Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

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Part 8: Information and Assets SharingInternational audienceHealth systems around the world have been continuously subject to many questions about their performance. In order to improve the functioning of such systems, Health Information Systems (HIS) and Technologies (HIT) are deployed to support patient care pathways and ensure information exchange between health structures, actors of patient care. The aim of this paper is to propose a generic modelling framework for describing the exchange of information between health institutions in the context of patient's care, concerning a given chronic pathology. The purpose is to facilitate building of flow models starting from the proposed modelling framework, those models will be used to support quantitative evaluation through discrete event simulation, useful to evaluate the impact of communication between health institutions on patient care pathway. This work is a part of a research project entitled e-SIS (" Assessment in Health Information Systems "), project funded by the French health ministry (DGOS) as part of its research program called PREPS (" Research Program on Performance of Healthcare Systems ")

Objectives: To develop an economic evaluation of cost-effectiveness of using Everolimus versus Axitinib for the treatment of patients with metastatic renal cell carcinoma, after they have progressed in the first-line treatment with pazopanib or sunitinib, in the Colombian context. MethOds: Two Markov models were designed in quarterly cycles, with a time horizon of three years for a hypothetical cohort of 1 patient diagnosed with metastatic renal cell carcinoma, who have progressed on first-line treatment, one after using sunitinib and the other after using pazopanib. Second-line treatment technologies are everolimus versus axitinib. The analysis included the probabilities of second-line progression, progression-free survival and the adverse events the technologies can produce. The outcome evaluated was life years saved, in addition to the total costs for treatments. These costs were taken from Colombian health system information databases. The costs are showed in United States dollars, using current exchange rate to Colombian pesos. Results: According to the analysis, in terms of cost-effectiveness, the use of Everolimus has 0.11 life years more than Axitinib, with savings of US $ 2,586 if patients used pazopanib during first-line. If patients used sunitinib during first-line everolimus has 0.02 life years more than axitinib, with savings of US $ 2,508. Concluding that the cost of using everolimus treatment is less than using axitinib and effectiveness is greater compared to Axitinib. A sensitivity analysis using different discount rates was made, showing dominance in all the scenarios, the discount rates used were 0%, 3.5% and 10% cOnclusiOns: The use of Everolimus is a dominant option compared to Axitinib, in a time horizon of three years related to the treatment of patients with metastatic renal cell carcinoma in both models, which means, in patients who were treated in first line with pazopanib and patients who were treated with sunitinib in first line.