The sars-cov-2 an accelerator of e-health startups !!!

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Chapter I Lifen from Honestica confirms.

Since September 2016 in artbzen.com we have been announcing for sure and with confidence the disruption of our reshaped society as we liked to predict it through NICTs. We weren't a soothsayer but we liked to look around. The example of Estonia became our almost favorite model. A conversation with Madame Kadi Metsandi attached to the Estonian Embassy in Paris, our Estonian e-resident card in my pocket and everything was possible. (1-3)

For the past 3 years, we had the impression that this did not advance in the image of what we hoped for. However, many specialists from the medical world or the web had taken the plunge, and initiatives were numerous. Numerous health applications were emerging and starting to educate this world of health which had lagged behind other sectors of the tertiary sector. Specialists in NICTs, new mathematics (cognitive and others) have started to revolutionize the relationships between medical researchers and data scientists (Jérôme Pesenti at Benevolent (4))

Others after having left their mark on the rise of digital marketing had decided to clear this last non-"data driven" sector which was the world of health. And it was a great meeting with Franck le Ouay who explained to us on March 23, 2017 why and how he had decided to invest in this sector which is not very open to NICTs. (5) The rereading of this interview also shows that our internet champion at the time seemed to be stepping on eggs in this very cautious medical world to change its mode of operation and communication, this being in total opposition with these professionals in permanent training, constantly questioning the medical dogmas taught the day before!

So there was still a real thrill and even hope and optimism in this new intervention by Franck Le Ouay in our columns on Dec. 20. 2018 in this post "The future of health in 2030 seen by Franck Le Ouay CEO of Lifen" (6).

But nothing was won in advance and in "Some reflections on the digitization of health: the shared medical file (DMP), and messaging (Apicrypt, MSSanté)" (7), J'écrais Le 01 sept 2017: “It is a pity that nobody is considering a network allowing the communication and the routing of confidential data between all the actors of the healthcare system. It would be time to think about providing the public with their own secure email address… ”

This is why we are delighted to be able to start this new column (e-health and covid19), to once again highlight Lifen whose designers must already have had some advance algorithms at the time and which they can now draw …

Indeed a few years ago a certain number of elements seemed to be in place:

– MSsanté encrypted messaging which strengthened the Apicrypt system allowing public and private doctors, analysis laboratories, pathologists … to communicate easily and directly about their patients.

-The real Arlesian Shared Medical File of communication certainly between doctors but also theoretically between doctors and patients. But after spending probably over a billion euros, the gas plant still doesn't work in reality.

These two pillars were necessary (but not sufficient) to build e-health. But as we regretted at the time, the patient, given the failure of the DMP, was still not in the mouth of the exchange of documents concerning his health.

Yet we did not stop chanting that e-health was a factor of democracy with a citizen actor taking control of his destiny in care and even more in the field of prevention! (Empowerment, Quantified self … were the magic words).

And here comes this microscopic enemy who in a few weeks has destroyed communications and the possibilities of movement of men. Physical contact having become synonymous with potentially major risk, a crisis unprecedented since the 1918-1919 flu !!

Physical contact is suppressed by emergency laws, necessary given the circumstances.

But this business of human contact was one of my Leitmotifs in my posts and even in my continuing medical education (CPD). We claimed that e-health improved the contact between the doctor and the patient, the latter not only benefiting from a single quarter of an hour head to head with his therapist, head to head often provided a little arbitrarily to advance in the rigidity of monitoring protocols, but on the contrary with some APPs virtual contact became permanent with possibilities of face-to-face consultation when the “intelligent” APP detected the need.

The example we cited in 2016 was the application developed by Dr Fabrice Denis and his team (8) which concerned the care of patients with bronchial pulmonary cancer. In this application the patient had to answer each week on his Smartphone, to 10 basic questions, (weight, appetite, fatigue, pain, cough, shortness of breath, depression, fever, blood in the sputum), the follow-up is completed according to the triggering responses if necessary, consultation and additional examinations which are no longer systematic.

The study shows a marked improvement in the quality of life of patients and even an increase in the latter. The decrease in the number of control scanners is even spectacular.

Among other smart health connected solutions, this application was a promise of considerable progress for us and we dreamed of a universal APP that would envelop the patient by optimizing their care pathway and their own preventive actions.

But at the very least, the proof was made that digital created a link

Since this APP, many companies have effectively developed digital solutions for patient care, public hospitals and can be more often private make their patients benefit as well in surgical medical specialties or around maternity.

But given the ever more or less easy possibility of direct contact with his doctors, the public was a little shy about these proposed changes in habits.

And patatras here is the appearance of this invisible poison.

While I had to abandon my tele-consultation contract contracted over a year ago, for lack of motivated patient, (it is true that my specialty of general surgery was absent at the time of this type of practice,) , all of a sudden, patients worried about their health, but even more worried about this ubiquitous virus, no longer want to walk through the door.

