FR2878105A1 - Information platform for e.g. hospital, has server diffusing biological results in form of documents, and office automation and medical form server permitting to produce test reports and to communicate care tool with specialty files - Google Patents

Abstract

The platform has an imaging tool, a biology tool analyzing blood/urine and a care tool (3) allowing doctors and nurses to prescribe treatments and apply therapeutic plan. A communication module (4) transfers DICOM work list to a publication module (7). A server (5) diffuses biological results in form of documents. Office automation and medical form server (6) permits to produce test reports and communicate tool (3) with specialty files. An independent claim is also included for a method of managing and circulating digital documents.

Description

METHOD FOR AGGREGATING DOCUMENTS PUBLISHED BY THE

  The present invention relates to a technical platform for the circulation of medical information between different groups of users, with restrictions on access to certain information by certain groups of users and possibilities for incremental enrichment of the information by one or more users. several users, in a traceable way.

  The rapid flow of medical information within the hospital becomes a determining factor for the quality of medical practice. This information is mostly produced within specialized services that have "business" software. All or part of this information must be made accessible within the institution to authorized professionals who are responsible for taking care of the patient with whom this information is associated.

  The main problem lies in the establishment of a coherent "supply chain" of this "shared" patient file, based on a set of "application documents", derived from business tools or specialized publishing tools: it is a highly specialized environment, heterogeneous, variable according to the trades and in the same profession according to the cultural approaches of this or that hospital center. On the other hand, the consultation portal must allow a homogeneous vision of the patient's aggregated file, regardless of the production tool or publication tool, secure to preserve the rights of the patients and to guarantee the confidentiality of the information, obeying the big norms international medical devices, and robust to help maintain a consistent functioning of the portal whatever the information system malfunctions.

  The object of the present invention is to present an industrializable process making it possible to use heterogeneous market tools and publication tools - present in health establishments (hospitals or clinics, ES in the rest of the text) - to enable the implementation standardized, secure and robust implementation of an intranet and hospital city consultation portal In the state of the art, various platform solutions are known to facilitate the management of digital documents in a public health environment.

  The following patents show a part of the state of the art, to which the present invention aims to provide a technical improvement in terms of security of the aggregation of digital documents and management of these digital documents by different categories of users. .

  International Patent Application WO02067177 relates to a computer system for producing and maintaining an electronic medical record. The system includes a computer having a central processing unit, computer executable instructions for execution on the central processing unit, and an input device for entering medical record data into a computer. database of electronic medical records. This electronic health record database is in electronic communication with the central processing unit and stores and organizes data about a participant. The computerized system is also in electronic communication with an output device that provides access to the electronic health record database and the data stored therein.

  British Patent GB2385971 relates to the use of integrated health care files dedicated to specific patients, including information relating to the administration of health care to patients and information relating to the management of the administration of care. This type of file can be used as part of a health care system to facilitate management and provide proper care. The above two categories of information can be stored in one universal patient file, one file per patient, in the form of formatted data, links to formatted data, or selections from a single file. listing. The following three variants are distinguished: audit function, by recording any contact with the files as an audit trail; security function, with access control to the integrated file system; lock management, to control write access to this system. In another aspect, the invention provides an electronic health care information system, which includes a modular framework and a display function related thereto, for establishing a graphical user interface for users of the system. The framework encompasses a number of activities, each in a particular area of health care, and the framework can be adapted to additional activities for the implementation of a single integrated system. The graphical user interface can be adapted to display information that corresponds to one or more activities, with a common menu format for presenting the operations available in the interface and common visual components for presenting information to users of the system.

  Australian patent AU018696OA5 relates to a system for providing information related to public and private health via an open network. The system includes a server capable of communicating with the client equipment via the network. At least one database, accessible by the server, stores information related to public health, including health-related press reports and is intended for mass distribution. The database also stores definitions of different user groups, and information related to private health, including newsletters or specific forms of organizations, intended for dissemination only to members of user groups. The server provides public health information to any client device, but private health information is only provided to members of a group to which this private information applies. Users, and more particularly those in the medical and paramedical world, are encouraged to use the system insofar as it provides the user with general public press reports of general interest as well as specific information from a general public. organization. This makes the system more attractive to sponsors who wish to advertise online either to all users or to specific user groups.

  British patent GB0229681 relates to an integrated system that provides the patient with real-time, secure access to a health information system of a company's personnel and to personal health records. This access can be provided via the Internet and via a portal webpage dealing with personal health. From the Personal Health Portal secure web page, patients can view information created and updated by their practitioner. Patients can also request information and services from their practitioners, have direct access to the health information system of a company's staff, such as scheduling an appointment, paying an invoice, registering for a course, filling out insurance forms and so on, and viewing information and providing other services that relate to their particular state of health.

