Key Benefits:
Minister of Finance and Public Accounts and Minister of Social Affairs, Health and Women's Rights,
Vu le Public Health Code ;
Vu le Social Security Code ;
See?Article 36 of Act No. 2013-1203 of 23 December 2013 Social Security Funding for 2014;
Considering the decision of 10 June 2014 setting the list of selected regions on the basis of theArticle 36 of Act No. 2013-1203 of 23 December 2013 financing of social security for 2014 for the implementation of experiments in telemedicine;
In light of instruction No. DGOS/PF3/DSS/1B/2014/17 of 17 January 2014 on the application file and the selection criteria for the pilot SRIs for their participation in the telemedicine experiments scheduled for 17 January 2014Article 36 of Act No. 2013-1203 Social Security Funding 2014
Stop:
The section of the terms of referenceArticle 36 of Act No. 2013-1203 of 23 December 2013 for the management of chronic and/or complex wounds by telemedicine is annexed to this Order.
It is implemented by regional health agencies, health professionals, health institutions, coordinated exercise structures, social and mediocial institutions and services, and local health insurance organizations in the regions mentioned in the June 10, 2014 Order setting out the list of selected regions based on the basis of theArticle 36 of Act No. 2013-1203 of 23 December 2013 Social Security Funding for 2014.
It is also enforceable for health professionals, local health insurance organizations and patient care facilities as long as the telemedicine acts carried out concern a patient who resides in one of the 9 regions mentioned in Article 1 of the above-mentioned June 10, 2014.
The Director General of the Care Offer, the Director of Social Security and the Director General of the National Union of Health Insurance Funds are responsible for the execution of this Order, which will be published in the Official Journal of the French Republic.
Annex
CAHIER DES CHARGES DES EXPÉRIMENTS RELATIVES À LA PRISE EN CHARGE PAR TÉMÉDECINE DES PLAIES CHRONIQUES ET/OU COMPLEXES MISES ENGINE SUR LE FONDEMENT DE L'ARTICLE 36 DE LA LOI NO 2013-1203 FINANCING OF SOCIAL SECURITY FOR 2014
CONTENTS
1. Experimental objectives and scope
1.1. Experimental objectives
1.2. Perimeter of experiments
2. Missions and commitments of stakeholders involved in telemedicine management of patients with chronic and/or complex wounds
2.1. Conditions and procedures for patient care by teleconsultation
2.1.1. Conditions for a teleconsultation
2.1.2. Conditions for the use of teleconsultation
2.1.3. Prior actions to the realization of a teleconsultation
2.1.4. The realization of teleconsultation
2.1.5. The end of teleconsultation
2.1.6. Special cases of planned but unrealized teleconsultations
2.2. Conditions and modalities of patient care by tele expertise
2.2.1. Conditions for the realization of tele expertise
2.2.2. Conditions of use of remote expertise
2.2.3. Actions before the realization of a tele expertise
2.2.4. The realization of tele expertise
2.2.5. The end of tele expertise
2.2.6. Special cases of planned but unrealized tele expertise
2.3. Conditions for the implementation of telemedecine acts
2.4. Requirements in information systems
2.5. Participation in piloting experiments
3. Missions and commitments of the Trusteeship and Financing Organizations
3.1. Rates
3.2. Method of payment of the acts carried out
3.3. Support for the production of evaluation data
3.4. Piloting and accompanying health professionals
3.4.1. National piloting
3.4.2. Regional piloting
3.4.3. Accompaniment by ASIP Health
3.4.4. Accompaniment by the NAPA
4. Evaluation of experiments
4.1. Objectives, principles and scope of the evaluation
4.1.1. Evaluation objectives
4.1.2. Principles of Evaluation
4.1.3. Perimeter of evaluation
4.2. Evaluation framework and criteria for judgments
4.2.1. Accessibility to care
4.2.2. Professional practices and the organization of care
4.2.3. Quality of patient care
4.2.4. Patient satisfaction
4.2.5. Costs related to the use of care
4.3. Evaluation Protocol
4.3.1. Descriptive data
4.3.2. State reports
4.3.3. Data transmission to the High Health Authority
4.3.4. Completed data
5. Improve knowledge of the costs of telemedicine devices
6. Annexes
6.1. Annex 1: glossary
6.2. Annex 2: mobilizable financing
6.3. Annex 3: summary of the commitments of the parties
6.4. Annex 4: coordinates
6.5. Appendix 5: Scope of the monthly status report transmitted by SRAs to OSB
6.6. Annex 6: Reference lists
6.6.1. List of occupations
6.6.2. List of specialties
6.6.3. List of establishment categories
The purpose of this Terms of Reference is to:
- present the context of telemedicine experiments related to the management of chronic and/or complex wounds implemented on the basis of Article 36 of the SSA for 2014;
- to present the funding arrangements for these experiments;
- present the selected piloting arrangements;
- define the commitments of the actors involved in the management;
- present the procedures for the evaluation of experiments by the High Health Authority (HAS).
Experienced funding modalities based on this terms of reference intended to be generalized subject to a favourable assessment, their implementation implies that all of the prerequisites and conditions mentioned below are met.
1. Experimental objectives and scope
1.1. Experimental objectives
Telemedicine is an important vehicle for improving access to care, particularly in fragile areas, and allows for care to be taken up as close as possible to the place of life of patients.
It also helps to break the isolation that health care professionals sometimes face and is a factor in the efficiency of the organization and care of health care. Telemedicine is thus a new form of organisation of medical practice in the service of the patient's journey.
In order to facilitate the deployment of patients in the city (home, medical office or coordinated exercise structure), on the one hand, and in medical-social structures, on the other hand,Article 36 of Act No. 2013-1203 Social security financing for 2014 therefore allows experimentation for a duration of 4 years.
In this regard, instruction No. DGOS/PF3/DSS/1B/2014/17 of 17 January 2014 requested the regional health agencies (ARS) to apply to be pilot regions.
9 regions were selected by decree dated 10 June 2014: Alsace, Basse-Normandie, Burgundy, Centre, Haute-Normandie, Languedoc-Roussillon, Martinique, Pays de la Loire and Picardie (1).
These regions have been closely associated with the drafting of this terms of reference.
The main objective of the experiments is to set a pre-figurative pricing of telemedicine acts that allow health professionals, in particular close proximity, regardless of their mode of practice, and medical-social structures to develop coherent and relevant projects, in response to health needs and the provision of regional care.
1.2. Perimeter of experiments
This Terms of Reference is the first part of the experiments carried out under section 36 of the Social Security Financing Act for 2014.
It concerns the telemedicine management of patients with chronic and/or complex wounds whose treatment does not require emergency care (2).
The telemedicine management of these wounds, which may be of various origin (vascular, diabetic, traumatic, tumoral, pressure...), appears to be justified as part of their follow-up or in the event of complication or severity of the wound as it requires a use of care or specialized advice.
Definition of wounds taken up:
- chronic wound: a chronic wound is a wound whose healing time is extended. A wound is considered chronic after 4 to 6 weeks of evolution according to its etiology. Chronic wound causes include leg ulcers, streaks, diabetic wounds and amputation cords (3).
- complex wound: a wound is recognized as complex as long as it is assessed as such by the requesting health care professional.
The absence of a healing sign and the complex character of the wounds are most often multifactorial and can be explained by:
- factors related to the patient (no assessment of comorbidities or factors contributing to the wound, difficulties related to the behaviour and cooperation of the patient);
- factors related to the wound (surface, volume, damage of noble tissues, incorrect diagnosis of the etiology of the wound, absence of diagnosis of infectious or ischemic complications of the wound);
- factors related to the skills and knowledge of health professionals (no standardized or appropriate health care protocols);
- factors related to environmental or social difficulties in terms of available resources for the treatment of wounds (4).
In accordance with this terms of reference, these services or expert advice (5) may be given, as part of the management of, among other things, streaks, leg ulcers and diabetic foot wounds:
Either on the occasion of a teleconsultation (synchronous) for the benefit of a patient located:
- in a medico-social structure;
- within a coordinated exercise structure (health centre or multi-professional health home).
Either on the occasion of tele expertise (synchronous or asynchronous) for a patient located:
- in a medico-social structure;
- within the office of his treating doctor or a coordinated exercise structure (health centre or multi-professional health home);
- at his home.
When an exploration of the wound is necessary, it is recommended to carry out a teleconsultation allowing a synchronous audiovisual guidance of this exploration.
This Terms of Reference sets out the conditions under which these acts must be implemented in order to benefit from a prefigurative tariff.
2. Missions and commitments of stakeholders involved in telemedicine management of patients with chronic and/or complex wounds
2.1. Conditions and procedures for patient care by teleconsultation
2.1.1. Conditions for a teleconsultation
In application of thearticle R. 6316-1 (1°) of the Public Health Code, teleconsultation is intended to allow a medical professional to give a consultation to a patient remotely.
This act is performed in synchronous mode by means of information and communication technology.
Teleconsultation allows the required health professional to conduct a comprehensive assessment of the patient, with a view to identifying precisely the cause of the delay or absence of cure of the wound and defining the conduct to be carried out.
This required health professional must be:
- a doctor respecting the rules of practice of the profession provided for in the Public Health Codeacting in accordance with its specialization (medical or surgical) and/or its qualification and justifying a proven clinical experience in wounds and healing;
- where applicable, an IDE acting under a cooperation protocol based on Article 51 of the HPST Act of 21 July 2009 and duly authorized by the Director General of the Regional Health Agency (DG ARS) of the region within which he or she exercises.
The primary objective of this experiment is to provide patients with access to specialized care for wounds and healing under optimized conditions will not be the subject of the prefigurative funding referred to in 3.1 of this Terms of Reference:
- teleconsultation conducted by a required doctor who would not justify the necessary skills or sufficient clinical experience;
- teleconsultation carried out by a required IDE not acting under a cooperation protocol based on Article 51 of the HPST Act.
SRAs ensure that this requirement is met by any means.
2.1.2. Conditions for the use of teleconsultation
Teleconsultation may take place in the following three cases:
- either as part of a diagnostic teleconsultation to propose a care plan in connection with the attending physician;
- either as part of an act planned and programmed under the care plan put in place with the patient;
- either as part of an unplanned and unscheduled act as part of the care plan established with the patient. In this case, teleconsultation is carried out on the basis of a prescription established by the doctor dealing with the patient.
2.1.3. Prior actions to the realization of a teleconsultation
Step 1. - Detecting the need for a medical examination.
| In accordance with the provisions of Public Health Code and, in particular, articles R. 4311-5 and R. 4311-7, the State Graduate Nurse (DND) is the most common non-medical health professional involved in the monitoring and treatment of wounds. As such, it plays a leading role in the reporting of wounds whose complexity of monitoring or processing is such that it requires an adaptation of the care plan that has been put in place. However, the primary role played by IDE in managing chronic and/or complex wounds does not fail to prevent detection and reporting by other health professionals, including: - a general practitioner or specialist who can be a coordinator doctor; - a podologist; - an occupational therapist; - a physiotherapist. | There are many reasons why a medical examination may be necessary: - delay in healing; - worsening of the wound; - smell; - pain; - signs of infection or Isemia of the wound; - large surface and large volume of the wound; - worsening the general condition of the patient; - duration of care inappropriate to primary care; - the need for too frequent changes in dressings; - complexity of care, especially in a palliative context; - etc. | The observation of one or more of these states must be reported: - the doctor treating the patient in all cases; - to the co-ordinator doctor involved in the structure, on the other hand, when the patient is taken care of in the medico-social structure. |
Step 2. - Reporting the need for a medical examination.
The health care professional reports the need for a medical examination to a physician who is responsible for the patient's care and transmits the information that should, in particular, allow him to assess the patient's clinical situation.
