Collaborative and workflow-oriented digital portfolio: Creating a web-based tool to support a nationwide program of practices evaluation in the blood transfusion area.

PURPOSE: The French National Blood Transfusion Institute received approval from the French National Health Authority to organize a nationwide program for the evaluation of professional practices in the area of blood transfusion. Major issues of the project were: (1) managing numerous physicians spread nationwide; (2) tracking and storing the physician's entire process (from his/her enrollment to his/her lifelong follow-up); (3) creating a collaborative technique for processing an evaluation program; (4) enhancing exchanges between participants; (5) proposing effective implementation of the assessment. METHODS: As faculty members with experience in distance learning, we considered the digital/electronic portfolio to be one of the most suitable techniques to support such a project. Due to the lack of methods and tools to meet users' expectations, the decision was made to prototype a new and innovative assessment environment. A team was formed to complete the design phase within 6 months (information content, roles and functions). Implementation of the prototype, which includes tests, was also planned over a 6-month period. The methodology involves two approaches: one concerns business process modelling; the other is related to object-oriented methods for design and implementation. RESULTS: This primary work was aimed at describing a specific object, the evaluation program, which can be shared between players within a web-based collaborative platform. Four types of players were identified: (1) physicians enrolled into the assessment program; (2) tutors assigned to follow physicians' assessment process; (3) program directors who manage the content of the assessment program and the application of follow-up rules; (4) supervisors who administrate the global system. The evaluation program is composed of a set of actions, which has to be performed by the physicians. These actions are directly related to the activities of the business processes to which the candidate belongs. For each action, elements of proof have to be uploaded by the physician, according to a predefined schedule. The status of this object and its changes are followed and managed by a workflow engine. Implementation of the system required an object-oriented content management system (Zope/Plone). CONCLUSION: The object-oriented approach helped us to focus on the topic of interest, the assessment program, without being concerned by the whole environment. The assessment model we designed attempts to make a link with the business process performed in daily routine. This article explores the way business process modelling can contribute to the modelling of a professional practices assessment system. Apart from the modelling and technical aspects, this nationwide project contains major challenges: to enroll all physicians on an individualized basis and to create appropriate conditions for the extension of the evaluation program and device to other specialties.

[Evaluation of the professional practices of physicians in transfusion technology and medicine]. / L'évaluation des pratiques professionnelles des médecins en technologie et médecine transfusionnelles.

The evaluation of the professional practices (EPP) is obligatory for all the physicians since July 1, 2005 for a first five-year period. It represents one of the components of the continuous medical training (CMT). The French Society of Blood Transfusion and National Institute of Blood Transfusion are the promoters of the EPP in transfusion technology and medicine. Initially, the programs of EPP will be conceived and controlled by experts and will relate to their basic activities. During a five years cycle, the physician taking part in a program must validate a specific action and take part in a rolling programme. At the end of the programme, the physician will receive a certificate issued by National Institute of Blood Transfusion and will have to submit it to a committee placed under the responsibility of the regional physicians' committee.

Risk management in transfusion after the HIV blood contamination crisis in France: the impact of the precautionary principle.

The importance of the precautionary principle in public health was highlighted in France after the HIV contamination of blood products used for transfusion. However, the definition of this principle, its objectives, the way in which it should be applied, and its consequences had not been considered previously. The question as to whether the application of the precautionary principle is appropriate remains unanswered. The aim of this study was to analyze the interpretations of the application of the precautionary principle to determine its consequences in terms of risk management and patient rights. This was accomplished by interviewing persons involved in transfusion medicine. We conducted 33 interviews and describe the issues enunciated for and against the application of the precautionary principle. The precautionary principle concept was confusing to the respondents. A major issue emerging from the interviews was that the precautionary principle was perceived more as a means of protecting the decision maker than as a means of protecting the patient. Taken to its extreme, the use of the precautionary principle could prejudice sound medical decision making. However, it was felt that it also can lead to the introduction of measures that update and gradually reduce risks associated with transfusion.

[Informing the transfused patient of the possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion]. / L'obligation d'information du patient transfusé sur le risque potentiel de transmission de la variante de la maladie de Creutzfeldt-Jakob.

TRUE RISKS AND THEORETICAL RISKS: The texts ruling the obligation of the physician to inform the patient appears not to include theoretical risks in their application. In France however, the field of blood transfusions extends this obligation to the theoretical risk of potential transmission through the blood of the infectious agent responsible for Creutzfeldt-Jakob's disease. UNANSWERED QUESTIONS: From an ethical point of view, is information on the theoretical risk of transmission founded? From a formal point of view, the means used for such an extension (i.e.,a bulletin) is debatable; was this an adequate measure? THE RETURN OF COMMON SENSE: If we look at the earlier texts, the principle of an obligation to inform the patient of the theoretical risks does not appear widespread or even confirmed. Do these text simply the return of "common sense"? And if so, to what extent does it encourage the illusion of a zero risk...?