FR2826477A1 - INTEGRATED SYSTEM FOR COLLECTING MEDICO-SOCIAL DATA - Google Patents

Abstract

The invention relates to an integrated data collection system consisting of: a platform comprising means that provide secure access to hosted application services; at least one shared medical file incorporating the medico-social data and which is designed to organise said data in a semi-quantitative form according to (i) time and involvement of professionals and (ii) the social situation and pathologies; means for accessing said file by means of the Internet and/or using a file management software program; means for the client to update said file and display means; an XFS application server which is equipped with medical file storage means and means providing secure access to said files from different terminals. Said server can: link certain XML tags to one another in order to catenate the necessary items to the monitoring of patients over time; mark each datum by the date of occurrence in order to allow a factual display of the monitoring of said patients; and automatically to open a new patient follow-up with each pathology report. The invention is suitable for use by health professionals.

Description

<Desc / Clms Page number 1>

 The present invention relates to an integrated system for collecting medico-social data. It is dedicated to health professionals working in the medical and social fields. It aims to facilitate the collection of medico-social information of people and the understanding of their evolution over time.

 The invention lies in the field of information sharing, interdisciplinary and interprofessional cooperative work.

 The computerized management of health professions is developing rapidly in France. In particular, the need to have appropriate equipment to transmit care sheets to the Health Insurance has accelerated this phenomenon.

 In the field of health, it is no longer possible to consider isolated individual work in a firm. The quality of care depends on the ability to quickly share information between professionals in the medical, paramedical and social fields. The social situation plays a very important role in access to care and adherence to treatment.

 The patients, themselves, claim access to the data contained in their medical records.

 To respond to this evolution, many management systems have been developed. They come in two different forms: - Or they want to meet the needs of a general practitioner or specialist. They are inspired by the structure of traditional medical records. Around a nucleus constituted by a collection of information in free text, come to gather complementary services (prescriptions, mail, results of medical examinations).

 - Or they want to meet the needs of a group of professionals working in a network. The information is then selected according to a particular pathology. Access is often possible for medical and paramedical professionals. These systems are not compatible with previous systems.

 No integrated system exists in the medical and paramedical fields capable of responding to both of these types of needs. It follows from this observation that this deficit also exists for the social domain and the direct access of patients to these data.

 The known systems have many disadvantages: - software limited to the medical field does not give sufficient space to the social dimension, - incompatibility between the office management systems and systems developed to meet the needs of networks, - difficulty to visualize and, therefore, to understand, the evolution of the various diseases and the relations existing on the one hand between them and on the other hand with the social field,

<Desc / Clms Page number 2>

 - impossibility for the patients to have access to the data contained in their medical file.

 The aim of the invention is to describe the structure of an integrated system for collecting medico-social data and the tools necessary for its multiprofessional and multidisciplinary use as well as by the sick people (storage on a server, access rights, secure transmission and storage).

 For this purpose, the invention proposes an integrated system for collecting medico-social data, remarkable in that it comprises: a platform comprising means of secure access to various hosted business application services; a medical file; shared data integrating medico-social data, able to organize these data in semi-quantitative form based, on the one hand, the time and interventions of professionals, and, secondly, the social situation and pathologies, - means for accessing said file via the Internet and / or by a file management software, - means for viewing and updating said file by a client, - an "XFS" application server equipped with storage means medical files and means for securely accessing said files from different terminals, said server being able to link certain XML tags between them to string together items necessary for the follow-up of people who are ill. over time, to mark each data by the date of occurrence to allow an event visualization of the follow-up of the said sick persons, and to automatically open a new follow-up to each pathology declaration.

- il s'inscrit dans la durée car il couvre la totalité de la vie de la personne malade. The integrated system for collecting medico-social data according to the invention has many advantages:

- it is long-lasting because it covers the entire life of the sick person.

- the data are grouped by fields: * Identifier, * Social, * Medical, itself divided by present or potential pathologies (risky behaviors that justify prevention, family history that require interventions), - each intervention is characterized by its date , the nature of the professional consulted, his motive, the situation at the time of the intervention and the decision making (orientation, prescriptions).

 - the data are stored in semi-quantitative form corresponding to either recognized standards or, in their absence, in a form corresponding to a specific specification. The results of the biological examinations can be integrated directly.

<Desc / Clms Page number 3>

 This structuring allows: - at the level of the medical file: * to define access rights according to the profession of each stakeholder, * a visualization and modifications apart from any proprietary software present on the computer of the professional or the sick person, * original presentations crossing the data between them by involving the temporal dimension, representing them in the form of graphs, ..., They offer a synthetic vision of the evolution of the person (social situation, physical state, disease ). For example, a new worker can very quickly become aware of the nature, evolution and treatment of a disease. The same is true of social evolution. It also makes it possible to reconcile medical data with each other or medical and social data.

