Ecole Nationale De Sante Militaire Kaddi Bakir

SSH-1 ère partie

Présenté en Général commandant l’ENSM le :

Commandant Hadji Brahim docteur en Informatique Biomédicale

 Informatique Biomédicale

Introduction
Information
science

Health Computer
Care science
 Informatique Biomédicale

Objectifs
L’introduction des technologies de l’information (TI) en santé :
• L’amélioration de la qualité des soins [1-3] :
– Réduire les erreurs médicales (iatrogénie)

– Améliorer la qualité des résultats (outcome)

• L’amélioration de l’efficience [4-5] :

– Le retour sur investissements (ROI) ?  Décalé de 3 à 5 ans
[1] Chaudhry B, Wang J, Wu S et al. 2006. Systematic review: impact of health information technology on quality, efficiency, and costs of
medical care. Ann. Intern. Med. 144, 742–752.
[2] Hillestad R., Bigelow J, Bower A el al. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings,
And Costs. Health Aff. (Millwood) 24, 1103–1117
[3] McCullough JS, Casey M., Moscovice I, Prasad S, 2010. The effect of health information technology on quality in U.S. hospitals. Health Aff.
Proj. Hope 29, 647–654.
3
[4] Zhivan NA, Diana M.L, 2012. U.S. hospital efficiency and adoption of health information technology. Health Care Manag. Sci. 15, 37–47.
[5] Borzekowski R, 2009. Measuring the cost impact of hospital information systems: 1987-1994. J. Health Econ. 28, 938–949. / 45
 Informatique Biomédicale
Domaines d’application

– Consumer Health – Electronic

information Medical Records
– Evidence-based – Billing
medical information transactions
– Ordering Systems

– Telemedicine – Reminder systems

– Tele-radiology
– Diagnostic Expert
– Patient e-mail Systems
– Presentations
– Drug Interaction
 Informatique Biomédicale

À l’internationale

• USA : ARRA/HITECH de 2009 = 20 Milliards $ : une valorisation

financière des hôpitaux et des cabinets médicaux en cas d’utilisation
significative des dossiers médicaux électroniques

 de 2009 et 2015, niveaux HIMSS/EMRAM 5 à 7 : 7,5% à 64,1 %

( 750%)
• Europe : - 3 hôpitaux de niveau 7
- 59 de niveau 6

[1] Anderson GF, Frogner BK, Johns RA, Reinhardt UE, 2006. Health Care Spending And Use Of Information Technology In OECD
Countries. Health Aff. (Millwood) 25, 819–831.
[2] Jha AK, DesRoches CM, Campbell EG, et al., 2009. Use of Electronic Health Records in U.S. Hospitals. N. Engl. J. Med. 360, 1628–
1638.
[3] Jha AK, DesRoches CM, Kralovec PD, Joshi MS, 2010. A progress
/ 45 report on electronic health records in U.S. hospitals. Health
5 Aff.
Proj. Hope 29, 1951–1957.
 Informatique Biomédicale
United States EMR Adoption Model  SM
[1]
Stage Cumulative Capabilities 2009 2010 2011 2012 2013 2014 2015 Q3 %

Complete EMR; CCD transactions to share data; Data

Stage 7 1.0% 1.0% 1.2% 1.9% 2.9% 3.6% 4.1% 310%
warehousing; Data continuity with ED, ambulatory, OP

14.8 %
24.1 %

54.3 %
64.1 %
37.4 %
7.5 %
8.7 %
Physician documentation (structured templates), full
Stage 6 2.8% 3.2% 5.2% 8.2% 12.5% 17.9% 25.4% 807%
CDSS (variance & compliance), full R-PACS

Stage 5 Closed loop medication administration 3.7% 4.5% 8.4% 14.0% 22.0% 32.8% 34.6% 835%

Stage 4 CPOE, Clinical Decision Support (clinical protocols) 10.3% 10.5% 13.2% 14.2% 15.5% 14.0% 10.3% 0%

Nursing/clinical documentation (flow sheets), CDSS (error

Stage 3 49.7% 49.0% 44.9% 38.3% 30.3% 21.0% 17.3% -65%
checking), PACS available outside Radiology

CDR, Controlled Medical Vocabulary, CDS, may have

Stage 2 15.4% 14.6% 12.4% 10.7% 7.6% 5.1% 3.4% -78%
Document Imaging; HIE capable

Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.7% 7.1% 5.7% 4.3% 3.3% 2.0% 1.8% -73%

Stage 0 All Three Ancillaries Not Installed 10.5% 10.1% 9.0% 8.4% 5.8% 3.7% 3.1% -70%

Data from HIMSS Analytics® Database ©2014 n = 5233 n = 5281 n = 5337 n = 5458 n = 5458 n = 5467 N = 5454

[1] HIMSS Analytics [http://himssanalytics.org/provider-solutions

 Informatique Biomédicale

Qualité des
Adoption
soins

Utilisation
significative
du SIC

Efficience

[1] Hadji B, et al. 14 Years Longitudinal Evaluation of Clinical Information Systems Acceptance: The HEGP Case.
Int J Med Inf 2016; 86 : 20-9.
[2] Hadji B, et al. Determinants of continuance intention in a post-adoption satisfaction evaluation of a clinical
information system. Stud Health Technol Inform 2014; 205: 990–4.
[3] Hadji B & Degoulet P. Information System End-user Satisfaction and Continuance Intention: a Unified
Modeling Approach. J Biomed Inform 2016; 61; 185-193.
Stenehjem, et al. Evaluation of the relevance and access of EHR-based variables to support personalized medicine in
breast cancer. Cogent Med 2016;3
Kumar S, Meuter A, Thapa P, et al. Metformin intake is associated with better survival in ovarian cancer: A case-
control study. Cancer 2013;119:555–62.
“Everything you do and the way you do,
sends a message. The message has to be
Strong, Exciting, Distinctive, Authentic,
Consistent, Clear, and Credible.”
Nicholas Hayek, Founder of Swatch.

Merci…