International Conference on Healthcare Risk Management and Internet

April 8-9, 2002
at the Cité des Sciences et de l'Industrie, Paris

At the conference, delegates from Albania, Belgium, Benin, Cameroon, Canada, Germany, Greece, Ireland, Italy, Lebanon, Morroco, Netherlands, Russia, Slovenia, Thailand and also representatives from WHO were present.

WHO presented two interresting websites regarding the quality of health care, in particular patient safety:

http://www.who.int/gb/EB_WHA/PDF/EB109/eeb1099.pdf
http://www.who.int/gb/EB_WHA/PDF/EB109/eeb109r16.pdf

A European Committee for Health Risk Management should operate as a follow-up committee and we are working on its aims, strategy and budget, in order to set up a network implementing the Recommandations for action and the exchange of experience started during the meeting.

Attached are the Recommandations for action which are summarizing the main conclusions of the Conference. The presentations are available online on the site www.fwshealth.com

Recommendations for Action

1. The definition and application of an overall risk management strategy, based upon a shared vision of all the elements contributing to effective care for the patient :
   • How, with the use of information technology, the work carried out by physicians and other health workers may be optimised, while risks are minimised.
   • This overall strategy can only be drawn up with the participation of the many individuals involved in risk management: from the organisation constructing the hospital to the health workers in their entirety, together with the hospital management. Each of the individuals involved has a 'risk-reduction duty' and must operate pre-emptively to control risks within his or her field of activity.
   • As 'zero risk' does not exist, by the very nature of healthcare as an imprecise science, this strategy requires as full an inventory as possible with constant updating of existing risks.
   • While such a strategy will not enable risk to be entirely eliminated, it will make it possible to assess the causes of risk and, except in the event of serious negligence or misconduct, to highlight the fault of a single individual in order to establish the responsibility of a team, draw the appropriate lessons and create a compensation fund for payments to the victims.
   • For this overall risk management strategy to work effectively, it must be placed under the control of a 'pilot executive'.
   • This strategy must be based upon the application of European-level mechanisms, which implies accreditation of the Health Télématique products and technologies.
   • The end result of this process must be a project integrated on a European level.
2. The implementation of a set of initiatives, enabling the exchange of experiences, to train health professionals in overall risk management
   • While each country has its own culture and individual regulations, the increasing internationalisation in almost all fields must lead to improved awareness of current procedure in other countries, so that this may if appropriate serve as inspiration. Rather than 'reinventing the wheel', it would be appropriate to use the experience already acquired by pioneer nations which may be adapted for each country.
   • The pace of ongoing developments in knowledge (requiring Knowledge Management) means that data bases must receive permanent updating, with use made of all information originating with the various participants, including for example such sources as insurance companies.
   • The administration of complaints also provides useful information as regards risks.
   • It is vital that all the individuals involved in risk management acquire an improved knowledge of laws, regulations and case law.
   • The full range of these risk management elements must henceforth be incorporated into the training received by health professionals, including students who in some countries play an active part in medical teams responsible for approving the course of action.
3. The sharing of benchmarks, with implementation of a modern approach to the administration of knowledge, expertise and assessments (Knowledge Management)
   • In order to ensure the practical utility of the aforementioned data bases, they must be assembled on the basis of benchmarks as regards medical practices, common standards, quality and legibility, so that they may be consulted with ease. The information thus collected must be transformed into knowledge and this knowledge must lead to advances in applications and assessment.
   • The use of the Internet has made it possible to remove the obstacles which hindered the collection of valuable information regarding patient safety and risks.
   • The resources offered by information technology enable previously unidentifiable problems to be detected and access to be available in a matter of minutes to information which previously took weeks or even months to collect.
   • The procedures used in defining these benchmarks must be evidence-based and certified.
   • The data bases must be constructed on the understanding that they are for the most part accessible by the public at large.
   • Health professionals must be encouraged to obtain and make use of the information available in these data bases and to contribute to these data bases information drawn from their own experience, in order to share it with others. For this to take place, resistance stemming from the cost of the operation, from force of habit and from doubts as to the security of Internet data must be overcome.
4. The development of electronic patient records (EPRs) to be encouraged and use of this element for risk management to be made progressively easier
   • It would initially be appropriate for patient records (in their present form) to be easily accessible by their patient subjects.
   • It will take some time for electronic patient records to enter into general use. However, printed records will remain in use, and information will be divided between the two forms.
   • The patient records will contain data which is personal and information which is crucial for an improved knowledge of the risks in each sector.
   • Printed patient records in their present form may be used for risk management but not for complaint management.
   • It is vital that an ad hoc committee be set up to supervise the standardisation of record compilation.
5. Use to be made of the networks developed in order to ensure consistency with regard to the risk management data for each referent and to promote remote learning and exchange
   • Hospitals are no longer sealed institutions, but instead fit into networks : hospital networks and town-hospital networks.
   • The experience acquired by the Faculty of Medicine at the University of Nice demonstrates that the problems posed by distance and transport costs may be overcome in a satisfactory manner by 'tele-medicine' and by application of information technologies.
   • The network set up by this university made it possible to provide training and consultation for people in mountainous areas of the Haute Provence region, which are totally cut off during winter.
   • Another network enabled lecturers in Nice to provide a large proportion of the medical training of students at Shanghai's Rui-Ji University by means of the Internet.
   • Countrywide networks must be constructed on the basis of pre-existing regional networks.