For almost two years, the Victor Dupouy hospital in Argenteuil and Saint-Louis hospital in Paris have had a remote expertise system for dermatology. It’s the first long-term project of its kind in France. Doctor Emmanuel Mahé, Head of Argenteuil hospital’s Dermatology department, told us more about this effective, innovative system.
expertise WITH photoS
Tell us about the remote dermatology project at Argenteuil hospital
Dr Emmanuel Mahé: We do tele-expertise using photos: during the consultation, a photo taken by the doctor is sent to the platform along with the patient records. The dermatologist receives an email alert. If the information is inadequate, we can ask for them to complete it, which give us a greater guarantee.
It really is tele-expertise as opposed to a remote consultation or teleconsultation. With teleconsultation, two healthcare professionals are present: there’s an expert and a doctor or nurse with the patient, and it involves making an actual appointment. It’s an important distinction, particularly in the places we work in – in prisons – because it’s rather difficult to get inmates to stick to specific times. In Le Mans, where they’ve been experimenting with remote consultations, there was about a 20% no-show rate.
We work a lot with prisons in the Greater Paris area; they send us on average two to three requests a day. We undertake to respond on the same day. Tele-expertise works well in this situation.
“We’ve carried out over 400 expertise consults and patients have never refused.”
SWITCHING FROM AN INFORMAL modEL TO A FULL REMOTE dermatologY PLAN
How did the project come about?
“In dermatology, all doctors carry out informal tele-expertise.”
For the past twelve years or so we’ve been doing consultations via email, on an informal and not very secure basis. About four years ago, the Agence Régionale de Santé (ARS, Regional Health Agency) launched an invitation to tender to develop telemedicine at penitentiary centres. We were contacted because remote dermatology is fairly simple to set up.
Meanwhile, Saint-Louis hospital was working with Fresnes Prison. So we merged our two projects, based on our tele-expertise model. The ARS selected the project and the IT and regulatory aspects were handled by the GCS D-SISIF, a healthcare cooperation in charge of developing shared healthcare IT systems in the Greater Paris area. It handled all the security procedures, the declarations to the CNIL, (French administrative regulatory body in charge of ensuring data privacy, Ed) and the administrative formalities.
“The main obstacles are human ones: some centres contact us every week, whilst others aren’t really on-board.”
The project started about two years ago. It puts the experts from Argenteuil and Saint-Louis hospitals in touch with around a dozen healthcare units of prisons in the Greater Paris area.
“Moving an inmate requires staff, an armoured van, and costs several hundred euros. With tele-expertise, we just charge a one-off consultation fee.”
A medical and economic assessment of the project is in progress; the first results are very encouraging, despite the development costs. Feedback in terms of team satisfaction has also been positive.
It’s also created demand: Bois-d’Arcy prison never used to call us three times a week for a medical opinion. This system offers them new possibilities for requesting consultations.
ExTENDING tele-expertise to other disciplines
What’s the next step?
Over the next few months, our platform is going to switch to ORTIF, Paris’ regional telemedicine tool that all the area’s hospitals with emergency services are linked up to. Our platform was relatively private up to now, but soon, other organisations will be able to use it, provided of course they ask for the necessary approval.
ORTIF is also going to incorporate videoconferencing capabilities and will be able to transfer larger volumes of images. For example, there’s no reason we won’t be able to share anatomical_pathology images, which are very large files. Tele-expertise could be used for other disciplines – orthopaedics, for example, by sending X-rays.
The project has been such as success that we’re now working with Versailles hospital, who are having trouble finding a dermatologist. The idea is eventually to cover the whole area by opening up the platform to other hospitals. And as everyone has an ORTIF subscription now, the cost is minimal.