  International Patent Application WO0124038 relates to methods, apparatus, and computer-readable media for collecting health, medical, and state of the well-being information for establishing a client health profile. Medical and health information relating to a client is collected based on a health profile of that client. A service provider provides access to a health profile associated with that client and maintains that profile. This health profile has many events that reflect medical, health or client welfare characteristics. Client information based on this health profile is found in many external sources, such as web servers and file libraries, at predefined time intervals or at the request of the client. Relevant information is displayed on a user interface so that the customer can effectively evaluate that information. The health and medical profile of the client can, moreover, be modified by the user interface.

  International Patent Application W004051415 relates to a computerized method for integrating data into a medical flow process. The method includes receiving data related to a patient, initiating a computer search of data based on the received patient data, receiving the results of the computerized data search, and integrating the search results with the flow method. medical.

  International Patent Application W00195158 relates to a method and apparatus for managing and accessing information relating to a computer system. The method includes collecting information about the state of the computerized information monitoring system, translating the information into a user-friendly format, posting the user-friendly information on a customer-accessible medium, and allowing one or more clients to access the information. audit support. The invention also consists in generating a fault sheet for the problems related to the computerized system, in posting the said fault sheet to the support, in updating the status of the repairs in real time or in near real time, and finally in recording in a database said sheet and each additional state of the repair.

  International Patent Application WO004038560 relates, in embodiments, to systems and methods for managing clinical trials. A clinical trial management system includes a web client, a client, a server, and a patient registration database. The server offers several different applications that a user can run, depending on their role in the clinical trial process. These applications are divided into main and secondary components. In an exemplary embodiment, there are twenty-nine major and minor components. Information from the patient registration database is reported based on the role of the user accessing it in the clinical trial process. Users with different roles are protagonists, namely the sponsor, regulator, investigator, site, patient and supervisor. Also provided are methods for reporting information relating to clinical trials, monitoring clinical trial events, scheduling and tracking appointments, providing good clinical information, concluding a trial and display information for the protagonists.

  These different solutions are not entirely satisfactory because they do not make it possible to secure the access and the modifications of the information contained in the information system, nor to manage in a specific manner the modes of access to this information.

  The invention aims to solve the technical problems posed by these solutions of the prior art, by a solution constituted by a platform comprising means for dissociating the acquisition and the changes in a traceable way of the digital documents, and access by a user group to aggregate documents without risk of modification of the original documents, from separate or identical computer networks but in the latter case with different access modes.

  To this end, the invention relates, in its most general sense, to a computer platform comprising a plurality of business modules consisting of digital data acquisition technical means, a plurality of technical publishing means for producing digital documents recorded on a first secure server accessible on a first computer network provided with means for standardization and publication of documents and registration in a relational database, and a second secure server accessible by a second computer network, said servers being isolated physically, the second server having a replication of a configurable portion of the content of the first server, with a periodic update.

  Advantageously, this platform comprises a hardware and software architecture comprising said means of standardization and publication of documents, an access portal, an electronic safe, a DICOM standard imaging web server, a relational database and a database. programming language for deploying web applications around the relational database.

  According to one preferred variant, the documents are defined by a minimum list of attributes associated with the documents and / or the imaging procedures, and a syntax (in accordance with the XML, HL7 and IHE standards) making it possible to construct standardized exchange envelopes. .

  The invention also relates to an electronic method for managing and circulating digital documents comprising information acquisition steps via a plurality of business modules, digital document production steps recorded on a first secure server. accessible on a first computer network through a plurality of technical publishing means provided with means for standardization and publication of documents and registration in a relational database, and steps of publication of aggregated documents from users from a second secure server accessible by a second computer network, said servers being physically isolated, the second server having a replication of the content of the first server, with periodic updating.

  Preferably, this method includes document publication notification steps of generating an XML-HL7-IHE envelope from the attributes associated with any document and conveying the attributes of the document to the portal, and converting the document into a format. pre-defined numeric (in particular PDF or XML) prior to routing to the electronic safe.

  According to variants, the method according to the invention comprises the following additional features: a treatment: compression of static images or dynamic images; archiving selected images on a Web server with DICOM imaging standard; Transmission of the minimum attributes associated with the procedure means (7) for standardization and publication of documents in a predefined computer format, including including URLs for viewing jointly from an Internet Explorer the imaging procedure on the imaging web server, and the documents associated with the imagery.

  at the publication notification of a static or dynamic imaging procedure, a step of generating and routing to the server an XML-HL7-IHE envelope from the attributes transmitted by the imaging server; The portal integrates in its relational database all the elements contained in the standard envelopes transmitted by the standardization and publication means, including in particular the URLs for pointing to the corresponding document (stored in the electronic safe); and to the corresponding imaging procedure (archived in the imaging web server); - any document is accessible from the elements archived in the relational database of the portal - from the HL7 envelopes and data transmitted asynchronously by the GIP (Patient Identity Manager of the institution) and the directory of business; at least some of the electronic vault and imaging web server data is outsourced, that is, copied to a configuration of the same externally located architecture, provided that the standard envelopes associated with the relevant documents are also made available to an approved external host.

