The maze of the care pathway

You may be here because you know more about the path of your Amazon package than you do about your hospitalized grandmother. Could there be a common thread between Hanzel and Gretel and your grandmother? The answer is yes, because unfortunately, being lost in an unfamiliar place does not only happen in fairy tales! So what should you do? Ask your grandmother to sprinkle the hospital corridors with small pebbles or small pieces of bread? Put an electronic bracelet on her ankle like a prisoner? If one day you are caught red-handed thinking that it is necessary to reach this point to avoid losing her in the labyrinth of her hospital journey, then nothing is going right.


The hospital, a life-size escape game

For the third time, you call the central reception of the hospital where your grandmother has been admitted. They put you through to the emergency room, which tells you that your grandmother has finally been transferred to the pneumology unit while waiting for a bed to become available in cardiology. You finally get the pulmonary nurse but no luck, your grandmother is not her "patient". She inquires. Her colleague is busy, you'll have to call back later. You call back (yes, you are bold) on the direct line this time (life's little victories) and you finally get some information about your grandmother. But you are already anxious about tomorrow. Where will she be? Will someone warn you if there is a problem? How is her stay? Many of you are asking these questions, and rightly so. 


Orientation from the emergency room to a care unit, transfer to a new unit, change of room, deprogramming of an operating room... The hospital is the perfect daily place to experience a life-size escape game. However, neither the caregivers nor the patients have the time or the means to solve all the puzzles of this labyrinth. The lack of real-time information can quickly become a source of anxiety for patients and their families, who are unable to find out more about their loved ones' state of health. For the care teams, it is not easy either, lack of time, loss of view on the patient's journey, confidentiality obligation, lack of communication... are all reasons that sometimes make life hard for the reputation of a hospital and that leave bad memories of hospitalization. The world remembers, so do the patients.


Is it possible to improve care paths?

Yes, fortunately, there is reason to be hopeful with the latest developments of several startups to improve the care path of patients. Transfer tracking, bed availability, services, secure exchanges, are all new solutions to improve the quality of the care pathway and save your patience and energy for other things. Here's what the hospital stay might look like for your grandma who lives 500 km away:


Letting your grandmother go to the hospital with peace of mind

Knowing a little more about the level of quality and reputation of a healthcare facility is an important thing. The start-up Hospitalidée has done just that. Thanks to it, the reputation or rather the e-reputation of hospitals and clinics can be consulted by everyone. You can read and discover the opinions of other patients in order to form an opinion before your grandmother sets foot there. 


Find your grandmother in real time

Ambuliz is revolutionizing the hospital care pathway. This young company already works with nearly 70 facilities and offers a real-time bed management tool. With this tool, knowing exactly where your grandmother is has become possible, whether she is in a care unit or on a stretcher. This may seem trivial, but this traceability is still far from being acquired in some hospitals where we sometimes lose track of patients in the maze of the facility. And with this new service, the care teams can also program your grandmother's transfer according to the availability of beds in real time. In short, you don't necessarily have to know Professor Thingy (reputed to be the best cardiologist in the region) to get a bed in his department. This is already a great victory.


Personalize your grandmother's stay in a very special way

The sick button has become a thing of the past with the new application created by the start-up Hospitalink. During her hospitalization, your grandmother can express one or more requests during her stay from the application and follow their progress. The idea of this application is to strengthen the relationship between caregiver and patient on a daily basis and to avoid forgetting, which can happen quickly when faced with a multitude of requests.


And then, in another category, for a few years now, the Deliveroo of hospitalization has made its entry. Happytal simplifies the life of many patients by offering a delivery service in their room. This is the little extra that can give your grandmother the feeling of a pleasant hospital stay and a well-organized discharge.


Because communication between healthcare professionals is essential, Teamdoc and Pandalab have created secure messaging systems to improve communication and coordination around the patient. These startups offer complete solutions to promote exchanges between healthcare professionals via secure channels.


What about tomorrow?

Amazon has better watch out, your grandmother's pathway can now compete with it. And imagine if tomorrow, we invented chatbots to give news to the relatives of a hospitalized patient? To follow the evolution of the patient's health in real time, to accompany his or her loved one at a distance, to break the isolation... And why not?