Step 3. - Information and collection of patient consent.
This step is carried out in accordance with the conditions specified in 2.3.1 a of this specifications.
Step 4. - The request for a medical examination and its registration in a care plan.
When it considers it relevant to the views of the health information and data transmitted, the doctor prescribes the conduct of a teleconsultation and enrolls it in a care plan. It securely transmits its application to the required professional, as well as information relevant to the coordinated care of the patient (patient identification data, medical data and billing data).
Step 5. - Television planning.
The health professional who requires the telemedicine act identifies the time when it signals the need to the required doctor (time of access to the specialist). If the report is made by secure health messaging, the date is automatically saved.
The required expert records when he receives the request for teleconsultation (time of access to the specialist).
He ensures that the patient is known to him or that he is addressed to him by a doctor who is responsible for the patient. It ensures that it has the information necessary to carry out its act and requests, where appropriate, details or supplements to the requesting health professional.
It plans teleconsultation and informs the patient.
The required expert or the requesting professional verifies the address of the patient's home and, where applicable, the update (displacement and kilometer avoided).
The required expert indicates whether the teleconsultation is planned on the occasion of an hourly range dedicated to the realization of telemedicine acts (televisions at a dedicated beach).
He indicates whether, according to him, the patient would have benefited from a telemedicine-free consultation (deficit of access to care [renouncing or lack of supply]).
2.1.4. The realization of teleconsultation
Assessing chronic and/or complex wounds requires that they be explored. As such, the presence of a nurse or a state graduate nurse or a patient's doctor is essential during teleconsultation.
When an IDE is located with the patient, the presence of a doctor during teleconsultation is not required.
The required expert records:
- the date of completion of teleconsultation (time of access to the specialist);
- the start time of teleconsultation (time devoted to an act of TLC).
2.1.5. The end of teleconsultation
The required expert records the teleconsultation time (time spent on a TLC act). If the report is made by secure health messaging, the date is automatically saved.
He prepares a record of the teleconsultation act and completes the patient's file under the conditions referred to in 2.3.1 d of this notebook.
It records the report in the patient file (release or cancellation rate).
It sends a copy of the secure account:
- to the doctor treating the patient;
- the IDE that was standing alongside the patient during the teleconsultation, subject to the patient's consent;
- the case beyond, to the health professional who reported the need for a medical examination;
- the coordinator physician in the case of a patient residing in EHPAD, subject to the patient's agreement;
- any health professional involved in the care of the patient, subject to the patient's agreement;
- any other health professional designated by the patient;
- to the patient.
If there is and subject to the patient's agreement, the report is recorded in the patient's personal medical file (DMP).
If applicable, the expert may attach any requirements to his or her record.
Finally, at the end of the act, the required health professional collects the patient's consent:
- the transmission of the data referred to in paragraphs 4.3.2.1. and 4.3.2.2.1. of this Terms of Reference to the NCAM-TS and SRAs in order to allow HAS to evaluate the experienced acts;
- participation in the satisfaction survey referred to in paragraph 4.3.2.4. of this specifications.
2.1.6. Special cases of planned but unrealized teleconsultations
The expert records the cause of the non-realization of planned but unrealized teleconsultations and specifies the cause, i.e., because of the patient, because of the professional or because of the technique (release or cancellation rate).
In this case, teleconsultation cannot result in any billing.
2.2. Conditions and modalities of patient care by tele expertise
2.2.1. Conditions for the realization of tele expertise
In application of thearticle R. 6316-1 (2°) of the Public Health Code, the purpose of the tele-experts is to allow a medical professional (or health professional acting under a protocol of cooperation taken on the basis of Article 51 of the HPST Act of 21 July 2009) to request remotely the advice of one or more medical professionals (or health professional acting under a protocol of cooperation taken on the basis of Article 51 of the HPST Act of 21 July 2009) due to their particular medical training or
The tele-expertise act thus defined can be used for the benefit of the patient carrying a chronic or complex wound as specified in 1.2 of this specifications. The monitoring of a wound by this means may be in case of repeated necessity without delay or completed by teleconsultation or consultation. In this way, it differs from a one-time act of consultant in the course of care within the meaning of the general nomenclature of professional acts (NGAP) (6).
Under the scope for the implementation of this experiment, to be the subject of the prefigurative funding referred to in 3.1 of this Terms of Reference, tele expertise may be carried out:
- either between a physician seeking the advice and a required liberal or hospital doctor;
- either between a physician seeking the notice and a required IDE(s) acting under a cooperation protocol based on section 51 of the HPST Act of July 21, 2009.
Once the decision is made to request an expert opinion, the applicant physician or the applicant physician may request an IDE to collect and transmit information to the required expert that he or she has designated. In this case, the relevant IDE does not necessarily act under a cooperation protocol based on Article 51 of the HPST Act of 21 July 2009.
The required doctor should be asked for specialization, training, diplomas or, if not, clinical experience.
The purpose of this experiment is to deploy telemedicine as part of the care of patients located in the city (home, office, coordinated exercise structures) and in medical-social structures, and the tele expertise carried out between two hospital health professionals will not be the subject of the prefigurative funding mentioned in 3.1 of this specifications.
SRAs ensure that this requirement is met by any means.
2.2.2. Conditions of use of remote expertise
The request for a tele expertise may, for some patients, be formulated only after a physical (face-to-face) consultation or teleconsultation with the required professional.
2.2.3. Actions before the realization of a tele expertise
Step 1. - Information and collection of patient consent.
The information and consent of the patient shall be obtained in accordance with the conditions specified in 2.3.1 a of this specifications.
Step 2. - Transmission of the information needed for tele expertise.
The applicant of the notice or, where appropriate, any other health professional involved in patient care shall transmit the information necessary to the expert (patient identification data, medical data and billing data). This transmission operates through a secure device. It is performed by a health professional duly authorized to access the patient's administrative and health data.
It ensures that it has the necessary information and requests, if any, clarifications or supplements to the requesting physician.
2.2.4. The realization of tele expertise
The health professional who requires the telemedicine act identifies the time when they apply for advice to the required doctor (time of access to the specialist). If the report is made by secure health messaging, the date is automatically saved.
The required expert outlines the time when he receives the request for tele expertise (time of access to the specialist).
The required expert or the requesting professional checks the address of the patient's home and updates it if necessary (displacements and kilometer avoided).
The required expert indicates whether the completion of the tele expertise required a request for clarification or supplements from the requesting physician (precision requests or supplements).
The required expert indicates whether, according to the patient, the patient would have benefited from a notice or consultation without telemedicine (deficit of access to care [renouncing or lack of supply]).
2.2.5. The end of tele expertise
The required expert prepares his or her report and completes the patient's file under the conditions referred to in 2.3.1 d of this specifications.
Where applicable, the required expert may attach any requirements to his or her record. The required expert records the report in the patient file (release or cancellation rates). The required expert shall send a copy of the tele-disciplinary report by secure means:
- to the doctor or IDE who requested his opinion;
- to the doctor treating the patient;
- any health professional designated by the patient;
- to the patient.
2.2.6. Special cases of planned but unrealized tele expertise
The required expert records the cause of the non-realization of tele expertise: due to the patient, the professional or the technique (release or cancellation rate).
In this case, tele expertise cannot result in any billing.
2.3. Conditions for the implementation of telemedicine acts
2.3.1. This Terms of Reference does not deviate from the application of the provisions relating to the conditions for the implementation of telemedicine acts referred to in Articles R. 6316-2 to R. 6316-4 of the Public Health Codethat is,
(a) The acts of telemedicine are carried out with the free and informed consent of the person, including the provisions of articles L. 1111-2 and L. 1111-4 of the aforementioned Code.
This consent occurs after appropriate information has been provided to the patient. This information is in particular:
- on the terms and conditions of telemedicine management and, in particular, the qualification of the expert required for teleconsultation or the expert whose opinion is required by tele expertise;
- on the nature of health data that will be exchanged between health professionals in order to contribute to its best care.
The consent of the patient or, where appropriate, his legal representative may be collected by any means by a health professional involved in the care and upstream of the telemedicine care.
When collected in writing, the patient's consent is retained in the patient's medical records.
(b) The structures, organizations and health professionals using information and communication technologies for the practice of telemedicine acts ensure that the use of these technologies is in accordance with the provisions regarding the hosting of personal health data.
This data hosting, regardless of the support, paper or computer, can only take place with the express consent of the data subject. In application of theArticle R. 6316-10 of the Public Health Codesuch consent may be expressed electronically.
(c) Each telemedicine act is carried out in conditions that guarantee:
- the strong authentication of health professionals involved in the act;
- identification of the patient;
- the access of health professionals to the patient's medical data necessary for the completion of the act by means of the DMP if there is or by receipt by secure health messaging in particular;
- when the situation imposes it, training or preparing the patient to use the telemedicine device.
(d) Registered in the patient's file held by each medical professional involved in the telemedicine act and in the observation sheet mentioned in theArticle R. 4127-45 of the Public Health Code :
- the record of the realization of the act;
- the drug acts and prescriptions carried out under the act of telemedicine;
- the identity of health professionals involved in the act;
- the date and time of the act;
- if any, the technical incidents that occurred during the act.
The record of the act and the requirements are recorded in the patient file held by the required health professional and in the DMP when it exists (and with patient authorization), and transmitted in a secure manner to the treating physician, patient and health professionals designated by the patient and involved in the care.
2.3.2. This terms of reference do not deviate from the compliance with the provisions of section 51 of the HPST Act of 21 July 2009 allowing the establishment, as a derogatory and the initiative of field professionals, of transfers of acts or activities of care and reorganization of modes of intervention between health, medical and paramedical professionals, among patients.
2.3.3. This Terms of Reference does not deviate from the application of theArticle R. 6316-8 of the Public Health Code which provides that health structures, organizations and professionals that organize a telemedicine activity, must have concluded between them a convention organizing their relationships and the conditions under which they carry out their activities.
2.3.4. Each professional must be covered by a liability insurance for the telemedicine activity to which he/she participates.
2.3.5. In view of the terms of reference taken by order and forming a national program, it is not necessary to enter into a contract between the Director General of the Regional Health Agency and the (or) health professional(s) involved in the telemedicine activity (in accordance with the terms of reference) provisions of Article R. 6316-6 (3°) of the Public Health Code).
2.4. Requirements in information systems
The elements to be exchanged as part of the telemedicine act are identical to those contained in the summary medical component that includes:
- administrative information: contact details of the patient and the attending physician, update date;
- clinical information: current pathologies, personal history (including possible allergies and drug intolerances), risk factors (family history, lifestyle risk factors: alcohol, tobacco, absence of physical activity, diet, occupational risk factors);
- long-term treatments;
- points of vigilance;
- in case of printing, the signature.
The exchange or sharing of information is essential to the realization of the act. It is recommended that:
- to take into account the document model developed by the HAS (medicine volume);
- and, when relevant, to respect the interoperability framework of health information systems (CI-SIS) specified by ASIP Health.
In addition to the data required for the completion of the act, the health professionals involved will be responsible for collecting data for the evaluation. These are referred to in Part 4 of this Terms of Reference.
2.5. Participation in piloting experiments
Health professionals wishing to participate in telemedicine experiments must be known directly or through their regional representatives to the regional health agency of the region in which they are located.
They don't have to sign the contract at the 3° of article R. 6316-6 of the Public Health Codeas mentioned in 2.3.5 of this Terms of Reference.
However, they are required to enter into an agreement with SRAs and local health insurance organizations that define the modalities for the production of the data required for the evaluation as described in item 4 of this Terms of Reference. This agreement may be concluded either by each professional individually or through their representatives.