  The method according to the invention additionally comprises: a step of exporting the images intended to be printed and / or reports associated with the images from an imaging technical platform, whether or not provided with a local archiving system in DICOM format; a step of integrating these documents and images into the entire patient file contained in the aggregation portal; - Steps for capturing, modifying and signing imaging documents and automatically integrating documents and images corresponding to all documents in the patient's aggregated file; - an identification step conditioning access to the corporate directory and determining the identity and status of the speaker, as well as the identity and status of all patients present.

  The invention will be better understood in the description which follows, relating to a nonlimiting example of implementation with reference to FIGS. 1 to 4 and sheets 1 to 3.

  FIG. 1 is a description of the method according to the invention in an INTRANET configuration intended for the consultation of the portal for the only authorized participants of the Health Establishment (referred to as ES below). Modules 1, 2 and 3 represent the business tools of the ES. These business tools include imaging tools (1) constituted by facilities providing static or dynamic imaging to radiologists (angiography, CT, magnetic resonance ...), nuclear medicine, cardiologists (angiography, ultrasound) , ophthalmologists, etc. Most of these devices meet the DICOM image acquisition and transfer standard. These imaging tools (1) thus include the apparatus (scanner for example), the advanced consoles which make it possible to work the image, and the local archiving system which allows the specialists to archive for a longer period of time. shorter images and analyze them using advanced consoles, using the standard DICOM for image analysis and communication.

  These business tools also include biology tools (2) that allow all analyzes including blood or urine: these tools include PLCs and computer systems related to automata to produce in numerical form the results of analyzes and publish them in the form of documents, printed or transmitted.

  These business tools also include care tools (3) that allow doctors to prescribe treatments and nurses to apply the treatment plan, or medical secretariats (with word processors for capturing reports and letters, directly or through the use of digital transcription tools).

  Modules 4, 8 and 6 represent the specialized publishing tools of the ES.

  These specialized publishing tools comprise the communication module (4) of the imaging web server: this module (4) provides - in a compressed format - the uncompressed DICOM format images selected in module 1, and exports them to the storage bay N 9 of the image server, from where they can be viewed from an Internet browser. There is a link between Module 4 and Module 6, as will be explained later. The communication module (4) exports to the module 7 in DICOM format the DICOM attributes of the study (called DICOM Worklist ').

  These specialized publication tools also include a server (5) for disseminating biological results, which allows the dissemination of the results of module 1 in the form of documents, most often available through a browser, otherwise in the form of physical documents. .

  These specialized publishing tools also include an office automation server (6) and medical forms that allow: - the secretariats to produce documents, by

transcription of dictated letters;

  - Physicians to directly produce test reports either in text form (by typing reports or dictating to a voice transcription tool), or in structured form (in this case the doctor has medical forms, and the report is generated automatically when the form is completed in its entirety, at the time of the electronic signature); - care tools to communicate with specialty files, via specialized medical forms (in this case the corresponding document is produced in the same way as for the point above).

  It should be noted that there must be a link between the modules 6 and 4, so as to possibly match the accounts sent with the corresponding images.

  In general, it should be noted that several systems are available commercially that allow to fulfill the functions of modules 1 to 6 as outlined above. In any case, the report is made available for consultation at the time of electronic signature by the authorized health professional. The object of the present invention is to organize the flow of data between these different modules, by implementing a hardware and software architecture so as to allow the standardized, secure and robust implementation of a Intranet consultation portal allowing an aggregated view of all the documents concerning a patient, whatever the business tools or original publication.

  The solution also includes a module for standardization and publication (7) of the attributes of the documents produced by the modules 1 to 6, which has two functions.

  - the standardization of physical documents and their transfer to module 8: "physical documents" means the documents produced by modules 5 or 6 in a material form (for example in the form of a Word document, or PDF, or an Excel or PowerPoint file, but not exclusively). The function of module 7 is to convert these heterogeneous documents into a standardized format selected by the ES, in particular PDF or XML formats. In the case where the document would be produced by the publication tool in the form of a link to the modules 5 or 6 to open the document on a browser, the module 7 converts this document into a standard physical document and transfers it in module 8; the production of a standardized XML-HL7-IHE attributes envelope.

