record
Patients (EHR)
Semantic Knowledge bases
2
interoperability EBM sources
platform
Disease-oriented
Databases 4
Registries
Diagnostic,
Clinical Data predictive,
3 therapeutic
Warehouse
Clinical Trials (CDW) models
Databases Analytical
Heterogeneous processing (OLAP),
data integration Data Mining (OLAM)

29. eCRF & EHR : inclusion criteria
Clinical Research Integration
Arcadia Project

30. Clinical Research Integration eCRF & EHR : clinical data capture

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

32. eHealth Governance Key Issues
– Define an organization to foster collaboration between the care and
research actors
– Define an IT staff organization to cover both the care and research
activities
– Promote sound IT infrastructures
Design the EHR in a data warehouse perspective
Promote architectures that foster (semantic) interoperability
Security traceability policy

33. Acknowledgments
IECR
Marie-Christine Jaulent
Michel Azizi
Gilles Chatellier
Christel Daniel
Thierry Dart
Pierre Durieux
Didier Heudes Lise Marin
Eric Zapletal Bruno Frandji
Pharmacy
Brigitte Sabatier
Patrice Prognon
patrice.degoulet@egp.aphhp.fr