Medical record: systematic centralization versus secure on demand aggregation

<p>Abstract</p> <p>Background</p> <p>As patients often see the data of their medical histories scattered among various medical records hosted in several health-care establishments, the purpose of our multidisciplinary study was to define a pragmatic and secure on-demand based system able to gather this information, with no risk of breaching confidentiality, and to relay it to a medical professional who asked for the information via a specific search engine.</p> <p>Methods</p> <p>Scattered data are often heterogeneous, which makes the task of gathering information very hard. Two methods can be compared: trying to solve the problem by standardizing and centralizing all the information about every patient in a single Medical Record system or trying to use the data "as is" and find a way to obtain the most complete and the most accurate information. Given the failure of the first approach, due to the lack of standardization or privacy and security problems, for example, we propose an alternative that relies on the current state of affairs: an on-demand system, using a specific search engine that is able to retrieve information from the different medical records of a single patient.</p> <p>Results</p> <p>We describe the function of Medical Record Search Engines (MRSE), which are able to retrieve all the available information regarding a patient who has been hospitalized in different hospitals and to provide this information to health professionals upon request. MRSEs use pseudonymized patient identities and thus never have access to the patient's identity. However, though the system would be easy to implement as it by-passes many of the difficulties associated with a centralized architecture, the health professional would have to validate the information, i.e. read all of the information and create his own synthesis and possibly reject extra data, which could be a drawback. We thus propose various feasible improvements, based on the implementation of several tools in our on-demand based system.</p> <p>Conclusions</p> <p>A system that gathers all of the currently available information regarding a patient on the request of health-care professionals could be of great interest. This low-cost pragmatic alternative to centralized medical records could be developed quickly and easily. It could also be designed to include extra features and should thus be considered by health authorities.</p

Revue Bibliographique des Méthodes de Couplage des Bases de Données : Applications et Perspectives dans le Cas des Données de Santé Publique

International audienceRecord linkage has become a powerful tool for public health, since the rise of medical and administrative database or cohort (Loth, 2015). This process allows matching individual's information obtained from different databases which don't have necessarily a common identifier. Furthermore, if such common identifier exists it could take a long time to obtain the necessary approval to use it. In France, the NIR is the identifier which is the most likely to be an identifier at the national level. However, in order to use the NIR, it is still compulsory to obtain the authorization from the CNIL even after the change of law concerning the modernization of the French Healthcare system. This paper presents a broad set of methods to perform record linkage, in particular the method proposed by Fellegi and Sunter and its extensions. The aim is to give some guidelines to researchers and to introduce some approaches to incorporate uncertainty associated with the linkage in their analysis. Mots-clés : couplage/appariement indirect, bases de données médicales et administratives, réseau bayésien naïf, mo-dèle mixte.Le couplage des bases de données est un enjeu important en santé publique, particulièrement en cette période de multiplication des bases de données administratives et de cohortes (Loth, 2015). Cette procédure consiste à faire correspondre des informations concernant un individu issues de base de données différentes sans pouvoir utiliser un identifiant unique. En France, dans le cas des données médicales et administratives, le Numéro d'Identification au Répertoire (NIR) est un exemple d'identifiant susceptible d'être utilisé pour servir de clé de couplage. Cependant ce dernier restera, en dépit de la loi du 26 janvier 2016 de modernisation de notre système de santé, difficile d'accès en raison de sa qualité d'identifiant direct commun à de nombreuses bases de données. Nous présentons les méthodes de chaînage susceptibles d'être utilisées par des chercheurs, en nous concentrant sur le modèle génératif de Fellegi et Sunter qui est une approche non supervisée, ainsi que sur quelques méthodes issues de l'apprentissage statistique. En-fin nous présentons rapidement différentes approches pour réaliser une analyse statistique sur des données appariées et comment répercuter l'incertitude de l'appariement dans l'analyse

Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

International audienceThe purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. METHODS: We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. RESULTS: We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. CONCLUSIONS: Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities

Incidence des procédures de chirurgie du glaucome en France de 2005 à 2014

National audienceIntroduction Cette étude a pour objectif de décrire l’incidence des différentes procédures chirurgicales de traitement du glaucome en France métropolitaine et dans les départements d’outre-mer (DOM) entre 2005 et 2014. Méthodes Tous les patients hospitalisés pour une chirurgie du glaucome et résidant en France métropolitaine et dans les DOM entre le 1er janvier 2005 et le 31 décembre 2014 ont été identifiés à partir de la base nationale du PMSI. Les séjours de chirurgie de glaucome étaient repérés par les codes correspondant dans la classification commune des actes médicaux (CCAM). Le dénominateur des taux d’incidence a été obtenu dans les données du recensement de l’institut national de la statistique et des études économiques (Insee) pour chaque année. Les taux d’incidence ont été standardisés sur la population française. Résultats L’incidence de la chirurgie du glaucome était de 30 procédures pour 100 000 habitants entre 2005 et 2014, diminuant légèrement sur la période d’étude (taux standardisé sur la population française). On a observé des variations dans le temps de l’incidence des différents types de procédures. Par exemple, le taux d’incidence annuel de trabéculectomies a légèrement diminué au cours de la période d’étude passant de 15,6 en 2005 à 12,1 procédures pour 100 000 habitants en 2014. Ensuite, le taux d’incidence des sclérectomies profondes a doublé entre 2005 et 2006 passant de 5,3 à 10,4 procédures pour 100 000 habitants, puis a diminué régulièrement pour arriver à 7,8 procédures pour 100 000 habitants en 2014. Enfin, le taux d’incidence des procédures de drainage de l’humeur aqueuse a augmenté sur la période passant de 0,24 en 2005 à 0,95 procédures pour 100 000 habitants en 2014. Discussion/Conclusion La base nationale du PMSI permet de décrire les tendances de la chirurgie du glaucome sur une période de 10 ans. On observe une diminution de la pratique des trabéculectomies au profit d’autres procédures telles que la sclérectomie profonde et les procédures de drainage de l’humeur aqueuse

Empowerment of Patients over their Personal Health Record Implies Sharing Responsibility with the Physician

Through this article, we point out the unavoidable empowerment of patients with regard to their personal health record and propose the mixed management of patients' medical records. This mixed management implies sharing responsibilities between the patient and the Medical Practitioner (MP) by making patients responsible for the validation of their administrative information, and MPs responsible for the validation of their patients' medical information. We propose a solution to gather and update patients' administrative and medical data in order to reconstitute patients' medical histories accurately. This method is based on two processes. The aim of the first process is to provide patients administrative data, in order to know where and when they received care (name of the health structure or health practitioner, type of care: outpatient or inpatient). The aim of the second process is to provide patients' medical information and to validate it under the responsibility of the MP with the help of patients if needed. During these two processes, the patients' privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows the pseudonymization of patients' identities. The Medical Record Search Engine we propose will be able to retrieve and to provide upon a request formulated by the MP all the available information concerning a patient who has received care in different health structures without divulging the patient's true identity. Associated with strong traceability of all access, modifications or deletions, our method can lead to improved efficiency of personal medical record management while reinforcing the empowerment of patients over their medical records

Empowerment of patients over their personal health record implies sharing responsibility with the physician

International audienceThrough this article, we point out the unavoidable empowerment of patients with regard to their personal health record and propose the mixed management of patients' medical records. This mixed management implies sharing responsibilities between the patient and the Medical Practitioner (MP) by making patients responsible for the validation of their administrative information, and MPs responsible for the validation of their patients' medical information. We propose a solution to gather and update patients' administrative and medical data in order to reconstitute patients' medical histories accurately. This method is based on two processes. The aim of the first process is to provide patients administrative data, in order to know where and when they received care (name of the health structure or health practitioner, type of care: outpatient or inpatient). The aim of the second process is to provide patients' medical information and to validate it under the responsibility of the MP with the help of patients if needed. During these two processes, the patients' privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows the pseudonymization of patients' identities. The Medical Record Search Engine we propose will be able to retrieve and to provide upon a request formulated by the MP all the available information concerning a patient who has received care in different health structures without divulging the patient's true identity. Associated with strong traceability of all access, modifications or deletions, our method can lead to improved efficiency of personal medical record management while reinforcing the empowerment of patients over their medical records

Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity.