  Any document publication by modules 4 to 6 corresponds to a number of attributes associated with the document. These attributes are for example the name of the patient, his identification number in the ES, the type of document produced, the signatory of the document, the ES service to which the signatory belongs, and so on. They also include attributes for the outsourcing of documents, attributes that will be described later. Sheet N 1 summarizes the minimum attributes that modules 4 to 6 must provide to module 7. These attributes can be provided in any format to module 7 (as long as the format is formally specified, for example a Txt file, or Excel , etc.). Should also be specified in Module 7 if it is: 1 / a main document (for example a hospital report) 2 / a document associated with the main document (eg an account - operative rendering associated with the hospitalization report, or the letter of the practitioner who addresses the patient etc.) 3 / Imaging associated with the main document (these are the images associated with the main document, available at module 4 by activating the location URL specified in form N 1) These attributes will be transferred by module 7 into a suitable directory of the Aggregation Portal of Documents published by Medical Applications, ADAM in the rest of the document, after conversion into an envelope Standardized Module 7 will ensure the conversion of the attributes transmitted by modules 4 to 6 when publishing a document in XML language and according to the international standard medical standard HL7, compliant with the standard of norms. IHE (Information Hospital Enterprise). The form N 2 gives a non-limiting example of a standard XML-HL7-IHE envelope corresponding to the IHE attributes of the form N 1 transmitted by the module 7 to the ADAM portal. This standardized attribute file will be named below standardized envelope.

  In summary, the module 7, upon receipt of the notification of a document publication by the modules 4 to 6, transmits the corresponding document in a standardized format (including PDF or HL7) to the module 8, and the standard envelope corresponding to the ADAM portal after proper conversion of the attributes provided by modules 4 to 6 to XML-HL7-IHE interchange format.

  With regard to the images, transferred in compressed DICOM format from module 4 to module 9, module 7 builds the corresponding envelope HL7 from the attributes of the DICOM worklist transmitted by module 4 and also attributes for the module. study considered that come from module 6: indeed, module 4 and module 6 participate in the complete definition of attributes of the HL7 envelope of attributes of imaging, so as to link the main document (report) imaging), and routes this envelope to the portal ADAM, as specified in the sheets N 1 and N 2. This link is made at the level of the module 6 by the imaging operator who combines the images a DICOM study in the corresponding report that it captures or dictates in module 6.

  The platform comprises an electronic safe (8) where the physical documents are deposited by the module 7, as explained above. It is a secure storage server, with the appropriate backup and redundancy devices necessary to ensure maximum security of archived documents.

  A storage bay (9) of the imaging web server contains the recording of the selected and compressed images, as specified above. These images are accessible through an Internet Explorer from a URL pointing to the study specified in the HL7 envelope of attributes, as specified above.

  The invention comprises a software layer built around Internet technologies making it possible to organize, for each type of examination characterized by an examination code (which may be a standardized IHE code) and an examination label, the consultation of the main document, any associated document (s) and imagery possibly associated with the main document. The ADAM portal is connected to 3 modules and obeys rules of consultation established by the ES: first module: the Patient Identity Manager or GIP: it is the identity server of the ES, which includes d information on the patient (including a unique identification number within the ES) and information on the status and movements of the patient: at any status of the patient (hospitalized or consultant or coming to perform an external act) or his movements within the different care units of the ES. This information is transmitted very closely to the ADAM portal (for example every 5 minutes) by means for example of a messaging service, or by any means of asynchronous communication adopted by the ES.

  - second module: the Company Directory. It is a directory, including but not exclusively obey the LDAP standard, which informs periodically - also asynchronously, including by means of a message or by any other asynchronous means of communication defined by the ES - the ADAM portal (eg weekly) on the identity and status of the various medical and non-medical personnel of the ES, as well as on their assignment in the different administrative or care units defined in the ES.

  third module: this is the module 7 which transmits to the ADAM portal the standard envelopes, as described above in detail.

  The ADAM portal is built around a relational database, for example but not limited to Oracle. This database performs the relationship between the patients (defined by their unique identification number), the different attributes transmitted by the HL7 envelopes and the different identification and status data imported from the GIP and the company directory. . When an actor of the ES connects to the portal by means of an identifier and a password or any other type of identification (in particular a professional health card or a biometric identification), he is identified in his function at the level of the ES and - in relation to this function - rules can be applied defining which patients - at the time of the connection can be consulted depending in particular on the origin of the documents (depending on whether or not they come from the medical unit to which the consultant belongs) and according to the patient's status. To give a concrete example, the sheet N 3 illustrates - without limitation - a type of rules that an ES can set up for the consultation of documents of a patient by the medical profession. It will be noted that, in this example, the ES chooses to allow the doctor who asks to consult a patient of which he does not have the free access to force the rights by testifying the reasons justifying this request: one understands the importance for the software layer of the ADAM portal to provide administrators with complete traceability of the accesses of the various stakeholders and consultants, as well as configurable toolboxes for easily setting up such access rules.