Health professionals and their representatives must comply with the regional piloting procedures for each SRA, in accordance with 3.4.2 of this specifications.
3. Missions and commitments of the Trusteeship and Financing Organizations
3.1. Rates
As part of a teleconsultation conducted under the conditions of this notebook, the required physician or the required EDI acting under a cooperation protocol taken under section 51 of the HPST Act of 21 July 2009 shall be paid €28 per act.
Within the framework of a tele expertise carried out under the terms of this Terms of Reference, the required physician or the required EDI acting under a cooperation protocol taken under section 51 of the HPST Act of July 21, 2009 shall be paid €14 per act.
The payment of these rates is conditional on the full compliance with the provisions of this specifications.
In addition, it is expressly specified that the pre-figurative tariff referred to in this item is only applicable to health professionals. Unconventional physicians (called "Section 3") are therefore not allowed to charge their telemedicine acts on the basis of this specifications.
Additional funding may be mobilized for telemedicine activities as recalled in Annex 2.
3.2. Method of payment of the acts carried out
The above rates are paid to health care professionals or institutions or structures employed by health insurance funds in accordance with the terms and conditions in place for the billing of external acts and consultations:
- the required professionals or institutions identify according to the usual terms (by means of a CPS or CPE);
- the patient is identified according to the usual procedure (by NIR)
- the act is identified by means of one of the two specific codes (one for teleconsultation and the other for tele expertise) created by health insurance and communicated to the health professionals concerned within 1 month of the publication of this specifications.
Payments for these experiments are liquidated and paid over water by local health insurance organizations.
These amounts are charged by the paying agencies on the 657213452 account dedicated to the monitoring of the blurred credits of these experiments (7).
The health insurance addresses monthly, to each SRI concerned and to DGOS (8), a statement comprising a minimum of the amounts paid under the IIR of the region, the volume of related acts (by act), the active patient line and the number of health professionals involved.
The regional breakdown of the sums is carried out according to:
- the location of the patient's affiliate body;
- the location of the default health professional.
Eligible for these remuneration are the required health professionals installed in one of the 9 pilot regions selected by order of 10 June 2014 or taking care of patients installed in the same regions.
CNAMTS network letters will specify these billing arrangements.
Checks may be carried out a posteriori to ensure that the professional receiving the remuneration is in full compliance with the provisions of this Terms of Reference.
3.3. Support for the production of evaluation data
In addition to the pay for the activity referred to in 3.1, each professional concerned may also benefit from the payment of an annual endowment not exceeding €200, to cover the costs related to the production of the data required for the completion of the evaluation by HAS.
This amount is paid in accordance with the usual payment terms and conditions under the IFRA, after commitment by the SRA. The health professional wishing to benefit from this additional assistance must apply to the ARS corresponding to the region in which it is installed.
These sums will also be charged to account 657213452 and therefore supported by the credits for these experiments.
3.4. Piloting and accompanying health professionals
The description of piloting modalities is of great importance to ensure the homogeneity of the format of information exchanged between the parties involved in the experiments.
National piloting aims to provide the national authorities involved in these experiments with accurate and up-to-date information on the conduct of the experiments and in particular on the possible difficulties encountered by health professionals involved in the experiments.
Regional piloting focuses on supporting health professionals who wish to engage in these experiments and ensuring the proper functioning of information exchanges (including evaluation information).
3.4.1. National piloting
The National Steering Committee for Telemedicine is responsible for monitoring the implementation of experiments. The general guidelines are submitted for validation.
It ensures that the evaluation is implemented within the time limits set out in section 36 and under the conditions set out in this Terms of Reference. A point of credit consumption is also presented.
A technical group of experiments called "Article 36", led by DGOS, meets every quarter. In charge of monitoring experiments, this group prepares the capitalization of successes and successes. It is also responsible for lifting any difficulties encountered.
This technical group includes:
- the mission officers of the pilot SRAs;
- the central directorates (DGOS, DSS, DGCS);
- national operators engaged in support (ANAP and ASIP Health);
- health insurance (CNAM-TS);
- HAS;
- representatives of health professionals;
- the ISSC;
- the Société française de télémédecine (SFT-ANTEL).
On this occasion, pilot SRIs transmit a detailed report with the activity indicators produced in connection with health insurance organizations, the obstacles encountered in the deployment of experiments and any other subject they would like to alert the technical group.
The activity indicators to be presented are a minimum:
- the number of telemedicine acts performed by type of act;
- the number of patients per type of act;
- the number of applicants involved;
- the number of professionals involved;
- the regional consumption of credits for these experiments by distinguishing the amounts paid for teleconsultations, those paid for tele expertise and those paid in support of the production of the evaluation data.
Pilot ARS sends each month to the technical group (dgos-pf3@sante.gouv.fr) a synthetic note (Annex 5 format) with the main activity indicators.
3.4.2. Regional piloting
ARS is a project team "Experiments Article 36" and designates a regional repository for the development and monitoring of experiments in the region. The project team is piloted by the regional referee. It includes a minima:
- representatives of health professionals in the region;
- representatives of users;
- the directions of the ARS concerned;
- representatives of possible GCS and AMOA from the region;
- representatives of local health insurance organizations.
The project team must, in particular, ensure the proper flow of information and funding needed to evaluate the experiments and pay of health professionals involved in the experiments.
The regional referent is the only interlocutor for health professionals in the region who wish to participate in the experiments. This includes:
- the preparation of conventions with health professionals or their representatives wishing to integrate experimentation;
- monitoring and accompaniment of health professionals who wish to integrate experiments.
3.4.3. Accompaniment by ASIP Health
The support of ASIP Health aims to help the actors mobilized as part of the activities implemented in the experiments (ARS, project carriers, industrials) by:
- support for the implementation of national repositories of health information systems (security, identification/authentication, interoperability, etc.) in support of telemedicine activities. The integration of the repositories is indeed a strong challenge for, on the one hand, ensuring compliance with the legal framework in force and, on the other, a lever for the deployment of the uses;
- methodological support for the recovery of the data required for the evaluation.
ASIP Health is also responsible for assessing the cost of telemedicine information systems as referred to in paragraph 5 of this Terms of Reference.
3.4.3.1. Support to the implementation of national repositories of health information systems
The actions of ASIP Health will aim to:
- conduct interregional activities on themes shared by several regions. The choice of themes will be validated by the governance bodies of experimentation in order to retain the subjects to be taught. These topics will result from land issues raised over water by SRAs, project holders, or industrialists;
- capitalize and disseminate know-how and experience returns to the actors not involved in the experiments in order to facilitate the national deployment of telemedicine activities.
For example, the first workshops will address the following issues:
- the planning framework for "e.santé" projects including the interoperability framework for information systems and telemedicine services;
- Secure health messaging;
- the interoperability framework for health information systems (CI-SIS): presentation of the VSM, identification of IC-SIS extensions (new content streams) to cover a new need for interoperability.
Deliverables will be produced through experimentation and will be able to lead to practical guides or fairs to questions by subject.
3.4.3.2. Methodological support for the recovery of the data required for the evaluation
The ASIP Health will propose a test phase with voluntary pilot regions to verify the compliance of the formats and data values transmitted prior to the launch of the evaluation campaign, in order to ensure their technical feasibility.
The purpose of this test is to find the following points:
1. Understanding the data to be collected by the ARS and the ability of information systems to produce the expected data:
ARS and project holders designated by the ARS are aware of the data to be collected, and consider the modalities to be used to collect them on the following aspects:
- nature of data, format and data values;
- frequency of collection (e.g., in each act);
- actor of the collection (system, human) ;
- data quality (data entered);
- from the point of production to the point of centralization of the lifts before transmission to local health insurance organizations;
- so relevant.
2. Identification of discrepancies between expected data (to be collected) and data produced and available from telemedicine devices:
- identification of discrepancies between expected data and data produced;
- possible review of the data (adaptation of the evaluation to the back-up capabilities that are consistent with the schedule of experiments on the evaluation component and budgets).
3. Testing of the data supply circuit required for the evaluation (production, collection and transmission of data): this phase occurs once the necessary changes have been made to the production and collection circuits. This is to qualify the files produced prior to their integration into the evaluation device. This test will be carried out in a region. The files will be transmitted via an address to be provided by the health insurance organization. HAS, or even local health insurance organizations, will be responsible for the qualification of lifts.
3.4.4. Accompaniment by the NAPA
The NAPA support is intended to help stakeholders mobilized as part of the activities in the experiments (regions, project carriers) to define and establish an optimal organization for the production of the data required for the evaluation.
4. Evaluation of experiments
4.1. Objectives, principles and scope of the evaluation
4.1.1. Evaluation objectives
It has expressly agreed in section 36 of the SSA for 2014 that "at the end (of) experiments, an assessment is carried out by the High Health Authority for a generalization (...) It is the subject of a report transmitted to Parliament by the Minister for Health before September 30, 2016".
The implementation of a scientific and independent evaluation of telemedicine management experiments of chronic and complex wounds, thus creating a fundamental element of government decision-making assistance for the generalization of the deployment of telemedicine in this pathology.
This evaluation is carried out in conjunction with SRAs, CNAM-TS, local health insurance organizations, health professionals, multi-professional health homes, health centres, health facilities, and medical-social institutions and services involved in experimentation.
In order to ensure the proper conduct of experimentation and the generalization, if any, of experienced telemedicine acts, it has expressly agreed that the evaluation of the HAS is:
- a medico-economic assessment to base the opinion required under section 57 of the SSA for 2015 with a view to registering experienced acts with the nomenclatures of health insurance;
- an element of the notice referred to in third paragraph of Article L. 162-1-7 of the Social Security Code, necessary to trigger the accelerated registration procedure of the acts experienced in the nomenclature.
The objective of the evaluation is not to assess the effectiveness of medical practice with telemedicine in relation to "traditional" medical practice, but the expected effects of this new mode of care organization for its deployment. In this regard, the main objective is to provide knowledge on the impact of experienced acts in terms of access to care, the quality of care, the organization of care and costs following the evaluation framework published by HAS in July 2013 (9).
In addition, one of its main issues is to make a global judgment on the impact of experienced acts, taking into account the specificities, including territorial and organizational, inherent in each pilot region, using common assessment criteria to understand the multiplicity of the dimensions at stake.
The objective will be more precisely to assess whether the organizations in place are of a nature to:
- facilitate access to the provision of care by permitting to meet a care request within a reasonable period of time;
- substitute for the patient's movement and for possible renouncement of care (geographical, economic, social aspects);
- improve the organization of care: respond to organizational difficulties of care, optimize the use of medical time and provide formalized responses to applicants;
- improve the quality of care and have an impact in terms of satisfaction of patients involved in this mode of organization;
- have an impact on the use of care (care consumption, transport).
4.1.2. Principles of Evaluation
The evaluation will be conducted from the common framework proposed below in item 4.2 and defined in different approaches:
- the operational evaluation examines the modes and effects of the implementation of the intervention; it requires to characterize the intervention processes accurately from an analysis grid to describe each organization in a standardized manner;
- the impact assessment assesses the effects of the intervention; it requires quantifying the effect of the intervention in relation to a reference situation and measuring the effects with a sufficient temporality. A forward/after measurement with a control group is recommended, however, in the present case, projects being already operational this method cannot be mobilized;
- monitoring the evolution over time of some activity indicators.
4.1.3. Perimeter of evaluation
The evaluation covers all telemedicine projects related to the management of existing and future chronic and complex wounds in the 9 pilot regions.
The relevant telemedicine acts are: teleconsultation and tele expertise. These actions are carried out for patients in medical and social structures and services or in the city (only in coordinated exercise structures for teleconsultation (10).
