The Parisian hospitals have opened almost 10 million patient records and experiment with an AI technique for early detection of colorectal cancer.

10 million patient records

After eight years of deployment and 180 million euros of investments the Orbis information system, which manages the patient’s medical record, is operational in all 39 hospitals of the hospital system in the region of Paris called AP-HP. This information system manages the digital identity of nearly 10 million patients. In comparison, under the umbrella of the National Health Insurance only 6 million shared electronic health records were created on the national level in 2018 for the so called dossier médical partagé.

The new information system has outsized dimensions: 70,000 users, doctors and paramedics, 314 million laboratory results, 26 million medical records (some patients still have different files e.g. one file for radiology, another file for the reports of hospitalization…). To switch the data of the last hospital, Robert Debré, it was necessary to transfer more than five years of history from 270,000 records, including 130,000 duplicates which had to be deleted. “The previous information system was thirty-five years old, it took us two years to prepare, three months to check the data, and one night to migrate to Orbis.” reported Laurent Treluyer, the director of the information systems.

What does this mean in practice? Every patient who enters an establishment of AP-HP is in theory provided of a unique number needed to access their data via a security portal. Orbis is not only a safety deposit box: the portal gives the patient the ability to make an appointment, pay online or fill in a questionnaire that will facilitate the work of the doctor during the next consultation.

A Doctor of, for example, the hospital Ambroise-Paré will have the ability to consult reports of the Hospital Robert-Debré and vice-versa. If a doctor did a CT scan at the hospital La Pitié, he could within one click ask for an opinion from a radiologist at Beaujon and when he is on shift at Samu de Garches and receives a call, he can immediately open the medical record of the patient to gain insight on the background and the treatments of the patient.

However, not all data is yet accessible in the 39 establishments via Orbis. The patient records will be shared in all facilities by mid-2020. They are added to the nationally shared electronic health record: dossier médical partagé… when the patient has created one, because the hospital cannot do it for him.

The enthusiasm is not present among all the staff. “If we need the advice of a radiologists of the hospital Cochin, we take our iPhone and send a picture in the intern orthopedic group,” explains an emergency doctor at the hospital Hotel Dieu, who judges Orbis as “not ergonomic” and “full of bugs”. The clinician regrets not being able to consult his patient records on a mobile application, and he wonders if overworked caregivers will manage to successfully complete the patient record.

AI for early detection of colorectal cancer

Two establishments of AP-HP have tested Gi Genius in August and September 2019. Gi Genius is an AI based device that improves the early detection of colorectal cancer. The device is designed by Cosmo Pharmaceuticals, an Irish company specialized in gastrointestinal disorders. When Gi Genius is linked to the usual colonoscopy equipment, it makes it possible to automatically detect a polyp (an excrescence that could be cancerous) with more precision. According to the National Cancer Institute, colorectal cancer is the second most common cancer in women and third in men in France.

“It is a recreation of diagnostics from raw images without interpretation. For now, it’s just detection: normal or not normal” explains Robert Benamouzig, head of the gastroenterology department of the hospital Avicenne.

The small device will detect and report all anomalies that could indicate a colorectal polyp automatically and in real time. When the device detects an unusual outgrowth, it projects a green frame around the affected area and beeps.

Image courtesy of Globe Newswire.

“When we perform the colonoscopy in duplo, we find 10 to 20% more lesions at the second examination”. Gi Genius has a reliability of 99.7%. “The system hardly misses any polyps,” states robbert Benamouzig. This safety is essential because the endoscopies – colonoscopy and fiberoptic endoscopy – concern almost two million French people a year.