Health Telematics (AIM) Final Report


	Updated: Feb 1, 97
ISAR

Integrated Systems Architecture

Project Code: A2052

Project value: 1676 KECU

EC contribution: 1352 KECU

No of partners: 12

No of countries: 5

Duration: 24 months

Contact:
Prof. Regis Beuscart
DIM, CHRU de Lille
Rez de Jardin
Hôpital Calmette
2 av. Oscar Lambret
F-59037 Lille Cedex, France
Tel.: 33-20-44.60.38
Fax: 33-20-44.69.45

Overview

ISAR is a project launched in December 1993 to integrate six clinical prototypes from the AIM Third Framework Programme on the HIS of the Regional and University Hospitals of Lille (CHRU). The goal in ISAR is to demonstrate that products resulting from the AIM programme can be used to support clinical activities although they were developed in other environments, and in other perspectives: these products can be integrated in the daily operation of the already installed HIS.

Purpose and objectives

ISAR originated from the decision of customers and users (i.e. the Management of the hospital and several clinical departments) to exploit AIM prototypes in their daily work, as a mean to achieve the strategy of the hospital. The CHRU de Lille (University Hospital) was currently developing and installing an integrated Hospital Information System among the 9 hospitals on its campus. This HIS provides clinicians with basic software applications, including communication facilities, Common Patient Minimum Record, and telecommunication possibilities. These Telecom capabilities are currently used with several Hospitals of the region Nord Pas-de-Calais and Picardie, in Northern France (CIFASSIH & TELECHO projects).

The local hospital information system responds to the fundamental management needs of the medical and administrative users. On top of the basic services provided by the HIS, specific clinical activities have been supported by dedicated telematic systems.

The technical integration of the AIM prototypes on the HIS platform of the hospital is subordinated to the "change for improvement policy" of the hospital management and of the host clinical departments (framework-based approach). The choice between different computer applications has been made according to the importance of the domain and the strategy of the hospital.

The specific objectives of the ISAR project were:

To integrate six AIM prototypes in the daily practice of the clinical departments (medical functional integration) and on the HIS platform of the CHRU (communication, technical and functional integration): the prototypes are from ESTEEM, EURIPACS, MENELAS, OEDIPE, OPADE and the mobile workstation from TANIT.
To evaluate the results of the integration process, making use of the methodology proposed by KAVAS-2.
To develop and propose to the AIM community and to Health Authorities guidelines for integrating medical telematic projects on (existing) Hospital Information and Communication Systems.

The AIM prototypes are used as tools to support the following clinical activities:

The integration of neuro-physiological tests in clinical neurology
The fast communication of medical images in emergency situation (neuro-surgery for cerebral vascular diseases) and the creation of complete PACS
The extraction of useful medical information out of (coronary) patient discharge summaries
The follow-up of heart transplants as a prelude to the follow-up of other chronic cardiac pathologies
The use of intelligent support tools for drug prescription
The mobile collection and the integration of preoperative data in comprehensive anaesthesia records
Demonstrate the usability, in daily clinical practice, of prototypes resulting from the AIM Programme.
Demonstrate the acceptance of the AIM products by the clinical users
Demonstrate the interest of a hospital authority for AIM products and their compatibility with the hospital strategy.
Realise the technical integration of heterogeneous AIM prototypes with a proprietary HIS and with legacy information services / products in the clinical departments.
Realise the convergence of information products focusing on the enhancement of personal productivity (as stand alone systems), and products covering communication aspects of medical / managerial data for the complete hospital organisation (HIS).
Work out a comprehensive approach that can be used as guidelines for the integration process of foreign information services / products in the clinical processes of any hospital".

Results

ISAR is an experimental project based on a systematic methodology.

The human interaction perspective: Interactive human dynamics to develop the project (called the "alignment process") i.e. generate information, elaborate solutions, co-ordinate tasks, reach consensus, get commitments, clear risk factors ...

The technical integration of the AIM prototypes on the HIS platform of the hospital is subordinated to the policy and to the organisation of the clinical departments and of the hospital as a whole. Are involved: the manager of the hospital, individual clinicians and work teams, clinical department managers, legacy information services suppliers, HIS platform developers, telematic suppliers, AIM prototype developers ...

The information perspective: it is the logical information structure of the project; is sequential build-up and is representation as a construct made up of several components: current system analysis (including the analysis of the work organisation in the clinical departments and of the offer / requirements of the AIM prototypes), scoping and framework, target system analysis, requirements specifications in terms of data model, process model, integration data exchange, architecture design, ....