The Hospital & the Tech: Episode 2 The Surgery

In your grandparents' time, you could find yourself on the operating table for an "exploratory laparotomy".

What is this? The concept is simple, and a mechanic operates in the same way. Let’s see: you open the hood and take a look. There you go…

Imagery (X-ray, MRI, CT scan etc) was either non-existent or scarce. So, if the other medical examinations were unsuccessful, patients were dissected to find the reason for their illnesses. The consequences of these surgeries ended up making more damages than illnesses themselves and eventually complicated the understanding of them. What was the way out of this primitive stage? Technology, combined with knowledge.

Today, technology has an even greater impact. It is even in the process of revolutionizing services provided to patients. While gestures themselves are changing, everything around the surgical act is undergoing profound transformations.

In order to have a common language, let's get back to the basics of the work:

The preoperative phase

The stakes of this stage are multiple and divided into two parts:

preparation of the patient: A good preparation of the patient goes through information. A well-informed patient will be more relaxed and able to better manage the postoperative phase as well as the convalescence. It is also necessary to follow a preoperative patient pathway, planning consultations with the anesthetist, the nurse and the surgeon.

The surgical act

On the surgeon's side, he/she must decide how he will proceed. Where to open, what to remove or what to put on, where to put it... depending on the pathology, it can be simple or extremely complex. In some cancers, for example, resecting a tumor can be much more complicated than you might think. Where exactly does the tumor stop? You should not cut too wide to preserve as much of the affected organ as possible, but if you don't remove enough tissue, the risk of recurrence is certain.

The operation

Surgery itself is increasingly assisted by technology. The robotization of certain gestures, as in breast cancer, makes it possible to limit the incision and thus the risk of infection, and to have a more precise gesture which will consequently alter less the adjoining structures. In the same way,The training of surgeons itself is being revolutionized by virtual reality and 3D.

The postoperative phase

The challenge of postoperative care is to ensure the success of the surgery and the patient's recovery. This implies, among other things, establishing a real follow-up, providing information on the procedure to be followed, especially in case of anomalies, and observing the patient's treatment if necessary.

Romain's adventures carry on !

In our previous episode (The Hospital & the Tech: Episode 1 The Emergency Room), we left Romain with the diagnosis of a fracture and nerve damage that needed a surgery. This one will be done as an outpatient: entrance and exit on the same day.

During the preoperative phase, the doctor provides Romain with access to Maela, a platform that helps the patient to organize himself before surgery. There he finds a preoperative checklist so that he doesn't forget anything on D-day, has access to educational content about his operation that is clear and validated by professionals that he can share with his family and friends, and to a network of connected nurses who can discuss his care with him. Romain feels reassured and well prepared.

The surgeon on his side prepares the operation. Thanks to Visible Patient technology, he can create a 3D image of the patient from his medical imaging. This way, he knows what he will find when he opens and decides in full knowledge how to proceed. Some technologies, such as PrédiSurge, even allow to digitally simulate a surgical procedure. Currently specialized in cardiac prostheses, this allows to predict the effect and efficiency of an aortic prosthesis thanks to a 3D model. Maybe soon, this will exist for all surgeries.

Romain is slowly waking up. The operation went well, and thanks to Maela he can go home with a connected postoperative follow-up. He can give an alert in case of problems and is monitored 24/7 by a network of nurses. The hospital is not to be outdone since it has a chatbot, "MemoQuest" developed by Calmedica, which is programmed to exchange with patients before and after their surgery. Questions created and reviewed by doctors are sent to the patient in the post-operative phase. The answers can trigger further questions and ultimately send alerts to medical teams if necessary.

Thanks to this technological arsenal, Romain's care pathway is much more complete, adapted and safe. He can go to bed peacefully with his two big cotton wool pads in his nose.

More convenient.

The Hospital & the Tech: Episode 1 The Emergency Room

AND IF, tomorrow, at the hospital, thanks to the technology, a robot will take you to the emergency room and pre-diagnose you based on the data from your iWatch and your digital medical record?