 - at the server level: * to use the files to study transversally the characteristics of the population followed by the professionals or longitudinally the evolution of the diseases and the impact of the treatments.

This novel approach can complement the information obtained in randomized clinical trials by comparing them with the results observed in the general population, * using the files to make referrals directed to the professionals or to the sick people themselves. These recommendations appear when the files are opened when they are useful, * to use the files to measure the impact of the training actions intended to modify the practices,
The main objectives of a health network are to facilitate access to care for users and to help health professionals in their care and prevention mission. Taking into account the highly innovative nature of the NICT (New Information and Communication Technologies) approach, an experimental phase on a favorable ground (the GT 69 network on the city of LYON, a member of the CNR) is performed.

 After the identification of the requirements of the GT 69 network (generalizable to all the networks as well as professionals working together outside a formalized network), the needs were prioritized to define the solution to deploy to the "pilot" users of GT69 ". The provision of a shared medical and social file accessible to all professionals working in the field of health as well as to the sick appeared as one of the priorities of all the persons who were the subject of the investigation. .

 The implementation of the integrated system for collecting medico-social data, object of the invention, is based in this context on the exploitation

<Desc / Clms Page number 4>

 an "XFS" server which will be described in detail later. This server renders services comparable to those of a relational DBMS, but with XML documents: definition of user accounts, storage of documents in a transparent manner for the user, management of access to documents according to precise rules, search for documents based on certain criteria, execution of transactional queries.

 Relative to a relational model, the adoption of the XML format to represent the data makes it possible moreover to efficiently arbitrate the write accesses to the different parts of a document, to fix very finely access rights, at any level of the XML tree, to associate binary files with documents, and to give direct access to the server to a wide range of platforms and client software.

 The following description with reference to the accompanying drawings, given as non-limiting examples, will make it clear what the invention consists of and how it can be achieved.

 Figure 1 is a general diagram of the integrated service system according to the invention.

 FIG. 2 is a diagram illustrating the exchanges between the server of FIG. 1 with a client station.

 Figure 3 shows various client stations according to their pathology.

 Figure 4 is a diagram of evolution of the tree in time in a server of the prior art.

 Figure 5 is a filter scheme according to the access rights in a server of the prior art.

 FIG. 6 is an excerpt from a medical-social file obtained by means of the integrated data collection system in accordance with the invention.

 The main technical elements constituting the integrated medico-social data collection system consist of: - a shared file integrating medico-social data It structures these data in semi-quantitative form according to a part of the time and interventions of professionals and on the other hand the social situation and pathologies. It can be viewed and updated either by a thin client accessible directly via the internet or by a heavy client integrated with a medical file management software, - a platform allowing to securely access various hosted business application services. ; an application server "XFS" storing medical-social files and allowing their secure access from different terminals. This server serves as support for several experiments and developments. To allow the relevant use of the integrated system, object of the present invention, software developments are made, allowing: * to link certain XML tags between them for the sequence of items necessary to follow the sick people over time, * a marking each datum by the date of occurrence in order to allow event visualization of the patient's follow-up,

<Desc / Clms Page number 5>

 * the automatic opening of a new follow-up to each pathology declaration.

 Figure 6 shows an excerpt from a medical file obtained by means of the integrated data collection system according to the invention.

 The XFS server implemented in the invention will now be described in detail.

 The proposed server, shown in FIG. 1, is a document server in XML format intended to allow the sharing of these documents by a set of users. This server, called XFS (XML File Server), is at the center of a classic client-server architecture, namely an accessible central server, via a network of any type, by client computers.

 The server renders services comparable to those of a relational DBMS, but with XML documents: - definition of user accounts, - storage of documents in a transparent manner for the user, - management of access to documents according to precise rules - search for documents on the basis of certain criteria (but in a very limited way compared to a relational DBMS, the objective being the sharing of documents and not the search for information), - execution of transactional queries.

 Relative to a relational model, the adoption of the XML format to represent the data allows us, moreover: - to arbitrate effectively write accesses to the different parts of a document, - to fix very finely access rights , at any level of the XML tree, - to associate binary files to documents, - to give direct access to the server to a wide range of platforms and client software.

 The goal is to be able to provide all these services by minimizing constraints on hosted XML documents and making the server independent of the processed data.

 To allow access to the server for a wide variety of clients, the protocol for invoking server functions is simplified to a minimum. The options chosen are: - requests independent of each other (no notion of session), - transactional operation (a request is either canceled or executed in full), - except for the description of the attached files, a purely ASCII format for queries (as in SQL) and, moreover, of XML type, as for the documents handled.

 The invocation of functions through XML requests joins the principle of SOAP protocol (Simple Object Access Protocol). However,

<Desc / Clms Page number 6>

 Much simpler and more specific formulation of XML document processing has been adopted. Unless the client requests a binary file associated with a document, the server also responds with an XML message.