4.1.3.1. Populations and inclusion criteria
The target population corresponds to the population over the age of 18 who, under the prefigurative tariffs defined in this specifications, benefited from reimbursements by health insurance for the treatment of chronic and/or complex wounds.
The population included corresponds to patients followed by chronic and/or complex wounds that have benefited from an organization of telemedicine care (television and/or remote expertise coded in SNIIRAM. Only patients treated for skeletons, ulcers and diabetic foot are considered in the evaluation.
The control group: the construction methodology of the control group is based on the one used under the " Chronic wounds" component of the PRADO (Home Return Program) which uses national data, defined on comparable scopes.
4.1.3.2. Exclusion criteria
Excluded from the perimeter of the evaluation and therefore from any feedback to HAS:
- data on other types of wounds, including tumor wounds;
- data from patients in an EHPAD with internal pharmacy to the extent that it is not possible to identify their care consumption;
- the data of patients supported in an EHPAD funded under overall staffing;
- data from patients who have not resorted to care as individuals are identified from the mandatory reimbursement bases for benefits;
- the data of patients who do not fall under the general health insurance scheme in order not to complex the collection of information from the different plans.
4.2. Evaluation framework and criteria for judgments
The evaluation framework is divided into 5 judgment criteria that are defined as viewing angles on a dimension to be assessed. It was defined from the construction of the impact matrix of the effects of telemedicine (see table 1 below).
The judgment criteria were considered in terms of their ability to be collected in a simple and homogeneous manner in order not to increase the work of the actors.
In addition, the HAS takes into account the complementary evaluations conducted locally by each project and that the RSAs have been able to transmit to it within a time frame consistent with the evaluation report.
The judgement criteria used shall be used to monitor the following 5 dimensions.
4.2.1. Accessibility to care
Accessibility is interpreted in terms of relative difficulty in accessing the care offer that can itself be defined in terms of distance and travel time. Its interpretation also depends on the adopted viewpoint.
For patients, the accessibility criterion can be measured in terms of use of expertise (for patients who waived care) and reduction of time for care (according to the specificities of the territory concerned). It may also refer to aspects related to access distances and transportation costs.
From the point of view of health insurance, accessibility can potentially be translated into terms of increasing the consumption of care, as well as improving observance, preventing complications, reducing the use of care and transportation costs.
4.2.2. Professional practices and the organization of care
The use of telemedicine requires an adaptation of existing care organizations that impact professional practices. In particular, it leads to a change in working practices and times as well as a transformation of coordination mechanisms among the actors.
4.2.3. Quality of patient care
The assessment of the impact of telemedicine on the quality of care can take place at different levels (patients, health care professionals, health care institutions) and can take into account both the process (medical acts carried out remotely) and the result in terms of health consequences of the individuals and resources consumed (remediation).
The death rate is generally used as a generic judgment criterion.
Other "quality" judgment criteria can be defined in connection with the use of the hospital: hospitalization rates and emergency rates.
The quality of care also involves reducing the time to obtain a consultation, reducing the time between the request for expertise and the return of expertise.
In addition, from the patient's point of view, the failure to move can have consequences on the quality of its care (see Satisfaction Dimension).
4.2.4. Patient satisfaction
The assessment of patient satisfaction is subject to specific methods and requires a direct questioning of people benefiting from a telemedicine organization. Measuring tools (questionnaires and items) as well as collection methods (random or targeted survey, face-to-face collection or telephone interview) have been the subject of a proper methodological reflection. Explored sub-dimensions relate to acceptability, access to care, information and understanding, doctor/patient relationship and trust.
4.2.5. Costs related to the use of care
The deployment of telemedicine experiments is based on an assumption of induced economy in terms of investment and operating costs.
From the point of view of health insurance, the expected savings (or avoided costs) relate to several health-care consumption positions: hospital use (hospitalizations and emergencies), transport, consumables (pansements and compresses, restraints, anti-scarre equipment), drug use, nursing, physiotherapy and medical consultations.
Conversely, improving access to care, can mechanically translate into terms of increasing the use of care (medical counselling, nursing, etc.).
Table 1. - Impact matrix of the expected effects of telemedicine in managing chronic and/or complex wounds
1. Accessibility.
| Patients and health professionals | Time of access to the specialist | Teleconsultation Number of days between the request for teleconsultation by the applicant and the completion of the act | Project Information System Grid of compendium | Face-to-face appointment time for consultation with a specialist: estimated data or control group Witness group: - reference value at the regional level (or in a reference territory); - if descriptive indicator: interpretation required from the local context. |
| Time of access to the specialist | Tele expertise Number of days between the request for tele expertise by the applicant and the receipt of the medical report | Project Information System Grid of compendium | Face-to-face appointment time for consultation with a specialist via the attending physician: estimated data or control group Witness group: - reference value at the regional level (or in a reference territory): aggregated data; - if descriptive indicator: interpretation required from the local context. | |
| Number of kilometres avoided | Number of kilometres A/R between the patient's place of life (home or medico-social structure) and the place of the closest competent exercise structure (health house, reference centre...) in which the act could have been performed face to face | Patient file Grid of compendium | No comparison Reference value at the regional level (or in a reference territory): aggregated Correspondence with the number of avoided trips that correspond to the number of TLC and TLE realized | |
| Failure to provide care (renouncing or lack of offer) | Would the patient benefit from a consultation (or expertise via its MG) without telemedicine? + specify the reason for the lack of access | Grid of compendium | Quality indicator No comparison |
2. Professional practices and care organization.
| Medical and paramedical professionals | Time devoted to the realization of a teleconsultation act | Duration (expressed in minute) of synchronous exchange between the required and the patient. + number of wounds examined | Project Information System Grid of compendium | Description |
| Teleconsultation rate during a dedicated time range | Number of teleconsultations made on a dedicated time range/number of teleconsultations made | Done that requires to be traced | Description If defined time period: comparison to the number of consultations over the same period and calculation of an average duration of teleconsultation and consultation | |
| Tele expertise: quality and completeness of the information transmitted necessary for the realization of the act | Complements of medical information requested by the expert after receipt of a request (Exhibits added to the file or modified following the initial request) | Done that requires to be traced (real/fals) | Description | |
| Rate of abandonment or cancellation of the act made by telemedicine | Number of teleconsultations /téléexpertises planned but not realized + specify the reason for non-implementation | Done that requires to be traced | Description |
3. Quality of care.
| Patients/guardians, family | Hospitalization rate | Patient hospitalization rate of experimentation/hospitalization rates for patients out of experimentation over a period of time | SNIIRAM data - PMSI Analysis by type of wound (diabetic foot wounds, ulcers and streaks) | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie |
| Emergency transit rates | Emergency Response Rates for Experimental Patients / Emergency Response Rates for a Witness Group | SNIIRAM data - PMSI Local AM data Analysis by type of wound (diabetic foot wounds, ulcers and streaks) | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Death rate | Death rate of test patients/teacher death rate over a given period | SNIIRAM data - PMSI Local AM data Analysis by type of wound (diabetic foot wounds, ulcers and streaks) | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Modeling the impact of the intervention on the consumption of dressings | Number of dressings consumed over a period by patients of experimentation/control group | SNIIRAM data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie |
4. Patient satisfaction.
| Patients | Impact on patient satisfaction | Satisfaction survey |
5. Costs related to the use of care.
| Health insurance | Transport | Transport costs: amounts reimbursed by health insurance | Pain type analysis and patient characteristics SNIIRAM aggregate data - PMSI | Regional control: average transport cost identified in the SNIIR-AM for equivalent subpopulation (average cost* number of avoided trips = cost of avoided transport) |
| Hospitalizations | Cost of hospitalizations | SNIIRAM aggregate data - PMSI Analysis by type of wound (diabetic foot wounds, ulcers and streaks) | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Nurses | Cost of nursing based on wound type | Analysis by type of wound (diabetic foot wounds, ulcers and streaks) SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Acts of physiotherapy | Cost of physiotherapy based on wound type | Analysis by type of wound (diabetic foot wounds, ulcers and streaks) SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Medical consultations | Cost of medical consultations | Analysis by type of wound (diabetic foot wounds, ulcers and streaks) SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Consumption of dressings and compresses | Cost of dressings | SNIIRAM aggregate data - PMSI Analysis by type of wound (diabetic foot wounds, ulcers and streaks) | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Hardware | Cost of anti-scarre material: mattresses, mattresses and anti-scarre cushions | Slight analysis SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Bands of contention | Costs of restraint strips | Analysis for ulcers SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie | |
| Drugs: antibiotics and antalgic | Costs of antibiotics and antalgic | Analysis by type of wound (diabetic foot wounds, ulcers and streaks) SNIIRAM aggregate data - PMSI | Comparable control group (population characteristics, care and consumption profiles) = control group PRADO plaie |
4.3. Evaluation Protocol
This protocol defines the format and modalities for the production, collection and transmission of data to HAS based on their nature.
4.3.1. Descriptive data
Each SRA collects and addresses data to HAS to understand organizational changes and local issues.
These data are:
- on the one hand, the state of the location of the care and needs of the territories (or other territorial level): production of the territorial diagnostic indicators and the characteristics of the population;
- on the other hand, telemedicine projects deployed: local context of the deployment of telemedicine and medical needs that motivated each project, state of the location of management practices without telemedicine and telemedicine (described on the organizational model and the telemedicine acts concerned).
These data are not the subject of a status report as they do not directly contribute to assessing the expected effects of the organization of telemedicine care but are necessary to interpret the evaluation results.
4.3.1.1. Data on the status of the care supply and the needs of the territories
The general data on the regional care offer and the territory are as follows:
Demographic and socio-economic context:
- population density for the region and the relevant health territory;
- the share of persons aged 75 and over for the region and the relevant health territory;
- departs from 75 years and more living in institutions for the region and the territory of health concerned;
- median tax income per consumption unit for the region and the relevant health territory.
State of health and population dependence for the region and the territory of health concerned:
- mortality rate for the region and the relevant health territory;
- health status of home-based APA recipients assessed in IG 1 or IG 2 (Health Quality).
Health, social and medico-social offer:
- number of beds in medicine and surgery for the region and the relevant health territory;
- number of beds in follow-up care and rehabilitation for the region and the health territory concerned;
- number of hospitalizations at home (HAD) for the region and the relevant health territory;
- number of seats in EHPAD for the region and the relevant health territory;
- number of places in home nursing services (SSIAD) for the region and the relevant health territory.
Medical and paramedical demography:
- density of general practitioners exercising in the territory concerned by experimentation: number of general practitioners exercising in the territory / number of inhabitants of 18 years and more of the territory concerned;
- density of dermatologists, geriatrics, diabetologists and vascular surgeons exercising in the territory concerned by experimentation: number of dermatologists practising in the territory/number of inhabitants of 18 years and more of the territory concerned;
- density of nurses in the territory concerned by experimentation: number of nurses in the territory / number of inhabitants aged 75 and over the territory concerned.
4.3.1.2. Descriptive data of a telemedicine project
The "Telemedicine Project" is understood as the one in which patients are supported by telemedicine in the context of a common medical problem, a territorial dimension and identified actors.
The data below include data on the local context of the deployment of telemedicine and the medical needs that motivated each project.
Descriptive data for a telemedicine project include:
- the precise definition of the medical need for telemedicine;
- the territorial dimension of the project in particular with regard to the health territories;
- an estimate of the annual massing of telemedicine acts likely to be carried out (and if any carried out) within the framework of the project, divided by type of wound and type of act;
- the date of entry of the project as part of the experiments provided for in section 36 of the SSA 2014 (this date corresponds to the time when the data of the acts of telemedicals and the consumption of care begins to be collected);
- if the project started prior to the start of the experimentation, it is necessary to specify the date of care of the first patient (month/year);
- the decomposition of the costs of the information systems used.