AND IF, because you had a too many Chlamydia infections, a potential employer who bought access rights to your medical data would not hire you? 

AND IF... everything was going wrong? The era of data, service 8.0 and AI in healthcare is frightening. Yet the increase in demand for care combined with decreasing resources requires investment to modernize the way we care, manage the healthcare system and protect the patient. 

With 100% more patients seen in the last 20 years, a 9% increase in overall mortality and a 30% increase in the most severe cases, here is our 1st step in the hospital challenges: Emergency or the art of renovating a burning house. 


The recipe of the trainwreck

Take a shortage of general practitioners, a fertile but aging population, and shrinking budgets resulting in fewer beds in downstream departments, mix it all together and you'll have a congested Emergency Department. This unsolvable equation was aggravated by the lack of assumed investment by the State in a sector that was nevertheless crying out for help. But to every problem its solution! "Are you hungry? Well eat", hospitals have recovered their financial management and have borrowed heavily, increasing the hospital debt from €9 to 30 billion in 15 years thanks to advantageous loans... which will become toxic with the subprime crisis. 

What are the solutions to treat this shoemaker with such bad shoes in the short term? Certainly, a better awareness of the use of the 15 which allows to direct patients towards the structures adapted to their ills is a necessity. If we must not forget the importance of giving a ringing and stumbling recognition to the nursing staff who are fighting to assume the public service mission of the hospital, in working and fatigue conditions that would make more than one private employee quit, other solutions exist.


Rethinking the Emergency Department with the help of the Tech 

A structural overhaul of the hospital care pathway must be undertaken and this is where technology comes in. While it will never replace a doctor or emergency doctor, it will be able to intervene in the emergency room and upstream 24 hours a day to improve the quality of care and relieve congestion in the emergency room.


Let's imagine Romain's care path

8:00 pm: The newscast is on but Romain, who has had a sore nose for a few days, realizes that he no longer feels it when he touches it. He then downloads the Hellocare application, which allows him to get a teleconsultation with a general practitioner in less than 2 minutes without an appointment.

If he was not so late, he could also have gone to his local pharmacy or to his workplace to use a teleconsultation booth (Tessan, H4D) or even a shelf equipped with a multitude of medical tools (blood pressure monitor, oximeter, etc.) in a dedicated area to obtain a precise diagnosis.


8:15 p.m.: The doctor has been formalized : he will have to go through the emergency room and leave Gilles Bouleau alone with his old tomatoes that are coming back on the market stalls : Romain asks his roommate to bring him there.

Thanks to the Urgences Chrono app, he knows which hospital has the shortest waiting time and avoids going to the most overcrowded emergency rooms in his region. Once there, thanks to Capsul Protect and contactless technology, the nurse can quickly access Romain's medical record, which is stored in this small capsule glued to his phone.


8:45 p.m.: It's now up to an intern to check it out. The diagnosis doesn't seem so terrible, but the intern has a doubt and the doctor is momentarily absent. Normally Romain would have had to wait a few hours in a corridor for the doctor to return, but the intern has several tools at his disposal:

One of Incepto's applications that allows an A.I. to compare Romain's case with a cohort of anonymized data, the intern can quickly confirm his intuition. 

The MedPics application that allows the intern to question his peers (30,000 professionals, 1,000,000 views per week) on clinical cases encountered.

Thus, in a few minutes the diagnosis is made: Romain has done the evil to Saint Christin and fought: The nose is broken, which damaged the nerve. We have to operate!




GUYnecology* - Fertile innovations in male contraception

We already know 1001 options for women to not have a bun in the oven when they have a choice to, but it seems that men’s choices are still a bit limited. Indeed, the market for female contraception weighs billions of euros in Europe for 263 millions of women, but only represents a few pennies to take care of 252 millions of men (apart from the Holy-Graal Condom, of course). So I wonder… How could we have missed such a deal ?! Fortunately, the "pill crisis", which calls into question the impact of pills on women's health, has made it possible to question this contraceptive model, which could evolve towards a more equal contraception, better shared between women and men.