International audienceOBJECTIVE: To measure the accuracy of blood transfusion (timing and number of blood units) in postpartum hemorrhage (PPH) in a perinatal network. STUDY DESIGN: (1) The ANONYMAT software system was used for anonymization and linkage of two large stand-alone databases, the Burgundy Perinatal Network (BPN) and the National Blood Centre (EFS) databases, which contain, respectively, clinical data from hospital discharges and information concerning any blood transfusion in France (considered as the gold standard database for identifying any transfusion). (2) Identification of prescriptions of at least one red blood cell (RBC) unit at the day of delivery (≥22 weeks) and up to 42 days, with manual reviewing of medical records in case of discordant recording. (3) Assessing the sensitivity and positive predictive value of data from the BPN database. RESULTS: Among the 9736 women receiving at least one blood product dispensed between 01/01/2006 and 12/31/2007 and the 35,779 women who delivered, 233 women (0.65% of deliveries) received at least one RBC unit for post partum hemorrhage. In the BPN database according to the type of hospital stay in our perinatal network (delivery stay only, delivery and post-delivery stays), sensitivity and positive predictive value for RBC transfusion ranged from 61.4% (55.1-67.6) to 67.8% (61.8-73.8) and 82.2% (76.5-87.9) to 83.2% (77.8-88.5), respectively. Linkage of both BPN and EFS databases allowed accurate recording of all but one RBC transfusion. CONCLUSION: Our approach allowed 100% electronic recording of PPH requiring blood transfusion, making it an important sentinel event of maternal morbidity to assess the perinatal network

L'administration conjointe du dossier patient: une responsabilité partagée entre le patient et le praticien

National audienceThe main problem faced by patients, health practitioners and the authorities, is namely the gathering and updating of administrative and medical data in order to accurately reconstitute a patient's medical history. Although solutions to accelerate and to ease this gathering are being implemented at the national level in several European countries, as unique health identifier in France, information still have to be validated before use. Through this article, we propose a mixed management of patients' data, split between the patient regarding administrative information and the Medical Practitioner (MP) regarding medical information. This method is based on two processes. The first process aims to obtain from health structures a list of probable cases of care provided to the patient. After validation by the patient (i.e. real or not care providing), the aim of the second process is to provide a patient's medical information and to validate it under the accountability of the MP with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. Our method, based on specific Medical Record Search Engines can lead to improved efficiency of personal medical record management regarding information gathering. The other interest is, by the use of several combinations of identifiers, to make available some data, initially unreachable due to inefficiency of recently developed tools

Is combined cataract surgery associated with acute postoperative endophthalmitis? A nationwide study from 2005 to 2014

International audiencePURPOSE:To assess the incidence of acute postoperative endophthalmitis (POE) after cataract surgery combined with corneal, glaucoma or vitreoretinal surgical procedures from 2005 to 2014 in France.METHODS:In this cohort study, acute POE occurring within 6 weeks after surgery was identified by means of billing codes recorded in a national database in patients operated for cataract extraction with phacoemulsification, or corneal, glaucoma or vitreoretinal surgical procedures, either combined or stand-alone.RESULTS:From January 2005 to December 2014, up to 6 260 477 eyes underwent phacoemulsification cataract surgery as a single procedure and 115 468 eyes underwent phacoemulsification combined with corneal, glaucoma or vitreoretinal surgical procedures. The crude incidence of acute POE after stand-alone or combined cataract surgery was 0.102% and 0.149%, respectively. In multivariate Poisson analysis, combined surgery taken as a whole was at higher risk than cataract stand-alone surgery, with an adjusted incidence rate ratio (IRR) (95% CI) of 1.38 (1.11 to 1.70; p=0.0054). Glaucoma surgeries were associated with a lower acute POE incidence compared with phacoemulsification, conversely to vitreoretinal surgical procedures: IRR 0.63 (0.47 to 0.85; p<0.001) and IRR 1.78 (1.58 to 2.01; p<0.001), respectively.CONCLUSION:A higher incidence of acute POE after combined cataract surgery than after cataract surgery done as a stand-alone procedure was observed based on the French nationwide medical-administrative database. The incidence of acute POE after combined surgery was related to the type of surgery performed simultaneously with cataract extraction