May 2017
Summary
Réalités industrielles
Patients and practitioners in the field: Innovations in health
Complete issue
This issue was coordinated
by Robert PICARD
This issue was coordinated
Foreword
By Robert PICARD
Ingénieur général des Mines, référent Santé au Conseil général de l’Économie
Conducting collaborative health projects
Feedback from a procedure for co-conception
By Cédric ROUTIER
Directeur de l’unité de recherche pluridisciplinaire HADéPaS (Handicap, Autonomie et Développement de la Participation Sociale) de l’Université catholique de Lille
Agnès D’ARRIPE
Enseignante-chercheure au sein de l’équipe HADéPaS
et Stéphane SOYEZ
En charge de la direction des Ateliers du nouveau quartier Humanicité à l’Université catholique de Lille
Out of a brief attempt to define a “living lab”, the idea is advanced that this procedure is mainly intended for collectively constructing values and bringing diverse stakeholders into relation. Humanicité, a living lab in a new neighborhood in the Lille Metropolitan Area, France, serves as the grounds for a critique and observations that apparently hold for all other arrangements of like sort. Special attention is paid to designing a living lab as an enabling environment and inclusive space. Under these conditions, each stakeholder’s participation can be increased (at least for those who are the least accustomed to the living lab experience) both in innovation and in the activities related to the lab’s territorial dimension.
On-going co-design, a key factor of success in patient care
By Agnès CAILLETTE-BEAUDOIN
Calydial
et Arnault THOURET
Tmm Software
Providing patient care through standardized, prescribed channels allows for a medicine of quality that acts back upon both itself and the doctor-patient relationship. New needs are voiced; and digital technology is here to propose answers, which must be more efficient. Besides this objective, there is the determination to design arrangements and procedures that are both complete and less expensive. The doctor can now imagine and organize supplements to these new forms of care for chronic illnesses by providing an educational content for treatments, assessing medically and economically these new solutions, and diffusing them. The focus herein is on care for chronic illnesses, in particular, renal failure. Medical innovations for remote monitoring at the patient’s home enable the concerned to handle their illness condition while more attention is devoted to their quality of life.
The role of patients and their organizations in health innovations: Conceptions and real transformations
By Caroline GUILLOT
Responsable du Diabète LAB à la Fédération française des diabétiques
Ideas about patients are undergoing a major change in the realm of medicine: a shift from the “patient alibi” to the “patient-actor”. A discourse has shaped this dominant view of patients and put it into words. But how to make this new conception enter the realm of acts and the concrete organization of medicine? Two principal forces are capable of making this change. On the one hand, patients are much more often solicited (for technical reasons), and the doctor’s monopoly over knowledge is being questioned. On the other hand, patient organizations are using this trend to switch from a defensive to a proactive attitude. By analyzing patients’ data, inquiring into their experiences, and trying to co-assess and co-design new solutions for health, these organizations place the patient as an actor in the process of care. It is of utmost importance to closely follow these apparently irreversible trends, since they will transform the realm of medicine.
Implicating patients in connected solutions for controlling compliance with prescribed treatments
By Sylvie ARNAVIELHE
Kyomed
and Virginie DELAY
Stiplastics
Noncompliance by patients with prescribed treatments is a public health issue. One of the major reasons for the lack or absence of compliance is often an inadequate interpretation of the therapeutic protocol, which might be complicated, especially for patients taking several medications over a long period. A response to this problem is the connected pillbox. Designed under a program funded by the FUI (Fonds Unique Interministeriel) and tested as a prototype in a living lab, such a pillbox was submitted to an economic assessment and an evaluation of how patients accepted and used it. This study was essential for a product of this sort to be taken under consideration and for defining a marketing strategy. The current program, which should lead to the device being placed on the market in 2019, has signaled the start of new projects for connected devices to better control patient compliance with the oral administration of medication in oncology and to settle issues related to the safety of this sort of ambulatory treatment.
