Sunday, April 09, 2017
We Have Been Fibbed To! A National myHR Like System Has Just Failed And Seemingly Been Abandoned!
This appeared while I was resting!
The idea of a ‘dossier médical personnalisé’ (DMP, or electronic health record) for every French citizen was first inaugurated in 2004. Now, over 10 years and €500 million later, we can look at the pros and cons encountered during this still incomplete journey and consider if similar projects would be a useful addition to healthcare administration in other European countries, or not.
Report: Jane MacDougall 16/03/2017
The main DMP aim was that all doctors involved in a patient’s treatment would have immediate access to a complete medical record, to avoid repetition of investigations/prescriptions or risk from overlooked illnesses etc., which can occur when relying on an oral medical history.
Also wanted: Faster exchange of secure information between the various healthcare structures involved in a case e.g. an in-patient having exams in different locations. Another long-term aim was to use the information collected for epidemiological and eco-epidemiological syndromic surveillance to help in the early detection of health problems, as has been the case in the USA from 2013-2014.
A brief history
As early as the 1960s, when the potential power of computing first became apparent, the idea was postulated to digitise medical records as a means to help in population healthcare. However, it was not until 2004 that the French health minister, Philippe Douste-Blazy, launched the DMP as a fully-fledged two-year project to ensure the transfer of medical information between healthcare providers, which he declared would result in €3.5 million annually saved from wasted examinations, prescriptions etc.
Nonetheless, the experiment, which had included, private doctors, hospitals, healthcare networks, and allowed them access to computerised medical notes, was legally terminated by the end of 2006. In the audit of this failed attempt it was decided that any such development had to be considered as a long-term commitment and could not be implemented precipitously. The objectives had to be reconsidered.
Thus, in 2009, it was announced that a new DMP format would be launched in 2010. Online in December 2010, from the 5 January 2014 all French citizens with a Social Security number would be able to create their personal medical dossier. By 2012 the programme still had not met its objectives with only 6,000 medical professionals using the system.
In 2014, Marisol Touraine launched the Second Generation DMP that would be administered completely by Social Security. According to the Health Law of 20 January 2015, the DMP now known as the d’ossier médical partagé’ (shared) will be accessible to all chronically ill and their healthcare professionals in order to share the entirety of the patient’s medical history.
How it should work
A DMP can be created at the demand of a patient, doctor or healthcare provider. In the latter two cases the patient must be informed and their consent received before the record is created. To create a DMP, the healthcare provider or doctor needs compatible software, or to connect to the dossier via the internet. Patient access is by internet only. The dossier belongs to the patient and they control the healthcare provider’s access to it.
Any patient with a ‘Carte Vitale’ and a national social security (SS) number can create a dossier. A doctor or healthcare provider has to be registered with a smart card and know the patient’s SS number. Patient secure access depends on their SS number and a password via a protected HTTPS site. All data are stored in France.
----- Gory details of the failure omitted! Read at your leisure.
Whatever the future of EHR in Europe, one important thing to consider is cost. By January 2015, only 500,000 dossiers, (many of which are empty!) were opened in France, for an average cost of €1,200 each. This is 10 times higher than the original estimates.#
Here is the link:
Remember, this is a record created for a country of about 65 million people which somehow – despite two (or was it three) attempts – achieved only 500,000 users - and which really has to be said to be a comprehensive clinical and technical failure.
The similarities to the myHR as truly amazing so we now know that the real reason for all the forced adoption and opt-out is at least – in part – due to the abject failure of an opt-in system which was quite similar to the myHR.
In summary, the lesson from all this is that a national system such as this and the myHR are not attractive to the public and despite huge expenditure have a very high risk of failure.
Maybe we (and the ADHA) need to look at other strategies and architectures – once we have some clarity about what the ADHA is really wanting to achieve, which beyond the motherhood statements, is not all that easy to discover. A major rethink certainly seems to be what France is doing.
Turns out there are serious lessons to be learnt from overseas – I wonder why these are not better known?
Posted by Dr David More MB PhD FACHI at Sunday, April 09, 2017