The DMP : a project that is structuring the development of e-health in France

DMP | 21 Jun 2010
Created by the law of 13 August 2004, the electronic health record (DMP) is a service designed to help improve the coordination, continuity, and therefore also the quality of healthcare. For the DMP to be constructed and deployed successfully, a diverse range of issues need to be resolved – from the interoperability and security of information systems, to the organization of regional project management, and, in a wider sense, the involvement of all the stakeholders concerned. The interdependence of the various elements, and the challenges associated with the development of e-health in France, mean that the DMP is bringing structure to the gradual development of a coherent e-health "ecosystem". This is an overview of the stages and stakeholders involved in the ambitious project.

The DMP is a set of services enabling the patient and the healthcare professionals authorized by that patient to share, in electronic form, health information judged to be useful and relevant for improving preventative treatment and the continuity, coordination and quality of care. A personal, shared record, it can be accessed from anywhere in France, at any time.
Here we set out the services offered by the DMP, and the stages in its construction within the framework of the first version, which will be operational by the end of 2010.

A relaunch based on experience

The subject of trials in 2006, then a call for projects in 2007, the DMP has faced difficulties caused by its environment : information systems that could not share data; insufficient development of hospital care provision information systems; compartmentalization of healthcare organization; disparate, non-cohesive products on the market; fragmented governance in the form of multiple stakeholders, etc.

Having had various investigations conducted on the subject (the report by the inspectorate-general of finances – IGF, the inspectorate-general of social affairs – IGAS and the general council for information technologies – CGTI in November 2007, and the Gagneux report in May 2008), Roselyne Bachelot-Narquin, Minister for Health and Sports, decided to relaunch the DMP and the shared health information systems, and get involved in the changes needed to support the relaunch, which she announced at the conference on 9 April 2009 on this very topic. Most notably, she placed the development of the DMP in the context of renewed governance (simplification of the way in which public projects are managed and organized, and the creation of regional health agencies) by associating it with the wider realm of shared health information systems.

As part of this approach, the creation of ASIP Santé (the shared healthcare information systems agency) responds to the objective of creating and implementing the right conditions for deploying shared health information systems in coherence with a national framework : interoperability frameworks reference standards, the national health identifier (INS), mobilization of the stakeholders, support for users, etc.

Therefore, the development of the DMP can now be viewed as part of a clearly defined trajectory which involves its partners and takes account of the results of trials.

The involvement of private and public e-health stakeholders…

Software developers are heavily involved in this process, participating in joint discussions to drive the gradual construction of an interoperability framework forward. This framework is necessary for the development of a solution that is coherent and provides added value services for healthcare professionals.

Software developers have also participated in a working group alongside France's data protection commission (CNIL), the French national health insurance fund for salaried employees (CNAM-TS) and the Ministry for Health, on the subject of the National Health Identifier programme.

In parallel, cooperative partnerships are being forged with institutional stakeholders:
  • ASIP Santé and the French agency supporting the performance of health and medico-social institutions (ANAP) are pooling their competences to support the modernization of information systems for health institutions.
  • The French national cancer institute (InCA), the French general medical service (SFMG), the hospital-at-home organization (FNEHAD) and the French institute for public health surveillance (INvS) are working with ASIP Santé to develop services that are tailored both to the new working methods for healthcare professionals and to specific public health objectives.

Crucial to the construction and deployment of health information systems, local project management teams, supported by the regional health agencies (ARS), are being urged to give further structure to their projects and acquire the resources that will allow them to organize the deployment of the first version of the DMP (at the end of 2010) and to trial specialized services. Their activities are being conducted within the framework of the new  Regional Digital Health Environments (ENRS).
A new framework for governance and project funding has also been put in place by ASIP Santé, which takes account of the new scope of action proposed by the law on hospital reform and on patients, healthcare and the regions (HPST). The aim is twofold: firstly, to extend the range of subjects handled; and secondly, to specify and narrow down the level of supervision and monitoring required for these projects.

…in the improvement of healthcare organization

Healthcare professionals have high expectations and their involvement is commensurate with the public health challenges, and also with their questions about changes to their working conditions. They are demanding more time to do their jobs. It is important to take this demand into account by providing them with tools which will save them time while improving the conditions in which they practise medicine (access to relevant information at the right time).

Consequently, numerous projects are underway: medical summaries (status, production conditions); access to health information managed within networks (such as the shared oncology record – DCC, or diabetes); the framework for and status of telemedicine activities; the transmission of biology test reports; hospitalization reports (production and transmission); the development of software packages for doctors' surgeries (more than double data entry, integration of tools to assist decision-making), etc.

These require changes to the organization of and legal framework for the delivery of care, intense involvement in the leadership of health institutions, training activities for healthcare professionals and proper mobilization of software developers.

Patients, who increasingly want to take responsibility for their own healthcare, will also take responsibility for their DMP, insofar as they will consent to its creation and control the conditions for accessing it. The associations that represent patients, by getting involved in the governance of ASIP Santé alongside representatives of healthcare professionals, will ensure that their rights are upheld during the construction of the future DMP in particular, and all shared health information systems in general. Which is why patient representatives have participated in a working group alongside professional associations, the French medical insurance scheme, the CNIL and ASIP Santé, to draft a practical guide to patient consent.

The DMP, designed for all patients and to improve the quality of healthcare, will therefore be constructed gradually – in stages, with the results of consultation and trials taken into account. It acts as a natural catalyst for the modernization of the French healthcare system and the quest for greater efficiency within it.