TSN: The Healthcare Pathway in the Digital Age

10 April 2016


The increased prevalence of chronic diseases in France calls for a reassessment of our model of delivering medicine. Treating these patients calls for a way of ensuring smooth collaboration between different health professionals, institutions and patients themselves. This is one of the primary objectives of the Digital Healthcare Regions programme (‘Territoire de soins numérique’ [TSN]), an ambitious project which uses digital technology to put patients right at the centre of their care pathway.


Keys figures:

  • 10 million French people suffer from a long-term health condition, ie one in six. Between 2004 and 2014, the number of patients in France affected by a chronic condition went up by 33%. Source: General Health Insurance scheme (opens in a new window)
  • €80 million has been invested in supporting the eHealth sector as part of the ‘Digital Healthcare Regions’ (TSN) programme.
  • Following the national ‘Digital Healthcare Regions’ call for projects, €10 million has been granted to the XL-ENS project in Aquitaine, as part of the National Fund for the Digital Society (Fonds national pour la Société Numérique).
  • Aquitaine is France’s top region in terms of eHealth: 45% of national eHealth turnover is generated within the region, and 50% of the Health ITC sector workforce is based there.

Find out more :





Interview with Marie-Noëlle Billebot, Director of the TSN project, ARS Aquitaine.

« The patient pathway is complex and can’t easily be modelled. »

At a time when more than 15% of the French population is affected by a chronic condition 1, what does the patient pathway look like? From the general practitioner to the hospital, and from the specialist to the home nurse: there are complex processes and lots of players involved, and treatment remains far from optimum. Health professionals would benefit from better cooperation and information sharing around best practice in caring for patients with long-term conditions such as diabetes, cancer, heart failure, asthma and even Alzheimer’s disease.

This was the context for the Health Minister, Marisol Touraine, launching the ‘Digital Healthcare Regions’ (TSN) plan in 2013. Regarded as an investment in the future, the TSN programme is funding five pilot projects to develop e-health initiatives in the regions of France, with a total budget of €80 million. Out of 18 applications coming from the various Regional Health Agencies (Agences Régionales de Santé), five regional projects were selected by the DGOS (Délégation générale de l’offre de soins – General Healthcare Commission) in Aquitaine, Bourgogne, Ile-de-France, Rhône-Alpes and Indian Ocean. These projects, set to run from 2014 to 2017, all share an aim to put forward “innovative user-focused solutions” and to “strengthen the pathway structure”  2, according to the Health Minister. As an approved health data hosting and storage provider and shared data network provider, Orange has won three tenders within the TSN programme, in the Aquitaine, Rhône-Alpes and Indian Ocean regions.

Platforms for centralising data

« When it comes to the healthcare pathway, we can’t have a direct impact on the disease itself, but we can improve coordination, by creating health services platforms for all health professionals and patients to use », explains Pascal Nibeaudeau, Commercial Director of Orange Healthcare’s Health Division. These platforms provide infrastructure based on new care pathways: a common basis for storing, networking, receiving and sharing patient data. « Using this as a starting point, services are developed based on the conditions and usage patterns experienced by patients in the given regions », explains P. Nibeaudeau. In Ile-de-France, for example, 40 hospitals can now upload and store medical imagery in the cloud, allowing them to simplify the consultation procedure and the transfer of images between doctors, institutions and patients.

These platforms enable doctors to have direct access to the patient’s prior medical history, to avoid duplicating tests and to communicate directly with other practitioners. For patients, access to their own medical history via their computer or mobile allows them to stay connected with their lab or doctor and therefore ensure continuity of care. « These platforms are shifting the centre of gravity from the doctor to the patient, by helping them to self-organise more effectively. If the TSN pilot projects achieve what they have set out to do, they can then be rolled out across major regions, making it possible to manage a larger number of patients using the same infrastructure. »

Mobile tools for better patient monitoring

The healthcare pathway in the digital age favours treatment at home, and is equipped with innovative mobile tools to support this. « Connected devices and apps related to chronic conditions are effectively medical devices in their own right, which form part of a care protocol and are linked to the service platforms », says P. Nibeaudeau.

In Aquitaine, the ‘Santé Landes’ platform will soon be releasing its patient app, which includes a diary, appointment reminder functions and access to therapeutic educational tools. Local start-ups are also involved, such as the Dom-Assist tablets and smart devices developed by a team at Inria, which enable remote monitoring of older people in their homes. The only obstacle to using these solutions is that at the moment it is not yet easy to monitor the daily output of these devices. How should we treat these data, and which methods and techniques should we use? These questions still need to be answered between now and 2017.

Data centres for data security

The connecting up of doctors and health institutions, together with the use of health apps and smart devices, means that the volume of data to be stored within platforms is set to grow exponentially.

Heart rate, blood pressure, ECGs, hospital admission reports, « all the data accumulated by patients monitored via the ‘Santé Landes’ platform are stored in our data centres », explains Christian Combot, Orange Business Services’ South West lead for health sector sales. These centres are specifically approved by the state, meet 74 safety and regulatory requirements overseen by the CNIL, and are capable of encrypting all data, backing it up for security and observing a strict protocol in the event of decoding: only a doctor can then consult and transfer the data stored there. « In Aquitaine the second half of 2016 should see us moving on to working on managing data produced by connected devices, says C. Combot. The regional coordination platform will need to supervise these connected devices if it is to monitor the data and correlate these to potential warning signs. »

1 Source: General Health Insurance scheme http://www.lesechos.fr/economie-france/social/021754654522-la-france-compte-10-millions-de-malades-de-longue-duree-1205999.php
2 http://social-sante.gouv.fr/systeme-de-sante-et-medico-social/e-sante/article/investissements-d-avenir-le-gouvernement-retient-5-projets-dans-le-programme