  The standard envelopes, the company directory and the GIP thus make it possible to build in real time the relational database allowing to point to the documents and to the archived images at the level of the modules 8 and 9. The transmission of the data of the the company directory and the GIP being done asynchronously, the functioning of the portal is ensured independently of the possible malfunctions of the hospital information system: for example if the GIP or one of the modules 1 to 6 failed, it would remain possible to consult all the documents and images transmitted to modules 8 and 9 until the moment of failure, provided that the relational database of the ADAM portal and modules 8 and 9 operate normally.

  FIG. 2 is a description of the method according to the invention in an EXTRANET configuration intended for consulting the portal from outside the ES, in particular within the framework of a consultation of the Shared Patient Record at the regional level, or national or even international. It involves the presence of an authorized operator and rules of access to documents defined by the health and political authorities. The method that is the subject of the present invention enables the ES to adapt very easily to the obligations and constraints imposed by these authorities.

  We recognize the left part of the figure, modules 1 to 8, which corresponds to the description given above of FIG.

  As we recall when describing the attributes of the HL7 envelope built by Module 7, we indicated that outsourcing attributes would be associated with the documents as part of an Outsourced Shared Patient Project project. These attributes include: 1 / the notion of exported or non-exported document for each document, the practitioner who signs this document decides whether this document is intended to stay inside the ES or must be outsourced. Rules can also be applied according to the legal provisions imposed and the type of document concerned (for example the hospitalization reports can be systematically outsourced while some documents concerning the patient can remain in house, especially if they concern teaching or research problems). 2 / For exported documents, the concept of unaccompanied document or accompanied document which will be explained below.

  The module 10 is a copy of a configurable part of the contents of the modules 7 and 8, made at the level of an outsourced electronic safe, by means of a connection of an adequate flow between the ES and the authorized hosting provider. .

  Module 9 is an adequate directory of the information system set up by the authorized hosting provider. This directory is fed regularly by the HL7 envelopes from the ADAM portal corresponding to the exported document attribute. The information system of the authorized hosting provider therefore receives the attribute envelopes of the ADAM portal documents intended to be outsourced, and can therefore point to these documents (and possibly the associated images) deposited in the module 10. The host accredited may establish a relationship between the identity of the patient exported through the ADAM portal of an ES and a global identity (eg national identity) using appropriate identification server technology, which remains under the responsibility of the the host depending in particular the corresponding legal provisions. If the document export rules change (for example, if you decide to outsource some documents that remained inside the ES), you just need to modify the document attribute in modules 5 or 6 not exported from these documents into an exported document so that new standard envelopes are issued to Module 7, and that these documents become searchable - possibly associated with associated documents and imaging - without the content of Module 10 being required to be modified, by a very light operation dealing only with the exchange of XML files.

  In a variant of the same method, only the documents and / or the images corresponding to the exported document attribute are outsourced to the module 10. In this configuration, if a document contained in the modules 8 or 9 must be outsourced, the data Corresponding documents (document or image) will be transferred secondarily to the module 10 at the same time as the corresponding HL7 envelopes will be sent to the module 7.

  FIG. 3 (the numbers of FIG. 3 already allocated correspond to those already mentioned and defined in FIGS. 1 and 2) is a description of the method according to the invention in a configuration more particularly intended to illustrate the operation of a control system. imaging related to the ADAM portal. Imagery, because of the considerable volume it represents in terms of storage capacity, is indeed one of the key points to appreciate the operational nature of a shared patient file access portal. Three scenarios are described - to optimize the work of an imaging service in relation to the ADAM process and according to the equipment levels of this service - depending on whether the imaging service is equipped with a system local archiving (module 1) and / or an advanced information system for imaging (or RIS Radiology Information System, module 11), including adequate support for the production of reports of imaging within the business tool centers that do not have the local archiving solution and working with a little evolved RIS, not supporting the management of the reports: the RIS (module 11) transfers to the modalities the DICOM Worklist , which contains in DICOM format a number of attributes of the exam. The modalities automatically transfer to the module 4 by the DICOM protocol the images intended to be archived by the imaging web server (module 8). The module 4 communicates to the module 6 the attributes of the DICOM Worklist and images, the module 7 producing the corresponding standard envelope, as explained above. The operator has on the module 6 software tools: 1 / a transcription joblist allowing him: a / to consult in alphabetical order or by modality the list of examinations pending report; b / to visualize the corresponding images, c / to digitally transcribe the report numerically, to index it and to sign it electronically. 2 / an update joblist allowing him to consult the imagery files and the associated reports, to modify them and to re-sign them electronically. All signed reports are published on ADAM in the form of a document PDF transferred by the module 7 to the module 8, and an HL7 envelope transmitted by the module 7 to the ADAM portal, allowing in particular the viewing of the images from any station of the network equipped with an Internet browser. The imaging files are thus automatically aggregated around the unique identity of the patient by the ADAM portal; centers with Local Archiving and working with a poorly evolved RIS, not supporting report management: the previous scenario remains unchanged, but the stream of images is optimized for production by Module 1 local archiving), which: 1 / ensures the complete and definitive archiving of images in DICOM format according to modalities specific to each center 2 / optimizes the imaging flows between the modalities and the visualization and advanced processing stations, in particular for sequences with a large number of images; 3 / allows to transfer to the module 4 selected or reconstructed images according to the choice of operators (arrow N 14 of the figure); centers with Local Archiving and working with an advanced RIS, supporting reporting management and complying with the HL7-IHE standard: The previous scenario is made even more fluid. In this case, the report as well as the attributes associated with it can be transferred by module 1 to module 6 in HL7-IHE format (line N of the diagram), within the same business tool. The advantage of this organization is not only that the creation and signing of the report can be fully integrated at the production site, but that the parallel availability of the ADAM platform can further create or modify later and re-sign if necessary - a report from any station of the institution connected to module 6, remote from the business tool.

