The health care organisation in France is supported by both the public and the private system. In order to guarantee an optimal service for the patient, the two parties should be working closely together. At ITIS'98, Dr. Régis Beuscart of the University of Lille, was offered a chance to illustrate the growing potential for medical collaboration through electronic networking, but also to mark down the human factors which sometimes hinder a smooth follow-up of the patient's data between the hospital, the specialist, the general practitioner (GP), the social security, and the nurses. He made an engaged plea for the strong involvement of the user in the health care network, resulting in the creed: "The Virtual World is for Humans".
The regional University Hospital Centre of Lille is situated in the North of France in the district Nord Pas de Calais. It is the fourth largest hospital in the country, serving a region of four million people. It has been involved in two European projects, called ISAR and IRISI, to optimise the communication between health professionals. Unfortunately, the French government exercises a centralising policy which makes it very difficult to launch regional projects between hospitals and GPs. The public system in France consists of 25 university hospitals as well as general and local medical facilities, social services and emergencies. The private system includes specialists, GPs, and laboratories.
Dr. Beuscart briefly outlines the development of digital datatransmission in the nineties for the medical sector in France. In 1990, there only existed some few administrative computer applications. A user requirements analysis was being performed in 1991, followed in 1995-1996 by the installation of OTALIA, a hospital information system consisting of 3500 PCs, serving 135 medical units. The ISAR Telematics European project was developed in 1997, together with the IRISI European regional initiative for the installation of computers in the GPs' offices. Currently, the RÈseau SantÈ Social supports a national network for transmission of administrative and billing information between doctors and social security. The diffusion of smart cards will form the next step.
Continuity of patient care and information flow constitutes the main objective in the network project. At present, the information is fragmented and the patient gets inevitably lost between the different health care parties. The connection needs standardisation to avoid that patient records are dispersed among the GPs with a PC based office, the biological labs, the hospitals where every unit has its own format, and the specialists. The patient data is not unified or, worse, not available which amounts in what Dr. Beuscart calls a "data-cemetery". Factors adding to the complexity of solving the problems are the free choice of GP as well as the total security required.
A users requirements analysis on the international level is being planned to define the actions which have to be undertaken. In any case, the GP needs to be informed of the admission, discharge, emergency problems and transfers of his patient. This implies the reception of results, discharge letters, and information about performed treatments and integration of these data in the PC. Hospitals should exchange data and information, and hold them at the GP's disposal. In turn, the GP has to provide the hospital with all necessary reports on his patient.
The ideal solution would be to build the required software, using existing technology with a strong focus on authentication systems for optimal security. This however constitutes a difficult procedure to be accepted by the national health care organisation. Yet, a tunnelling system is being envisaged for confidentiality, referred to as MATRANET M. Future applications involve the use of smart cards as well as packaging and commercialisation initiatives. In the end, the GP disposes of mail, files and work for which he needs two packages: a programme for the management of his records and a mailing system. The hospitals are putting events and movements on the net which requires unification in message format and notification facilities to warn the GP that a message has arrived. The system is currently tested in the French cities of ArmentiËres and Annecy as well as in Tournai, situated in Belgium.
Although the users sometimes have the strangest suggestions with regard to possible applications, they should by all means be involved. The network programmes have to be user friendly so that people need not have to change their activities while working with telematical systems. The real users needs in health care have to be met with the establishment of a simple mechanism for complex tasks. The need for a cost-benefit analysis and a thorough evaluation are obviously the following steps in the process. As a general conclusion, Dr. Beuscart states that the European experience undoubtedly has proven to be of decisive help and support for the French electronic health care network organisation.