Marshaling the social and human sciences to understand the new uses of digital technology
Health and disabilities: From a user-centered to a universal conception
By Véronique LESPINET-NAJIB
Enseignant-chercheur en cognitique
Amélie ROCHE
Post-doctorante en cognitique
et Quentin CHIBAUDEL
Doctorant en cognitique
A first (classical) approach to health and disability is user-centered; it has come out of the ergonomics of human/system interfaces. A second approach corresponds to a universal conception (for everyone) borrowed from the field of architecture. The limits and advantages of both approaches are discussed. The two are not contradictory. On the contrary, they may be connected and become complementary. Avenues of innovation in the methodology of design and development are proposed…
Hospitality in health establishments, an innovative social experiment in hospitals
By Barbara BAY et Christelle CARRIER
La Fabrique de l’hospitalité
La Fabrique de l’Hospitalité, a laboratory of innovation at the teaching hospitals in Strasbourg, France, is intended to stimulate “co-creation” by hospital employees and users for the purpose of improving patient care and relations with the persons close to the patient. To “make hospitality” by improving the ways human relations and the hospital premises are experienced, resources from the social and human sciences and from design, in particular, are tapped…
Domesticating technology
By Myriam LEWKOWICZ
Université de Technologie de Troyes, ICD, CNRS UMR 6281 Tech-CICO
How is technology for health and autonomy appropriated, in particular when installed at the patient’s home? According to the theoretical approach to home use presented herein, users must domesticate technology; and this entails eventual modifications and an integration of it in everyday routines. This domestication reaches beyond the adoption or use of a technological device, whence the need to understand what the technology means to users and how it fits into their lives. This theoretical approach lets us see domestication as a process with four phases: appropriation, when the technological device is acquired by its future user; objectification, when it finds its place in the home environment; incorporation, when it is put to use; and conversion, when the user is capable of telling about it.
Living labs in health and autonomy: From procedure to process, from innovation to “e-novation”
By Sophie MARTIN
Maître de conférences habilitée à diriger des recherches en psychologie à l’Université Paul Valéry de Montpellier et psychologue clinicienne spécialisée en neuropsychologie en UEROS
Denis BROUILLET
Professeur de psychologie cognitive et expérimentale à l’Université Paul Valéry de Montpellier et membre de l’équipe DynaCSE au sein du laboratoire Epsylon
et Gérard DRAY
Enseignant-chercheur à l’École des Mines d’Alès – Institut Mines-Télécom
According to the paradigm of embodied, situated cognition, the body, environment and situation are interlinked with cognition. What we know is not abstract but fundamentally related to our sensorial and motor systems. Observing and comparing the interrelations between subject, environment and situation, living labs bring to light the preferred means of adaptation. They explore the choices made by individuals and, too, the reasons why they do not make a choice. Their findings are, therefore, coherent with the operation of human thought processes, which are embodied and situated, and with conceptions of health and disability conditions. Living labs, a source of induction and abduction in a natural environment, provide for the controls necessary to build up scientific knowledge. They are genuine tools that reach beyond innovation. The changes thus proposed are based on a strategy of “e-novation”, management and appropriation by and for the concerned.
E-health and prevention: What assessments for what sorts of interventions?
By Olivier AROMATARIO
Ingénieur d’étude, chaire de recherche en prévention des cancers INCa/IReSP/EHESP, doctorant en santé publique UMR 6051, CRAPE/ARENES EHESP – Université Sorbonne Paris Cité
Connected devices and health applications are ever more present in everyday life. What is the real value of these tools for health? We must examine the levers for affecting the population’s state of health and identify the ones effective for prevention work. Behavioral changes are fundamental for preventing illnesses that are avoidable and not transmissible; but electronic devices and applications might, or might not, stimulate such changes depending on how they operate. From the viewpoint of ethics, e-devices risk increasing inequality in health depending on how accessible they are and, too, on how adapted they are to people’s expectations. E-tools will have a major place in the patient’s life, depending on the psychological, social and environmental conditions. What theory can be worked out about these health devices and applications? This question is worth examining since it helps us orient the types of action to be undertaken in order to develop e-devices with the population and for the purpose of responding to its needs.
The importance of measuring quality in medical imaging
By Jean-Marie MOUREAUX
Professeur à l’Université de Lorraine et chercheur au Centre de recherche en automatique de Nancy (CRAN)
In recent years, digital technology has grown considerably in the field of health. Medical images and videos are now being massively produced. These key data for providing care require procedures for their transmission, storage in archives and use for other purposes. Since algorithmic procedures might damage images to varying degrees, measuring the quality of images is a major scientific and economic issue, given the sensitive nature of these data and their uses in health. The concepts of subjective and objective quality are discussed; and devices related to them, described.
