ctors are brought in to intervene in the most coordinated way possible: hospital professionals, treating physicians, liberal nurses, social actors, and actors carrying out new professions such as coordinating nurses or telemedicine assistants. During this course, the appearance of certain medical innovations (such as oral chemotherapy), combined with the desire to shorten hospital times and contacts (reduced length of stay, development of ambulatory medicine, control of unjustified readmissions) accentuate the tendency to keep the patient as much as possible at home, and consequently to ensure follow-up at a distance. Finally, there is a trend to recognize the preferences of the patient in a more global manner, as illustrated by the concept of “patient-centered care”, and to personalize the response. We can thus speak of coordinated and personalized health pathways for which the care offer must be as integrated as possible to respond appropriately.
The use of ICT has a structuring effect in the construction of this integrated care offer, but it should not be considered in isolation. If the structuring of information and exchanges between professionals, as between professionals and patients, is associated with the emergence of ICT, it would be naive to think that they constitute the only component of the integrated organization of the care offer. The initiatives that go in this direction are most often inspired by the Chronic Care Model which combines the use of ICT, new organizational methods (such as the creation of coordinating nurses), actions promoting patient self-management, and the establishment of a payment-type incentive for coordination. These new payment methods (capitation, payment per episode of care, global package) aim to compensate for the weaknesses of current payment methods (activity-based pricing, fee-for-service, in particular) to encourage cooperation between professionals and multidisciplinary exercise.
If these dimensions are not inherently innovative, take them head on, assess them qualitatively and understand the impact they have.
In this context, the implementation of ICT presents organizational impacts, and faces barriers. By leading to new forms of coordination, ICTs require mediators, bearers of this coordination. It is the role currently assigned to coordinating nurses, and health networks, to ensure the proper use of ICT.
The barriers mentioned in the report show for their part that the implementation of ICT is not an easy process. Their accumulation often leads to observing the paradox of Solow’s productivity: a long return on investment while the theoretical gain in efficiency is easy to determine from the start. Their resolution requires endurance and strength of conviction. Because the question of support for change is central to avoid investing heavily in a tool that would not be used. Operators must be sufficiently convinced of the contribution to overcome the technical problems of interoperability. This point underlines that the implementation of ICT cannot be decreed, but that it must be shared by the actors to ensure the dynamics of the process, and be supported institutionally. It is at this price that the increase in load towards more integrated care offers can be envisaged.
In this movement to integrate supply, the role of the hospital as well as the patient’s home is certainly going to evolve. The following example helps to understand this evolution. NXT health is an American team of people with diverse profiles (ranging from architect to hospital administrator to scientific researcher) having developed a project (partly funded by various industrialists) of the hospital room of the future, called “Patient Room 2020”. This room of the future is designed in a “patient centric” spirit where “technology becomes the connective tissue that supports the continuum of care”. Following this trend, the hospital room of the future could become the room of the patient’s home, full of vital sign detection technology and capable of regulating the individual or issuing alerts. In this way, th