Data, the keystone of e-health

Laurent Frigara, co-founder of Enovacom, presents his vision and advice for taking full advantage of digital data in the world of healthcare.

Published on 25 November 2021 at 09h26

Data, the keystone of e-health.

It's an undeniable fact. The exploitation of health data will revolutionize the way we deal with patients. It is the basis of the digital medicine called "5Ps", more personalized, preventive, predictive, participative, and evidence-based. 

Rather than arguing about the potential, which you all have already clearly in mind, the idea here is to understand how to move forward: from intuition to action. To do this, we talked to a specialist in the field. 

Laurent Frigara, co-founder of Enovacom, French leader in medical interoperability and early supporter of Future4care's development.

In charge of Orange Business Services' healthcare division, Enovacom now has more than 250 experts involved in healthcare.

In the following lines, he talks to us about sharing culture, interoperability and methodology.

The context

Today, the healthcare professionals expect the right data at the right time, for the right patient. This is the basis for the entire medical decision chain. Whether it's test results, vital signs from biomedical devices and sensors, prescription history or health episodes, sharing this information is essential. This sharing ensures better patient management and better coordination of care, while avoiding the redundancy of examinations already performed.  

The challenge is also to use health data in a consolidated way and in very large quantities. For example, using data from large cohorts of patients with common characteristics opens up interesting perspectives and promising advances for healthcare and medical research. We are able to detect the emergence of diseases at an early stage, to accelerate diagnostics, and to evaluate the effects of medical treatment with greater precision.

Data is also the raw material for AI learning. The quality and performance of an AI is directly linked to the quantity and quality of the data used.

At the level of an institution, the proper use of data from its information system allows it to optimize its operations, and thus to improve care by adapting processes thanks to concrete elements. 

Proportionally, at the level of a territory, data consolidation is more important. It allows us to adapt health policy or, as we saw during the health crisis, to fight effectively against a pandemic. 

At the same time, no one denies that health data is also desired for less virtuous purposes. They are so precise and personal that they can, for example, easily allow identity theft. They are traded at a high price on the dark web, or can also be used against health structures to obtain ransom payments. 

Based on this observation, we wanted to share with you five essential lessons to succeed in the digital transformation of your company, institution or other healthcare structures, with an efficient and reliable data strategy at the heart of it.

No. 1 Dealing with market constraints

The healthcare sector is facing multiple constraints, whether from an organizational, regulatory or economic point of view. Healthcare establishments that produce and manage a large amount of data do not have adapted information systems today and their transformation is slow. Most of them are made up of several application layers from different generations, from ten, fifteen or even twenty years ago. Under these conditions, data sharing is much more difficult. 

Historically, French doctors have rarely been inclined to share their patients' information. This culture of sensitive, anonymous and exclusive data locks up usable data in information silos that are not conducive to exchange and sharing.

Moreover, it is the patient who owns his or her data. When they give their consent to use their personal information, they do so within a certain framework of use, which can sometimes hinder the use or consolidation of existing databases.  

To overcome this situation, healthcare stakeholders must work on information systems to make them interoperable and standardized, based on common reference systems. To ensure optimal use of health data, it is necessary to ensure that it is well collected, structured and of sufficient quality. It is also necessary to adapt the processes that integrate patient consent, in order to obtain a clear vision of where the data comes from and how it will be used. 

No. 2 Learning in order to structure and communicate

We need to create the optimal conditions for these exchanges, whether it be security, trust, or the ability to share reference systems to better understand each other. It is therefore necessary to set up a technical, standardized, common, understood, integrated and shared base for and by all the players. Enovacom has been working in this field for 20 years, and it is also one of the missions of the French National Health Agency, which, through the financial support of the ‘Ségur de la Santé’, is accelerating this harmonization. This voluntary governmental impetus is an opportunity to ensure that the information systems of all healthcare organizations are based on the same reference systems. 

The digital solutions of the various players must communicate with each other, if not natively, through dedicated complementary services. This will also enable them to exploit the structured data contained in healthcare documents to offer users even more relevance.

