Igas points to "delayed convergence" of HIS in GHTs (report)

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This report, planned in the Igas work program for 2019, establishes a progress report on the implementation of GHTs, "at the time when the law of July 24, 2019 relating to the organization and transformation of the system plans a second phase of (their) deployment. "

The mission is based on two surveys, one addressed to regional health agencies (ARS), the other to GHTs (100% and 90% responses respectively), and conducted interviews in 12 regions.

"Hospital information systems (HIS) are characterized by the diversity of software used by establishments in the same GHT, whether medical or management IT. The GHT IS departments are created and but the ambitions for convergence are often limited to the interoperability of applications, for lack of consensus on a choice of common software and sufficient means to acquire it ", deplores the inspection in its report.

In terms of information systems, "95% of GHTs (114/120 responses) do not have a common patient IS within the group" and "a large majority of GHTs" even have between two and five patient SIs has been detailed.

The mission notes a great diversity within the GHTs, both for the choice of solutions and with regard to the chronologies of implementation. Regarding the convergence deadline, the range of responses also reflects uncertainties as to organizational and especially budgetary and financial feasibility.

"The information systems of healthcare establishments have been developed for several decades under a regime of autonomy of technological strategies and choices both in terms of infrastructure and in terms of applications," recalled the Igas.

Less than 40% of GHTs do not have interoperability tools, which leads to deduce "that about 80 GHTs currently have no possibility of sharing information", calculates the Igas. "This situation greatly penalizes cooperation and the pooling of medical resources," she regretted.

IS convergence too vague and expensive

While the decree implementing the health law of January 26, 2016 provided that GHTs equip themselves on January 1, 2018 with a common information system master plan (SDSI) to set the convergence path for their information systems, 10 GHTs responding to the IGAS survey declared that they had no not yet stopped their SDSI.

"However, 8 of these 10 GHTs say that it is being developed," said the inspection body in its report.

In a methodological guide published in July 2016, the DGOS noted, however, that "IS converging towards a single IS is essential to allow health professionals brought to intervene on several GHT sites to have, not only a transverse view of information of the patient record, but above all to benefit from a uniformity of software across the GHT, facilitating access to data and the use of tools on a daily basis. "

It seems however "that convergence remains a concept with contours still uncertain" and subject to interpretation, notes the Igas. Indispensable for coordinating medical practice at regional level, PGD seems to be a very distant objective in general.

"Thus, 19 GHT out of a workforce of 105 declare that the objective of a single DPI (computerized patient record) within the GHT is not part of the objectives of the SDSI," the report stressed. "This question of convergence, three years after it was listed as a priority target set for GHTs still seems to be the subject of interpretation."

Delays of 5 to 10 years are mentioned before the single DPI is adopted but – in addition to the eternal problems of interoperability – "the costs of infrastructure (network, data hosting), purchases and deployment of software are much higher than the "levers" funding that can be mobilized under the Hop'EN program, "pointed out the inspection.

Insufficient and poorly exploited DIM resources

As a reminder, the medical information departments (DIM) of health establishments are managed by a doctor responsible for medical information designated by the director of the support establishment. The practitioners send him the nominative medical data necessary for the analysis of the activity.

The progress report of the Igas underlines a "difficult emergence of IMGs" and expresses its "uncertainties as to the organizational feasibility and especially budgetary and financial".

"Regarding the organizational and IT environment of the DIMs, almost all of the GHTs responding to the Igas survey declare that they do not have an identical patient IS on the various member establishments (114 GHTs out of 121)", details The report.

"The presentation of an action plan concerning the exhaustiveness and the quality of the data is already a reality for 45 GHT while the piloting of medico-economic analyzes by the common DIM is for 43 GHT" , is it also reported.

Without the mission trying to verify it, the shortage of skills was mentioned in some GHTs as a brake on the development of the territory's DIM. The results cited above, without validating the hypothesis, however show an implementation of territorial DIMs whose progressiveness must accelerate to fully meet the objectives.

The Igas explains these figures by "a shortage of medical resources and a" reserve to collaborate between establishments ", as well as a" concentration of the activity of DIM teams on the coding of stays and external acts, to the detriment of their function quantitative and qualitative analysis of activity at the regional level ".

In addition, among the GHTs: 11 declare that they have a data warehouse when 77 have one planned, "which augurs a progressive ramp-up", welcomes the inspection.

Insufficient financial means

Budget pooling, also pointed out by the Igas.

It is "often limited to the G budget, the implementation of which still gives rise to tensions". The integrated finance departments "only seem to concern GHTs that are very advanced in the integrative model (mergers and joint departments)", the report underlines.

"The subject remains sensitive because touching on the autonomy of establishments", add the authors of the report noting "budgetary registrations far below the means actually devoted to pooling", and volumes still insignificant.

"Only 6 GHT out of 86 having answered this question reach or exceed 1% of all expenditure", specifies the Igas.

In its recommendations, the mission therefore recommended to the DGOS a more important but conditional financial support in this area for GHTs "without self-financing capacity and hampered in their development".

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