Publications (15)6.36 Total impact
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Article: [Impact of the chemotherapy protocols for metastatic breast cancer on the treatment cost and the survival time of 371 patients treated in three hospitals of the Rhone-Alpes region].
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ABSTRACT: The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P < 10(-3)). The average cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.Bulletin du cancer 08/2009; 96(10):929-40. · 0.67 Impact Factor -
Article: [Quality and usefulness of an anonymous unique personal identifier to link hospital stays recorded in French claims databases].
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ABSTRACT: Since 2001, the French national case mix program is allowed by law to use an enciphering algorithm named "FOIN" to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm "thrashes" the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated. Foin error flags were first assessed in the 2002 Rhône-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes. First, among 1,668,971 hospital discharge abstracts from the regional case mix database, 206,710 (12.4%) had at least one Foin error flag. The most frequent error flag (93026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137,236 patients from university hospital of Lyon and 0.3% among 39512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers. The overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.Revue d Épidémiologie et de Santé Publique 07/2007; 55(3):203-11. · 0.78 Impact Factor -
Article: A road from health care classifications and coding systems to biomedical ontology: the CEN categorial structure for terminologies of human anatomy: Catanat.
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ABSTRACT: There is an increasing need for updated and harmonised health care classifications and coding systems to allow international comparisons and cooperation for instance for population based WHO indicators, Electronic Health Record safety, trans border migration of population, case mix and procedure payment. It is not feasible to propose a standardisation of the linguistic expressiveness of different health care professionals and of the citizens. Natural language expressions show inconsistencies and ambiguities as assessed by biomedical ontology driven tools. In order to build a road towards standardisation the European Standard Body CEN has stated that it was not possible to convince the different European member states using different national languages to agree on a reference clinical terminology as Snomed-CT or to standardise a detailed language independent biomedical ontology. It has developed since 1990 an approach named categorial structure as a step standardising only the terminologies model structure. The categorial structure for terminologies of human anatomy currently in the phase of final approval is presented as a methodology for bridging between classifications and coding systems and biomedical ontology on the way to semantic interoperability between different languages, legacies and goals.Studies in health technology and informatics 02/2007; 129(Pt 1):735-40. -
Article: Integrating the Modelling of EN 1828 and Galen CCAM Ontologies with Protégé: towards a Knowledge Acquisition Tool for Surgical Procedures.
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ABSTRACT: The presentation assess the usability of the ontology platform protégé integrated with the terminology reasoning tool RACER to represent different terminology systems as the CEN European standard EN 1828 which is a categorical structure and the extensive French coding system CCAM supported by a GALEN representation. We present the 2 systems and some results showing the easiness to test the consistence of the ontology or of instances of terminology systems.This type of software tool which is accessible as open source could support a convergent "reference terminology representation" approach. Based on a formal representation development and allowing diversity in linguistic expressiveness of end users this approach can associate shared knowledge acquisition in the public domain and competing systems, software developers and researchers.Studies in health technology and informatics 02/2005; 116:767-72. -
Article: Linking Hospital Discharge Summaries from Oncology Departments in Order to Achieve Epidemiological Cancer Monitoring for Strategic Planning
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ABSTRACT: In anticipation of the creation of a cancer institute (ICL) in Saint-Etienne, France, 3 hospitals tested a procedure which permanently links hospital discharge summaries to DRG’s (PMSI). To this end used the asymmetric hashing and encrypting software developed by one of the authors which had been evaluated from 1996 to 1999 by selecting discharge summaries from each institution containing at least one malignant tumour ICD code. Thus, we were able to compile an anonymous 16,000 patient register. 5 tumour locations were found in almost half the patients: breast (16.7 %), bowel (9.6 %), lung and bronchi (9.1 %), prostate gland (6.8 %), and skin (5.5 %). We estimate that the future ICL will take care of 2,500 cancer patients annually. We compared the number of new patients hospitalized each year (1,500) to the incidence reported by the manual cancer registers (FRANCIM). We conclude that this linking procedure is both feasible and acceptable when its precise health goal is clearly defined. Following this initial step, we are extending the procedure to involve other health care institutions (both public and private) in the Saint Etienne area and to the main regional cancer network (ONCORA). Beginning in 2001 the French ministry of health has approved this DRGs linking procedure throughout France.Revue médicale de l'assurance maladie. 01/2001; -
Article: GALEN: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.
