The move towards the "Digital Hospital" will call for a good understanding of the needs and objectives of each player in the sector.

The Digital Hospital "not about bringing computers to the patient's bedside"

Joint interview with Noël Minard, CEO of A2COM, a company which provides IT solutions to companies, and Pierre Jannin, a researcher at the French Institute of Health and Medical Research (INSERM) and head of the Inserm MediCIS team, a research team at the University of Rennes, France, during a day of discussion and debate in Rennes focusing on the Digital Hospital.  One of the round table sessions addressed the topic of ‘the hospital as an experimentation and innovation ground for digital players’.

What do you think of the existing digital applications in the health sector?

Noël Minard: I believe that IT is only in its infancy in the hospital sector, so we’re very far from where we need to be. IT in the hospital sector is first and foremost centred on hospital information systems, which deal with managing the administrative aspects of patients at a hospital, i.e. when they’re admitted, when they’re released, and  everything that indirectly concerns billing, but those IT systems don’t yet deal with processing actual medical data. That’s a different stage altogether as it has to do with pathology and service. Getting these aspects computerised will be a much longer process than the more general aspects of a hospital information system.

Pierre Jannin: It’s always useful to make comparisons with other professions where they use digital tools in order to see just how much work remains to be done in our field. Take aeronautics for example. People often compare the job of a doctor with that of an airline pilot – from the point of a view of a surgical operating theatre. But if you look at the computer assistance the pilot receives to do his/her day-to-day job – to fly the plane, then the performance assessment and ongoing training and so on – you can see just how much is done using digital tools. But in the health sector we’re not at that stage yet. Of course this analogy does have its limits but it shows just how much work there is still to do.

What do you think are the first steps that should be taken to start the move towards the digital hospital? Who will be the major players in this transformation?

Noël Minard: As far as I’m concerned a ‘digital hospital’ doesn’t mean putting tablets in patients’ rooms and enhancing the services that we already had with PCs. It’s not about bringing computers to the patient’s bedside. It’s really all about processing information, going into and getting to grips with medical processes and protocols, going deeper into patient care. It’s about responding to new requirements and aligning more closely with the work of the practitioners and the needs of patients. We need to align the IT services much more closely with the users, i.e. the physicians, care staff, etc.

And we can only do that if we get deeply involved in the various services and specialist departments, developing applications to meet the specific needs of these areas of medicine, types of illnesses and required services. We need to work on ‘vertical’ applications. The current hospital information system is what I would call a ‘horizontal’ application. It meets the overall needs of all the departments of a hospital. However the medical file of a dermatology patient cannot be the same as that of a person being treated at the nephrology department. So we need to develop software that can cope with each speciality and provide tailored services. This means working with healthcare practitioners to get to know the work of the different departments.

Pierre Jannin: I think that basically there’s a problem of resources and time. Staff need to be able to try out, develop further, and train up on digital tools. For that to happen, we also have to look at ethics and mindset. And this all starts with the teaching at medical faculties and beyond. We need to get students used to digital techniques.

The second point is that we need to think about what we expect from computer technology in the context of a hospital. Using digital tools anywhere and everywhere sounds good, but what’s the objective? Are we looking for improvements in terms of health and clinical outcomes for the patient, or enhancements in the quality of life, or longer life, or progress in terms of reducing healthcare costs and so on? These days, when we see the technologies that are being developed, there’s a huge amount to do to improve these various aspects. At the moment we’re still at the stage of trying to find out what our aims are and to properly integrate the technologies which already exist.

However, if the project is run by IT people, there won’t be a proper understanding of the special features and requirements of the healthcare field. And if it’s run by healthcare practitioners, they’ll have an incomplete grasp of the technical potential. So what we need is an interchange of both skills and people – including of course the patient. But there are also other people that we ought to be including – for example practitioners in the social sciences field. It’s not enough to talk solely about health and medicine. We need to take a wider approach and look into where the technology fits into society and into people’s personal development. We need to see things in the round.

How do you see the relationship between IT and health evolving over the coming years?

Noël Minard: I think there are two major aspects. Firstly we’ll be witnessing the opening up of the hospital system to the outside, i.e. giving greater accessibility to data from other places and to other experts. We shouldn’t restrict this just to hospital personnel. Secondly there’ll be a much greater personal involvement of the patient in the management of his/her own data. The patient will be an active generator of data and will be much more involved than before in the management of his/her own medical data.

Pierre Jannin: I see strong growth coming in the use of IT tools to improve quality. Quality in the sense of quality initiatives rather than actual healthcare quality, I mean. While there has been a boom in recent years in imaging and sensors and therefore in information on patients, I think that the real revolution will be about patient care, the development of treatment practices and the training of medical practitioners. And this drive for higher quality will of course call for IT tools because this is a very big job we have to do in a very short time. In the longer term, that will mean implementing smart systems – such as smart operating theatres which enable practitioners to obtain more data so that they can take more informed decisions. At the end of the day, the practitioner will always be at the centre of the process.

By Eliane HONG