L’utilisation des TIC à l’hôpital prend une place de plus en plus importante et son développement ne cesse de croître. Le cadre juridique applicable se révèle cependant complexe à appréhender, composé à la fois de textes de droit commun et de textes plus spécifiques, le tout formant un ensemble pas toujours cohérent. Pour accompagner au mieux l’utilisation des TIC à l’hôpital, le législateur doit trouver le juste équilibre entre cadre propice pour le développement de ces pratiques, protection des droits fondamentaux et sécurisation des pratiques. Or, à l’heure actuelle, le cadre juridique applicable à l’utilisation des TIC à l’hôpital ne permet pas d’assurer cet équilibre délicat. Les pouvoirs publics ont donc un rôle stratégique à jouer dans la sécurisation de l’utilisation des TIC à l’hôpital. Une impulsion nationale doit être donnée en la matière, afin d’assurer la cohérence des projets développés, au travers d’une gouvernance forte. Le cadre juridique doit, quant à lui, être rénové afin d’accompagner l’innovation dans le numérique en santé et assurer la sécurité juridique nécessaire à la bonne utilisation des TIC. Dans ce contexte, les hôpitaux ont un rôle essentiel à jouer afin de sécuriser leurs pratiques / The use of ICT has become increasingly important in hospitals. However, the legal framework structuring its use is very complex to grasp. Indeed, it is made up of general laws as well as specific ones and makes this framework sometimes unconsistent. To provide an optimal legal framework for the ICT to expand safely, the legislator needs to strike the right balance between protecting fundamental rights and securing practices. As the current legal framework does not provide this delicate balance, public authorities have a strategic role to play to ensure a secure use of ICT within hospitals. To guarantee the development of consistent projects, a strong governance has to set up a national leadership. The legal framework needs to be rehabilitated to support digital innovation in Healthcare and to ensure a legal protection required for an appropriate use of ICT. Hospitals have then a key role to play in securing their practices

Background: Previous studies have shown that ICT applications could affect elderly people who suffer from mild dementia (MD) or mild cognitive impairment (MCI) positively. These applications might help patients with MD or MCI, improving their cognitive performance, independency and, their quality of life. Elderly may also be able to live alone at their own home with the help of these ICT applications. Therefore, the burden of caregivers and family members can be reduced. An IT-enabled solution was proposed to create new knowledge and experience among MCI and MD patients and their caregivers. The project was funded by European union and four countries i.e. Sweden, Spain, Italy and Israel were involved in it. Purpose: The purpose of this study was to apply a technology-enabled integrated care model. Two aspects of the study were to measure the quality of life of the elderly with mild cognitive impairment (MCI) or mild dementia (MD) after using the model and to understand the professional caregivers’ perspectives of the model. Method: A mixed-method approach was applied in this research which was a combination of using standard and internally developed questionnaires and semi-structured interviews. Conclusion: The result of the study showed that DECI could have positive effect as a complementary tool for the care process of the elderly who suffered from dementia. The general perception in all sites was positive and professionals confirmed the willingness to use DECI in the future.

