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
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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,...
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Xiaolan Xie What is health care engineering? bed requirement
Outpatient queue, 6h AM,11/15/2011
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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
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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)
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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 -
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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, data- base updates,
cryotube numbering or label edition Problems: Error probabilities
(Hand-copy, inventory, picking, computerization) Impacts of
Radio-Identification on Cryo-Conservation Centers, TOMACS,
2011.
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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
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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)
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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
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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)
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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
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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
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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
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Xiaolan Xie Plan Contexte Problmatique du planning mdical
Formulation mathmatique Rsultats numriques Perspectives
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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
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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.
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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.
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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
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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
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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
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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
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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
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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
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Xiaolan Xie Rsultats numriques sur les donnes des deux premiers
trimestres de ICL Modle mathmatique rsolu avec le solveur
commercial ILOG- CPLEX Rsultats numriques
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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
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Xiaolan Xie Rsultats numriques
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Xiaolan Xie Perspectives Dveloppement des algorithmes
doptimisation efficaces pour rduire le temps de calcul (passer de
>3h