Evaluating uses and behaviors in immersive environments: A few current issues
By Guillaume JÉGOU
Responsable du Laboratoire Usages et Acceptabilité, Institut de recherche technologique B-Com
et Nico PALLAMIN
Institut de recherche technologique B-Com
The maturity of digital technology and the new generation of devices now available for producing virtual reality allow us to imagine applications that would have been hard to realize a few years ago. For professional uses, virtual reality is now serving purposes in education, simulation and tele-collaboration. For the design of products and services, in particular of innovations with little feedback from experience, virtual reality can potentially shorten the design-assessment cycle and the time needed for feedback on the means of interaction or visualization. Nonetheless, much research is still to be done about hot to optimally use all these possibilities. Certain current issues must be addressed. How to improve credibility and enhance the virtual presence? What new tools exist for non-intrusive observation; and how acceptable are they?
Research-intervention and living labs: Derived from “immersive research”?
By Mathias BÉJEAN
Maître de conférences à l’Université Paris-Est-Créteil-Val-de-Marne
et Jean-Claude MOISDON
Professeur et directeur de recherche honoraire à Mines ParisTech – Institut Mines-Télécom
Thanks to their agility and openness, living labs hold promise. They seem to be an appropriate response to the challenge of contemporary innovation, especially in health. Nonetheless, their procedures, in particular the relation to sponsors, are not transparent enough. More effort should be put into formalizing them, all the more so since many living labs, beyond the initial phase of co-engineering, seek to become durable, economically viable structures and to be a driving force for proposing innovative solutions. In this task of formalization, the procedures of living labs can be related to those, already formalized, of research-intervention. Both these approaches are descended from “immersive research”, from which we can learn…
Participatory innovations in health: Which public policies?
Citizen participation in making decisions in and about health: Issues, traps, risks and innovations
By Yves CHARPAK
Médeci n de santé publique et épidémiologiste, ancien conseiller principal du directeur du Bureau régional de l’OMS pour l’Europe, à Copenhague, vice-président de la Société française de Santé publique
Citizen participation in decision-making has two distinct aspects in the field of health. First of all, how to implicate citizens in whatever has a direct bearing on health problems, their own or those of persons close to them? The second, more general, aspect has to do with involving citizens in decisions about the health-care system and its organization. The following topics come under discussion: citizen participation in decisions about funding the health system; their responsibility for this system’s lack of efficiency (owing to their poor use of health services); the systemic causes of the system’s inadequate organization; and the role of the “producers” of health risks before the start of illness. Thought is devoted to introducing the concept of “health literacy”, or rather of forms of literacy related to each of the aforementioned topics.
Health in the flesh and in digits
By Gérard DUBEY
Professeur de sociologie à Télécom École de Management, Institut Mines-Télécom
On the margin, and in extension, of the processes of abstraction and control, digital technology in the field of health translates into technical language the strong desire (which, in essence, is not technical) for emancipation and reconnection with the world. How to relearn to touch, to feel, to renew a sensorial relation with the material and social worlds? These trends, which we observe in society, clash with other fascinations: “automaticity”; putting health into digits following rules for making calculations; and disembodiment, synonymous with freedom. Far from being obsolete however, the flesh clearly emerges as the horizon for our thoughts even as we resist the magic of digits and the spell of breakthroughs.
Living labs, levers of innovation in public health
By Valentin BERTHOU
Doctorant à l’Université de technologie de Troyes (UTT)
et Robert PICARD
Ingénieur général des Mines, référent Santé au Conseil général de l’Économie
Living labs in patient health and autonomy are an innovative response to the complexity of health-care institutions. Based on open innovation, they propose an organizational model that combines the participation of a wide range of stakeholders on the supply side with the contribution of users in the effort to design products and services. Living labs have a significant place in the health system as a third party owing to their determination to be innovative. Since the activities of engineering and design is underlaid by an organization similar to that of start-ups, living labs can deploy innovative solutions that find their market and are capable of addressing the issues of chronic illness and demographic ageing.
