Urgence News: APM / SFMU
- PARIS, March 20, 2025 - Access to a qualitative National Database for monitoring and managing the activity of Emergency Services is more dependent on legal issues...
- The activity of Emergency services is tracked using Résumés de Passage aux Urgences (RPU), a standardized collection of medical data.
- Created in 2006, upon the suggestion of the Société Française de Médecine d'Urgence (SFMU), this indicator serves as a tool for health monitoring.
National Database Access for Emergency Services: A Legal Hurdle
Table of Contents
- National Database Access for Emergency Services: A Legal Hurdle
- National Database Access for Emergency Services: A Q&A
- What is the main obstacle to accessing the national database for Emergency Services?
- What is the role of Résumés de Passage aux urgences (RPU) in tracking Emergency Service activity?
- Who contributes data to the RPU system, and where does the data go?
- What are the challenges faced by the Fédération des observatoires régionaux des urgences (fedoru) regarding data access?
- How is RPU data used at the regional level by the Agence Régionale de Santé (ARS)?
- Why is national-level access to Emergency Service data important?
- What technical and legal hurdles exist regarding data reporting and access?
- What regulatory and governmental issues are delaying the implementation of improvements to the RPU system, such as the new V3 version?
- What are some of the complexities that are emphasized by the DGOS regarding this data?
- Summary of Data Access Challenges and Delays
PARIS, March 20, 2025 – Access to a qualitative National Database for monitoring and managing the activity of Emergency Services is more dependent on legal issues than technical ones. This was the consensus among participants at a round table during the national conference of the Fédération des observatoires régionaux des urgences (fedoru), held on March 11 at the Ministry of Health.
Tracking Emergency Service Activity
The activity of Emergency services is tracked using Résumés de Passage aux Urgences (RPU), a standardized collection of medical data. Currently, it encompasses 18 indicators that describe each visit to an Emergency Service.
Created in 2006, upon the suggestion of the Société Française de Médecine d’Urgence (SFMU), this indicator serves as a tool for health monitoring. it aims to prevent exceptional health events through data flow, a measure initiated following the summer 2003 heatwave. It has been mandatory as 2013.
Key Data Points in Résumés de Passage aux Urgences (RPU)
- Patient demographics
- Arrival and departure times
- Reasons for visit
- Medical procedures performed
- Patient outcomes
Data Flow and Challenges
Marc Noizet, president of Samu-urgences de France (SUdF) and vice-president of Fedoru, explained, “Today, the actors who generate this flow are the emergency physicians and the emergency structures, who send the data to a regional operator, the ORU [regional emergency observatories] and/or the Grades [regional groups supporting the growth of e-health].”
This data is then forwarded to the Agence Technique de l’Details sur l’Hospitalisation (ATIH) and Santé Publique France (SPF).Dr. Noizet pointed out, “And therefore two different databases,” also noting that some RPU fields are “more fragile” than others, such as the “reason for seeking care.”
The Fedoru faces limitations. Its vice-president stated, “The Fedoru is not able to have an exploitable database.” Consequently, the federation relies on data aggregations from each ORU to conduct national surveys, “wich makes things extremely complicated when we want to do analysis.”
He added, “The business challenges for us today are easier access to this database, which can be national, respecting the scope of the RGPD [General Data Protection Regulation] and the Cnil [National Commission for Information Technology and Liberties].”
“Hot” and “Cold” Management
When questioned about the uses of this data, Benoît Ricaut-Larose, deputy director of first response at the Agence Régionale de Santé (ARS) Occitanie, explained that his agency has two primary uses for the data reported by its ORU:
- “Hot” management, exemplified by the creation of a “hospital in tension” (HET) indicator by ORU Occitanie, “which allows to have a daily visual report on the level of tension of an establishment” (downstream capacities, activity of the emergency reception service -SAU-, number of geriatric passages…)
- “Cold” management, with feedback “to see what we have not seen, not well detected or interpreted.”
Benoît Ricaut-Larose cited an example: “Currently, we are preparing a retex [feedback] on the last winter flu epidemic.” He added, “We may have triggered the internal mobilization plans too late even though we had the data.”
He continued, “The cold retex also allows us to analyze the pathways, the organizations, the use of Emergency Services of a structure, of a territory,” adding that this data also has a financial stake as the population allocation assigned to Emergency Services “is also determined on the basis of the RPU.”
Marc Noizet reacted, “How can we locally manage a healthcare offer if we don’t have the outlook of the whole of France? It’s just impractical!”
He continued, “The challenge is to have simple access to these data flows,” calling for aggregating access to other data flows such as those from regulation and the implementation of a new generation RPU, called “V3”: “All that’s missing is the implementing text.”
Xavier Vitry, head of the public health and exceptional health situations division of the Délégation au Numérique en Santé (DNS), remarked, ”There are still technical issues for data reporting.”
He continued, “Uploading data every month is not the same as uploading it every week, there are still budgetary impacts,” also noting the absence of a “legal framework at the national level to facilitate access, depending on the purposes and type of use”: “I think everyone agrees on the purposes and usefulness [of access to this data], to better operate our system, to better understand, but we need this regulatory framework in order to allow our actors to operate research and real-time data analysis.”
“Technical Issues in Terms of Law”
Mickaël Benzaqui, deputy director of access to care and first response at the Direction Générale de l’Offre de Soins (DGOS), stated, “There are no technical problems in terms of plumbing perhaps, but there are technical issues in terms of law.”
He notably emphasized the complexities raised by the use of data to objectify care activities.
