Stéphane Spahni

Comprehensive management of the access to the electronic patient record: Towards trans-institutional networks

BACKGROUND A system ensuring tight control access is used since 5 years at the University Geneva Hospitals (HUG) over a four campuses health care system with ambulatory care settings behaving like a small community care network. Access to identified clinical information is limited to care providers that have a therapeutic relationship with the patient and to those data needed for that relation. The same policy applies to administrative or scientific research accesses. This paper presents how the HUG met the challenging goal of protecting patient privacy within regulatory limits while keeping the system operational in terms of use and management. SOLUTION The main characteristics of the system are: (a) an institution-wide policy for access rights to the computerized patient record; (b) an institutional management of the contracts of the collaborators; (c) access profiles based on application-independent, fine-grained access rights; (d) a decentralized attribution of profession-specific access profiles; (e) a complete, centralized log of all accesses to the clinical information system; and (f) a decentralized verification of the accesses. Many of these characteristics can be maintained when evolving towards a trans-institutional computerized patient record, but new constraints need to be taken into account.

Health search engine with e-document analysis for reliable search results.

OBJECTIVE After a review of the existing practical solution available to the citizen to retrieve eHealth document, the paper describes an original specialized search engine WRAPIN. METHOD WRAPIN uses advanced cross lingual information retrieval technologies to check information quality by synthesizing medical concepts, conclusions and references contained in the health literature, to identify accurate, relevant sources. Thanks to MeSH terminology [1] (Medical Subject Headings from the U.S. National Library of Medicine) and advanced approaches such as conclusion extraction from structured document, reformulation of the query, WRAPIN offers to the user a privileged access to navigate through multilingual documents without language or medical prerequisites. RESULTS The results of an evaluation conducted on the WRAPIN prototype show that results of the WRAPIN search engine are perceived as informative 65% (59% for a general-purpose search engine), reliable and trustworthy 72% (41% for the other engine) by users. But it leaves room for improvement such as the increase of database coverage, the explanation of the original functionalities and an audience adaptability. CONCLUSION Thanks to evaluation outcomes, WRAPIN is now in exploitation on the HON web site (http://www.healthonnet.org), free of charge. Intended to the citizen it is a good alternative to general-purpose search engines when the user looks up trustworthy health and medical information or wants to check automatically a doubtful content of a Web page.

Implementing a new ADT based on the HL7 version 3 RIM.

The University Hospitals of Geneva (HUG) are the result of the merge of six hospitals into one single organization. While a true fusion of the management has been effectively done, it was not the case 5 years after for several databases, and in particular the ADT (admission, discharge, transfer). In order to truly realize the fusion, a new ADT service has been built using state of the art technology and standards in order to replace the existing seven services. This paper presents the results of the redesign and development of the new ADT service. The data model, based on HL7 RIM, is described and the technologies selected are presented. Finally, a status after 1 year of production is presented.

KidsETransplant : un serious game pour les enfants malades ou greffés du foie

Serious games are increasingly used in pediatric care, especially to educate young patients with chronic diseases, to improve their understanding of the disease and develop independence in disease management, as it can ultimately improve clinical results. This is also true for liver transplanted children and adolescents, who are not only challenged by their therapeutic burden, but who need to face transition to adult care, often without remembering their transplantation, which was performed, most of the time, very early in their life. KidsETransplant aims to improve long term outcomes of liver transplanted patients, using the principle of a serious game in 3D.

Linking the Shared Treatment Plan to Clinical and Decision-Support Systems

Based on previous experiences of educating patients about their medications, and through an iterative process involving all key stakeholders, a shared treatment plan tool has been developed for MonDossierMedical.ch, a service of the e-toile regional health information exchange (HIE) platform. It is based on the secure architecture of federated documents, and is organised in a modular way to enable various interfaces with existing prescription and dispensing systems. Although the first phase provided only a web-interface on the MonDossierMedical.ch portal, the second phase introduces integration mechanisms that are used to streamline processes around medication reconciliation. A true integration of this tool into existing environments and systems (hospital information systems, private practices, pharmacies, etc.) then becomes possible. Support for the integration with larger projects such as epSOS, the European-wide interoperability eHealth platform, is also one of the objectives of this second phase. In addition to communication with external stakeholders, decision support system services are integrated into the global process for providing valuable advice to prescribers. The usefulness of the first phase has been demonstrated on the e-toile platform, where it has been in production since summer 2012. Initial feedback from key stakeholders shows again a high interest in this forthcoming functionality.

e-toile: arrêt sur image à mi-chemin

eHealth constitutes a very complex field which will probably induce structural, organic and cultural major modifications in many activities related to the human health. It is even probable that one can speak here about singularity, that means the moment when technological change becomes so rapid and profound, it represents a rupture in the fabric of human history. E-toile is a community medical electronic network centered on the patient with universal vocation developed in Geneva, which passed from the state of project to that of pilot in 2011. The objective of this presentation is to confront the data of the international literature with the first experiments carried out in the framework of the doctors offices, solo or group, with an aim of drawing the preliminary conclusions, identifying and priorising the necessary innovations and initializing the essential cultural changes.