a decision support tool tested at GHT Novo (Val-d'Oise)

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So-log, domiciled in Bordeaux, was created in 2015 by Edouard Devaud, who was not yet president of the CME of CH com Pontoise (GHT support establishment) but worked there as a practitioner in internal medicine and infectiology since 1997, and by a computer scientist, Souvanxay Sphabmixay.

"Since I started practicing medicine, I realize that there are big organizational problems and patient flow and that one of the solutions is relevance," said Edouard Devaud during '' an interview with APMnews (information site of the APM International group, of which TICsanté is a part), estimating from local surveys around 30% the irrelevant admissions and days of hospitalization each day.

For him, reducing irrelevancy must make it possible to "free up clogged capacity", to improve the quality of care for patients by reducing the length of stay and therefore the morbidity linked to the stay.

While the subject of relevance has been on the table for several years, he believes that at the time of the creation of his start-up, the only existing solution, proposed by the Canadian company Medworxx, was not suitable because very Anglo-Saxon reasoning criteria and the obligation to fill in additional software.

Souvanxay Sphabmixay then embarked on the development of rules engines based on relevance criteria for admissions and hospital days of the High Authority for Health (HAS), based on the French version of the Appropriateness Evaluation Protocol (AEPf).

The idea was to integrate the tool directly into the DPI so that it is "almost invisible" for practitioners and that filling it does not require additional time.

"As the practitioner enriches the medical file, there is a word cloud in certain boxes of the DPI which is being organized" and "when the practitioner is going to validate his file", the analysis engine tells him indicates whether or not hospitalization is relevant based on the criteria entered, explained Edouard Devaud. "The practitioner remains in control of his decision, it is a decision aid."

Similarly for days of hospitalization, if the average length of stay (MDS) for the pathology is reached, the tool analyzes the data provided, looks for reasons for the fact that the patient remains (waiting for imaging exam. ..) and indicates whether it is relevant or not to keep the patient hospitalized.

The co-founders nevertheless provided for the possibility of not following the notice by justifying an irrelevant hospital stay or length of stay. The practitioner sees the message of irrelevancy appear and is asked if he wants to justify hospitalization from a list of criteria.

"We have made a completely configurable tool that can be adapted to the internal rules of the medical communities" and be enriched by the results of working groups on relevance, underlined Edouard Devaud.

The tool, designed in a modular way, will first of all relate to the relevance of admissions and that of hospital days, then in a second step will address biology (relevance of the examination and relevance of the redundancy of the examinations).

GHT support needed

Alone, the start-up (€ 7,000 of capital) is likely to "hit a wall" by going "to see big industrial behemoths" in order to present their solution to help doctors in terms of relevance, observed the director of GHT establishments.

"The weight of the public establishment and especially of a GHT which is beginning to have this size and (…) is looking for a DPI for the complete GHT, it helps that the industrial CEO of computer software you listen and tell you 'maybe I can help you try an experiment' ", underlined Alexandre Aubert.

On the occasion of the transition in common direction of the 3 establishments of the GHT, it was indeed decided to opt for a single digital solution (against 4 previously for the DPI), which gave weight to the negotiations, added Edouard Devaud.

In 2017, DXCare from Dedalus France (ex-Medasys) was chosen by the GHT.

The So-log tool was tested in standalone mode and installed in August 2019 on the servers. The founders are still fixing bugs and are now waiting to have access to the production base. "A priori in early 2020, it should be implemented," noted Edouard Devaud.

The solution will first be installed in the emergency room and in the emergency downstream unit of the Pontoise hospital, of which Edouard Devaud is department head. It could be deployed to the Carnelle-Portes com l'Oise hospital group (GHCPO, Beaumont-sur-Oise, Saint-Martin du Tertre and Méru) in the second half of 2020.

In 2016, by the time Alexandre Aubert arrived at the head of the Pontoise hospital, Edouard Devaud was ready to go into the private sector, finding it too difficult to move the hospital, but he changed his mind in particular because of listening to the new director and supporting his project, said the two hospital staff at the FHF Ile-com-France congress.

For the hospital director, working with a doctor from his establishment enabled him to commit confidently to the project. He was doing a "double blow" because at the same time, he found internally the start-up who could help him and he became "attractive" to the doctor.

The start-up, which is part of the Tech care incubator, also brings its agility and creativity. "The hospital is limited by its inertia and its capacity for creation is hampered by entangled interests which prevent it from taking risks in investments," observed Edouard Devaud.

For So-log, the Pontoise hospital is a development site and the start-up does not charge it for the solution. It is in discussion with another Ile-com-France establishment to implement its solution.

The president of CME indicated that the heads of pole and the members of the CME were in favor of the tool but that there could be reluctance internally, in particular of the emergency doctors, because they have to remove the patients under their responsibility.

"You have to show that the principle is win-win", that there is a project larger than the tool itself, he explained.

According to him, emergency physicians can expect to find beds more easily to hospitalize their patients because on the one hand, there will be fewer irrelevant patients in the services and on the other hand, they will themselves have fewer of patients to be hospitalized.

The relevance rules are already in force in its emergency downstream unit, created in 2014, which has helped to reduce capacity tensions, with the exception of those that can take place during winter crises in a very targeted manner. These tensions are more frequent at the GHCPO (Beaumont-sur-Oise emergencies), which does not have an emergency downstream unit.

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