Overview of contraceptive methods for penis owners

It seems complicated for men who don’t want to seed their embryos here and there to find a convenient solution. Condoms aren’t always reliable and vasectomy is usually supposed to be definitive, so it is a bummer if our famous protagonist, Romain, is in his twenties and plans to be a super-daddy in the future. 


Method 1: It’s gettin’ hot in here…

Did you know that above 37°C, testicules can’t produce spermatozoids? Well, the French professor Mieusset actually knew, and created a heated underwear, some sort of boxer, which pulls the testicles at the base of the penis, exactly like these Emo-style pants from the 2000s, and then raises their temperature, stopping the production of spermatozoids. You want your own? Well, be patient, they are going through clinical trials. 


Method 2: Lord of the Rings

« You shall not pass! » screamed the great endocrinologist Gandalf the White, using his special weapon called Andro-Switch against reluctant spermatozoids. Founded by Maxime Labrit, the purpose of the Andro-switch is also to use thermal contraception. But instead of a boxer, it is a cute lil’ silicon ring that creates a push-up effect on the testicules and keeps them super warm. You can buy your own « cockring » for 37 € on the Thoreme website.

Method 3: No one moves!

Our third method has a very sexy name: EP055. It consists in doing an injection that paralyzes spermatozoids which can no longer swim to the egg in a real Michael Phelps style. It is still in clinical trials, so… Not for today! 


What about the pill?

This concept is still hard to swallow among gentlemen - whereas birth control pills remain the most widely used contraceptive method for women in Europe. But if the pill isn’t quite ready yet, hormonal treatments do exist through daily testosterone injection! It costs approximately 10 € a week and you can get your baby-repulsive dose at your local pharmacy. 

« But it’s a woman business y’all...»

More than 90 % of couples who seek to limit births use modern contraceptives and yet it seems that women “should be” in full responsibility. Also, women use sterilization way more often than men (30 % vs 4 %) whereas women are fertile only a couple of days a month (vs all-the-god-damn-time for men). Not quite fair.

We know some men think that dealing with contraception is not quite manly, and that women may not trust men to deal with it, so they prefer taking a pill or have a piece of copper stick in their uterus. The debate is still very sterile, but some changes can be expected with better pedagogy and innovation. With contraception, men don’t grow a uterus and we don’t take on our shoulders the weight of a millennial struggle. Because change is a mix of education and innovation, let’s see what will happen in the next 10 years!


*inspired from a book by Rene Almeling GUYnecology: The Missing Science of Men’s Reproductive Health.

Épisode 2 : La Chirurgie

Du temps de vos grands parents, vous pouviez vous retrouver sur le billard pour une « laparotomie exploratrice ».

Quèsaco ? Le concept est simple et un garagiste opère de la même façon. Voyez plutôt : on ouvre le capot et on regarde. Voilà voilà voilà…

L’imagerie (radio, IRM, scanner etc) n’existait pas ou peu. Ainsi, si les autres examens ne donnaient rien, on disséquait les patients pour trouver la raison de leurs maux. Les conséquences de ces chirurgies étaient souvent, plus nombreuses que les maux eux-mêmes et en complexifiaient finalement la compréhension. Qu’est-ce qui permit de sortir de cette étape primitive ? La technologie alliée à la connaissance.

Aujourd’hui, la technologie a un impact encore plus important. Elle est même en train d’opérer une vraie révolution au service du patient. Si les gestes en eux-mêmes changent, tout ce qu’il y a autour de l’acte chirurgical est en profonde mutation.

Afin d’avoir un langage commun reprenons l’essentiel du travail :

La phase préopératoire :

Les enjeux de cette étape sont multiples et centrés sur deux axes : La préparation du patient :

Une bonne préparation du patient passe par l’information. Un patient bien informé sera plus détendu et apte à gérer le post-opératoire ainsi que la convalescence. Il faut aussi suivre un parcours patient préopératoire, planifier les consultations avec l’anesthésiste, l’infirmière et le chirurgien.