However, the historical publishers in the ecosystem do not make their often proprietary databases easily accessible. Interoperability services, on site or in the cloud, by positioning themselves in an agnostic way, make it possible to break down these silos. 

For the evolution of their IS, institutions must now ensure that future devices, applications and healthcare software are interoperable by nature and allow the data they produce to be used. This means that the health data generated by these new elements of the healthcare ecosystem must be stored in structured data warehouses based on common repositories. Everyone must speak the same language to value and exploit the data collected. 

No. 3 Demonstrate methodology

Knowing how to deal with market constraints and initiating an open approach are unfortunately not enough. A lot of precautions must be taken at every stage of the data journey to avoid losing its value. If only one of the steps is poorly done, the data is no longer qualified and therefore unusable. It is therefore necessary to be meticulous, from the entry into the care production software, or the sampling of vital data from biomedical devices, to the storage in an adapted database. 

This means providing caregivers with ergonomic software that is natively designed to store data that can be used. Training in the tools is also imperative to ensure the quality of the information entered. 

Beyond the syntax of the data, which must be standardized for sharing and consolidation, it is also important to work on the semantic aspect. In the first case, this concerns the definition of the message: the nature, type and format so that it can be understood by all. 

Semantics concerns the medical content of these data and requires sharing semantic interoperability repositories. 

The "Systematized Nomenclature of Medicine - Clinical Terms" (SNOMED CT) appears to be a key terminology to meet these challenges.  It is an international descriptive terminology that covers the broadest range of clinical specialties and operational needs.  It allows standardization of the capture, classification and sharing of any clinical information by healthcare professionals. 

Data quality control tools also exist to ensure that the data exchanged respects these different standards and benchmarks. Like the work Enovacom is doing in the SI-DEP project, where its solutions analyze and control the structure and semantics of data transmitted by analysis laboratories. 

No. 4 Generalize interoperability

We can’t talk about digital health without looking at the subject of interoperability. Interoperability concerns the ability of different digital systems, applications or services to communicate and interact with each other. In particular, it enables the sharing of patient information throughout the patient's journey. Interoperability also facilitates the integration of innovative solutions or services into an existing establishment or ecosystem. Finally, this makes the care process more secure, simplifies procedures for the patient, improves the relevance of medical decisions and ensures more effective prevention, etc.

The many digital solutions used by healthcare professionals must be interoperable not only with each other, but also with government services such as the Personal Medical Record, the Digital Health Space, regional platforms, and data warehouses such as Health Data Hub.  

Interoperability is also a key factor in the exploitation of health data. It enables the extraction or consolidation of this data from existing systems to feed the warehouses, as well as the sharing of repositories to ensure that everyone speaks the same language. 

No. 5 Data is at the heart of the model proposed by Future4care

It is important for players in the ecosystem to be supported by specialists in collecting, storing and using healthcare data.  

Future4care's ambition is to support startups to accelerate the market access of their innovative solutions.    

Beyond the provision of exclusive and qualified data, Future4care supports these European startups throughout the life cycle of their solution. We help them focus on their core value or their differentiation, as they often don't have much time to break through and competition is tough. Thanks to Future4care, they can rely on the best experts for all subjects related to infrastructure, security, regulation or data exploitation tools. Its members, starting with three of the historical members, Orange, Sanofi and Generali, will offer their own skills, but other experts will be called upon to intervene on the subject.

Future4care will also be able to support startups in the development of their solutions, so that they are based on standards and infrastructures that will make them sustainable. We will also facilitate the integration of their applications or services into the existing ecosystem thanks to our members' expertise in interoperability.  

Finally, we support startups in the use of data made available to them by Orange, Sanofi, Generali, Capgemini and our future members. This is to guarantee optimal exploitation, but also to ensure that they do so in compliance with patient rights and ethics. 

You are a startup and wish to benefit from this support? You are a large group and share our vision? Finally, you are a healthcare center, a patient association or an academic and wish to innovate with us? Write to us in response to this email and let's take the time to discuss.