1. From Hospital…… ……. to Home « The use of I C T for healthcare in France » Bertrand BAILLEUL European Health Managers Forum

2. New challenges in the healthcare  The power of the consumers  The technological transition  The epidemiological changes  The problem of the human resources  The difficulty of public funding

3. Which vision for the new decade ?  The patient is unique  The place of the different caregivers  Bringing an added value

4. The emerging solution  An integrated service system - From hospital to home : a global solution for the patient - A new organisation of the care provider

5. The place of the Rehabilitation The rehabilitation : A real bridge between hospital and home A more specialised and larger job A way to decrease the cost of acute care

6. Towards a New Concept « The Home-Based Long-Term Specialised Care » - In addition to the traditional home care, the specialised home care (managed by the hospital) New ways of specialised clinical treatments with a coordination of specialized services an increased patient and caregiver support a medicalisation of the home a large use of the new technologies, especially ICT

7. The place of the ICT  Can ICT bring solutions ?

8. THE TELEMEDECINE A NEW TOOL  Teleexpertise/Telediagnostic  Teleconsultation  Telesurveillance  Teleassistance  Visioconference  Teleinformation, ehealth

9. THE TELEMEDECINE IN PARIS AREA - Paris : a large area with 15 Millions people (20 University Hospitals, more than 100 General Hospitals) - The telemedecine in Paris area : a network of  41 Hospitals in Paris area  52 Applications  40 Specialities  The example of TELIF : A tool for the neurosurgery

10. Some examples  The stroke  The transplantation  The home care

11. THE STROKE (1) - 150 000 Brain Strokes in France per year - 20% patients die in the first days - 70% patients have severe handicaps - 3 Hours for dealing a patient with a brain stroke - Difficult transfert in Paris due to large traffic jams - With Telemedecine, it was possible to decrease these figures from 30% during the last three years (scann and thrombolyse)

12. THE STROKE (2)  Telemedecine is now used for : - Telediagnostic - Teleconsultation - Visioconference of medical meetings - Medical files

13. THE STROKE (3)  Telemedecine is starting to be used in rehabilitation centers in connection with stroke centers for : - Choice of transferts - Teleconsultation - Visioconference of medical meetings

14. THE STROKE (4)  Telemedecine is planned to be used for home care in connection with stroke centers and rehabilitation centers for : - telesurveillance - visioconference with local and home caregivers - medical files - telediagnostic

15. THE TRANSPLANTATION (1)  Liver transplantations need a short stay in the transplantation centers and quick transfers in specialised rehabilitation centers.  Telemedecine is used for : - Choice of transferts - Teleconsultation - Visioconference of medical meetings

16. THE TRANSPLANTATION (2)  Telemedecine is planned to be used for home care for : - telesurveillance - visioconference with local and home caregivers - medical files - telediagnostic - teleeducation (nutrition)

17. THE HOME CARE (1)  Specialised Home care are now using technicals tools for : - Heart pressure controle - Chimiotherapie - Palliative care - Life support/ventilator assistance system

18. THE HOME CARE (2)  Telemedecine is planned to be used for home care for : - telesurveillance - visioconference with local and home caregivers - medical files - telediagnostic - teleeducation, ehealth - telesupport

19. THE PLACE OF ITC - ITC will allow the development of new ways of care - but it will raise new challenges partly for the rehabilitation care but mainly for the home care

20. The specialised home care a big challenge for the coming years thanks to ICT ……but large unsolved problems remain  Which cooperation with the traditional home care ?  Are the home caregivers ready to be so much involved ?  How to deal with the risks in a home which become a mini hospital ?  Is it cheaper and more efficient than keeping these patients in the hospital ?

21. CONCLUSION  ICT are necessary for facing the new challenges of healthcare  but it will be necessary to deal with new problems What will be the place of the hospital with which organisation and …………….which architecture ?