Xiaolan Xie Health care engineering Ingénierie des systèmes de production de soins Prof. Xiaolan...

Xiaolan Xie Health care engineering Ingnierie des systmes de production de soins Prof. Xiaolan XIE ([email protected]) cole Nationale Suprieure des Mines de Saint-Etienne Centre Ingnierie & Sant - Dpt. Gnie industriel hospitalier CNRS UMR 6158 LIMOS - ROGI SFR IFRESIS, Cancrople CLARA, cluster co. I-Care

Xiaolan Xie Health care in the world Rising health expenditures (16% in USA, 11.2% in France for 2008) Rising health care demand (chronic diseases due to aging population) Better diagnosis and better treatment thanks to the progress of medicine Shift from offer-driven to patient-centered health care with more active role of patients in health care and better informed patients Growing concern of health care safety and quality -> Need of traceability of health care delivery Arrivals of new ICT technologies (delivery robots, RFID, telemedicine, HIS, ) Government responses: reforms of health systems (referee physician, T2A, carte vitale, personal health record, new governance,...) Hospital responses : merging, reorganization, lean health care, home health care,...

Xiaolan Xie What is health care engineering? bed requirement Outpatient queue, 6h AM,11/15/2011

Xiaolan Xie Research initiatives The 2005 "Building A Better Delivery System " report of American Academy of Science for the contribution of systems engineering (industrial engineering, operations research, ICT, ) "Optimizing health care delivery" is one of the three priorities of EU's health research program FP7 Emergence of new health care engineering research centers CIS (Centre for Health Engineering) - ENSMSE in 2004 Regenstrief center - Purdue Centre for Health Care Management- UBC NSF I / UCRC for health organization transformationh (A&M, Georgia Tech,...) Centre for Health Care Engineering - SJTU ORAHS (operational research for health services) : active Euro working group since nearly 40 years

Xiaolan Xie Department of Heath Care Engineering A group created in 2005 with 3 faculty members and 6-7 PhD/Post- docs Develop quantitative methods for modeling, simulation and optimization of health care systems & health services Explore the integration of medical knowledge and patient health condition data in operations management of health care systems in close collaboration with French hospitals Top-ranking (A+) in 2010 national AERES research lab assessment (affiliated to LIMOS CNRS UMR-6158 since 01/01/2012)

Xiaolan Xie Theme I : Engineering health care systems & services Goal : develop scientific methods for performance evaluation and design of health care delivery systems and new health services. Theses: Vincent Augusto, Modeling, analysis and control of flows in health care with UML and Petri nets, 2008, (Operating theatre, Merging pharmacies, LoS of stroke patients) Sylvain Housseman (Mistral project), Impact of RFID on hospital supply chains, 2011 H. Baalbaki (FP6-IWARD), Health care logistics with service robots, 2011. Carlos Rodriguez (OSAD project) : Integrated care chain optimization from hospital to patient's home, 10/2009 - Canan Pehlivan (Prinatal 92), Modeling and simulation of health care networks, 10/2010 -

Xiaolan Xie Traceability in biobanks Research questions Performance evaluation of traceability technologies Design supply chains of drugs and medical devices with RFID New operation management problems (re-warehousing of bio-banks, skill/quality monitoring,...) Info errors Inventory error Current situation Samples stored in nitrogen tanks (77K) Cold Chain constraints Resistance of the tags? Hand-made inventories, database updates, cryotube numbering or label edition Problems: Error probabilities (Hand-copy, inventory, picking, computerization) Impacts of Radio-Identification on Cryo-Conservation Centers, TOMACS, 2011.