He cited, “What are the right indicators to determine the proportion of visits that are truly emergency medicine?” He highlighted that the clinical classification of patients in Emergency Services (CCMU) as well as visits potentially related to the city (PRPV) could be subject to criticism: “There is always a subject on the quality of the data.”
He continued, “On the subject of data access, even we, at the DGOS, do not have access to all the data.” He added, “Obviously, when we ask for access to the ATIH, we have the data because they are nice and we are their supervisory authority, but we do not have access to the data of Santé Publique France” (SPF).
he also cited the example of the Caisses Primaires d’Assurance Maladie (CPAM) which do not have access to national health insurance data.
regarding repeated requests concerning the RPU V3,the deputy director of the DGOS reminded that governmental instability had not helped the subject to advance at the expected pace: “It must not be forgotten that in 2024,we had four prime ministers,that for two years we have had seven ministers in charge of health.”
He concluded, “The difficulty is that every time there is a new minister, there is a new cabinet, it’s the systematic stop and go,” while inviting representatives of emergency physicians to come and discuss their priorities with him.
National Database Access for Emergency Services: A Q&A
This article explores the challenges and complexities of accessing national databases for monitoring and managing Emergency Services activity. It addresses key issues discussed at the national conference of the Fédération des observatoires régionaux des urgences (fedoru) in Paris on March 11, 2025.
What is the main obstacle to accessing the national database for Emergency Services?
The primary obstacle to accessing a qualitative national database for monitoring and managing Emergency services is rooted in legal issues rather than technical limitations.
What is the role of Résumés de Passage aux urgences (RPU) in tracking Emergency Service activity?
Résumés de Passage aux Urgences (RPU) is the standardized system for collecting and managing medical data to track the activity of Emergency Services. Created in 2006, it involves a comprehensive set of data points designed to prevent health issues and ensure emergency services work optimally. The RPU encompasses 18 indicators that detail each visit to an Emergency Service.
Key data points in RPU include:
- Patient demographics
- Arrival and departure times
- Reasons for visit
- Medical procedures performed
- Patient outcomes
Who contributes data to the RPU system, and where does the data go?
Emergency physicians and emergency structures generate the data flow. The data is then sent to a regional operator, the ORU (regional emergency observatories) and/or the Grades (regional groups supporting the growth of e-health). This data is then forwarded to the Agence Technique de l’Information sur l’Hospitalisation (ATIH) and Santé Publique France (SPF).
What are the challenges faced by the Fédération des observatoires régionaux des urgences (fedoru) regarding data access?
The Fedoru faces these primary challenges:
- Limited Database Access: The Fedoru cannot access a readily usable database.
- Data Aggregation: The institution is forced to rely on data aggregations from each ORU to conduct national surveys, which complicates analysis.
- Legal and Regulatory Compliance: The need for easier, national-level database access while respecting the scope of the General Data Protection Regulation (GDPR) and the National Commission for Information Technology and Liberties (CNIL).
How is RPU data used at the regional level by the Agence Régionale de Santé (ARS)?
The Agence Régionale de Santé (ARS) uses RPU data for two primary purposes:
- “Hot” management: This involves real-time monitoring, such as creating a “hospital in tension” (HET) indicator, to track the level of stress of a medical establishment.
- “Cold” Management: This involves retrospective analysis (feedback) to assess what was not detected, or interpreted well, including analyzing pathways, system organizations, and the use of Emergency Services.
Why is national-level access to Emergency Service data important?
National-level access to Emergency Service data is critical for several reasons:
- Comprehensive View: Enables a broader view of healthcare service activity.
- Healthcare offer Management: Allows local healthcare offers to be managed more efficiently, based on a national outlook.
- Resource Allocation: Population allocation assigned to Emergency Services is steadfast on the basis of the RPU.
- Research and Analysis: Facilitates research and real-time data analysis, which is not possible when using the data from only one database.
What technical and legal hurdles exist regarding data reporting and access?
Technical hurdles for data reporting include the frequency of data uploads (e.g.,monthly vs. weekly) and associated budgetary impacts. A meaningful challenge is the absence of a legal framework at the national level to facilitate data access based on purpose and type of use, therefore the government needs to create a regulatory framework in order to allow actors to operate research and real-time data analysis.
What regulatory and governmental issues are delaying the implementation of improvements to the RPU system, such as the new V3 version?
Governmental instability has significantly slowed progress. High turnover in ministerial positions and cabinet changes have led to delays as policies are repeatedly halted and restarted with each new management.
What are some of the complexities that are emphasized by the DGOS regarding this data?
The complexities raised by the use of data to objectify care activities include:
- Determining the right indicators: Establishing accurate indicators to determine the proportion of visits that are truly emergency medicine.
- Data Quality: The clinical classification of patients in Emergency Services (CCMU) could be subject to criticism, and also visits potentially related to the city (PRPV): “There is always a subject on the quality of the data.”
- Data Access: Even government bodies, such as the DGOS, do not have access to all necessary data.
Summary of Data Access Challenges and Delays
| Issue | Description | Impact |
|---|---|---|
| Legal Framework | Lack of national legal framework. | Limits research and data analysis. |
| Data Access | Inconsistent access to data across different health organizations. | Hinders comprehensive analysis and management |
| Governmental Instability | Frequent changes in government leadership. | Delays in implementing new RPU versions and policies. |
| Data Quality | Concerns about the accuracy of data with the clinical classification systems. | May lead to inaccurate conclusions if the data is not reliable. |