L’acte chirurgical :

Du côté du chirurgien, il doit décider de la manière dont il va procéder. Où ouvrir, quoi enlever ou quoi poser, à quel endroit… selon la pathologie, ce peut être simple ou extrêmement complexe. Dans le cadre de certains cancers par exemple, réséquer une tumeur peut s’avérer bien plus compliqué qu’on ne le pense. Où s’arrête exactement la tumeur ? Il ne faut pas couper trop large pour préserver au maximum l’organe touché, mais si l’on n’enlève pas assez de tissu, le risque de récidive est certain.

L’opération :

L’acte chirurgical en lui-même est de plus en plus assisté par la technologie. La robotisation de certains gestes, comme dans le cancer du sein, permet de limiter l’incision et donc le risque infectieux, et d’avoir un geste plus précis qui par conséquent altèrera moins les structures voisines. De la même manière, La formation des chirurgiens elle-même est révolutionnée par la réalité virtuelle et la 3D.

Le post-op :

L’enjeu du post-opératoire est de s’assurer de la réussite de la chirurgie et du bon rétablissement du patient. Cela implique entre autres d’établir un vrai suivi, d’informer sur la marche à suivre notamment en cas d’anomalie et l’observance de ses traitements si nécessaire.

La suite des aventures de Romain :

Dans notre épisode précédent (L'hôpital & la Tech : Épisode 1 les Urgences), nous avions laissé Romain avec le diagnostic d’une fracture et d'une lésion du nerf qu’il fallait opérer.

Celle-ci se fera en ambulatoire : entrée et sortie dans la même journée.

Lors de la phrase préopératoire, le médecin fournit à Romain un accès à Maela, une plateforme qui aide le patient à s’organiser en amont de la chirurgie. Il y trouve une check-list préopératoire pour ne rien oublier le jour J, a accès à des contenus pédagogiques sur son opération clairs et validés par des professionnels qu’il peut les partager avec ses proches et à un réseau d’infirmières connectées qui peuvent discuter avec lui de sa prise en charge. Romain se sent rassuré et bien préparé.

Le chirurgien de son côté prépare l’intervention. Grâce à la technologie de Visible Patient, il peut créer une image 3D du patient à partir de son imagerie médicale. Ainsi, il sait ce qu’il va trouver quand il ouvrira et décide en parfaite connaissance du terrain de la marche à suivre. Certaines technologies, comme celle de PrédiSurge permettent même de simuler numériquement un acte chirurgical. Pour l’instant spécialisé dans les prothèses cardiaques, cela permet de prédire l’effet et l’efficacité d’un prothèse aortique grâce à un modèle 3D. Bientôt peut-être, cela existera pour toutes les chirurgies.

Romain se réveille doucement. L’opération s’est bien passée, et grâce à Maela il peut rentrer chez lui avec un suivi post-opératoire connecté. Il peut donner l’alerte en cas de problème et est surveillé 24/7 par les infirmières du réseau. L’hôpital n’est pas en reste puisqu’il s’est doté d’un chatbot, «MémoQuest» développé par Calmedica qui est programmé pour échanger avec les patients avant et après leur chirurgie. Des questions créent et revues par des médecins, sont envoyées au patient dans sa phase post-opératoire. Les réponses peuvent déclencher d’autres questions et in fine des alertes auprès des équipes médicales si nécessaire.

Grâce à cet arsenal technologique le parcours de soins de Romain est bien plus complet, adapté et sûr. Il peut aller se coucher sereinement avec ses deux gros cotons dans le nez.

Plus pratique.

L'hôpital & la Tech : Episode 1 les Urgences

ET SI demain à l'hôpital, grâce à la tech un robot vous prenait en charge aux urgences en vous pré-diagnostiquant à partir des data issues de votre iWatch et de votre dossier médical digital ?

ET SI parce que vous avez eu un nombre d'infections à Chlamydias un peu trop élevé un potentiel employeur ayant acheté des droits d'accès à vos données médicales ne vous embauchait pas ?

ET SI.. tout dérapait ? L'ère de la data, du service 8.0 et de l'IA dans la santé effraie. Pourtant, l’augmentation de la demande de soins combinée à la diminution des moyens nécessite d'investir pour moderniser la façon dont on soigne, gère le système de santé et protège le patient.