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ABSTRACT: Generalised architecture for languages, encyclopedia and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalization of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology.International Journal of Medical Informatics 10/2000; 58-59:71-85. · 2.41 Impact Factor -
Article: Reconciling Users' Needs and Formal Requirements: Issues in developing a Re-Usable Ontology for Medicine
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ABSTRACT: A common language, or terminology, for representing what clinicians have said and done is an important requirement for individual clinical systems, and it is a prerequisite for integrating disparate applications in a distributed telematic healthcare environment. Formal representations based on description logics or closely related formalisms are increasingly used for representing medical terminologies. GALEN's experience in using one such formalism raises two major issues: . How to make ontologies based on description logics easy to use and understand for both clinicians and applications developers; . What features are required of the ontology and description logic if they are to achieve their aims. Based on our experience we put forward four contentions: two relating to each of these two issues: . That natural language generation is essential to make a description logic based ontology accessible to users; . That the description logic based ontology should be treated as an `assembl...10/1999; -
Article: Model-based semantic dictionaries for medical language understanding.
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ABSTRACT: Semantic dictionaries are emerging as a major cornerstone towards achieving sound natural language understanding. Indeed, they constitute the main bridge between words and conceptual entities that reflect their meanings. Nowadays, more and more wide-coverage lexical dictionaries are electronically available in the public domain. However, associating a semantic content with lexical entries is not a straightforward task as it is subordinate to the existence of a fine-grained concept model of the treated domain. This paper presents the benefits and pitfalls in building and maintaining multilingual dictionaries, the semantics of which is directly established on an existing concept model. Concrete cases, handled through the GALEN-IN-USE project, illustrate the use of such semantic dictionaries for the analysis and generation of multilingual surgical procedures.Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/1999; -
Article: Reconciling users' needs and formal requirements: issues in developing a reusable ontology for medicine.
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ABSTRACT: A common language, or terminology, for representing what clinicians have said and done is an important requirement for individual clinical systems, and it is a pre-requisite for integrating disparate applications in a distributed telematic healthcare environment. Formal representations based on description logics or closely related formalisms are increasingly used for representing medical terminologies. GALEN's experience in using one such formalism raises two major issues, as follows: how to make ontologies based on description logics easy to use and understand for both clinicians and applications developers; what features are required of the ontology and description logic if they are to achieve their aims. Based on our experience we put forward four contentions: two relating to each of these two issues, as follows: that natural language generation is essential to make a description logic based ontology accessible to users; that the description logic based ontology should be treated as an "assembly language" and accessed via "intermediate representations" oriented to users and "perspectives" adapting it to specific applications; that independence and reuse are best supported by partitioning the subsumption hierarchy of elementary concepts into orthogonal taxonomies, each of which forms a pure tree in which the branches at each level are disjoint but nonexhaustive subconcepts of the parent concept; that the expressivity of the description logic must include support for transitive relations despite the computational cost, and that this computational cost is acceptable in practice. The authors argue that these features will be necessary, though by no means sufficient, for the development of any large reusable ontology for medicine.IEEE Transactions on Information Technology in Biomedicine 01/1999; 2(4):229-42. · 1.68 Impact Factor -
Article: Full text multilingual automatic morphosemantems for stand-alone or Internet based applications.
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ABSTRACT: The authors present an automatic tool able to provide real-time morphosemantic decomposition of natural language sentences in French, German and English. This tool demonstrates the feasibility of Natural Language Processing on standard PC computers and the technology involved has been successfully implemented in daily used applications in several European hospitals. It considerably alleviates the burden of coding with various international classification and enhances the quality of the final results. This tool, delivered on PC platforms, is highly convivial and provides a versatile interface to any existing applications based on the Microsoft Windows standards. Moreover, all high levels functions have been encapsulated in Object Oriented Components and can therefore be reused using the Common Object Model standards to develop stand-alone or Internet applications.Studies in health technology and informatics 02/1998; 52 Pt 1:155. -
Article: Galen-In-Use: using artificial intelligence terminology tools to improve the linguistic coherence of a national coding system for surgical procedures.
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ABSTRACT: GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centers co-operating within the European Federation of Coding Centre (EFCC) to create a language independent knowledge repository for multicultural Europe. We used an integrated set of artificial intelligence terminology tools named CLAssification Manager workbench to process French professional medical language rubrics into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation we generate controlled French natural language. The French national coding centre is then able to retrieve the initial professional rubrics with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.Studies in health technology and informatics 02/1998; 52 Pt 1:623-7. -
Article: Galen-In-Use: an EU Project applied to the development of a new national coding system for surgical procedures: NCAM.
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ABSTRACT: GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centre co-operating within the European Federation of Coding Centre (EFCC) to create a multilingual knowledge repository for multicultural Europe. NCAM (Nomenclature Commune des Actes Médicaux) is the new French multipurpose coding system for surgical procedures. The labels are processed from the intermediate dissections to the Grail representation and the natural language generation by the electronically related Medical Informatics research centres network of Saint Etienne, Manchester, Geneva and Nijmegen. The national coding centre is able to retrieve the initial labels with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.Studies in health technology and informatics 02/1997; 43 Pt B:897-901. -
Article: [DRGs in Europe].
