Swiss Medical Informatics

Edition 2013/00

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SMI

Etude de l'impact médico-économique d'un projet de télémédecine au Mali

Original article
Laurence Thévoz, et. al.
Published on 27.09.2013
CS2\Cs2Journal\Domain\Model\Author:105703
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In the struggle against the medical desertification of rural areas, telemedicine proves itself to be a promising tool. Its impact, as described by numerous studies conducted in Nordic countries, lacks proof in its implementation in developing countries. EQUI-ResHus is a hybrid electrocardiography and echography tele-expertise project in Mali, enabled by an internet connection implemented in four centres countrywide. This study aims to investigate its medico-economic impact through the use of surveys filled in by patients and medical professionals alike. The results show a higher local expertise when conducting echographies but a sizeable use of external consultations when interpreting electrocardiographies. Demands of expertise vary greatly between the different sites. The medical centres showed a higher rate of visits, proving the technology's mass appeal. Even though the exam's utility has been proven, tele-expertise has had a mitigated impact on diagnostics and subsequent follow-up of the patient. The economic benefits to patients are clear in the form of savings accrued from not having to travel and stay in the capital, Bamako. The additional costs brought about by tele-medicine, such as the internet connection, are cushioned by the patient saving money as a result of conducting monthly one or two medical exams at the aforementioned sites.
Read more
Frederic Ehrler
Published on 27.09.2013
Frederic Ehrler

Les soignants sont déjà nombreux à consulter des références médicales par le biais d’outils portables. Ils ne comprennent pas pourquoi l’utilisation de leur smartphone devrait stopper à la porte de l’hôpital. Ces outils pourraient être couplé au dossier patient informatisé et permettre un accès constant et immédiats aux informations des patients partout dans l’hôpital. Malgré ces promesses, les décideurs restent prudents face à l’introduction de ces outils dans les processus de soins. Leur utilisation ouvre de nombreuses interrogations quand à la qualité des données enregistrées à travers ces outils. En se basant sur l’hypothèse que la qualité des données est influencée par l’interface de saisie, nous avons mis en place une étude pour découvrir celle qui est la plus appropriées. Les smartphones étant adaptés à la prise de signes vitaux au lit du patient, nous utilisons cette tâche pour comparer les performances de six modèles de saisie. Un programme a été développé afin d’accompagner les participants tout au long de l’expérience sans intervention extérieur. Durant l’étude, les participants passent tout d’abord par une phase de familiarisation des interfaces de saisies avant de saisir les signes vitaux le plus rapidement possible. A la fin du test, les participants peuvent donner leur avis concernant les différents modèles. Les mesures enregistrées durant l’expérience ont permis de découvrir quelle interface est la plus précise et la mieux acceptée par les utilisateurs. Environ 150 soignants ont participé à l’expérience. De façon générale, au vu des résultats obtenus, deux groupes d’interfaces émergent. Le groupe qui contient les interfaces que nous pouvons qualifier de standards et celui contenant les interfaces plus innovantes. Les interfaces standards obtiennent globalement de meilleurs résultats que ce soit au niveau de la précision ou de la vitesse de saisie. Plus précisément, les résultats ont montrés que le clavier numérique prend significativement moins de temps pour entrer les mesures. Concernant la précision, le clavier numérique ne domine pas mais occupe les meilleures places. L’évaluation faite par les utilisateurs reflète bien ces résultats étant donné qu’ils ont unanimement élu le clavier numérique comme étant leur modèle favori. Les résultats montrent clairement que le clavier numérique est l’interface la plus efficace pour rentrer des mesures numériques. C’est non seulement le model le plus rapide mais aussi le plus précis et préféré des utilisateurs. Ce résultat est très important pour le développent futur d’application médicale mobile afin de s’assurer de la qualité des données enregistrées ainsi que l’acceptation des utilisateurs.