Avec 100% de patients supplémentaires accueillis depuis 20 ans, une augmentation de 9% de la mortalité globale et de 30% dans les cas les plus graves, voici notre 1ère étape des challenges de l'hôpital : Les Urgences ou l'art de rénover une maison qui brûle.  

La recette du naufrage

Prenez un manque de médecins généralistes, une population féconde mais vieillissante et des budgets qui diminuent entrainant une baisse du nombre de lits dans les services d’aval, mixez le tout et vous obtiendrez un encombrement des Urgences. Cette équation insoluble s'est trouvée aggravée par le manque d'investissement assumé de l'État dans un secteur qui, pourtant, criait famine. Mais à tout problème sa solution ! "Vous avez faim ? Eh bien mangez", les hôpitaux ont donc récupéré leur gestion financière et ont emprunté à foison faisant passer la dette hospitalière de 9 à 30 milliards € en 15 ans grâce à des emprunts avantageux... qui deviendront toxiques avec la crise des subprimes.

Quelles solutions pour soigner ce cordonnier si mal chaussé à court terme ? Certes, une meilleure sensibilisation à l'utilisation du 15 qui permet d'orienter les patients vers les structures adaptées à leurs maux est une nécessité. S'il ne faut pas oublier l'importance d'accorder une reconnaissance sonnante et trébuchante au personnel soignant qui fait front pour assumer la mission de service public de l'hôpital et ce, dans des conditions de travail et de fatigue qui feraient démissionner plus d'un salarié du privé, d'autres solutions existent.  

Repenser les Urgences avec l’aide de la Tech

Une refonte structurelle du parcours de soin à l'hôpital doit être entreprise et c'est ici qu'intervient la technologie. Si elle ne remplacera jamais un médecin ou un urgentiste, elle pourra intervenir au sein des urgences et en amont 24h/24 au service d'une meilleure qualité de soins et d'un désengorgement des urgences.

Imaginons le parcours de soins de Romain.

20h : Le JT est lancé mais Romain qui a mal au nez depuis quelques jours se rend compte qu’il ne le sent plus quand il le touche. Il télécharge alors l’application Hellocare, qui permet d’obtenir d'obtenir une téléconsultation avec un médecin généraliste en moins de 2 minutes sans RDV. S’il n’était pas si tard, il aurait aussi pu se rendre dans sa pharmacie de quartier ou sur son lieu de travail pour utiliser une cabine de téléconsultation (TessanH4D) voir une tablette équipée d’une multitude d’outils médicaux (tensiomètre, oxymètre, etc) dans un espace dédié pour obtenir un diagnostic précis.

20h15 : Le médecin a été formel il va falloir passer par les urgences et laisser Gilles Bouleau seul avec ses tomates anciennes qui reviennent sur les étales des marchés : Romain demande à sa colocataire de l’y amener. Grâce à l’appli Urgences Chrono, il sait dans quel hôpital il y a le moins d’attente et évite de se rendre dans les urgences les plus surchargées de sa région. Une fois sur place, grâce à Capsul Protect et la technologie sans contact, l’infirmier peut accéder rapidement au dossier médical de Romain qui a stocké ses données en amont dans cette petite capsule collée sur son téléphone.

20h45 : C’est maintenant à un interne de l'osculter. Le diagnostic ne semble pas si terrible mais l’interne a un doute et le médecin est momentanément absent. Normalement Romain aurait dû attendre quelques heures dans un couloir que celui-ci soit de retour mais l'interne a à sa disposition plusieurs outils :

  • Une des applications d’Incepto qui permet à une IA de comparer le cas de Romain avec une cohorte de données anonymisées l'interne peut confirmer rapidement son intuition.

  • L'application MedPics qui permet à l'interne d'interroger ses pairs (30 000 professionnels, 1 000 000 de vues par semaine) sur des cas cliniques rencontrés

Ainsi, en quelques minutes le diagnostic tombe : Romain a fait le malin à la saint Christin et s’est battu : Le nez est cassé, ce qui a abîmé le nerf. Il faut opérer ! Prochain épisode : La chirurgie.