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Biomedical subjects

J M Renard

Publications and source records attributed to J M Renard.

15 recordsLinked to original sources
PubMed2001

Integrating users' activity modeling in the design and assessment of hospital electronic patient records: the example of anesthesia.

As computers become more and more an aid in the management of medical information, some specialists, such as anesthesiologists, demand tuned applications to support their own activity. The development of these specific applications is based upon the user's requirements analysis, and functional and technical specifications. But some failures show that a better understanding of human factors of acceptance could improve the usability and utility of these tools. In this study, we demonstrated that when the management of medical information is closely intertwined with the physician's activity, it is necessary to perform a precise analysis of this activity in order to identify the cognitive and organizational constraints that affect the usability and acceptance of the tool. We focused our study on the pre-operative anesthetic consultation. After recording and analyzing 50 consultations, we were able to identify the key points to fulfill in order to meet users' acceptance. From this study, we propose some strong recommendations to handle the constraints imposed by the anesthesiologists' activity in their daily working environment. We applied this method to evaluate an electronic patient record (EPR) for the pre-anesthetic consultation. The results of this evaluation validate our hypotheses and the importance of the activity constraints. In conclusion, human factors, and particularly those linked with the activity of healthcare professionals, have to be carefully studied before any development and installation of an EPR into a specialty domain.

Anesthesia Department, Hospital↗
PubMed2001

Social and health status of arrivals in a French prison: a consecutive case study from 1989 to 1995.

BACKGROUND: To assess the demographic, socioeconomic and health status of male arrivals in French jails and to analyze the time trends of these characteristics. METHODS: The study was carried out in a prison for detained persons and short term prisoners. Using a standardized questionnaire, we recorded the characteristics of all male detainees and prisoners arriving in the prison between 1989 and 1995. The information collected concerned: demographic data, level of education and professional status, reasons for detention or imprisonment, social and family background, lifestyle, medical and psychiatric history, suicide attempts and illicit use of drugs. The characteristics of the study population were compared with those found in the general regional population. We analyzed developing trends in the health status of the prison population as well as their socio-economic profile over a period of seven years (1989 to 1995). RESULTS: A total of 14,785 questionnaires were analyzed. Of the study population, 56% had no professional qualification, and 62% was unemployed. About two-thirds of the inmates presented psychiatric problems or problems with illicit drug use (one or several drugs). Amongst these, 70% had not had any form of care -neither therapeutic nor educational- before their arrival in prison. Between 1989 and 1995, the proportion of drug users increased by 30%. A parallel increase was observed in the level of unemployment and in the frequency of mental problems. CONCLUSIONS: Our results suggest a need for therapeutic and educational care to be provided for prison inmates. This poses a problem which needs to be addressed in terms of public health. The study also illustrates the usefulness of a standardised questionnaire for each arrival. The systematic use of such a tool would make it possible to identify inmates'needs and to propose adapted care solutions.

Adolescent↗
PubMed2001

Impact of a modelization of the task allocation problem on the design of a prescription management software for intensive care units.

After having studied the coordination in Intensive care Units we have proposed a dynamic model for improving coordination in respect of human control over the work. We have performed simulations for analysing the impact of different strategies on coordination and we have found that our task centred coordination model could be efficient to improve the health care actors coordination and the efficiency of care delivery. We have built a first prototype based on this model. This implementation uses Internet technologies.

Computer Simulation↗
PubMed2000

How to convince your manager to invest in an HIS preimplementation methodology for appraisal of material, process and human costs and benefits.

Investing in information technology has become a crucial process in hospital management today. Medical and administrative managers are faced with difficulties in measuring medical information technology costs and benefits due to the complexity of the domain. This paper proposes a preimplementation methodology for evaluating and appraising material, process and human costs and benefits. Based on the users needs and organizational process analysis, the methodology provides an evaluative set of financial and non financial indicators which can be integrated in a decision making and investment evaluation process. We describe the first results obtained after a few months of operation for the Computer-Based Patient Record (CPR) project. Its full acceptance, in spite of some difficulties, encourages us to diffuse the method for the entire project.

Algorithms↗
PubMed2000

A modelization of the task allocation problem for prescribing activity in an ICU.

The improvement of coordination between Health Care Professionals belonging different specialities and who are extremely mobile, is a crucial problem in Medicine. A workflow System is one example of the new informatics tools which facilitate the transfer of information and responsibility between health care providers. Medical informatics systems in particular should be reactive enough to cope with the flexibility of real work situations: in this paper, we present the task allocation problem. We distinguish between the workflow control process and the notifying process, which concerns the sharing out of the tasks between the actors concerned. We focus on the impact of strategies of notification on the progress of coordinated work. We propose a simulator to model and study the different ways of sharing tasks between actors in an Intensive Care Unit's activity of prescription.

Computer Simulation↗
PubMed2000

Integrating users' activity analysis in the design and assessment of medical software applications: the example of anesthesia.

As the computers become more and more and aid for the management of medical information, some specialists like anesthetists demand specialized applications to support their own activity. Usually, these applications are developed following a Users' Requirements analysis and functional specifications. We demonstrate here that when the management of medical information is closely intertwined with the physician's activity, it is also necessary to perform a precise ergonomics analysis of this activity in order to identify the cognitive and organizational constraints that affect the usability and acceptance of the tool. We report here the results of such an analysis for the pre-operative anesthetic consultation, and illustrate this analysis with the evaluation of a computerized anesthetic record.

Anesthesia↗
PubMed2000

Professional communication for coordination of care: inter-mediation for a better management of patients.