  FIG. 4 is a description of the method according to the invention allowing a schematic representation of the access to the ADAM portal by an internal speaker of the ES. Any internal speaker at the ES has an identifier and a password. to link it: 1 / to the company directory, which makes it possible to identify it (the identification containing all the information on the identity and on the status within the ES); 2 / the Patient Identity Manager (IPG) of the ES (which allows to know the identity, status and movements of all the patients who had at least one coming in the ES) The status of the worker includes in particular the medical or non-medical nature of the activity carried out, the service (s) in which the worker works, his rank and the activity within this department. The patient's status includes the type of the time of the connection (hospitalization, consultation or external act) its location in a care unit at the time of the connection, the movements during a visit In a second configuration of the same process, the identification of the intervener can be other means, such as CPS card or biometric identification Simultaneous knowledge of the identity and status of the connecting practitioner and the patients present in the GIP at the time of the connection may arise from the rules of ac to documents. The software architecture of the portal must allow simple configuration of these rules by the system administrator. Form N 3 gives an example of such rules, which can be applied to an ES to serve as a basis for the consultation of documents: these rules must indeed be able to be decided by the decision makers of the ES in accordance with the legal provisions and with the rules adopted by the CNIL to guarantee the security and confidentiality of information.

  Once identified, the worker can access the patient of his choice, through an interface shown schematically in Figure 3, allowing: - direct access to authorized documents; - to access the restricted access patient's documents only after justifying reasons for the request for access (see in particular file N 3, where the example provided allows access to restricted documents in the event that it is a medical emergency or if the consultation of the documents is necessary within the framework of the dispensing of care to the patient by the doctor requesting the access to the file) - to have a synthetic view allowing the direct access the main document and - if applicable - the document (s) associated with the main document and associated imagery as defined above.

  With regard to access to documents through an external accredited hosting provider as defined in Figure 2, the procedures for accessing documents will be defined by the hosting provider according to the provisions entrusted to it by the authorities. having entrusted him with his mandate.

NOTES

  File N 1 Interface with ADAM XML swap file Purpose To provide the data needed to publish documents in ADAM through an XML file

  Description of the data to be transmitted

  You can define 4 families of data to be transmitted: É Patient information ^ The main document É Related documents (Sound Imaging indexed document)

PATIENT INFORMATION

Variable Description Example 1

  PIN * N ID 1230456789 Patient NAME * Name DUPONT PNOM * First Name Charles DATNAI * Date of Birth 1965-12-15 00:00:00 SEX * Sex (M / F) M NOMPAT Surname FRION (*) Required Variables

MAIN DOCUMENT

  Variable Description Example 1 Example 2

  TP_EXM * Label examination MAPA Emergency brain scanner CD_EXM Exam Code HeadboardCreminence URGENT STATUTNENUE Exam status (3 items Hospitalization Possible consultation) ^ Hospitalization É Consultation ^ External Act DT_EXM * Exam Date or 2003-12-15 2003-12-15 00: 0:00

  Transcription date of the document 00:00:00

  CD_SIGN * Signatory Code SIGNATORY Author of Signature Dr. Dumont Pr Fabre DT_SIGN * Signing Date 2003-12-15 2003-12-28 00:00:00 00:00:00 CD_HOP * Hospital Code LRB LRB SERV_PROD ** Service Codes producers 22 CARDIO SERV_DEST ** Recipient Service Codes 24 RADIO ID_DOC * Document Identifier LRB22031027161 LRB53031027161483 VERSION * Document Version 1 CONFIDENTIALIT 0 Unaccompanied 1 0 E * 1 - Accompanied URL * Document Localization (*) Mandatory Variables (**) 1 or more services

