A dual challenge: care quality and care availability in the community

Points de vue | 15 Mar 2012
Points of view of Élisabeth Hubert, former minister, chair of FNEHAD.

The aim of the French hospital-at-home organization (FNEHAD) is to show that it is possible to combine high-quality hospital care with the comfort of being at home. It is with this purpose in mind, and with a desire to apply new technologies to its work in health, that it has worked with ASIP Santé for the last two years.

We all know that our healthcare system must change and develop over the coming years, for reasons that are as much about changing needs and scientific advances as they are about budget constraints. In a country that is often stubborn in the face of change, these transformations are seen as constraints or even threats, insofar as they are occurring in a climate in which there is concern over access to care and increased demands in terms of quality and safety of care.

Such obstinacy is to forget how much the huge increase in information and communications over the last twenty years has transformed our society, and how much the creation of such tools could change the healthcare sector, for which these tools represent a great opportunity.

These technologies do not just facilitate diagnosis and some treatments, but they provide a response to the dual challenge of ensuring care that is both high-quality and available in the patient's community.

Information systems support exchanges between professionals, and by their very nature they are transparent, fast and comprehensive.

General rollout of such systems, merely by removing the barriers between hospital and community medicine, is in itself an instrument of change in healthcare professionals' practice, and is thus a guarantee of effectiveness for our health and social care system.

The hospital-at-home sector is a supporter of health information systems, because of its brief to co-ordinate and carry out care, because of its obligations as a provider of care, and because it operates in all regions, including the most deprived.

The work that ASIP and FNEHAD have been carrying out over nearly two years has been innovative, as it arose from the two organizations' common wish to push forward the long-neglected issue of health information systems. It is also innovative in the method it has used, which is attuned to the real situation, and is enriched by the experiences and needs of those involved in HAH, and of employees in these facilities and in partner facilities.

Beyond the contribution it can make to care provision, this project is also a great opportunity to push forward decisively and permanently information systems in health and (more broadly) telehealth, as HAH facilities interact with all other health facilities, whether hospital or community-based, medical or paramedical. The success of this project, even if the volume of HAH care falls, would be an example for all others involved in health, particularly those involved in home-based healthcare.

It is now time to take action and make this project a reality. In order to achieve this, we need support from the public authorities. Such a commitment would be a good illustration of a wish to see interoperable health information systems in our country in the near future, which would be useful for patients and for professionals, and which would be a key element in the modernization of our healthcare system.


FNEHAD was set up in 1973 and is the only hospital federation that is specifically concerned with hospital-at-home treatment. It brings together over 200 hospital-at-home organizations. Its brief is to raise awareness of the existence and role of HAH (hospital at home), to develop HAH across the country to ensure that the whole population has access to it, to make available members' experience for the benefit of all, and to represent members and uphold their interests.
Extract from the ASIP Santé's Annual Report 2011.