Xiaolan Xie Theme II: Planning and logistics of health care delivery Goal: develop optimization-based methods for operations management of health care delivery and its supply chains. Theses: Mehdi Lamiri, Planning operating theatres subject to uncertainties, 09/2007 Na GENG (with SJTU, China) : Combinatorial optimization and Markov decision process for planning MRI examinations, 29/04/2010 (CHU-SE) Alexandre Mazier, Stochastic optimization for hospital bed allocation, 06/12/2010 (CHPL, Hpital de Firminy) Abdellah Sadki (with Frank Chauvin), Operation management of oncology cares (hpital de jour de ICL), defense in 05/2012 Rabeh Redjem (with Eric Marcon), Home health care planning, 11/2009 - Edgar Alfonso, Blood collection optimization (EFS), 01/2010 - Zheng Zhang (SJTU), Optimization of operating theatres, 09/2010 - Theses to start : Labex IMOBS3, ANR-TECSAN HOST, Rgion Rhone-Alpes ARC2

Xiaolan Xie Optimization of outpatient chemotherapy ICL Loire Cancer Institute Major challenges of further research: Integration of decisions different levels and different time scales (medical planning, patient assignment, appointment scheduling) Modeling treatment protocols with rich medical knowledge Modeling the dynamics of health conditions based on rich patient data High uncertainties of patient flow and patient's health care requirement Large variation in bed capacity requirement in actual planning 20% reduction of peak bed requirement in the optimized planning bed requirement Planning oncologists of ambulatory care units. Decision Support Systems. (To appear)

Xiaolan Xie Capacity planning of diagnostic equipment (MRI) MRI examination of stroke patients Expensive (over 1 million $) -> high utilization Demand uncertainties and demand diversity (both elective and emergency) Goal: Reduce waiting time for stroke patients without degrading MRI utilization Actual waiting times of 30-40 days for MRI examination 2 - 10 days with the optimized reservation and control strategy Monte Carlo optimization and dynamic programming approach for managing MRI examinations of stroke patients. IEEE Transactions on Automatic Control, 2011

Xiaolan Xie Some projects ANR-TECSAN project HOST on management of winter epidemics (grippes, bronchites, castroentrites,...) 2012 - 2014 (1 thesis) LABEX IMOBS3 Home health care planning and logistics. 2012-2014 (1 thesis + 1 post- doc) Ambulance location & routing. 2013 - 2015 Regional projects OSAD & ARC2 on home health care. 2009-2015 (2 theses) CLARA Procan : organization of cancer care delivery & chemotherapy at home. 2008- FP6-IST6-IWARD on mobile & reconfigurable robots for hospital logistics. 2007-2010 (1 thesis)

Xiaolan Xie Some projects Health care engineering center / Shanghai Jiao Tong University 5 Mio CNY for lab setup NSF China project on resource optimisation and planning in health care, 2012-2016 (2,36 Mio CNY) Health care resource planning and optimization Joint patient diagnostic scheduling and equipment maintenance Collaborative resource planning Hospital emergency plan management, scheduling and simulation Purdue GRPI project on Engineering Smarter Health System Solutions with Emerging e-Health Technologies

Xiaolan Xie Building an experimentation platform Hptal Virtuel Organization component Cloud Computing Information component Communication component Database App server PC Simulation Optimization Health care Living lab for new ICT technologies RFID tags Health care information system hub

Xiaolan Xie A. Sadki, Xiaolan Xie Centre Ingnierie et Sant Ecole Nationale Suprieure des Mines de Saint Etienne Franck Chauvin Institut de Cancrologie de la Loire Optimisation du planning mdical dun hpital de jour en cancrologie

Xiaolan Xie Plan Contexte Problmatique du planning mdical Formulation mathmatique Rsultats numriques Perspectives

Xiaolan Xie Contexte Laxe IV du CLARA sattaque lingnierie de la production de soins en cancrologie et tudie la transfrabilit des outils de gestion industrielle pour amliorer lefficience de la production de soins. Une collaboration stablit entre CIS-ENSM.SE et ICL sur loptimisation de production de soins en cancrologie dans le cadre du CLARA mais aussi dans le cadre de lIFR 143 INSERM en Sciences, Ingnierie et Sant. Une thse de doctorat (Abdellah Sadki) a dmarre depuis oct. 2008 sous la direction de Franck Chauvin et Xiaolan Xie