 Figure 2 illustrates the principle of the client-server dialogue in XML.

The envelope represents the communication protocol whose nature is of little importance. In practice, the http protocol has been retained, since it is now available on a large number of client computers.

 Any software able to communicate in XML with the server, according to the appropriate communication protocol (HTTP, ...), can a priori play the role of client. To allow direct access to the server (that is, without intermediate software) from thin browsers such as HTML or WML browsers, a mechanism for transforming the XML response using style sheets has been integrated to the server.

 The simplicity of server access and the ability to apply style sheets lead to a wide range of potential customers, as shown in Figure 3.

 In order to validate the concepts developed and their possible application in tele-medicine, we have modeled a client software of each type.

 There are a number of concepts or products that have points in common with the system we offer: - Simple Object Access Protocol (SOAP): this protocol allows you to perform functions remotely. Compared to other protocols used in distributed computing (RMI, CORBA, DCOM ...), it is characterized by an exchange of messages in XML format.

 - XML-compatible relational DBMSs: Many relational DBMS vendors provide open XML. Storage remains in relational (or object-oriented) form, XML is only used as an exchange or query format, not storage.

The advantage of the relational model lies in the ability to handle complex queries.

 - XML DBMS: in this case, the documents are well stored in XML.

 - Query languages in XML (search for information or update).

 Nevertheless, the existing XML servers have essentially been designed to facilitate the search for information on the basis of any criteria (as for relational DBMS) and not for the purpose of sharing XML documents and managing access rights in these documents.

 However, in the latter case, XQL and related query languages (XUpdate, SXQL, etc.) do not seem to be very suitable, since the designation of the tags is based on a description of paths in the XML tree. . The problem lies in the fact that this tree is constantly evolving in a multi-user context (adding or deleting subtrees by different users) and depends

<Desc / Clms Page number 7>

 access rights (two users may not have the same view of the same document on the server).

< B > 2 < /B > alors qu'il modifie en réalité la balise < B > 3 < /B > . A first type of inconvenience concerning the evolution of the tree in time is shown in Figure 4. A document on the server is simultaneously read by three users and then updated by them with the help of a XUpdate type syntax. Although there is no error generated, it is noted that the user number 3 believes to modify the tag

<B> 2 </ B> while actually modifying the <B> 3 </ B> tag.

 A second drawback relating to the effect of the filtering as a function of access rights is shown in FIG. 5. In this simple example, the read access rights are signified by an Access attribute. It is easy to understand that the designation of the tags by a path is difficult in this case, especially as the access rights can themselves change over time.

 As already mentioned above, the main purpose is to share XML documents and not to search for information in these documents. On the two examples of the preceding paragraph, it is thus expected that the updates made by the different users will be made without ambiguity. In other words, the server must effectively manage access competition and access rights at any level of the XML tree. In particular, we want to allow users to work simultaneously on different tags of the same document.

 To enable efficient sharing of documents, there is provision for a unique and systematic labeling by the server of all the tags of the documents. This approach makes the documents larger but leads to a concise and unambiguous expression of change requests.

 This original designation technique has been associated with a simple versioning mechanism. Each user indicates the version of the document that he has, which enables the server, by comparison with version numbers associated with each tag on the common document, to arbitrate the access competition.

 As far as access rights are concerned, the XML tag hierarchy lends itself well to rights expression in the form of attributes.

 It is therefore clear that the solutions offered at these different levels are very naturally integrated into a new query language in XML format, which is simple, efficient and capable of encompassing many useful features on an XML document server. (association of files with documents, administration of accounts, notion of domain, application of style sheets ...).

 XFS server developments were motivated by a telemedicine application aimed at sharing patient medical records among a range of health professionals. In this area, access rights management features are particularly

<Desc / Clms Page number 8>

 helpful. In addition, the sharing of medical information seems to meet a very real need.

 The implementation of the invention requires the following elements: * at the hardware level: - a server computer - a network - one or more client stations * at the software level: - an XFS server - an HTTP server with interface support CGI - for thin clients: the client software to download (HTML, WML, Javascript, WMLScript pages ...) * on the client: - heavy client: client software - thin client: HTML or WML browser.

Claims (1)

CLAIM An integrated medico-social data collection system, characterized in that it comprises: a platform comprising means of secure access to various hosted business application services; a shared medical file integrating the medico-social data; , able to organize said data in semi-quantitative form based on, on the one hand, the time and interventions of professionals, and, on the other hand, the social situation and pathologies, - means of access to said file by the Internet and / or by a file management software, - means for viewing and updating said file by a client, - an "XFS" application server provided with means for storing the medical files and the means for storing the file. secure access to said files from different terminals, said server being able to link some XML tags between them to string together items necessary for tracking people who are sick in the long term, to mark each e given by the date of occurrence to allow an event visualization of the follow-up of the said sick persons, and to automatically open a new follow-up to each pathology declaration.