4.3.2. State reports
The objective of the evaluation is to measure and explain the differences between expected effects and results achieved. It requires the collection of data on the ground (via local telemedicine information systems or other), the analysis of the data available in the medical-administrative databases and the establishment of ad hoc surveys (satisfaction survey).
To do so, four state reports are produced and sent to the HAS under the following conditions.
4.3.2.1. State report No. 1 on data of a telemedicine act
The production of state report No. 1 is at the expense of each SRA. It concerns data from a telemedicine act collected from a grid of indicators that gather data on accessibility to care, the process of planning and carrying out the act; data on the characteristics of patients and health professionals.
In this state report:
- each line corresponds to a telemedicine act;
- each column corresponds to a given in table 2 below;
- the order of the data necessarily corresponds to the order of presentation in the table;
- the lines are sorted by increasing chronological order on the year and month of realization of the telemedicine act.
Table 2 below is as follows:
- data to identify the framework for patient care;
- patient data;
- the data common to the realization of a telemedicine act;
- data specific to the realization of a teleconsultation act;
- data specific to the realization of a tele expertise act.
The protocol for the production of data in the status report No. 1 is schematized as follows:
Health professionals provide data manually or automatically, via the computers available to them and instructions defined by the pilot RSAs. Several assumptions are considered and left to arbitration in each region:
- the ARS has the ability to trace all descriptive data through its information system. In this case, it uses only this tool;
- the ARS does not have the ability to trace all descriptive data through its information system. In this case:
- either adapts its information system for the automation of the production of all the requested data;
- it favours the production of all data via an ad hoc collection tool;
- either it uses both its information system and an ad hoc collection system. In this case, it specifies to the required health professionals and applicants the data they have to produce manually, in what format and in what time.
Pilot SRAs or their regional works masters:
- collect descriptive data from health professionals, institutions, structures and/or services involved in experiments;
- produce state report number 1 and transmit it to HAS semi-annually.
Table 2. - Data of a telemedicine act
| REG_PATIENT | Pilot region | Name of pilot region | N/A | Enumerated, unique choice | Alsace, Basse-Normandie, Burgundy, Centre, Haute-Normandie, Languedoc-Roussillon, Martinique, Pays de la Loire, Picardie | N/A |
| ID_THEMATIQUE | Theme of the telemedicine project | Designation of the theme of the telemedicine project | N/A | Enumerated, unique choice | Chronic and complex wounds, psychiatry and geriatrics, nephrology, cardiology | N/A |
| ID_PATIENT_ARS(**) | Patient | Anonymous patient identifier | N/A | Alphanumeric | N/A | |
| ID_ACTE | Type of telemedicine act | Designation of the type of telemedicine act | N/A | Enumerated, unique choice | TLC, TLE, TLS | N/A |
| REQUERANT_PRO | Occupation of the health care provider | Occupation of the health care provider (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| REQUERANT_SPE | Specialty of the applicant health professional | Specialty of the health care provider (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| REQUERANT_MOD | Practice of the applicant health professional | Practice of the applicant health professional (*) | N/A | Enumerated, unique choice | Liberal, employee, liberal and employee, military doctor | N/A |
| REQUERANT_LIEU | Applying Health Professional Exercise Category | Required Health Professional Exercise Category (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| REQUIS_PRO | Occupation of the required health professional | Occupation of the required health professional (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| REQUIS_SPE | Specialty of the required health professional | Specialty of the required health professional (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| REQUIS_MOD | Method of exercising the required health professional | Method of exercising the required health professional (*) | N/A | Enumerated, unique choice | Liberal, employee, liberal and employee, military doctor | N/A |
| REQUIS_LIEU | Health Professional Exercise Category Required | Health Professional Exercise Category Required (*) | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| ACCOMPAGNANT _PRO | Occupation of the health professional present with the patient | Occupation of the health professional present to the patient during teleconsultation | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| ACCOMPAGNANT _SPE | Speciality of the health professional present with the patient | Speciality of the health professional present to the patient during teleconsultation | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| ACCOMPAGNANT _MOD | Method of exercising the health professional present with the patient | Method of exercising the health professional present with the patient during teleconsultation | N/A | Enumerated, unique choice | Liberal, employee, liberal and employee, military doctor | N/A |
| ACCOMPAGNANT _LIEU | Health Professional Exercise Category present to the patient | Level of exercise of health professional present with the patient during teleconsultation | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| PEC_LIEU | Category of patient care facility | Category of patient care facility | N/A | Enumerated, unique choice | Cf. "Reference Lists" attached as annexes | N/A |
| ÂGE | Age of patient | Age of patient | N/A | Digital (years) | N/A | Valid if ♣ 0 |
| SEXE | Sex of the patient | Patient sex according to PMSI coding | N/A | Digital | 1 = female, 2 = male | N/A |
| MOTIF | Initial address pattern | Initial address (or initial diagnosis) that led to telemedicine support | N/A | Enumerated, multiple choices | Diabetic foot wound, ulcer, escarre, angiodermite, cancer wound, post-operative wound, stoma, burn, traumatic, other | N/A |
| TLM_PNR | Planned but unrealized telemedicine act | The judgment criterion is true in the case of a planned teleconsultation or tele expertise but not realized | TLC, TLE | Boolean | True, false | If teleconsultation or planned remote expertise has not been realized then tlm_pnr = true. otherwise, tlm_pnr = false |
| TLM_MPNR | Motif de non réalisation d'un acte de télémédecine | Indicates the cause of non-realization of a telemedicine act | TLC, TLE | Enumerated, unique choice | As a result of the patient, as a result of the applicant, due to the requirement, | No information if TLM_PNR = false |
| TLM_ANNEE | Year of realization of the act of telemedicine | Year corresponding to the time the required person makes the act of telemedicine (television or tele expertise) | TLC, TLE | Digital, 4 characters (AAAA) | N/A | N/A |
| TLM_MOIS | Months of realization of the act of telemedicine | Months corresponding to the time the required person makes the act of telemedicine (television or tele expertise) | TLC, TLE | Digital, 2 characters from 1 to 12 (MM) | N/A | N/A |
| TLM_NKE | Number of kilometres avoided | Number of kilometres round-trip between the patient's place of life (home or medico-social structure) and the place of the closest competent exercise structure (health house, reference centre...) in which the act could have been carried out in front of the face | TLC, TLE | Digital | N/A | Valid if ♣= 0 Note: avoided movements (see impact matrix) corresponds to the number of acts performed and therefore does not require any specific collections. |
| TLM_DAS | Failure to provide care | The criterion is true if, according to the applicant, the patient would not have received a consultation (TLC, TLE or TLS) in the absence of telemedicine | TLC, TLE | Boolean | True, false | If, according to the applicant, the patient would not have received a consultation then TLM_DAS = true. Otherwise, TLM_DAS = false |
| TLM_MDAS | Failure to provide care | Indicates the main cause of a lack of access to care | TLC, TLE | Enumerated, multiple choices | Enabling of the place of care, time of care, patient's state of health that does not allow it to be transported | Not informed if TLM_DAS = false |
| TLC_TAS | Access time specialist | Number of days elapsed between the day the requested person receives the request for teleconsultation transmitted by the applicant and the day the teleconsultation is performed | TLC | Digital (number of days) | N/A | N/A |
| TLC_TCR | Time devoted to the realization of a teleconsultation act | Duration (expressed in minute) of synchronous exchange between the required and the patient. This duration may be the connection time, the time between the patient's opening and closing, etc. | TLC | Digital (number of minutes) | N/A | N/A |
| TLC_NB_PLAIE | Number of wounds | Number of wounds examined during teleconsultation | TLC | Digital | N/A | Valid if ♣ 0 |
| TLC_PHD | Teleconsultation made during a dedicated time range | The judgment criterion is true if teleconsultation has been made during a time range dedicated to the realization of telemedicine acts | TLC | Boolean | True, false | If teleconsultation was made during a dedicated time range then TLC_PHD = true. Otherwise, TLC_PHD = false |
| TLE_TAS | Time of access to the specialist | Number of days elapsed between the day the requested person receives the request for tele expertise transmitted by the applicant and the day on which the applicant receives a copy of the medical CR. | TLE | Digital (number of days) | N/A | N/A |
| TLE_DPC | Request for clarification or additional information | The judgment criterion is true if, in order to carry out the tele expertise act, the requested person had to request clarifications or additional information from the applicant (excluding requests for further examinations) | TLE | Boolean | True, false | N/A |
| (*) Applicants and required are defined in the chapters "Terms and Conditions for Teleconsultation" and "Terms and Conditions for the realization of tele expertise" of this Terms and Conditions of Reference. | ||||||
4.3.2.2. Status reports from the analysis of health insurance databases
The assessment of the impact of telemedicine on the quality of care and the consumption of care on the target population and the control population is implemented using the SNIIRAM - PMSI data analysis.
These data are collected and processed by CNAM-TS and then sent to HAS in an aggregate form per patient.
The processing of these data results in the production of 2 reports of NCAM-TS dependent states. The SNIIRAM data analysis period - PMSI carries a minimum of 6 months.
The starting point and the time limits of the different variables are:
- for the population included: the first act of telemedicine;
- for the witness population: the first consultation conducted in the year with a specialist doctor (dermatologist, geriatrician, diabetologist...).
The time limits for both populations are 6 months for monitoring consumption, hospitalization and death.
CNAM-TS addresses data to HAS within the month of the end of the period required for the collection of all data. As a reminder, complete city liquidations will be available 3 months after the end of observation and full hospitalizations and external consultations 5 months after the end of the observation.
The identification of individuals who have benefited from a telemedicine act is carried out from the teleconsultation or tele expertise code entered in the DCIR (ambulatory and private) and PMSI (external consultations file).
The CNAM-TS extracted data from the DCIR, PMSI and resid-EHPAD provides data on patient characteristics and their care: hospitalization rates, emergency transition rates and death rates.
In terms of the consumption of care, care positions are identical to the positions identified under the PRADO program " Chronic wounds". They concern hospitalizations, transport, nursing, physiotherapy, medical consultations, dressings and compresses, restraint strips, anti-scarre equipment, drug use (especially antibiotics and anti-algics).
4.3.2.2.1. Status Report No. 2 on Care Consumption and Impact on the Health of the Included Population from the Analysis of National Health Insurance Repayment Data (SNIIRAM - PMSI), Accredited by Patient
In this state report:
- each line corresponds to a patient;
- each column corresponds to a given consumption of care and impact on the health condition;
- the order of the data necessarily corresponds to the order of presentation in the table;
- the lines are sorted by increasing the identifier of the region, followed by the identifier of the topic and finally the patient ID;
- REG_PATIENT_AM corresponds to the pilot region in which the patient's membership is located. When this body is located in a non-pilot region, " REG_PATIENT_AM" corresponds to the pilot region in which the first required health professional is employed.
| REG_PATIENT_AM | See Supra |
| ID_PATIENT_AM | |
| ID_THEMATIQUE | Table 2 of the "Data of a telemedicine act" |
| AGE | |
| SEXE | |
| MOTIF | |
| NB_ACTE | Number of telemedicine acts performed (for a given patient) |
| NB_ACTE_TLC | Number of teleconsultation acts performed |
| NB_ACTE_TLE | Number of acts of tele expertise made |
| PATIENT_HOSPIT | The judgment test is true if the patient has been hospitalized |
| NB_HOSPIT | Number of hospitalizations |
| PATIENT_URG | The test of judgment is true if the patient has resorted to emergencies |
| NB_URG | Number of emergency passages |
| DECES | The judgment test is true if the patient died |
| NB_PANS | Number of patient dressings |
| CT_TRANS | Transport costs (amounts reimbursed by the AM) |
| CT_HOSPIT | Cost of hospitalizations |
| CT_PANS | Cost in euros of dressings and compresses |
| CT_INFIR | Cost of nursing |
| CT_KINE | Cost of physiotherapy in euros |
| CT_CONS | Cost in euros of medical consultations |
| CT_MATERIEL | Cost in euros of anti-short equipment |
| CT_BANDE | Cost of contention strips in euros |
| CT_ATB | Cost in euros of antibiotics and antalgic |
4.3.2.2.2. State Report No. 3 on Care Consumption and Impact on the Health of the Witness Population from the Analysis of National Health Insurance Repayment Data (SNIIRAM-PMSI)
Indicators to identify the consequences of practices assessed on the quality of care and the cost of the population care consumption included in the experiments are compared to those of a control population.