RELATED DOCUMENTS

Variable Description Example 1

  TITLE Comment of the tooltip of Courrier du Dr Tardy of 12/12/2002 indexed document ID_DOC * Document identifier LRB2203102716142_FILS1 URL * Localization of the document 1SERVICE1ldocumentslpublication12565238009 \ LRB2203102716142_FI LS 1.pdf

ASSOCIATED IMAGING

Variable Description Example 1

  MODALITY * Imaging mode XA ID_DICOM * ID DICOM exam 1. 25335.2214.2225786 URL * Localization of imagery http://164.1.103.158/ 28 Correspondence beacon HL7

HL7 tag Description Remarks

  id Unique identifier of the main document version_nb Version of the document path Localization of the document mod_code Code Exam txt Label Effective exam_time Date + hour of completion of examination or

transcription of the document

  availability_time Date + time of signature confidentiality Privacy level: 0-Unaccompanied 1-Accompanied id root NIP family Patient name given Patient name gender Sex (F / M) birthdate Date of birth of the patient (yyyy-mm-dd) br_family Name patient name type_evt Exam status (3 items possible): Hospitalization Consultation Act External id root Code Signatory supervisor Name of signatory id root Code Author author Author name organization Code hospital tracker Destination service code Some details ^ One file. ini of the same name is systematically created after the creation of the XML file (in order to confirm the end of the generation of the XML file) ^ The files are deposited in an EXPORT directory SHEET N 2 EXAMPLE OF NORMALIZED FILE XML TO STANDARD HL7 CORRESPONDING TO ATTRIBUTES OF THE DATASHEET N 1 <? Xml version = "1.0" encoding = "ISO-8859-1"?> <Office_document_publish xsi: noNamespaceSchemaLocation = "office-publish.xsd" xmlns: xs = "http://www.w3.org/2001/XMLSchema" xmins: xsi = "http: //www.w3. org / 2001 / XMLSchema-instance "> <id> 040907164752 </ id> <version_nb> 2 </ version_nb> <path> http: //164.1.99. 100 / pdfmiddlecare / bmiddlecare / SERVICE4 / documents / publication / 2600041983 / pdf / 040907164752_2. pdf </ path> <mod_code> </ mod_code> <txt> CR Hospitalization </ txt> <effective_time> 2004-09-07 00:00:00 </ effective_time> <availabiiity_time> 2004-09-22 12:00:10 </ availability_time> <confidentiality> 1 </ confidentiality> <items> <item> <title item> RHEUMATOLOGY A </ title_item> <cont item> 01 </ cont item> </ item> <item> <titre_item> RHUMATOLOGIE B </ titre_item> <cont_item> 05 </ cont_item> </ item> <item> <titre_item> Main document </ titre_item> <cont_item> CR Hospitalization </ cont_item> <tooltip> </ tooltip> < id> 040907164752 </ id> <url> http: //164.1.99 100 / pdfmiddlecare / bmiddlecare / SERVICE4 / documents / publication / 260004 1983 / pdf / 040907164752_2. pdf </ u rl> </ item> <item > <title_title> Indexed document </ title item> <cont_item> </ cont_item> <tooltip> </ tooltip> <id> </ id> <url> </ url> </ item> <item> <title_item> Indexed Imaging </ title_item> <cont_item> </ cont_item> <tooltip> </ tooltip> <id> </ id> <url> </ url> </ item> <item> <title_item> Its indexed </ title_item> <cont_item> </ cont_item> <tooltip> </ tooltip> <url> </ url> <litem> </ items> <patient> <root id> 2600041983 </ id root> <family> STEFANINI </ family> < given> Lucette </ given> <gender> F </ gender> <birthdate> 1935-04-23 </ birthdate> <br>> </ br> </ br>> </ br>> <evt> <encounter> </ encounter> <evt_type > Hospitalization </ type_evt> <encounter_time> </ encounter_time> </ evt> <supervisor> <root id> APH3197889 </ id root> <name> Dr. HYNAUX </ name> </ supervisor> <author> <id root> APH0501201 </ id root> <name> Dr DIEUDE </ name> <lauthor> <organization> LRB </ organization> <trackers> <tracker> 01 </ tracker> <tracker> 05 </ tracker> </ trackers> < / office_document_publish> Sheet 3 Example of medical rules for access to documents through the ADAM portal Access by the identified medical staff of the hospital to documents published on ADAM, from the Intranet of the Lariboisière group-

FW

  Access security level: attribute XML envelopes code 1: restricted access to documents for emergencies 2: access to documents for medical workers in the same service (documents produced by the service or sent to the service) or for inpatients 3 : access to documents for medical professionals from all ADM services: access declared authorized for medical needs. The medical worker identifies himself and states that he needs access to documents for medical reasons ADR: access declared authorized for research or teaching purposes. The medical worker identifies himself and declares to require access to documents for research or teaching purposes. He undertakes to anonymize the documents disseminated.

  AAFC: accompanied access: the document can only be consulted by the patient in the presence of a health professional.