Introduction: There is a growing interest in how technology can be used in order to provide efficient healthcare. Aim: The aim is to explore perceptions on the use of home telemonitoring in patients with COPD.                                                                                                                             Method: Semi-structured individual interviews were carried out with eight women and five men who were part of a larger project aiming to develop and evaluate a telemonitoring system. Participants were interviewed after having used the system for two to four months. Interview transcripts were analysed with qualitative content analysis. Results: The analysis resulted in the theme a transition towards increased control and security and the categories: facing enablers or barriers, increasing control over the disease, providing easy access to care and affecting technical confidence or concern. Participants expressed initial feelings of insecurity, both in practical aspects using the telemonitoring system as well as regarding their disease. The telemonitoring system could reinforce and confirm the participants´ feelings of their current state of health, and the practical management of the telemonitoring system became easier with time.     Conclusion: Telemonitoring can be a valuable complement to healthcare with the potential to contribute to equity in care. However, in order to improve further development and implementation of telemonitoring, several actions are needed such as improved patient education and the use of co-creation. Additional research is needed particularly in the design of user-friendly systems as well as tools to predict which patients are most likely to find the equipment useful as it may result in reduced costs and increased empowerment. / Introduktion: Intresset för hur teknologi kan användas för att erbjuda effektiv sjukvård ökar. Syfte: Syftet är att utforska KOL-patienters upplevelse av att använda ett webbaserat rapporteringssystem i hemmet. Metod: Semi-strukturerade individuella intervjuer med åtta kvinnor och fem män som deltog i ett större projekt med syfte att utveckla och utvärdera ett webbaserat rapporteringssystem. De intervjuades efter att ha använt systemet två till fyra månader. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat en övergång till ökad kontroll och trygghet samt kategorierna: möta möjligheter eller hinder, ökad kontroll över sjukdomen, skapar lättillgänglig vård samt påverkar teknisk självkänsla eller oro. Deltagarna uttryckte till en början osäkerhetskänslor, både vad gäller praktiska aspekter i användandet av rapporteringssystemet samt kring själva sjukdomen. Det webbaserade rapporteringssystemet kunde förstärka och bekräfta deltagarnas egna känsla av mående och det praktiska hanterandet av rapporteringssytemet blev lättare med tiden. Konklusion: Webbaserade rapporteringssystem kan vara ett värdefullt komplement till sjukvården med potential att bidra till jämlik vård. I syfte att förbättra fortsatt utveckling och implementering bör förbättrad patientinformation samt vikten av att ta med användarna i utformningen beaktas. Mer forskning behövs för att optimera användarvänlighet samt att identifiera de patienter som har bäst nytta av systemet då det kan ge hälsoekonomiska vinster och inte minst öka patienters delaktighet.

La thèse, réalisée dans le cadre du projet « investissements d'avenir » E-care, propose un processus méthodologique pour faciliter l'analyse et la conception de systèmes de télésurveillance médicale pour la détection précoce de signes précurseurs à toute complication. La méthodologie proposée est basée sur un système multi-agents utilisant plusieurs types d'ontologies associées à un système expert. Le système multi-agents est adapté à la télésurveillance médicale avec une architecture distribuée pour permettre l’autonomie et la réactivité au sein des sites de déploiement, en particulier les habitats. Les architectures ainsi conçues, prennent en compte l'ensemble des données du patient : son profil, ses antécédents médicaux, les traitements médicamenteux, les données physiologiques et comportementales ainsi que les données relatives à son environnement et à son hygiène de vie. Ces architectures doivent également être ouvertes pour s'adapter à de nouvelles sources de données.Cette méthodologie a été appliquée au projet E-care définissant ainsi son système d'information. Ce système d'information est composé de deux types d'ontologies représentant les connaissances pertinentes ainsi qu'un système expert pour la détection de situations à risque. Une première ontologie du problème a été construite pour gérer le système, les acteurs et leurs taches. Par la suite, trois ontologies de domaines ont été construites représentant, les maladies, les médicaments et les facteurs de risque cardio-vasculaire. Le système expert exploite des règles d'inférences construites en collaboration avec les experts médicaux et en utilisant des guides de bonnes pratiques dans le domaine de la cardiologie. Cette méthodologie a défini également l'architecture du système composé de quatre types d'agents autonomes à savoir : des capteurs pour la prise de mesures, une passerelle pour la collecte et la transmission depuis les habitats, un serveur pour le traitement et l'accès aux données, et enfin une base de données pour le stockage sécurisé des données des patients.Le système E-care a été testé et validé en utilisant des tests et des simulations inspirés de cas réels. Par la suite, une expérimentation a été faite pour la validation les différents composants du système dans milieu de télésurveillance médicale. Cette expérimentation est passée par deux phases, la première s'est déroulée au CHRU de Strasbourg, et la deuxième est en cours aux domiciles des patients. / The thesis, conducted as part of the E-care project, proposes a methodological process to facilitate the analysis and design of medical remote monitoring systems for early detection of signs of any complications. The proposed methodology is based on a multi-agent system using several types of ontologies associated with an expert system. The multi-agent system is suitable for medical monitoring with a distributed architecture to keep some autonomy and responsiveness of habitats. The process identifies the generic and specific aspects of each system. The designed architectures take into account all the patient data such as: patient profile, medical history, drug treatments, physiological and behavioral data, as well as data relating to patient's environment and his lifestyle. These architectures should be open to be adapted to new data sources.This methodology was applied to E-care project in order to define its information system. This information system is composed of two types of ontologies (problem ontology and several domain ontologies) and an expert system for the detection of risk situations. The problem ontology was built to manage the system including users and their tasks. Three domain ontologies have been built to represent, disease, drugs and cardiovascular risk factors. The expert system uses inference rules, which are defined in collaboration with medical experts using their knowledge and some medical guidelines. This methodology also defined the system architecture, which consists of four autonomous agents types namely: medical sensors to collect physiological measurements. The gateway collects data from sensors and transmits them from the patients' homes to the server. The server processes data and gives access to them. Finally the database secures storage of patient data.As part of the E-care project, an experiment was conducted to validate the various system components. This experiment has gone through two phases, the first was held at the University Hospital of Strasbourg, and the second is in the patients' homes.