The control population is defined in the SNIIRAM - PMSI based on the algorithms set up in the report "health insurance expenses and products" as well as in the PRADO program " Chronic wounds".
The control group corresponds to all patients treated for ulcer, escarre and diabetic foot for which it is possible to detect the use of care for the year 2014, with the exception of patients treated in EHPAD.
In this state report:
- each line corresponds to a patient;
- each column corresponds to a given consumption of care and impact on the health condition;
- the order of the data necessarily corresponds to the order of presentation in the table;
- the lines are sorted by increasing the area identifier, followed by the thematic identifier and finally the patient ID.
This status report contains the following comparator data:
| REG_PATIENT_AM | See Supra |
| ID_PATIENT_AM | |
| ID_THEMATIQUE | Table 2 "Data of a telemedicine act" |
| AGE | |
| SEXE | |
| MOTIF | |
| TX_HOSPIT | Witness group hospitalization rates |
| TX_URG | Witness group emergency response rate |
| TX_DECES | Witness group death rate |
| NB_PANS | Number of dressings consumed by the control group |
| CT_TRANS | Transport costs (amounts reimbursed by the AMF) of the control group |
| CT_HOSPIT | Cost of hospitalizations of the control group |
| CT_PANS | Cost in euros of dressings and compresses of the control group |
| CT_INFIR | Cost in euros of witness group nurses |
| CT_KINE | Cost of witness group physiotherapy in euros |
| CT_CONS | Cost in euros of medical consultations of the control group |
| CT_MATERIEL | Cost in euros of anti-short equipment |
| CT_BANDE | Cost of contention strips in euros |
| CT_ATB | Cost in euros of antibiotics and antalgic |
4.3.2.3. Status report No. 4 on patient satisfaction questionnaire data
The data to assess the satisfaction of patients in the course of the experiments are from a satisfaction questionnaire.
They are collected from a collection grid, from consenting patients and free from cognitive disorders. They are the subject of a state report No. 4 and are produced by the ARS at the HAS.
Patient satisfaction is assessed using the following scale (Likert scale):
1 = not at all agreed;
2 = no agreement;
3 = No disagreement or agreement;
4 = Okay;
5 = quite agree.
In this state report:
- each line corresponds to a patient satisfaction survey;
- each column corresponds to a data from the dictionary of the patient satisfaction questionnaire;
- the order of data necessarily corresponds to the order of presentation in the data dictionary;
- the lines are sorted by increasing order of the region's identifier, followed by the thematic identifier and finally the patient's identifier.
| REG_PATIEN T | Cf. dictionary of "Data of a telemedicine act" | |||||
| ID_THEMATI QUE | ||||||
| ID_PATIENT_ARS | ||||||
| SDP_Q01 | Non-response reasons: The patient is not willing | TLC | Boolean (cocher case) | 1 = True, 2 = False | N/A | N/A |
| SDP_Q02 | The patient is not in a capacity to respond (cognitive disorders in particular) | TLC | Boolean (cocher case) | 1 = True, 2 = False | N/A | N/A |
| SDP_Q03 | The patient has already answered the questionnaire | TLC | Boolean (cocher case) | 1 = True, 2 = False | N/A | N/A |
| SDP_Q04 | (1) Overall, are you satisfied with the remote management of your disease? | TLC | Digital | 1 = not at all agreed; 2 = no agreement; 3 = No disagreement or agreement; 4 = Okay; 5 = Very well agreed | N/A | N/A |
| SDP_Q05 | Compared to a face-to-face consultation, did telemedicine allow you to: 1-1) Improve your access to care? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q06 | 1-2) Losing less time? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q07 | 1-3) Being less tired? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q08 | 1-4) Avoiding certain trips? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q09 | 1-5) To receive care deemed equivalent? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q10 | 2)In general, are you satisfied with the communication with your doctor (or other health professional) remotely? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q11 | Compared to a face-to-face consultation: 2-1) Did the doctor speak to you clearly and understandably? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q12 | 2-2) Did you feel that the doctor was attentive to what you said about your health? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q13 | 2-3) Could you ask the questions you wanted? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q14 | 2-4) Have you received the necessary information on the care and treatment that has been offered to you? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q15 | 2-5) Did you trust the doctor's skills? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q16 | (3) Overall, do you have confidence in telemedicine? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q17 | 3-1) Does telemedicine seem easy to use? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q18 | 3-2) Are you satisfied with the quality of sound and image? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q19 | 3-3) Compared to a face-to-face consultation, does the confidentiality of exchanges seem satisfactory? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q20 | Following this experience of telemedicine, 4-1) Would you be happy to continue your medical monitoring by telemedicine? | TLC | Digital | Idem | N/A | N/A |
| SDP_Q21 | 4-2) Would you recommend the use of telemedicine to your entourage? | TLC | Digital | Idem | N/A | N/A |
Table 3. - Summary table of expected status reports
| No. 1 | Relatif aux données des actes de télémédecine | Descriptive data of telemedicine acts | ARS | HAS |
| No. 2 | Relative to care consumption and the impact on the health status of the population included from the analysis of national health insurance reimbursement data (SNIIRAM - PMSI), approved by patient | National data for the consumption of care related from the TLM act | CNAM-TS | HAS |
| No. 3 | Relative to care consumption and the impact on the health of the control population resulting from the analysis of national health insurance reimbursement data (SNIIRAM - PMSI) | Witness Group (excluding EHPAD) | CNAM-TS | HAS |
| N°4 | Data from patient satisfaction questionnaires | Elements from the Patient Satisfaction Survey | ARS | HAS |
4.3.3. Data transmission to the High Health Authority
The evaluation data shall be transmitted to the electronic format within the following time and conditions:
| Analysis of the state of the care supply and the needs of the territories | Free text (Cf. 4.3.1.1) transmitted at the time of actual start-up (*) of the experiments then in case of significant modifications | HAS tlm.art36@has-sante.fr |
| Descriptive analysis of a telemedicine project | Free text (Cf. 4.3.1.2) transmitted at the time of the actual start of the experiments, as a forecast and then every semester to take stock of the actual situation of each project (volumetry of acts carried out at the time, list of the actors actually involved...) | HAS tlm.art36@has-sante.fr |
| State report No. 1 | flat .csv files transmitted every semester | HAS tlm.art36@has-sante.fr |
| State report No. 2 | .csv files flat | HAS tlm.art36@has-sante.fr |
| State report No. 3 | .csv files flat | HAS tlm.art36@has-sante.fr |
| State report No. 4 | .csv files flat | HAS tlm.art36@has-sante.fr |
| (*) "Effective start" is the time when the collection of evaluation data is in service (or operational) in accordance with the specifications. | ||
State reports are organized and structured according to the following criteria:
- each line is separated by the character
- each column is separated by the character
- the first line of the file, corresponds to the text of the columns, contains the field codes defined in the tables above.
The files are named according to the following nomenclature: « REGION_RAPPORT_DEBUT_FIN » :
- « REGION » is an optional field to designate the name of the region among the nine pilot regions;
- "Report" and the status report number (from 1 to 4 as defined above);
- "DEBUT" and "FIN" respect the format "AAAAMMJ" and define the period of data collection for the experiments.
The coding of the data shall conform to the following specifications:
- the characters used belong to one of the ASCII character sets, ISO 8859-1 or unicode character set, ISO/CEI 10646, UTF-8 type;
- Boolean values correspond to "0" for "false" and "1" for "true";
- for digital values, the comma separates the entire fraction of the decimal part. No millier separator is accepted. Digital values can be signed. The sign is indicated by the first character from the left;
- dates are expressed in AAAAMMJJ format without separator;
- times are expressed in HH:MM:SS format.
An accompanying email specifies the character set used (ASCII or UTF-8).
4.3.4. Completed data
Only the data conforming to these specifications will be taken into account by the High Health Authority. Incomplete data (presence of one or more empty or unreported data in one line) or incorrect data (of a type different from that specified in this document) will be excluded from the evaluation.
5. Improve knowledge of the costs of telemedicine devices
During experimentation, a system for collecting data on the costs of information systems mobilized for the realization of telemedicine acts is implemented by ASIP Santé. These data give rise to the completion by ASIP Health of a cost study following the experiments.
The compendium of the cost evaluation data must allow the ASIP Health to have a homogeneous information base and a return of regular information throughout the experiments.
SRAs from selected regions are committed to participating in this study by providing the necessary data for the proper conduct of the study.
6. Annexes
6.1. Annex 1
Glossary
| CNAM-TS | National Health Insurance Fund for Employees |
| CPAM | Primary Health Insurance Fund |
| ARS | Regional Health Agency |
| HAS | High Health Authority |
| DGOS | Direction générale de l'offre de soins |
| DRSM | Regional Health Insurance Medical Service Directorate |
| EHPAD | Accommodation for dependent elderly people |
| ESMS | Social or social |
| FAM | Medical home |
| FINESS | National Health and Social Institutions File |
| MAS | Home specialized |
| NAS | Nomenclature of health actors |
| PMSI | Medicalization of information systems program |
| YES | Indoor Pharmacy |
| RPPS | Shared Directory of Health Professionals |
| SNIIRAM | National System of Inter-Plan Information for Health Insurance |
| TLC | Teleconsultation |
| TLE | Tele expertise |
| TLS | Medical surveillance |
6.2. Annex 2
Mobile financing
| Telemedicine (financed professional activity required) | Act / plan created for the purposes of experimentation |
| Telemedicine: funding of the activity of the applicant health professional, prescriptor or adjacent to the patient during the completion of the act | Mobilization of the existing nomenclature (C, CS, V, AMI, etc.) on the occasion of the support |
| Telemedicine: financing of the activity of health professionals working in medical and social structures | DAF |
| Telemedicine other | FIR |
| Training of professionals | OGDPC |
| Participation of health professionals in the collection of activity for evaluation | FIR |
| Therapeutic education | FIR /ENMR |
6.3. Annex 3
Summary of commitments by parties
| Health professionals | Compliance with organizational models Compliance with billing procedures Production of evaluation data (and agreement to this end with SRA and local health insurance organizations) Identification with ARS |
| The Ars | Promotion of regional experiments with users and health professionals Production of evaluation data (and agreement to this end with health professionals or their representatives) Elaboration of state reports 1 and 4 and transmission to HAS in accordance with the definitions, terms and times defined in this document DGOS alert on any difficulties encountered Production of the reports necessary for monitoring experimentation by the National Steering Committee Expression of need for support to the Health and NAPA and facilitation of these accompanying missions |
| Health insurance | Water payment of prefigurative acts Elaboration of state reports Nos. 2 and 3 and transmission to HAS in accordance with the definitions, terms and times defined in this document Monthly production of activity monitoring data and credit consumption |
| DGOS | Promotion of experiments with users and health professionals National piloting of experiments Support to SRAs on challenges |
| The HAS | Conduct of the evaluation and ensure compliance with the production of evaluation data by health professionals, SRAs and their masters of work and health insurance (and support as appropriate) |
| ASIP Health | Support to the implementation of national repositories of health information systems Methodological support for the recovery of the data required for the evaluation Evaluation of the cost of telemedicine information systems |
| ANAP | Organizational support for the organization of the data collection for the evaluation |
6.4. Annex 4
Coordinates
| DGOS | DGOS-PF3@sante.gouv.fr |
| CNAM-TS | tlm.art36@cnamts.fr |
| HAS | tlm.art36@has-sante.fr |
| Alsace | ARS-ALSACE-PERFORMANCE@ars.sante.fr |
| Lower Normandy | ars-bnormandie-performance@ars.sante.fr |
| Burgundy | ARS-BOURGOGNE-DOS-MODERNISATION@ars.sante.fr |
| Centre | ars-centre-telemedecine@ars.sante.fr |
| Haute-Normandie | ars-hnormandie-telemedecine@ars.sante.fr |
| Languedoc-Roussillon | ars-lr-esante@ars.sante.fr |
| Martinique | ARS-MARTINIQUE-DIRECTION-PERFORMANCE - EFFICIENCE@ars.sante.fr |
| Pays de la Loire | ars-pdl-deo-sit@ars.sante.fr |
| Picardy | ARS-PICARDIE-TELEMEDECINE@ars.sante.fr |
6.5. Annex 5
Trame of the monthly status report transmitted by SRAs to OSB
(Email to: DGOS-PF3@sante.gouv.fr)
monthly progress of telemedecine practices implemented under section 36 of the SSA for 2014 for the monitoring of chronic and complex wounds