  Sample access rules 1. All identified physicians in a service can view all records of all patients in the service, published by the service or sent to the service by another service (Level 2 by default).

  2. All identified physicians in a department can view all documents (regardless of publisher service) of all in-patients in the service (Level 2 by default) 3. All identified physicians in the hospital can view all Patient documents with at least one document published on ADAM as long as they certify (traceability of requests provided by ADAM): É That this consultation falls within the scope of a medical emergency concerning the patient (level 1 or above) É Or that this consultation is necessary as part of the dispensing of care to the patient by the doctor requesting access to the file (ADM = yes)

Claims (11)

  1 - Computer platform comprising a plurality of business modules (1, 2, 3) constituted by technical means for acquiring digital data, a plurality of technical publishing means (4, 5, 6) making it possible to produce digital documents recorded on a first secure server accessible on a first computer network provided with means (7) for standardization and publication of documents and registration in a relational database, and a second secure server accessible by a second computer network, said servers being physically isolated, the second server comprising a replication of a configurable portion of the content of the first server, with periodic updating.   2 - computer platform according to claim 1, characterized in that it comprises a hardware and software architecture comprising said means (7) for standardization and publication of documents, an access portal, an electronic safe, a web server DICOM standard imaging, a relational database and a programming language for deploying web applications around the relational database.   3 - computer platform according to claim 1, characterized in that the documents are defined by a minimum list of attributes associated with the documents and / or imaging procedures, and a syntax (in accordance with the XML, HL7 and IHE standards) allowing to build standardized exchange envelopes.   4 - Electronic process for managing and circulating digital documents comprising steps of acquiring information via a plurality of business modules (1, 2, 3), steps for producing digital documents recorded on a computer first secure server accessible on a first computer network via a plurality of technical publishing means (4, 5, 6) provided with means (7) for standardization and publication of documents and for recording in a database; relational data, and steps of publishing aggregated documents to users from a second secure server accessed by a second computer network, said servers being physically isolated, the second server including a replication of a configurable portion of the content of the first server, with a periodic update.   - Electronic method for managing and circulating digital documents according to the preceding claim, characterized in that it comprises publication notification steps of a document consisting of generating an XML-HL7-IHE envelope from the attributes associated with any document and to convey to the portal said attributes, and to convert the document into a predefined digital format (in particular PDF or XML) prior to routing to the electronic safe.   6 - Electronic method for managing and circulation of digital documents according to claim 4 or 5, characterized in that it comprises a treatment: compression of static images or dynamic images; archiving selected images on a Web server with DICOM imaging standard; transmission of the minimum attributes associated with the procedure means (7) for standardization and publication of documents in a predefined computer format, including in particular the URLs for viewing jointly from an Internet Explorer the imaging procedure on the Web server imaging, and documents associated with imaging.   7 - Electronic method for managing and circulation of digital documents according to claim 4, 5 or 6, characterized in that it comprises at the publication notification of a static or dynamic imaging procedure a generation step and routing an XML-HL7-IHE envelope to the server from the attributes transmitted by the imaging server.   8 - Electronic method for managing and circulating digital documents according to at least one of claims 4 to 7, characterized in that the portal integrates into its relational database all the elements contained in the standard envelopes transmitted by the means (7) for standardization and publication, including in particular URLs pointing to a main document, to documents possibly indexed to the main document (stored in the electronic safe) and possibly to the corresponding imaging procedure (archived in the imaging web server).   9 - Electronic method for managing and circulating digital documents according to at least one of claims 4 to 8, characterized in that any document is accessible from the elements archived in the relational database of the portal - from the envelopes HL7 and data transmitted asynchronously by the institution's Patient Identity Manager (IPM) and the corporate directory.   - Electronic method for managing and circulating digital documents according to at least one of claims 4 to 9, characterized in that at least part of the data of the electronic safe and the imaging web server is outsourced, c that is to say copied into a configuration of the same architecture located outside, provided that the standard envelopes associated with the documents concerned are also made available to an approved external host.   11 - Electronic method for managing and circulating digital documents according to at least one of claims 4 to 10, characterized in that it comprises an export step from an imaging technical platform that may or may not be provided with a local archiving system in DICOM format, images to be printed and / or reports associated with the images, and integration of these documents and images to the entire patient file contained in the portal of DICOM. aggregation.   12 - Electronic method for managing and circulating digital documents according to at least one of claims 4 to 11, characterized in that it comprises steps for entering, modifying and signing the imaging documents and automatic integration of documents. documents and images corresponding to all documents in the patient's aggregated file.   13 - Electronic method for managing and circulation of digital documents according to at least one of claims 4 to 11, characterized in that it comprises an identification step conditioning access to the corporate directory and determining the identity and status of the worker, as well as the identity and status of all patients present.