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ABSTRACT: DRG projects developments in Europe are shown since 1982 until 1989 being much similar in Western Europe different countries just as Prospective Payment System was implemented in the US International intergovernmental organizations like Council of Europe, OECD, WHO Europe and European Economic Community have supported and support the new system. Diagnostics and procedures coding was the main technical issue and European countries found different ways to cope with. How to use DRGs in Europe is still the main challenge. The European use is mainly in favour of internal management, planning, performance measurement but recently the most advanced projects have decided to relate partly hospital budget to case mix bases on DRGs as an incentive to greater efficiency.Sozial- und Präaventivmedizin SPM 02/1989; 34(4):152-5. · 0.82 Impact Factor -
Article: A Comprehensive Approach to Developing and Integrating Multilingual Classifications: GALEN's Classification Workbench
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ABSTRACT: The GALEN Classification Workbench presents a new user-oriented paradigm for maintaining terminologies which combines flexibility with formal rigour. It is based on three mechanisms: a user oriented ‘intermediate representation’, a formal description logic, and generated natural language. New terms are composed in the ‘intermediate representation’ which is transformed into the formal description logic from which natural language phrases are then generated. The formal description logic allows terms to be classified and manipulated rigorously while the intermediate representation and generated natural language allow the system to be tailored to the needs of individual users and applications. -
Article: Qualité et utilité d'un identifiant patient anonyme et unique pour le chaînage des séjours hospitaliers dans les bases de données médicoéconomiques françaises
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ABSTRACT: BackgroundsSince 2001, the French national case mix program is allowed by law to use an enciphering algorithm named “FOIN” to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm “thrashes” the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated.Methods Foin error flags were first assessed in the 2002 Rhône-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat® software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes.ResultsFirst, among 1 668 971 hospital discharge abstracts from the regional case mix database, 206 710 (12.4%) had at least one Foin error flag. The most frequent error flag (93 026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137 236 patients from university hospital of Lyon and 0.3% among 39 512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers.Conclusion The overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.RésuméDepuis 2001, un identifiant anonyme du patient, l'identifiant « FOIN » a été ajouté dans les données médicotarifantes françaises pour « chaîner » les hospitalisations se rapportant à un même patient. Il est créé par hachage–cryptage de trois traits d'identification : numéro d'assuré social, date de naissance et sexe. Avant de l'utiliser dans un objectif de financement, d'épidémiologie ou de coordination des soins, sa capacité de « chaînage » doit être évaluée.MéthodesLes anomalies de chaînage signalées dans les données de la région Rhône-Alpes en 2002 ont été décrites. Pour les CHU de Lyon et de Saint-Étienne, les doublons (au moins deux identifiants pour un patient) et les collisions (un même identifiant pour au moins deux patients) ont été recherchés sur l'identifiant Foin par comparaison à d'autres identifiants : l'état civil et un identifiant anonyme obtenu par le logiciel Anonymat® à partir des nom, prénom et date de naissance. Enfin, les anomalies de chaînage ont été croisées avec les erreurs de « doublonnage » ou de collision de l'identifiant Foin.RésultatsParmi les 1 668 971 hospitalisations des données régionales, 206 710 (12,4 %) comportent au moins une anomalie de chaînage avec Foin. L'absence des trois traits d'identification nécessaires à Foin est l'anomalie majoritaire (93 026 séjours soit 5,5 %). Les taux les plus élevés concernent les séjours de nouveau-nés (38,5 %) et ceux des établissements publics (17,3 %). Foin a provoqué peu d'erreurs de doublonnage : 1,2 % parmi les 137 236 patients du CHU de Lyon et 0,3 % parmi les 39 512 patients du CHU de Saint-Étienne. Mais 7776 (5,7 %) patients de Lyon et 460 (1,2 %) de Saint-Étienne participent à des collisions. L'identifiant Anonymat a chaîné sans doublon et sans collision 99,6 % des patients des deux hôpitaux. La majorité des séjours sans anomalie de chaînage n'a pas d'erreur sur Foin (plus de 99 % de chaînages corrects) alors que parmi les séjours avec anomalies, il y a pratiquement autant de séjours avec et sans erreur. La qualité du chaînage avec l'identifiant Foin n'est pas suffisante sauf pour certains départements et certaines pathologies. L'amélioration du chaînage des données de santé peut s'orienter dans plusieurs voies.Revue d'Épidémiologie et de Santé Publique. 55(3):203-211.
Top co-authors
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Institutions
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1989–2009
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Université Jean Monnet
- Faculté de Médecine
Saint-Étienne, Rhone-Alpes, France
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1999
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University of Geneva
- Division of Medical Informatics
Genève, GE, Switzerland
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