Alberto Guardia, et. al.
Published on 27.09.2013
Alberto Guardia
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In January 2007, the Hôpitaux Universitaires de Genève (HUG) went from flat rate billing day basis to flat rate billing case basis. The system used until 2012 was the All Patient Diagnosis Related Group (APDRG) system. Since 2012, the system used is the Swiss DRG. Assuming that nowadays the hospital stay billing depends on the DRG used, and that this DRG is made on a short stay resume basis, we have identified three works areas to optimize the output document and therefore the stay billing. Those three works areas, that are part of the Cassandra project, are the improvement of the completeness of the output document, the optimization of the principal diagnosis choice and finally the creation of an essential comorbidities list.   For the first area, we have implemented pathology detection algorithms, especially, for the dyskaliemies detection. In this case the potential gain is almost 2’000’000 CHF. For the second area, the principal diagnosis choice has to be done by having considered the diagnosis having concretely monopolized the most resources during the patient stay, in order to have a billing as fair as possible. Finally, for the third area, we have now identified 33 diagnoses that have an impact on the DRG choice and on the medical resources that those pathologies need. For those reasons, we have initiated a meticulous study regarding their clinical documentation and possible detection algorithms.   The initial results being encouraging, we believe that those three works areas will help us to create tools, that once implemented in the coding chain will improve the coding quality at the HUG and especially will achieve a more accurate billing for the patients, the insurers and our institution.

Marc Oertle, MD MSc
Published on 27.09.2013
Marc Oertle, MD MSc

Our society has chosen Integrated Care as main topic for the conference. Not only health managers and politicians are talking about integrated care as one of the most important scenarios in healthcare for the very near future. In the last decade, information officers invested most of their time in completing homework within their institutions. Clinical information systems were implemented, processes have been redesigned, clinical decision support has been implemented, and steps toward automatisation and personalisaton have been made. However, many of these efforts never crossed the borders of a hospital or a private practice. In the next decade, building transition of information will be much more in the forefront of our daily work than it is today. So that we can profit most from current experiences, this congress will show some existing pilot systems dealing with information transfer across institutions, cantons or even the country. We should learn as much as we can from pioneering groups and from practice examples, as Switzerland is lagging behind many other countries in terms of eHealth. Hopefully, the boards of directors in Swiss hospitals will recognise the signs of the times, the potential lying in information technologies, and will support the efforts made by information managers. A second important theme of this congress covers the evidence base behind our daily work. Not only do we know many things about how to design and implement information technologies, but we also have to learn from our failures. Contributions by international and national speakers will focus on how to perform – and how not to perform – in our area of interest. Not surprisingly, errors occur most where we don’t tailor our information systems to information needs and work processes, and also where we make too-rigid rules. One area of concern in this context – as shown during the congress – is data protection. The interpretation of our data protection laws, which resemble a pendulum swinging from the paper period when there was no real data protection to a period where data protection finally decides the possibilities in work with information technologies, determines many ICT implementations in these days. And they provoke e-iatrogenesis! In coexistence with the main topic of integrated care, all stakeholders should engage in working together and finding common, consensual solutions for the best of our healthcare systems! I finally wish you two intensive, vivid, interesting and communication-full medical informatics days!

Helinä Kalalahti, et. al.
Published on 27.09.2013
Helinä Kalalahti
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The Health On the Net Foundation’s (HON) mission is to guide users of the Internet towards transparent and trustworthy online health information. In May of 2012, HON conducted two surveys. The first survey had the objective of identifying current trends of the use of Web 2.0 platforms for health purposes among users and to gain a better understanding of their need for guidelines. The second survey aimed to find out the needs of webmasters regarding the implementation of Web 2.0 guidelines on their websites as well as to receive feedback on these guidelines. This paper presents the main findings of the first survey. The data gathered from a total of 115 respondents, representing men and women as well as all predefined age groups, was analysed. In tota 55% of them reported to checking a Web 2.0 platform dedicated to a health topic at least once on a weekly basis. Forums were the most used (46%) Web 2.0 platform, and the main purposes of using platforms were to get health-related information (42%) and to communicate with peers about health-related issues (34%). In total, 81% agreed that a set of ethical guidelines would be “very helpful” or “helpful” in guiding users of Web 2.0 platforms towards trustworthy health information. However, 37% did not know whether the platform they use applies ethical guidelines or not. The results of this survey have shown that the users have a need to be better informed about the guidelines used on Web 2.0 platforms. The webmasters of health websites play a key role in fulfilling this need, and the HONcode certification is a tool that can be used to assist in this task.

