To answer its mission of anticipation of health risks for the deployed forces outside France, French armies have developed a medical intelligence system (Boutin 2004).

Objectives

The goal is to build a medical intelligence system answering the different needs of sanitary information of the forces and military decision-makers, a system that feeds by fresh health data by automatic or semi-automatic process, a system where information is categorized and easily searchable, a system where information is synthesized and knowledge is organized.

Research questions

How to feed this system? How to update it? How to classify and architecture the information in the system? How to organize the knowledge to answer the medical intelligence mission?

Method

The system developed is powered by a documentary monitoring process in 6 steps with feedbacks: information content definition, automated collection on databases MedLine, ToxLine, Web of Science..., human and automated analysis of the information, classification and distribution in the system. The selection of documentary content is validated with users (physicians, health policy makers...). The documents are classified according to the classification of the National Library of Medicine (NLM) and named according to a naming procedure (Tanti 2012). The selected and classified resources are organized and capitalized in a documentary system which is based on four different information systems (IS) described in this article.

Results

The documentary system developed integrates access to multiple sources of information such as databases and hypertext. It is available on a secure Intranet. It is mainly based on four IS defined by Boulogne as “an organized unit, inter-connected procedures, methodologies, elements of organization, human resources, software and computer equipment allowing to collect, store, structure, insert, extract, move, control, post, exchange (transmit or receive) and to communicate the selected information in form of text, images, sound or coded data for the use of exploitation, and management of an organization” (Boulogne 2004).

Presentation

The first IS is called BEDOUIN. It provides the military health service directorate, medical advisers of military commands as well as physicians, pharmacists, and veterinary surgeons at unit level with updated information on potential health risks for deployed French forces. The informations in the IS are indexed by keywords, in natural language and by using the Medical Subject Headings MeSH thesaurus. The consultation is done either by hypertext navigation or via a search engine. The knowledge is organized by country, (animal and human) diseases and toxicological risks and accessible from an alphabetical index. BEDOUIN provides 189 country files. It also contains 893 scientific documents on 233 human diseases and 162 veterinary diseases and 1978 toxicological files.

REDUVES is the name of the second IS containing Research and Development information. It is made up differently in terms of appearance and its content is complementary to that of BEDOUIN. It informs the Military Health Service directorate and medical advisers of military commands about the latest scientific publications on agents of medical importance, in particular biological agents and agents that can be used for the production of weapons of mass destructions, and corresponding research activities. It provides R&D files giving an overview on preventive measures, diagnostic procedures, therapeutic assets and reports on documentary awareness. Like in BEDOUIN the consultation is done either by hypertext navigation or via a search engine. The knowledge is organized by risk and agent and accessible from an alphabetical index. REDUVES actually contains 46 files on agents posing health risks, 26 R&D files, 26 reports on documentary awareness, 20 works and reviews as well as 2,955 scientific source documents.

BOUGAINVILLE capitalizes rough scientific documents on agents of biological, natural and provoked risks, chemical substances, be it of industrial or military nature, and allows the permanent development of BEDOUIN and REDUVES. In terms of organizing and gathering information by topic, informations are classified by generic and specific terms, in folders and subfolders (classification by risks encountered outside the territory: biological, chemical and industrial ... and by agents: smallpox, anthrax ...). Documents are indexed by keywords, in natural language and by using the MeSH thesaurus, by first author and by year. To allow a fast location of documents, groups of documents or passages of text which answer specific questions, an electronic document management tool was installed. It allows querying the whole base, in simple or advanced research, by specific fields (title, summary...), by free or controlled key words, and via the boolean operators. BOUGAINVILLE, permanently evolving, contains 30,900 documents including 25,800 on biological risks, 2,070 on chemical risks, 280 on radiological risks, 610 on veterinary medicine related risks and 2,150 country documents.

The last IS, IntraCespa, capitalizes reports, notes, bulletins of epidemiological surveillance of the French forces and other internal documents relating to epidemiology and public health issues of French forces. INTRACESPA informations are consultable by author, topic or type, in multi-criteria mode, simple or advanced research but also by arborescent navigation.

Example of use

In the next Ebola epidemic, French military authorities and physicians at unit level regularly consult the documentary system to receive real time information on the global evolution of the medical crisis. They also consult scientific documents on the virus, research publications on its mechanisms of pathogenicity, as well as the daily progress in vaccine and treatment developments. Physicians seek information and ministerial recommendations, in particular within the framework of epidemiological surveillance and aspects of protection campaigns of military and civilian populations (Chatelet 2015).

Conclusions

The system is regularly updated. The information is organized, classified and searchable for users, especially for preparing deployments on theaters of operations or to respond to health crises, such as during the recent outbreak of Ebola and Zika. In the near future, the information of the system will be consultable by satellite, under extreme conditions. The system has proven its daily use and utility in crisis situations. It would now be interesting to qualitatively and quantitatively evaluate its effectiveness and efficiency.

Bibliography

Boutin JP and al. Pour une veille sanitaire de défense. Médecine et armées, 2004 32(4) :366–72.

Boulogne A. Vocabulaire de la documentation. Paris: ADBS, 2004.

Châtelet R, Tanti M. Évaluation de la communication organisationnelle en situation de crise sanitaire: application à la maladie d’Ebola dans le Service de santé des armées. In Communication organisationnelle : processus communicants, processus organisants et leurs médiations : actes du colloque international Org&Co 2015 : 296-305.

Tanti M. Naming electronic documents. Development and evaluation of a procedure. In Categories, contexts and relations in knowledge organization, Neelameghan A and Raghavan KS. Ergon-Verlag : 372-373.