An accelerator of innovation in health: Lab Santé Île-de-France
By Christine CALINAUD
Responsable du programme e-santé au Lab Santé Île-de-France
et le Pr. Jean-François DHAINAUT
Directeur du Lab Santé Île-de-France
Lab Santé Île-de-France has emerged on the initiative of the Health Agency for the Île-de-France Region, the intent being to create an environment friendly to health innovations. Its founders are the Chamber of Commerce and Industry of Paris Île-de-France and the technology cluster Medicen Paris Region. Its assignment is to stimulate, diffuse and evaluate innovative solutions that, as best possible, match the public health priorities: “ageing well”, long-term care, and tomorrow’s health organizations. Lab Santé Île-de-France presents itself as an accelerator in the service of public and private actors in health and the economy of the Île-de-France Region. Its actions try to open the access to health innovations to everyone; it is associated with an independent committee of ethics. The objectives are to increase opportunities of value-creating cooperation for all parties and to make innovations in health a lever for developing the economy and creating jobs.
The prospects for a policy of health innovation
By Jean-Yves FAGON
Délégué ministériel à l’innovation en santé
When creating a delegation for innovation in health, Marisol Touraine, France’s minister of Social Affairs and Health, sought to set up a “strong, coherent, transparent and comprehensible policy based on partnerships in matters of innovations in health”. A global, coherent policy: global because it applies to the whole range of health innovations while adapting to specific conditions in certain fields; and coherent, because it is based on coordinated contributions from all parties. This declaration of a clear national strategy does not prescribe a locked-down system. This strategy calls for a strong governance to set the direction for all parties and guarantee continuity in implementing its orientations, while retaining the agility needed for innovation. The solid, strategic chain, thus built, will allow for simple, rapid and fluid exchanges among all parties. Not only are administrations, public operators and industrialists concerned but also health professionals and patients/users – the latter now being full-fledged actors. It is high time that the experiences of both patients and health-care professionals contribute to the processes of drawing up and assessing strategies.
Health: common to public policies? The Canadian experience
By Eva KEHAYIA, Sara AHMED, Philippe ARCHAMBAULT, Joyce FUNG et
Anouk LAMONTAGNE
Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal (Canada) et School of Physical and Occupational Therapy, McGill University, Montréal
Bonnie SWAINE et Dahlia KAIRY
Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, et École de réadaptation, Faculté de médecine, Université de Montréal
Guylaine LE DORZE
Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, et École d’orthophonie et d’audiologie, Faculté de médecine, Université de Montréal
Hélène LEFEBVRE
Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, et Faculté de sciences infirmières, Université de Montréal
Tiiu POLDMA
Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, et Faculté de l’aménagement, Université de Montréal
et Delphine LABBÉ
Conducted by CRIR, a multidisciplinary research center on rehabilitation, and its partners, the living lab RehabMaLL has helped create an environment that, in a shopping center in downtown Montreal, facilitates the participation and inclusion of people of all ages, in particular the physically disabled. Besides its principal partner (FPI COMINAR who owns the shopping center), this program involves communities, associations, clinics and private operators along with researchers as well as local, national and international businesses. This living lab has emerged out of the active commitment from (and synergy between) researchers and stakeholders who intend to lift the obstacles created by discriminatory physical and social environments. This change has been realized through innovative solutions and strategies for reducing inequality and promoting accessibility, well-being and, as a consequence, the health of the people of Quebec.
Miscellany
Political and cultural aspects of contemporary utopias
By Philippe J. BERNARD
Économiste. président du Club Utopies (Association Prospective 2100)
et Alexandre ROJEY
Fondateur et animateur du think tank IDées (Fondation Tuck), vice-président de l’association SENS+
Invented in 1516 by Thomas More in response to The Praise of Folly written by his friend, Erasmus, the word “utopia” refers to an ideal place that exists nowhere. Nowadays, it has various meanings. For some, a truth stated prematurely. For others, a naive or dangerous vision: in particular the fantastic promises made by technical progress, especially in digital technology. However the focus herein is not on the prevention of all illnesses; nor on making the life span longer; nor on the enhancement of human thought processes thanks to all sorts of devices to be grafted onto the brain (whence transhumanism); nor on predictions for 2040. Instead, a critique of what actually exists leads us to the question of a vision – maybe a dream or, in any case, a project – for a better society both in terms of its political and social organization and its cultural traits.