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- Smart Healthcare, Wednesday 21 October 2009 09.00 BST
Working at a higher level: France's revised DMP record scheme will take more account of patients and doctors. Photo: jiunlimited.com
France's troubled programme to create a lifelong electronic medical record has been revived under a new drive towards implementing e-health, initiated by the Sarkozy government. A new agency, ASIP Santé (agency for shared information systems in healthcare), led by the Ministry of Health and Sports, will bring together all parties involved in e-health in France.
ASIP replaces three former agencies, giving a sharper focus to the national healthcare IT programme, which is also benefiting from a hefty injection of central government funding.
ASIP's main focus will be to relaunch the DMP (Dossier Médical Personnel), a lifelong shared electronic record. It will attempt to assuage critics of the five-year-old scheme by giving patients control over access to their electronic records.
However the DMP will be only part of a programme that points to a greater emphasis on e-health by Roselyne Bachelot-Narquin, secretary of state for health in the Sarkozy government. Under a EUR10bn (£9.1bn) national initiative called 'Hospital 2012', EUR1.5bn is ring-fenced for healthcare IT. Suppliers are expecting a spate of procurements by regional hospital consortia.
ASIP Santé's states its objectives as follows:
- Implementing a general heath information infrastructure, addressing medical, technical and legal requirements, and promoting its use;
- Creating and setting standards for security and interoperability, both technical and semantic, for domestic and international use;
- Designing and deploying shared healthcare IT systems such as the DMP, leading initiatives in telemedicine, and monitoring outbreaks and offering support through both surveillance and alert programmes to national public health organisations;
- Facilitating and increasing the use of IT systems in health and the wider medico-social sectors, both for healthcare professionals and the general public.
The agency's founder members are the Ministry of Health and Sport, the CNAMTS national health insurance agency for employees and a public investment company, Caisse des Dépôts et Consignations.
The initiative is interesting because, despite the high profile of its pioneering SESAM-Vitale health smart card scheme, now in its fourth version, France has not been a major actor on the European healthcare informatics stage.
One reason is the highly charged political and professional controversy created by the introduction of national IT systems. Although the SESAM-Vitale system has successfully automated reimbursement transactions at GP level, through which medical professionals reclaim fees from insurers, many clinicians remain suspicious of a scheme introduced at a time of headlong confrontation between the government and health professionals.
The DMP, likewise, has a troubled history. When it was originally announced in 2004 as a lifelong record accessible by clinicians, an overt aim was to control rising costs by cutting the number of unnecessary or repeated tests and procedures. Opponents claimed that this was an attack on clinical freedom. The EUR1.5bn project also became embroiled in rows over confidentiality and consent. Last year, the National Ethical Committee warned the ministry that the project would fail.
ASIP Santé says that lessons have been learned. An interesting feature of the relaunched DMP is that citizens will be able to retain their existing choice over who holds their main record, with only indexing and demographic information held centrally.
The programme begins with at least two advantages over England's National Programme for IT. First, the political argument has come out into the open before the system's deployment is attempted. Meanwhile the SESAM-Vitale system provides a basic infrastructure for authenticating patients' identities and handling contents. The Vitale 2 version of the card, to be deployed in earnest next year, will enable clinical data to be loaded up to the DMP.
However, like the English national programme, much will depend on the acute sector's ability to implement electronic patient records. Progress appears to be accelerating following health reforms which provide greater regional autonomy. For example, six hospitals in eastern France's Franche-Comté region are implementing Cerner's Millennium on a centrally hosted infrastructure. All six have deployed scheduling and radiology systems, with implementation of a full electronic medical record (EMR) system, including electronic prescribing, at one. Meanwhile in Valenciennes, in the north of the country, a single Cerner EMR is planned to serve 13 facilities.
"We feel quite good about the marketplace, in particular regional procurements will happen," Bruno Slosse, vice president and general manager, Cerner France, said.