Anne-Gabrielle Mittaz Hager, et. al.
Published on 27.09.2013
Anne-Gabrielle Mittaz Hager
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Introduction: Motor imagery (MI) and virtual reality (VR) are used in the upper limb amputee’s (ULA) rehabilitation. ULAs using  an advanced technical prosthesis are more and more numerous. Our aim was to better understand the motor working of ULAs, wearing prosthesis and using MI and VR. Method: A systematic research using Pubmed, Cochrane, ProQuest, Web of Science, CINAHL, and PSYCHINFO was conducted to analyse the consequences of such therapies on myoelectric and cerebral activities, motor performance and subjective data related to movement. Inclusion criteria for articles were: motor control of ULAs practicing MI or VR was investigated. Exclusion criteria were: only healthy subjects were tested or other therapies  except MI and VR were practiced. Results: Initial search provided 2,635 articles, in which 10 have been included in the analysis. ULAs and healthy subjects do not have the same neurological way of working when practicing MI or VR. The number of possible controlled movements and their accuracy are different. Some aspects, such as visual content of VR systems, may have an influence. If such therapies are interesting to be used for some ULAs, they have to be used as a supplement, but not as a substitute for classical therapies. Discussion: Supplemental search such as RCTs have to be conducted to provide strong evidences, that MI or VR are appropriate to be used for ULAs rehabilitation. MI and VR procedures have to be defined more clearly. These techniques must absolutely be tested with ULAs.

Caroline Perrin, et. al.
Published on 27.09.2013
Caroline Perrin
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epSOS (Smart Open Services for European Patients) was launched in July 2008 and is a European project, which is organised by representatives from different countries. The main objective of epSOS is the development and practical implementation of an eHealth framework and an information and communication technology infrastructure in Europe. Switzerland participates with the Canton of Geneva and the University Hospitals of Geneva with epSOS. Each participating country had to build a National Contact Point (NCP) as a national gateway for the transnational data exchange within epSOS. The secure connection between the various national NCPs forms the basis for the epSOS ‘circle of trust’. In epSOS at project start various legal, political, organisational and technical challenges arose based on the heterogeneity of the health systems in the EU countries, especially as health care is not part of the EU treaty. In this sense, the European situation at the beginning of the project is comparable with the Swiss one: firstly both don’t have a uniform legal basis, and secondly, the EU has a federal structure that is similar to the one in Switzerland. Both require a high coordination effort. The epSOS project has achieved the desired proof of concept. Since the second semester of 2012, the first countries are online with their use cases. This demonstrates that it is possible to find unified electronic processes even when starting from diverse situations. However, epSOS probably won’t be the solution for a homogeneous European solution for the transnational exchange of health data in the near future – as there are tremendous differences between the national eHealth infrastructures, policies and levels of development. The in epSOS implemented emergency data sets, electronic patient records and electronic prescriptions can make a major contribution to patient safety, by providing the medical personnel in emergency situations with lifesaving information to prevent treatment errors and to avoid the repetition of diagnostic procedures.

Marc Oertle
Published on 27.09.2013
Marc Oertle

Drug-drug interactions are frequent and over-alerting in clinical decision support systems is a major area of concern. Efforts to achieve a better fit between decision support and the clinical workflow are being undertaken. One possibility is to reduce DDI alerts by taking into account clinical information available in an electronic patient record, e.g. laboratory values. The present article describes the method and outcome of a patient-specific overruling algorithm using serum potassium levels to decide if DDI alerts should be overruled in circumstances where two drugs induce interactions that could lead to hyperkalaemia.