Both perspectives are supported by methods, tools and focal activities. The KAVAS evaluation methodology has been adapted to the specific integration issues in ISAR.

The confrontation of this approach with the actual results obtained is the basis for establishing integration guidelines.

The core of the ISAR activity is the management of the changes triggered in the clinical departments by the opportunities raised by 6 AIM prototypes that are heterogeneous and were developed in different countries. The integration is functional, as the AIM products become part of the daily practice of the clinical departments and are put in line with the strategical perspective of the hospital management. The integration is also technical, as the AIM products are connected to the HIS and used as active components.

The impact of the work can be summarised as:

Improvement of the HIS functionalities for facilitating the AIM platforms' integration
Adding value to an existing HIS & combining legacy information services with new information services / products
Opening a proprietary HIS to stand alone products developed for the support of focused activities
AIM platforms are made more universal and integratable: confronted to the users needs and expectations, some of them were modified or improved, in order to be adapted to the organisation of work. This adds value to the AIM programme.
Evaluation methodology is adapted to the integration process
Generic solutions for integration are produced to take into account the user needs, the HIS rigidity (security, coherence of common applications...), the platforms specificity, the standards, the impact for the organisation.
Practical guidelines to combine organisational changes, changes in clinical processes, and new information services

List of Deliverables

Year 1

Evaluation of the AIM Projects to be integrated and Agreement on detailed objectives
Specification for on-site integration of the AIM Projects
Methodology for assessment of the Integration process
Integration of clinical projects, 1st part: demonstrator and description of achievements

Year 2

Integration of clinical projects, 2nd part: demonstrator and description of achievements
General guidelines for the integration of applications
Guidelines for the inclusion of Projects in the regional tele-medicine network
Evaluation of the integration exercise: technical, user and clinical aspects

Year 3

Final report

List of Participants

Mr François Grateau Centre Hospitalier Régional de Lille 2 av. Oscar Lambret F-59037 Lille Cedex, France Tel.: +33-20-44.41.43 Fax: +33-20-52.39.64	Prof. Pedro Barahona Uninova Campus da FCT/UNL Monte da Caparica P-2825 Lisboa, Portugal Tel.: +351-1-295.32.20 Fax: +351-1-295.56.41
Mr Bijan Modjeddi Digital Equipment Europe 2 rue Gaston Cremieux PO Box 136 F-91004 Evry Cedex, France Tel.: +33-2-729.82.86 Fax: +33-2-244.82.03	Dr. Michel Demeester Premium S.A. 8 rue E. Guirsch B-1390 Grez-Doiceau, Belgium Tel.: +32-10-84.55.19 Fax: +32-10-84.25.67
Dr. Mario Veloso Hospital de Egas Moniz (HEM) 126 rua da Jungueira, P-1300 Lisboa, Portugal Tel.: +351-1-362.00.50 Fax: +351-1-363.34.09 Mr R. Mattheus Free Univ. of Brussels (VUB) 2 Pleinlaan B-1020 Brussels, Belgium Tel.: +32-2-466.22.84 Fax: +32-2-463.17.06 Prof. LeBeux Lab. d'Informatique Médicale Faculté de Médecine (LIM) 2 av. du Pr. Léon Bernard F-35043 Rennes Cédex, France Prof. Paul Rubel INSERM U 121 Hôpital de Cardiologie BP Lyon-Montchat F-69394 Lyon Cedex 03, France Tel.: +33-72-35.73.72 Fax: +33-72-34.18.76	Univ. Politecnica de Madrid, TEB S/N Ciudad Universitaria E-28040 Madrid, Spain Tel.: +34-1-336.73.08 Fax: +34-1-336.73.19 Mr Jytte Brender Medical Informatic Lab. ApS (MIL) 33d Steengaards Alle DK-2800 Lyngby, Denmark Tel.: +45-42-88.55.98 Fax: +45-42-88.00.45 Prof. Régis Beuscart CERIM Faculté de Médicine 1 Place de Verdun F-59045 Lille Cedex, France Tel.: +33-20-62.69.70 Fax: +33-20-52.10.22 Prof. Alain Venot ECLIMED 27 rue du Faubourg St. Jacqques F-75676 Paris, France Tel.: +33-1-43.29.20.19 / 42.34.13.81 Fax: +33-1-43.29.49.89 / 43.29.38.60

[ ISAR-T (4 FW, 1994-1998) ]



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