The DMP service: controlling costs for a key public health issue

Politique publique | 01 Oct 2012

Following the many stories in the press regarding the summary report from the Cour des comptes on the cost of the electronic health record (DMP) service, ASIP Santé's leadership considered a response necessary to shed light on this complex subject that has implications in multiple areas. It is a subject that deserves proper, informed discussion.
ASIP Santé today asked for the full court of auditors report to be made public. This report is an objective view of the real costs of the DMP service since its inception, and makes the distinction between the design and rollout periods.

The report states, correctly, that the cost of this type of public health project requires significant political will which, according to members of the court, appears to have been lacking, given that the implications for other information systems are fundamental and wide-ranging.

The court also criticizes the reticence of some regions and bodies, which continue to use public funds to develop their own competing systems, despite the express wish of the legislature.

Main sections of the report

The first part of the report estimates the total cost of the DMP between 2004 and 2011 at 210 million euros.

The experimental work done by the DMP public interest group (GIP), which was created for this purpose in 2005, continued until 2009, at which point ASIP Santé, which had taken over GIP-DMP's work from July 2009, either had to stop the work or merge it with the current DMP scheme. 100 million euros were spent during this period, which is described by the court as the "research stage". Although it was not possible to introduce the DMP in a sustainable way during this period, this phase did enable "legal, organizational and technical problems" to be clarified.

The new system was successfully set up by ASIP Santé in 2010 and is currently operational. This required investment of 95 million euros, which primarily went towards the cost of building the system, development and rollout. These costs are entirely consistent with the costs of similar computer systems, and are public knowledge, as they are published each year in ASIP Santé's annual report.

The court rightly stresses the reduction in resources allocated to the project, even as its oft-delayed rollout finally began. This is far from the trenchant criticism that some commentators are seeing in this report, and reflects the effect of the partial public spending freeze seen in France in 2011. This was at a time when ASIP Santé was becoming responsible for an increasing number of projects in addition to the DMP service.

The second part concerns hospital computer systems (computerized health records) designed to exchange data with the DMP :

Healthcare facilities in France spend around 1.2 billion euros each year on IT. The estimate of 500 million euros as the cost of patient records and national systems such as the health insurance reimbursement history are in no way linked to the costs of the DMP, although the court does seek to emphasize the lack of guidance provided by the state.

The third part examines the factors that are generating uncertainty about the costs of the DMP service :

The difficulties inherent in carrying out reliable economic evaluations in this area of healthcare IT are well-known, and feedback will need to be provided. There is still a clear need for improved consistency in policy, which should be created in close consultation with those involved in the sector, including (for example) incorporating the DMP service into the collective agreement on medical care and follow-up of patients with chronic conditions.

Le DMP est un facteur de transformation de notre système de santé avant d’être un projet technique et nécessite du temps et de la constance. Tous les pays développés s’y sont engagés et l’informatique de santé doit constituer une opportunité d’excellence pour la France.


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