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1 HL7 UK 2005 – HL7 in France How French healthcare IT is progressively moving to international standards François Macary : GWI Medica France - Chair of.

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Presentation on theme: "1 HL7 UK 2005 – HL7 in France How French healthcare IT is progressively moving to international standards François Macary : GWI Medica France - Chair of."— Presentation transcript:

1 1 HL7 UK 2005 – HL7 in France How French healthcare IT is progressively moving to international standards François Macary : GWI Medica France - Chair of HL7 France

2 2 HL7 UK 2005 – HL7 in France 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.

3 3 HL7 UK 2005 – HL7 in France 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

4 4 HL7 UK 2005 – HL7 in France 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

5 5 HL7 UK 2005 – HL7 in France 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

6 6 HL7 UK 2005 – HL7 in France 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.

7 7 HL7 UK 2005 – HL7 in France 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.

8 8 HL7 UK 2005 – HL7 in France 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)

9 9 HL7 UK 2005 – HL7 in France 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

10 10 HL7 UK 2005 – HL7 in France DMP: Candidate tools and standards for infrastructure IHE XDS profile: Cross Enterprise Document Sharing Document Consumer Retrieve Document Consumer Query Documents Document Registry Document Repository Provide&Register Document Set Submission set: Soap with MIME attachment Transport: http POST or SMTP A care provider or a care setting Document Source One host Key to the patient folder: Patient NIS + Host id

11 11 HL7 UK 2005 – HL7 in France 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

12 12 HL7 UK 2005 – HL7 in France 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)

13 13 HL7 UK 2005 – HL7 in France CDA R2 implementation guide for the care record summary in the French realm SectionLOINC CodeLOINC Name Antécédents personnels11322-5HISTORY OF GENERAL HEALTH Antécédents médicaux 11348 ‑ 0 HISTORY OF PAST ILLNESS Antécédents chirurgicaux 10167 ‑ 5 HISTORY OF SURGICAL PROCEDURES Antécédents psychiatriques10165-9 HISTORY OF PSYCHIATRIC DISEASES Antécédents gynéco-obstétricaux11449-6 PREGNANCY STATUS Autres antécédents11329-0 HISTORY GENERAL Antécédents familiaux 10157 ‑ 6 HISTORY OF FAMILY MEMBER DISEASES Allergies et intolérances 10155 ‑ 0 HISTORY OF ALLERGIES Liste des problèmes11450-5PROBLEM LIST Traitements médicamenteux 19009 ‑ 0 MEDICATION.CURRENT Autres traitements29554-3PROCEDURE Autres facteurs médicauxX-INFOOTHER MEDICAL INFORMATION Données biométriques8716-3 PHYSICAL FINDINGS Vaccinations 11369 ‑ 6 HISTORY OF IMMUNIZATION Habitus29762-2 SOCIAL HISTORY Décès31211-6 DATE OF DEATH

14 14 HL7 UK 2005 – HL7 in France 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

15 15 HL7 UK 2005 – HL7 in France Thank you for your attention Thanks to HL7 UK for its kind invitation François Macary : GWI Medica, chair HL7 France Some “French connections”: HL7 IHE information from DMP:

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