Here is a new start for this very useful tele-consultation to control, there a post op scar, there a chronic wound and there to take stock of a more or less complex pathological situation requiring information, explanations and above all patient support for the shed light on its foreseeable future, everything possible by word and image through a dedicated and secure application.

Indeed, a "good teleconsultation" in my specialty may require only a correct image and sound, without dedicated application, and more or less complex.

But for the suspect patients or carriers of our micrometric adversary, it was necessary to make a specifically dedicated weapon.

On the basis of its well-oiled know-how of exchanges between health professionals recently enriched by this facility of sending documents directly to patients, it became possible to adapt the Lifen solution to the remote management of the patient covid +

It is the Grand Est which benefits from the Lifen Covid application to "reduce contact with healthcare professionals, and therefore the risk of contamination", to absorb the flow of patients and optimize city-hospital coordination. By helping to combat the saturation of hospital structures. The idea is to reserve hospital places for the patient who really needs them and to keep patients who are less seriously affected or under simple surveillance at health home. But on condition of offering them a real reassuring remote monitoring device:

Space Covid19 lifen city medicine

With the APP, healthcare establishments and doctors can include patients carrying COVID19 on the platform by completing a quick questionnaire with contact information, comorbidities and COVID-19 symptoms. Once the follow-up is activated, the patient will receive a daily questionnaire inviting him to inform the evolution of his symptoms in a secure space. The platform centralizes all the responses and makes it possible to classify patients by order of severity. As a result, healthcare teams can focus on patients who need immediate care. Continuity of patient monitoring will be greatly facilitated, as shown by the following scenarios:

A patient diagnosed in hospital who does not require hospital care may be confined

at health home and "handed over" to the supervision of his attending physician with the use of the Lifen covid application, allowing doctor / patient and doctor / hospital communication with a possible and scheduled return of the patient to the hospital if necessary, but safely and at the right time (neither too early nor too late!).

A patient diagnosed by his general practitioner and requiring hospitalization, can be transferred immediately to the health establishment through the APP and secondarily returned to the "care" of his doctor after improvement.

A non-worrying patient diagnosed by his general practitioner remains under his supervision, the latter being able to be delegated to another doctor.

These medical principles are predefined and co-designed with the teams of Professor Ravaud, Epidemiologist Inserm umr1153.

In addition, the solution is based on Lifen's knowledge, in accordance with the need to secure data.

In practice, communication is done through a questionnaire sent by the doctor on the patient's Smartphone, which easily enters their answers. There is thus daily surveillance of the disease, with the possibility of triggering an optimal hospitalization, for example, without prior travel. patient or doctor.

Visit the space covid19.lifen.com

In my opinion, this device, added to all the others, (primary care doctors, SOS doctors type services, center 15, SAMU, firefighters, etc.) must allow relief in hospital services in very stressed areas, it must also allow to optimize by accompanying them the rules of containment (social and intra-family distancing), in the other zones it should participate in reducing the possibilities of contamination and therefore perhaps participate more quickly in the reduction of confinement.

Lifen covid must improve the course of the suspect or infected patient from the diagnosis phase, from surveillance under confinement, to trigger hospitalization, and I insist, at the most medically appropriate time for the patient, finally Lifen Covid allows "Recover" at health home a convalescent patient, who thus remains in continuous digital contact with his primary care doctor and or the hospital.

As with other applications, this system can be effective for older people through caregivers.

Lessons will need to be learned after the crisis from the impact of areas of poor telephone and internet coverage and individual sub-equipment.

By analogy and concerning the exchanges of mail by post, we saw that they were no longer as reliable today, this should convert the last septic tanks to resort to secure dematerialization and by extension to the APPs of e-health in general.

But what will the future invent for us, another type of crisis with piracy and a blackout on digital transmissions? And we will accuse politicians of not having foreseen it …

The mask problem could hide another…

1 Estonian Chronicle – Introduction

2 Estonian Chronicle Chapter II

3 Walk in E-stonie

4 Artificial intelligence mobilizes against Alzheimer's disease interview with Jérôme Pesenti

5 Dematerialization of the firm's letters – interview with Franck le Ouay – reflection on the digitization of relationships between doctors

6 The future of health in 2030 seen by Franck le Ouay ceo de lifen

7 Some thoughts on the digitization of health the shared medical file DMP and messaging apicrypt mssante

8 Denis F, Lethrosne C, Pourel N, et al. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients (published correction appears in J Natl Cancer Inst. 2018 Apr 1; ​​110 (4): 436). J Natl Cancer Inst. 2017; 109 (9): 10.1093 / jnci / djx029. doi: 10.1093 / jnci / djx029

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