This thesis reports on the use of Twitter during the 2009 H1N1 pandemic to explore its use as an “infoveillance” approach complementary to traditional surveys and content analysis.  This study aimed to: 1) report on the use of “H1N1” versus “swine flu”, 2) conduct a qualitative analysis of tweet content, and 3) assess the feasibility of Twitter as a real-time content, sentiment, and public attention trend tracking tool. A manual content analysis of tweets revealed that H1N1 resources were the most commonly shared.  Few tweets provided inaccurate information.  News websites were the most popular resources while official agencies were rarely referenced directly.  Our automated analysis correlated well with manual results and showed that Twitter activity was influenced by external events. This study describes the character and quality of Twitter communications during the H1N1 pandemic, and illustrates the potential of using social media to conduct real-time “infodemiology” studies for public health.

This thesis reports on the use of Twitter during the 2009 H1N1 pandemic to explore its use as an “infoveillance” approach complementary to traditional surveys and content analysis.  This study aimed to: 1) report on the use of “H1N1” versus “swine flu”, 2) conduct a qualitative analysis of tweet content, and 3) assess the feasibility of Twitter as a real-time content, sentiment, and public attention trend tracking tool. A manual content analysis of tweets revealed that H1N1 resources were the most commonly shared.  Few tweets provided inaccurate information.  News websites were the most popular resources while official agencies were rarely referenced directly.  Our automated analysis correlated well with manual results and showed that Twitter activity was influenced by external events. This study describes the character and quality of Twitter communications during the H1N1 pandemic, and illustrates the potential of using social media to conduct real-time “infodemiology” studies for public health.

This study aimed to utilize usability engineering methods in order to identify facilitators and barriers to electronic referral system adoption by radiation oncologists at Princess Margaret Cancer Centre, and provide recommendations for electronic referral system design. Analyses included workflow analysis of radiation oncologists reviewing referrals, belief elicitation interviews with radiation oncologists, a heuristic evaluation of an existing electronic referral system interface, and cognitive walkthrough of that interface with radiation oncologists. Based on these findings, the system interface was redesigned using mock-up software to address identified usability issues. The existing and redesigned interfaces were compared using observational usability testing with radiation oncologists. The redesigned system interface yielded reduced task times and enhanced user satisfaction as compared to the existing interface. Thus, user-centred design was useful in determining facilitators and barriers to e-referral adoption.

This study aimed to utilize usability engineering methods in order to identify facilitators and barriers to electronic referral system adoption by radiation oncologists at Princess Margaret Cancer Centre, and provide recommendations for electronic referral system design. Analyses included workflow analysis of radiation oncologists reviewing referrals, belief elicitation interviews with radiation oncologists, a heuristic evaluation of an existing electronic referral system interface, and cognitive walkthrough of that interface with radiation oncologists. Based on these findings, the system interface was redesigned using mock-up software to address identified usability issues. The existing and redesigned interfaces were compared using observational usability testing with radiation oncologists. The redesigned system interface yielded reduced task times and enhanced user satisfaction as compared to the existing interface. Thus, user-centred design was useful in determining facilitators and barriers to e-referral adoption.

