ORBIS EPR – delivering benefits across 39 French hospitals

The Assistance Publique Hôpitaux de Paris (AP-HP), an association of 39 hospitals and a public health facility in the Paris metropolitan area, implemented the ORBIS Electronic Patient Record (EPR) system across its 39 hospitals between 2009 and 2019. With the software system from Dedalus in place, healthcare professionals across all AP-HP hospitals can access the medical data of some 14 million patients in the hospital group’s database.

Avoiding information loss

The deployment of ORBIS is part of the AP-HP’s digital transformation, with the ultimate goal to offer care management within a single tool. Dr. Christophe Vincent-Cassy is an emergency physician and Director of the Patient File program within the AP-HP Information Systems Department, as well as Vice-President of the national ORBIS user group in France. For Dr. Vincent-Cassy, this aspect was crucial.

“Previously, we had several specific applications, used by different units or departments”, he says. “This multiplicity of information sources, coupled with the unreliability of certain interfaces between applications, meant that there was a risk of losing information – particularly about treatments administered in the past – and of breaking the chain of care, and therefore a major patient risk”.

“[Before ORBIS], the multiplicity of sources of information meant there was a risk of a breakdown in the care chain”.

Multi-facility

To illustrate his point, Christophe Vincent-Cassy, himself an emergency doctor working at the CHU Bicêtre, uses a concrete example: “Imagine a patient who, because he is unconscious when he arrives at the emergency department, is unable to give vital information about an allergy. Administering a drug containing this allergen could cause a catastrophe. But if this information has been entered into a centralised system such as ORBIS during a previous interaction, this sensitive data is accessible to any healthcare worker in any AP-HP establishment”. This capability to work across department and hospital borders is one of the major assets, and a decisive factor in the choice made by the management of the French hospital group, says Dr. Vincent-Cassy.

Standardisation of processes

At the AP-HP, ORBIS was first implemented at an initial pilot site, before being rolled out to the 38 other facilities, one after the other. Taking into account the preparation and support phases, Dr. Vincent-Cassy estimates that it took around two to three months of work, per department, for the system to be fully adopted in all the group’s hospitals. The solution was implemented department by department at each hospital site, before moving on to the next site. Overall, it took about 10 years for ORBIS to be adopted by all 39 AP-HP hospital sites.

During the transition, users were given support tailored to their jobs and responsibilities. For some, it was a matter of moving from highly specialised tools to a more general tool, and for others – who were not computerised at all — it was a matter of switching from paper to the digital system.

The implementation required the rationalisation and standardisation of multiple technical elements, as well as the standardisation of procedures so that everyone in every department worked and organised things in the same way, and gradually began to feed the ORBIS database with consistent and relevant data. In this respect, the Emergency Department, which sees a large number of patients, was one of the first to contribute a great deal of content to the EPR, to the database, acting as a driver for the other departments and speeding up the use of the tool.

Saving money, saving time

The standardisation of disparate elements and different ways of working within a department, for example, also offers financial advantages. “Maintenance teams, who previously worked on systems that sometimes competed with each other, can now optimise the information system maturation and development processes by focusing on a single main application”, says Dr. Vincent-Cassy. In addition to economic benefits, the implementation of ORBIS also saves time, as advances are immediately shared with the entire community much more easily.

And beyond saving time and money, having access to the entire history is obviously also beneficial for the patients themselves, for healthcare professionals and for the national social security system. “This avoids redundant and therefore unnecessary examinations”, says Dr. Vincent-Cassy.

“All data can be accessed by any healthcare professional in any AP-HP hospital”.

An unrivalled degree of customisation

While Christophe Vincent-Cassy acknowledges that other solutions on the market are also very successful, he points out a major shortcoming of the competitors that is, so to speak, a major obstacle: “These solutions are described as very rigid by users, because they have very few parameters that can be configured by the customer”. ORBIS offers the adaptability and plasticity required to meet the needs of numerous specialties and sub-specialties, which also makes it easier for everyone to accept the use of digital tools, considering that some people are initially more reticent than others. This adaptability also supports the evolution of certain professions, changing practices, the emergence of new professions and different types of care. Dr. Vincent-Cassy: “We need to be able to create content that is perfectly adapted to our users. ORBIS allows us to meet the specific expectations of organisations, practitioners and nurses… this ability to customise gives us a great deal of freedom”.

“Maintenance teams can now optimise the information system maturation and development processes by focusing on a single main application”.

Next steps for AP-HP

ORBIS is very comprehensive, comprising more than 40 modules (medical records, prescriptions, emergencies, intensive care, care records, social records, radiological imaging, etc.). It can be used to track the progress of each patient across all AP-HP hospitals.

The next challenges, says Dr. Vincent-Cassy, will be to go beyond the hospital itself and open up to the outside world, connecting the system to other tools outside the hospital, such as telemedicine and home monitoring and care.

Finally, he hopes that the contribution of innovative, intelligent solutions and connected objects will automate certain tasks that are sometimes very tedious and time-consuming for healthcare professionals. Precious time that they should be devoting above all to what’s essential: looking after their patients.

“The adaptability of ORBIS means we can meet the specific expectations of healthcare professionals, linked to changes in practices and the emergence of different types of care”.

Find out more about our ORBIS EPR system