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n°19  |  October   2007
Guest contributors
“Security is key to open information systems”
Interview with Germain Zimmerlé
IS Director at the Strasbourg University Hospital Center,
Chairman of the Bull European User Group (CUBE)
With seven different establishments, more than 2,500 beds and over 10,000 staff, the University Hospital Center (CHU) at Strasbourg is one of the largest in France. CHU has three main missions: providing care for most pathologies, teaching and training the paramedical professions with eight training institutes and finally, biomedical research conducted in its clinical investigation center. Bull is CHU’s partner when it comes to its IT infrastructures.

In what way is the openness - or ‘liberation’ of your information systems vital to CHU?
One of the challenges facing us today in our healthcare system - and it’s an economic challenge as well - is how to share medical data of individual patients between all the health professionals and specialists involved in their ongoing care. The objective is to provide better patient care, while being able to respond faster, and having extremely rapid access to specialists in the event of any given illness.

For us in the IT Directorate, this involves moving from a Hospital Information System, which is focused around the hospital, to a Health Information System centered on the patient. Our systems in the future will no longer be separate entities, but will have to open up to the various partners involved throughout the healthcare profession, such as the patient’s GP, and to all the other establishments involved in providing patient care, each of which managing its own medical records. Here in France the Single Electronic Patient Record project (known as DMP or Dossier Médical Personnel) is built largely around this notion of openness.

The IS will be open to the entire health network, including specialist networks such as those dealing with cancer or diabetes for example, and will enable remote diagnosis by specialists for given pathologies. We are also setting up video-conferencing systems to enable specialists to analyze and discuss difficult cases collaboratively. This is particularly important in the field of prenatal medicine, where it is already in use. The added value patients gain from this kind of approach is obvious: speed, better diagnosis and better care.
One project we have successfully implemented, for example, enables us to send the surgeon’s letter and accompanying report directly to the patient’s general practitioner if the patient has given his consent to the hospital.

What are your priorities when it comes to opening up your IS?
Security is key to open information systems. We are dealing with very sensitive personal medical data, and we need to implement the necessary security strategies: strong identification, encryption and traceability.

Another priority is to adopt industry standards for data exchange and presentation, to facilitate communication between information systems generally, as well as between the IS and medical equipment (imaging systems, automated laboratory equipments).

Finally, as soon as you start exchanging data there is the issue of uniquely identifying each patient, with each care provider currently operating its own system. The unique patient identifier is not yet resolved at a national level, so we need to start putting in place the mechanisms necessary to start that harmonization process.

What best practices might be deployed to achieve this transformation?
Because it’s so critical when it comes to the quality of healthcare, if you want information systems to be more open, all the players involved have to adopt an extremely rigorous and professional approach and to use the same tools.

In France, we have a national body whose mission it is to modernize hospital information systems – known as the GMSIH – that is helping us implement good practices in the areas we have just been talking about. In particular, the GMSIH produces guidelines for every layer of the infrastructure needed to facilitate interoperability between systems (patient identifier, IS security, directory updates...).

Between the vision and operational constraints, how are you managing this transition?
It’s clear that this requires huge amounts of awareness raising, information gathering and support if we are to achieve a veritable cultural revolution in the rather idiosyncratic world of healthcare. Inside the CHU, we have launched awareness campaigns and training programs to support the changes.

To sum up, I would say that opening up information systems is a major stake for health professionals. Our challenge is to achieve the change under the best conditions when it comes to IT security and support. Therefore, as Chairman of CUBE, I consider Bull’s positioning, with its campaign focused on ”Liberating IT” to be absolutely relevant.

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