| ARS XXXX |
| Month/year: |
| State arrested him: .../.../... |
| Teleconsultations: | Note | |
| Nb of teleconsultations | ||
| Nb of patients supported by teleconsultation | ||
| Tele expertise: | Note | |
| Nb of tele expertise | ||
| Nb of patients supported by tele expertise | ||
| Health professionals: | Note | |
| Nb of health professionals involved | ||
| Nb of required health professionals involved | ||
| Cost monitoring: | Note | |
| Sums paid for teleconsultations | ||
| Sums paid for tele expertise | ||
| Sums paid for supporting the production of evaluation data | ||
6.6. Annex 6
Reference lists
6.6.1. List of professions.
For the purposes of the evaluation, the field to be traced back to HAS is LIBELLE only.
| 10 | Doctor |
| 21 | Pharmacien |
| 40 | Surgery |
| 50 | Sage-woman |
| 26 | Audioprothesist |
| 28 | Opticien-lunetier |
| 60 | Nurse |
| 70 | Therapist |
| 80 | Pedicure-podologist |
| 81 | Orthoprothesist |
| 82 | Podo-Orthesist |
| 83 | Orthopedist-orthesist |
| 84 | Ocularist |
| 85 | Epithesist |
| 86 | Medical laboratory technician |
| 91 | Orthophonist |
| 92 | Orthoptist |
| 94 | Ergotherapist |
| 95 | Dietitian |
| 96 | Psychomotrician |
| 98 | ERM handler |
6.6.2. List of specialties.
For the purposes of the evaluation, the field to be traced back to HAS is LIBELLE only.
| 01 | General medicine |
| 02 | Anesthesiology and surgical resuscitation |
| 03 | Cardiovascular pathology |
| 04 | General surgery |
| 05 | Dermatology and venerealology |
| 06 | Radiodiagnosis and medical imaging |
| 07 | Obstetric Gynaecology |
| 08 | Gastroenterology and hepatology |
| 09 | Internal medicine |
| 10 | Neurosurgery |
| 11 | Oto-rhino-laryngologie |
| 12 | Pediatrics |
| 13 | Pneumology |
| 14 | Rhumatology |
| 15 | Ophthalmology |
| 16 | Urological surgery |
| 17 | Neuropsychiatry |
| 18 | Stomatology |
| 19 | Dental surgery |
| 20 | Medical animation |
| 21 | Sage-woman |
| 24 | Nurse (era) |
| 26 | Body massager |
| 27 | Sickness |
| 28 | Orthophonist |
| 29 | Orthoptist |
| 30 | Medical Analysis Laboratory |
| 31 | Physical medicine and rehabilitation |
| 32 | Neurology |
| 33 | General psychiatry |
| 34 | Geriatric |
| 35 | Nephrology |
| 36 | Dental surgery, specialist ODF |
| 37 | Anatomy and pathological cytology |
| 38 | Biologist doctor |
| 39 | Multi-purpose laboratory |
| 40 | Laboratory of anatomy and pathological cytology |
| 41 | Orthopaedic surgery and traumatology |
| 42 | Endocrinology and metabolism |
| 43 | Child surgery |
| 44 | Maxillo-facial surgery |
| 45 | Maxillo-facial surgery and stomatology |
| 46 | Reconstructive plastic surgery and aesthetics |
| 47 | Thoracic surgery and cardiovascular surgery |
| 48 | Vascular surgery |
| 49 | visceral and digestive surgery |
6.6.3. List of establishment categories.
For the purposes of the evaluation, the field to be traced back to HAS is LIBELLE only.
| 253 | Multi-purpose home for disabled adults | Foyer Poly.A.H. |
| 255 | Specialized home (MAS) | MAS |
| 256 | Home migrant workers not transformed into soc residence. | Foyer Trav. Migrants |
| 257 | Rent young workers not transformed into soc residence. | Foyer Jeunes Trav. |
| 258 | Houses relay-Family boards | Maisons Relais-Pens. |
| 259 | Social residences out of houses relay-Family boards | Resid.Soc out of MRel |
| 261 | DDASS | DDASS |
| 262 | Adapted regional education institution | EREA |
| 265 | Special Education Section | Education. Spec.Class |
| 266 | Anti-Venean costs | Disp. Anti-Venerian |
| 267 | Antihansenian expenditure | Disp. Antihansenian |
| 268 | Centre médico-scolaire | Ctre.Médico-Scolaire |
| 269 | University Medicine Centre | Ctre. |
| 270 | Sports Medicine Centre | Ctre.Méd.Sportive |
| 271 | Hosting families of the sick | Hostel.Fam.Malades |
| 272 | Ambulance school | Ambulance school |
| 273 | Nursing Training Institute (IFSI) | IFSI |
| 274 | School of Midwives | Midwives school |
| 275 | School of massage therapists | Chemistry school |
| 276 | School of Medical Testing | School laborantins am |
| 277 | School of Periculators | Graduate School |
| 278 | Multi-purpose training establishment | Etab.frm.polyvalent |
| 279 | School of Social Service | School social service |
| 280 | School of specialized educators | Education school. Sword. |
| 281 | Caregiver Training Centre | Ctre.frm.aides soig |
| 282 | School of pedicures-podologists | School pei.podo |
| 283 | School of electro-radiology manipulators | School manip.e-rad |
| 284 | School of Family Workers | School trav.famil. |
| 285 | Leisure centres without accommodation | Ctre.Loisirs ss.Heb. |
| 286 | Prevention Team Club | Club Equipe de Prév. |
| 289 | Nursing Centre | Ctre. |
| 292 | Centre hospitalier spécialisées lutte maladie mentales | CHS Mal.Mentales |
| 294 | Cancer Consultation Centre | Ctre.Consul.Cancer |
| 295 | Open Educational Action Service (AEMO) | Serv.AEMO |
| 297 | Multi-purpose | Please. Polyvalent |
| 300 | Schools in health professions | Health schools |
| 303 | School of Social and Family Economic Advisers | School CESF |
| 304 | School of occupational therapists | School ergotherap. |
| 305 | Psychomotrician school | Psycho-motric school. |
| 306 | School of Anesthetic Nurses | School inf.anesth. |
| 307 | School of surgery block nurses | School inf. bloc op. |
| 308 | Psychiatric vocational training centre | Ctre frm.pro.sec.psy. |
| 309 | School of Nurses | School cdr.inf. |
| 310 | School of Psychiatric Sector Management | School cdr.sect.psy. |
| 311 | School of Kneetherapists | School cdr.mass-kiné. |
| 312 | School of electro-radiology manipulators | School cdr.mani.é-rad |
| 313 | School of Young Child Educators | Ecole éduc.j.enf |
| 314 | School of specialized technical educators | Ecole éduc.tech.spé. |
| 315 | School of Teachers | School instructor-education |
| 316 | Medical-psychological school | School aid.med-psycho |
| 317 | School of socio-educational facilitators | School ani.socio-educ |
| 319 | Regional Social Workers Training Institute | IRFTS |
| 320 | UAS and Centre 15 | UAS and Centre 15 |
| 321 | Field hospital unit | Mobile Hosp Unit. |
| 322 | Regional hospital information centre | Ctre.Rég.Infor.Hosp. |
| 324 | Non-specialized housing | Log.Foyer non Spec. |
| 326 | School of executives | School of executives |
| 327 | Ambulance service | Serv.Ambulances |
| 328 | Dental clinic | Ctre.Cons.Soins.Dent |
| 329 | Psychiatric sector | Sectorization Psy. |
| 330 | Schools for social professions | Social schools |
| 340 | Judicial Agent Service for the Protection of Major | MJPM |
| 341 | Dedicated service personalized social support measures | MASP. |
| 342 | Family Guardian Information and Support Service | SISTF |
| 343 | Team preparation and reclassification (EPSR) | EPSR |
| 344 | Family Services | DPF |
| 345 | Trusteeship social service | Serv.Tut.Prest.Soc. |
| 346 | Family Workers Service | Serv.Trav.Familiales |
| 347 | Health Examination Centre | Ctre.Examens Health |
| 349 | School of midwives management | School cdr.sg-women |
| 350 | Centre for the Training of Pericultural Auxiliaries | Ctre frm.auxi.puéri |
| 352 | Psychotherapy Centre | Ctre.Psychtherapy |
| 353 | Day hospital medical specialities | Hop. |
| 354 | Home Nursing Service (SSIAD) | SSIAD |
| 355 | Hospital Centre (CH) | CH |
| 357 | Association assists in respiratory failures | Assoc.Aide Ins.Resp. |
| 359 | Centre district health and social | Ctre.Circons.San.Soc |
| 361 | Medical center | Ctre.Cure Médicale |
| 362 | Long-term care | Care Long.Dur. |
| 363 | Average and long stay | Ctre.moyen and long |
| 365 | Multidisciplinary care | Etab. |
| 366 | Therapeutic workshop | Workshop Therapeut. |
| 367 | Children's house not approved or authorized | But, child n.C.n.H |
| 368 | Home meals | Serv.Repas Domicile |
| 369 | Centre adaptation vie active (CAVA) | CAVA |
| 371 | Socio-educational services for families in difficulty | Serv.Act.Soc-Educ.F. |
| 373 | Centre de formation supérieure des travailleurs sociaux | Ctre frm.sup.trv.scx |
| 374 | National Public Health School (ENSP) | ENSP |
| 375 | Adaptation class | Adaptation class |
| 376 | Primary school special class | Class Spéc.Ecole.Pr. |
| 377 | Experimental establishment for disabled children | Etab.Expér.Enf.Hand. |
| 378 | Experimental child protection | Etab.Expér.Enf.Prot. |
| 379 | Experimental establishment for disabled adults | Etab.Expér.A.H. |
| 380 | Experimental establishment other adults | Etab.Expér.Other.A. |
| 381 | Experimental establishment for older persons | Etab.Expér.P.A. |
| 382 | Living home for disabled adults | Life home A.H. |
| 386 | Special secondary school | Secondary School |
| 122 | Establishment surgical-gynecological obstetric care | Etab.Obs.Chir.Gynecology |
| 125 | Dental Health Centre | Ctre. |
| 126 | Thermal | Etab.Thermal |
| 127 | Home hospitalization | Hosp.à Domicile |
| 128 | Surgical care | Etab. |
| 129 | Medical care | Etab. Medical care |
| 130 | Medical Care Centre | Ctre. Medical care |
| 131 | Centre for Cancer Control | Ctre.Lutte C.Cancer |
| 132 | Blood transfusion establishment | Etab.Trans.Sanguine |
| 135 | Functional rehabilitation | Etab.Readap.Fonct. |
| 136 | Bank of sperm | Bank of Sperme |
| 439 | Multi-purpose health centre | Ctre.Health Polyv. |