The introduction of newborn screening for hearing has refocussed attention on the information and support needs of families with deaf children. The Internet is providing an additional resource for families to access timely and relevant information and advice. However, the experiences and attributes of parents of deaf children who search the Internet for information and support remain largely anecdotal. This study aims to bridge some of this knowledge gap. Parents of deaf children were recruited to complete two online surveys. The Parent Survey sought to establish the demographic details and Internet use patterns of parents who use the Internet to search for information about deafness. The online Support Group Survey asked parents about their experience of participating in online support groups. One hundred and sixty-three respondents completed the Parent Survey. Analysis of the data found Internet use is unrelated to the age of the parent, the age of their child, where they live or their employment status. Their use of the Internet is also unrelated to the type of hearing loss of their child, if their child has a cochlear implant or an additional disability or medical condition, or the method of communication used by the child. Education level of the parent, however, does influence the level of Internet use. Qualitative data indicates the need for unbiased information that is evidence-based on a range of issues that are important for families to make informed decisions regarding raising a deaf child. Twenty parents responded to the Online Support Group Survey. They participate in online support groups for the wealth of information and the support and understanding they receive from other parents. All respondents would recommend an online support group to other parents. The respondents indicated that the benefits significantly outweighed the limitations. The two major issues this study has highlighted is the need for parents of deaf children to receive unbiased and evidence-based information from a variety of sources, including the Internet and online support groups, and the need to ensure that parents have access to timely and reliable information irrespective of education level, socio-economic status and ethnicity. This study provides a foundation of knowledge for service providers and hearing professionals developing Internet resources for parents of deaf children in Australia.

La gestion de l'acheminement de messages d'e-santé en environnement ubiquitaire soulève plusieurs défis majeurs liés à la diversité et à la spécificité des cas d'usage et des acteurs, à l'évolutivité des contextes médical, social, logistique, environnemental...Nous proposons une méthode originale d'orchestration autonome et auto-adaptative de services visant à optimiser le flux des messages et à personnaliser la qualité de transmission, en les adressant aux destinataires les plus appropriés dans les délais requis. Notre solution est une architecture générique dirigée par des modèles du domaine d'information considéré et des données contextuelles, basés sur l'identification des besoins et des contraintes soulevées par notre problématique.Notre approche consiste en la composition de services de fusion et de gestion dynamique en temps réel d'informations hétérogènes provenant des écosystèmes source, cible et message, pilotés par des méthodes d'intelligence artificielle pour l'aide à la prise de décision de routage. Le but est de garantir une communication fiable, personnalisable et sensible à l'évolution du contexte, quel que soit le scénario et le type de message (alarme, technique, etc.). Notre architecture, applicable à divers domaines, a été consolidée par une modélisation des processus métiers (BPM) explicitant le fonctionnement des services qui la composent.Le cadriciel proposé est basé sur des ontologies et est compatible avec le standard HL7 V3. L'auto-adaptation du processus décisionnel d'acheminement est assurée par un réseau bayésien dynamique et la supervision du statut des messages par une modélisation mathématique utilisant des réseaux de Petri temporels / Routing policy management of eHealth messages in ubiquitous environment leads to address several key issues, such as taking into account the diversity and specificity of the different use cases and actors, as well as the dynamicity of the medical, social, logistic and environmental contexts.We propose an original, autonomous and adaptive service orchestration methodology aiming at optimizing message flow and personalizing transmission quality by timely sending the messages to the appropriate recipients. Our solution consists in a generic, model-driven architecture where domain information and context models were designed according to user needs and requirements. Our approach consists in composing, in real time, services for dynamic fusion and management of heterogeneous information from source, target and message ecosystems, driven by artificial intelligence methods for routing decision support. The aim is to ensure reliable, personalized and dynamic context-aware communication, whatever the scenario and the message type (alarm, technical, etc.). Our architecture is applicable to various domains, and has been strengthened by business process modeling (BPM) to make explicit the services operation.The proposed framework is based on ontologies and is compatible with the HL7 V3 standard. Self-adaptation of the routing decision process is performed by means of a dynamic Bayesian network and the messages status supervision is based on timed Petri nets