The communication of data through telecommunication networks between Healthcare professionals and particularly Hospitals and family doctors is a fundamental challenge for the next decade. Some experiences are demonstrating the feasibility of this approach and give clear insight of the potentials, difficulties and constraints of the problem. Different technical solutions are proposed following a centralised or a distributed architecture, security and confidentiality obligations, and the users requirements. We propose an original solutions based on the principle of inter-mediation to provide intelligent treatments and services on the messages that are exchanged between the network participants. This approach proved to be successful in the experimental field of Armentières (France) where more than 30,000 messages were exchanged between the hospital and the General Practitioners during 1999. Following this experimental phase, the prototype is currently customised and industrialised to fulfil the requirements and needs of an healthcare sector.

Computer Communication Networks↗
PubMed1999

Telecommunication in healthcare for a better coordination between hospitals and GP's: routine application of the "ISAR-Telematics" project.

With the development of new information and communication technologies, the nature of data exchange between healthcare professionals is modified by the use of telematics tools. With the implementation of the "Réseau Santé Social" of the smart cards CPS and Sesam-Vitale, hospitals and private clinics are installing their hospital information systems, while general practitioners are computing their patient records. The environment is therefore suitable for the installation and diffusion of telematics services, allowing a better exchange of information between the physicians of a geographical sector. The RITHME intercommunication platform was developed in the ISAR-Telematics and IRISI European projects. It ensures several communication functions, such as movements of patients (in/out/inside) the hospital, management and mailing of letters and reports, specific information on prescribed treatments, or data concerning the hospital structure. This platform is tested in the town of Armentières in the large city of Lille (North of France). It is currently being routinely used to accelerate and secure data exchanges between all the physicians working in this area.

Family Practice↗
PubMed1999

A simulation of dynamic tasks routing to improve cooperation in intensive care units.

Cooperation between Health Care Professionals is essential for the quality of care. Workflow systems could improve the transfer of informations and responsibilities within Health Care Actors. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU. In such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have introduced some dynamicity by adding roles in the model. With the use of roles, the dynamicity of the workflow is assumed by the routing process. We need to use simulation to be able to study the impact of routing algorythms on the efficiency of the coordination.

Algorithms↗
PubMed1999

The RITHME inter-mediation platform for data exchanges between healthcare professionals.

Data Exchanges between Healthcare Professionals are always limited to paper. For letters, reports, results, the physicians and hospitals are yet using the classical post-office mailing system. With the growing development of Medical Informatics within the Hospital Information Systems and the GPs offices, the way to exchange medical data will be more and more oriented towards the Telematics procedures. If Tele-consultation, video-conferencing applications appear as routine procedures, a safe, protected, and rapid transmission of medical data and records through electronic mailing systems is not yet really available. The Rithme Intermediation Platform is an experimental product, tested in the town of Armentières (in the City of Lille) in the North of France to allow a better, safer, more rapid electronic communication between all the professionals of a geographical sector. One of the mail component of this platform is the "Events Server" which collects and displays all the available information concerning a dedicated patient to the medical authorized correspondents. To realise this task the Rithme Platform takes charge of 4 main functions: formatting the messages, assuring the security, managing the directories, notifying emergencies. Currently experienced with success in the City of Lille, this Platform will be soon customised and commercialized.

Computer Communication Networks↗
PubMed1998

Dynamic workflow model for complex activity in intensive care unit.

Cooperation is very important in Medical care, especially in the Intensive Care Unit (ICU) where the difficulties increase which is due to the urgency of the work. Workflow systems are considered as well adapted to modelize productive work in business process. We aim at introducing this approach in the Health Care domain. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU [1]. But in such a complex field, the flexibility of the workflow system is essential for the system to be usable. In this paper, we focus on the main points used to increase the dynamicity. We report on affecting roles, highlighting information, and controlling the system We propose some solutions and describe our prototype in the ICU.

Humans↗
PubMed1997

An asynchronous co-operative model for co-ordinating medical unit activities.

CSCW is devoted to the analysis of interactions among human beings when performing their work together (Ellis et al., Commun. ACM 1 (34) (1991) 38-58). The main fields of application are work organisation, healthcare, education and training. Our main goal is to study the co-operative models allowing task co-ordination and conflict management between actors within a distributed environment, particularly in medical units. We do not aim to produce a practical system suitable for near-term deployment in the intensive care units (ICU), but rather an experimental system that performs and co-ordinates a range of intelligent planning tasks in ICU activities. The emphasis will be put especially on asynchronous co-operation. We apply the Workflow approach to ICU organisation through the analysis and the proposal of a co-operative model.

Computer Simulation↗
PubMed1986

Non-menstrual toxic shock syndrome. A case report and a review of non-menstrual toxic shock syndrome in Western Europe.

Having been confronted with a post-operative toxic shock syndrome, we made a study of European literature and were struck by the more favorable course the disease promptly took when penicillinase-resistant antibiotics were used. We suggest that a new case, based on bacteriological analysis and phagotyping of the offending organism and wound appearance, was prevented by us when immediate antibiotic treatment was given.

Adult↗
PubMedDate not supplied

Dynamic workflow model for complex activity in intensive care unit.

Co-operation is very important in Medical care, especially in the Intensive Care Unit (ICU) where the difficulties increase which is due to the urgency of the work. Workflow systems are considered as well adapted to modelize productive work in business process. We aim at introducing this approach in the Health Care domain. We have proposed a conversation-based workflow in order to modelize the therapeutics plan in the ICU [1]. But in such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have concentrated on three main points usually proposed in the workflow models, suffering from a lack of dynamicity: static links between roles and actors, global notification of information changes, lack of human control on the system. In this paper, we focus on the main points used to increase the dynamicity. We report on affecting roles, highlighting information, and controlling the system. We propose some solutions and describe our prototype in the ICU.

Computer Simulation↗