| 440 | Educational Guidance Service (SIOE) | SIOE |
| 441 | Educational Action Centre (CAE) | CAE |
| 442 | Centre provisoire logement (CPH) | CPH |
| 443 | Home asylum seekers (CADA) | CADA |
| 444 | Centre crise permanent | Ctre.Crise Acc.Perm. |
| 445 | Medical-social support service adults with disabilities | SAMSAH |
| 446 | Social Life Support Service (SAVS) | SAVS |
| 447 | Interim insertion | Enter.Insert. |
| 450 | Senior Care Service | Serv.Aide Pers.Agees |
| 451 | Service for help to families in difficulty | Help Fam.Diff. |
| 452 | District rule | District rule |
| 453 | Criminal Repair Service | Serv.Repar. |
| 460 | Home Help Service (ADS) | SAD |
| 1 | Other beds m.R. | Other beds m.R. |
| 2 | Other seats of l-f. | Other seats of l-f |
| 3 | Other beds l-s | Other beds l-s |
| 101 | Regional Hospital Centre (CHR) | CHR |
| 106 | Hospital, ex local hospital | CH (ex HL) |
| 108 | Recovery and rest | Etab.Convales. |
| 112 | Centre for recovery or rehabilitation | Ctre.Conval.Cure Rea |
| 114 | Military Hospital | Armed hospital |
| 115 | Care of the Armed Health Service | Etab. |
| 119 | Diet house | Regime House |
| 390 | Temporary reception of disabled children | Etab.Acc.Temp.E.H. |
| 393 | Other for-profit residence for older persons | Aut.res.But luc.PA |
| 394 | Temporary reception facility for seniors | Etab.Acc.Temp.P.A. |
| 395 | Temporary shelter for disabled adults | Etab.Acc.Temp.A.H. |
| 396 | Housing for children and adolescents with disabilities | Foyer Heb.Enf.Ado.H. |
| 397 | Auxiliary Service for Disability | Serv.Auxil.Vie Hand. |
| 398 | Parental nursery | Parental nursery |
| 399 | Stop parental care | Halte Garderie Par. |
| 400 | Service Centre for Associations | Ctre.Assoc services. |
| 401 | DRASS | DRASS |
| 402 | Specialized kindergarten | Garden Children Special. |
| 403 | Specialized or versatile social service | Serv.Soc.Spec.Pol.Ca |
| 404 | Etablissement acc.collect.parental regular & occasional | Etab.Acc.Parental |
| 405 | Multi-sector social service | Serv.Soc.Polyv.Sect. |
| 411 | Social placement | Intermed.Pla.Social. |
| 412 | Therapeutic apartment | Appearance.Therapeutic |
| 413 | CECOS | CECOS |
| 414 | Poison Center | Centre Anti Poison |
| 415 | Regional Medico-psychological Service (SMPR) | SMPR |
| 418 | Social Investigation Service (SES) | Serv.Enq.Social |
| 419 | Drug addiction reception centre | Ctre.Acc.Toxico. |
| 420 | Company of insertion | Insertion |
| 421 | Emergency Relief Education Centre | CESU |
| 422 | Specialized home treatments | Trait.Spec.Domicile |
| 423 | School of Medical Analysis Workplaces | School cdr.labor.am |
| 425 | Part-time therapeutic reception centre (CATTP) | CATTP |
| 426 | Inter-Hospital Union (SIH) | SIH |
| 427 | Court Education Service (SEAT) | SEAT |
| 430 | Centre postcure mental illness | Ctre.P-Cure Mal.Men. |
| 431 | Postcury Centre for Alcoholics | Ctre.P-Cure Alcool. |
| 432 | Postcure centre for drug addicts | Ctre.P-Cure Toxico. |
| 433 | Prison health facility | Etab. |
| 434 | Special class in kindergarten | Special class.Ec.Mat. |
| 435 | Home Help Training Centre | Ctre frm.aide dom. |
| 436 | Schools in health and social professions | Multiprofessional schools. |
| 437 | Medical home for disabled adults (FA) | FAM |
| 438 | Centre for Collective Medicine | Ctre.Méd.Collect. |
| 174 | Regular and casual collective reception | Acc.Collect.Rég indicatorOcc. |
| 175 | Children's home | Foyer de l'Enfance |
| 176 | Children's village | Child Village |
| 177 | House of children with a social character | But, inf. car.Social |
| 178 | Home/ Accomp.Reduc.Risq.Usag. Drugs (CAARUD) | CAARUD |
| 179 | Permanent Children's House | MECS Permanente |
| 180 | Health Care Beds (LHSS) | LHSS |
| 181 | Family holiday home | But. Fam. Vacation |
| 182 | Special Education and Home Care Service | Serv.Educ.S.Soin.Dom |
| 183 | Institut Médico-Educatif (IME) | IME |
| 184 | Institut médico-pédagogique (IMP) | IMP |
| 185 | Institut médico-professionnel (IMPro.) | IMPro. |
| 186 | Educational Therapeutic Institute (ITEP) | ITEP |
| 188 | Establishment for children or adolescents | Etab.Enf.ado.Poly. |
| 189 | Centre médico-psycho-pédagogique (CMPP) | CMPP |
| 190 | Centre action médico-social tôt (CAMSP) | CAMSP |
| 191 | Establishment for deficient brain motors | Def.Mot.Cereb. |
| 192 | Establishment for impaired motor | IEM |
| 193 | Establishment for deficient motors and brain motors | Etab.Def.Mot.Def.M.C |
| 194 | Institute for visual impairment | Inst.Visual |
| 195 | Institute for hearing impairment | Inst.Decorative |
| 196 | Deaf/blind Sensory Education Institute | Inst.Ed.Sen.Sour.Ave |
| 198 | Pre- Orientation Centre for Disabled Persons | Ctre.Préorient.Hand. |
| 199 | Hospice | Hospice |
| 200 | Retirement home | Retirement home |
| 202 | Home housing | Home housing |
| 205 | Foyer club restaurant | Foyer Club Restaur. |
| 207 | Day centre for aging people | Ctre.de Day P.A. |
| 208 | Home home care service | Help menag.Dom. |
| 209 | Multi-purpose home care service (SPASAD) | SPASAD |
| 212 | Medico-social alarm | Alarm.Médico-Sociale |
| 214 | Centre accomodation sociale (CHRS) | CHRS) |
| 215 | House lai | House lai |
| 217 | Cité de transit | Cité de transit |
| 218 | Aire station nomades | Aire station nomades |
| 219 | Other reception centre | Other Ctre.Home |
| 220 | Social Centre | Ctre. Social |
| 221 | University Psychological Assistance Office (BAPU) | BAPU |
| 223 | Maternal and Child Protection (PMI) | PMI |
| 224 | Pre- and post-natal consultation | Etab.Cons.P.Post-Nat |
| 225 | Consultations of infants | Consult. |
| 228 | Family Planning or Education Centre | Ctre.Planif.Educ.Fam |
| 229 | Consultation problems birth | Consult. Prob. |
| 230 | Child protection consultation | Etab.Consul.Pro.Inf. |
| 231 | Establishment information consultation family counselling | Etab.Inf.Consult.Fam |
| 233 | Lactarium | Lactarium |
| 236 | Centre placement familial socio-educatif (CPFSE) | CPFSE |
| 237 | Specialized family placement centre | Ctre. Plac.Fam.Spe. |
| 238 | Specialized family reception centre | Ctre.Acc.Fam.Spécia. |
| 241 | Educational Action Home (FAE) | FAE |
| 246 | Workplace Development and Assistance Service (ESAT) | ESAT |
| 247 | Business adapted | Business adapted |
| 249 | Centre reeducation professionnelle | Ctre. |
| 250 | Retraining Centre at Work | Ctre.Reent.Work |
| 251 | Holiday home for disabled | House Vac.handicap. |
| 252 | Foyer accommodation for adults with disabilities | Foyer Héberg.A.H. |
| 137 | Organ Bank | Organ Bank |
| 138 | Centre for Periodic Analysis | Ctre.Period analysis. |
| 139 | Dialysis and Training Centre | Ctre.Dial.Entr.Dial. |
| 140 | Dialysis Training Centre | Ctre. |
| 141 | Dialysis Centre | Ctre.Dialysis |
| 142 | Tuberculosis | Disp.Anti-Tubercul. |
| 143 | BCG vaccination centre | Ctre.Vaccination BCG |
| 144 | Tuberculosis control | Etab.Lutte Tubercul. |
| 146 | Alternative structure to dialysis in center | Alternative dialysis |
| 156 | Centre médico-psychologique (CMP) | CMP |
| 157 | Postcure Centre | Ctre.de Postcure |
| 160 | Centre for Specific Drug Abuse (CSST) | CSST |
| 161 | Mental Health House | But it's evil. |
| 162 | Ambulatory treatment centre in alcoology (CCAA) | CCAA |
| 163 | Temporary Health Children's House | Temporary MECS |
| 164 | Experimental settlements early childhood reception | Etab.exp.petite enf. |
| 165 | Therapeutic coordination apartment (ACT) | ACT |
| 166 | Mother-child reception facility | Etab.Acc.Mother-Child |
| 167 | Collective nursery | Collective nursery |
| 168 | Family reception service for early childhood | Family home |
| 169 | Crèche multi accueil collective et familial | Crèche Fam.et Coll. |
| 170 | Stopwatching | Halt Garderie |
| 171 | Child care and garden | Guards Garden Enf. |
| 172 | Social empowerment | Car.Soc. |
| 173 | Sanitary component | Car.San. |
| 461 | IAD Resource Centres (with no indication) | Ctre.Resources |
| 462 | Places of life | Places of life |
| 463 | Centres locale information coordination PA (CLIC) | CLIC |
| 601 | Liberal Medical Office | Cabinet Libé. |
| 602 | Group Cabinet | Group Cabinet |
| 603 | Health House (L. 6223-3) | Health House |
| 605 | Medical Auxiliary Office | Cabinet Aux.Medicaux |
| 610 | Laboratory of analysis | Analysis |
| 611 | Medical Biology Laboratory | Labo Biolog Medical |
| 620 | Pharmacie d'officine | Officine Pharmacy |
| 621 | Medical cleaning | Medical cleaning |
| 622 | Device Center & prosthesis | Ctre.Appar. probation |
| 623 | Herboristerie | Herboristerie |
| 627 | Pro pharmacy | Pro pharmacy |
| 628 | Mining | Mining |
| 629 | Pharmacie mutualiste | Pharmacie mutualiste |
| 690 | Manufacturing facility annexed to an informal | Fab. |
| 696 | Health cooperation unit | GCS-Moyens |
| 697 | Health cooperation group-health establishment | GCS-ES |
| 698 | Other hospital law | Other Etab.Loi Hosp. |
| 699 | Authorization | Entity Having Autor |
Done on April 17, 2015.
Minister of Social Affairs, Health and Women ' s Rights,
For the Minister and by delegation:
The Director of Social Security,
T. Fatome
The Director of Social Security,
J. Debeaupuis
Minister of Finance and Public Accounts,
For the Minister and by delegation:
The Director of Social Security,
T. Fatome