Xiaolan Xie Contexte Verrous scientifiques: la complexit des protocoles de soins, importantes alas, la ncessit de prise en compte de ltat de sant du patient. Le problme central est loptimisation de la qualit du service rendu aux patients tout en respectant les protocoles de traitement, les disponibilits des mdecins et des ressources matrielles. Objectif de la thse: dvelopper des mthodes scientifiques pour loptimisation de production des soins en cancrologie comme par exemple la gestion des traitements chimiothrapies et radiothrapies. Pr-tude: optimisation du planning mdical de lhpital de jour.

Xiaolan Xie Hpital de jour ICL Parcours patient simple en HDJ: Enregistrement laccueil Consultation mdicale (OK chimio) Prparation de la chimiothrapie la pharmacie Installation du patient dans un lit Injection Hpital de jour Les patients viennent en cure, reoivent un ou plusieurs soins et puis rentrent chez eux.

Xiaolan Xie Hpital de jour ICL Protocoles de chimiothrapie Un compos cytotoxique (-> dure dinjection) Une frquence de rptition Une dure de rptition (environ 6 mois) Forte variabilit des temps dinjection (0,5 7h) pour une ouverture HDJ de 9h ChimioSemaine 1Semaine 2Semaine 3Semaine 4 Avastin1010 Cisplatin1101 Rituximab1001 Vinorelbin1100

Xiaolan Xie Hpital de jour ICL Observations Une croissance de flux de patient HDJ Flux de patients nest pas matris Rpartition des charges journalires trs erratiques Utilisation des ressources non optimale Forte pression sur les lits en HDJ Object de la pr-tude: Optimiser lutilisation des lits en HDJ travers un ramnagement du planning mdical

Xiaolan Xie Formulation mathmatique Variables de dcision: Planning mdical : y jt = 1/0 si mdecin j consulte la priode t (AM / PM) Affectation des patients: x it = 1/0 si patient i vient la priode t (le mme jour durant tout le traitement) Travail de linterne: Z jwt = Nb patients dlgus par mdecin j en priode t de semaine w

Xiaolan Xie Formulation mathmatique Reprsentation des donnes du problmes Protocole de chimiothrapie en tenant compte de larrive du patient : a iw = 1/0 si patient i vient la semaine w Chimioweek1week2week3week4week5week6 Patient1-Avastin101010 Patient2-Cisplatin110110 Patient3-Rituximab010010 Patient4-Vinorelbin001100

Xiaolan Xie Formulation mathmatique Donnes du problmes Pj : les patients du mdecin j di : dure dinjection du patient i Nt : nombre maximal de consultation dun mdecin dans la priode t BOXt: nombre de box de consultations de la priode t BEDt: charge-lit maximum de la priode t

Xiaolan Xie Formulation mathmatique Equilibrage de charge journalire Sous contraintes : Charge-lit max de laprs-midi(1) Charge-lit max journalire(2) Charge-lit min journalire(3) Nb max patients de mdecin j(4) Nombre max de box(5) Charge max de linterne(6) Venue des patients en prsence du mdecin(7) Modle de programmation linaire en nb mixtes

Xiaolan Xie Rsultats numriques sur les donnes des deux premiers trimestres de ICL Modle mathmatique rsolu avec le solveur commercial ILOG- CPLEX Rsultats numriques

Xiaolan Xie Charge-lit maximal journalire thorique des 18 lits en oncologie (9h/lit) = 162h Gain de pic de charges journalires denviron 30h sur 18 lits Rsultats numriques

Xiaolan Xie Rsultats numriques

Xiaolan Xie Perspectives Dveloppement des algorithmes doptimisation efficaces pour rduire le temps de calcul (passer de >3h

Xiaolan Xie Health care engineering Ingénierie des systèmes de production de soins Prof. Xiaolan...

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