Thursday, July 15, 2010

France Takes An Interesting E-Health Path. Any Useful Learnings?

The following appeared a few days ago – and it is interesting the Strategic Path being followed has substantial crossover to what I think should be happening in Australia.


Voilà! French e-health goes online in 2010

Report: John Brosky

The hosting service has been selected, software standards have been published, and on 11 December 2010 any French citizen will be able to open a file and begin creating a secure, personal electronic health record (EHR). If the agency charged with this ambitious programme meets the deadline, France will suddenly jump to the leading edge of e-health worldwide, rivalling advanced national programmes in Canada, Sweden and Denmark, as well as benchmark regional programmes implemented in Spain and Italy.

Launched with much fanfare in 2004, the dossier medical personalisé (DMP) was promoted as the pièce de résistance for reforming France’s healthcare system, expected to bring over €3.5 billion in cost savings annually for the state health insurance fund.

The July 2007 deadline set by the legislature passed, the programme became a national embarrassment and, in 2008, a joint commission of three government ministries declared the DMP officially dead.

Stubbornly, Health Minister Roselyn Bachelot re-launched the DMP in 2009. The solution may have failed, she said, but the need for patient-centred management and savings for the health insurance fund had not gone away.
Against all odds and in record time, the newly created agency charged with delivering the new DMP moved quickly and convincingly, securing the necessary funding, overcoming legal and technical problems and announcing the ambitious deadline.

During the national Health Information Technology exposition in Paris, European Hospital spoke with Jean-Yves Robin, the head of ASIP Santé (Agence des Systèmes d'Information Partagés de Santé) who is leading the French charge to the frontline of e-health in Europe.

He chafes at the suggestion that France is going to pull a rabbit out of its hat in December, suddenly to become the only country to offer a nationally coordinated healthcare record. ‘This is not a magic trick. This is the fruit of years of work,’ he said during our European Hospital interview. ‘We are not creating something completely new but re-launching the DMP, which is to say we are not re-inventing everything but instead pulling together several years of pilot programmes, development of security systems and tapping into independent efforts such as the medication records and the record of medical acts from the national health insurance agency.’

‘At the moment, yes, France is behind other countries that have launched impressive regional programmes or have focused on specific functions, such as pharmacy or scheduling,’ Jean-Yves Robin conceded. ‘We have had problems with governance and leadership of projects, but those issues are now settled.’ Legal disputes on patient identification and the rights of patients to direct medical records are resolved.

A key strategy, he explained, was to clearly separate the DMP into two different programmes, though both share the same designation in French as DMP.

The dossier médical personnel (DM-Personnel) to be launched in December is an EHR aimed at helping citizens organise health records for consultation with their general practitioner (GP) and other healthcare providers, such as home care providers or emergency caregivers seeking medication histories and a summary of recent surgeries.

The dossier médical patient (DM-Patient), which will be developed progressively over the next few years, is an electronic patient’s record (EPR) that will be shared among healthcare professionals, specialists and clinicians with detailed reports of a patient’s care and will include exam results, e.g. lab reports and medical images.

Lots more here:

What the French seem to be doing is creating a patient orientated play-pen where patients can record their health information and have it shareable, if they wish, with their GP.

In parallel they are embarking on a much more complicated and slow process to develop electronic patient records for their health professionals to share with each other.

Yet another county has figured out you actually need to work on both. Hardly voila but pretty sensible!



Anonymous said...

This article again mixes up those most basic definitions.

First if calls its system an EHR. The DMP is initially a patient entered health record. This is usually called a Personal Health Record (PHR).

Near the end of the extract it calls an EHR (SEHR) an EPR. EPR is not one of the usual terms.

All this redefinition of terms really only leads to confusion. David, you blogged about this at some stage. Why can't we get some decent, globally recognised, definitions?

Dr David More MB, PhD, FACHI said...

I agree. They should be talking about a PHR first and an EMR later as terms.(Shared or not to create a SEHR etc is a separate story to a degree).