The relaunch of the regional projects: One step closer to the electronic health record (the DMP)

Régions | 06 Sep 2010
On 9 April 2009, the French minister of health announced that the first national version of the DMP would be deployed in 2010. ASIP Santé gave further details on 11 June 2009, when it set out the terms and conditions for the relaunch of the regional projects. 
Medecin consultant un ordinateur avec sa patienteASIP Santé has been working in partnership with the regions that have already signed an agreement and wish to continue preparing for the arrival of the DMP. The first batch of seven pilot projects, in the Aquitaine, Brittany, Franche-Comté, Île-de-France, Languedoc-Roussillon, Picardy and Rhône-Alpes regions, were granted additional funding via an addendum. These regions were selected on the basis of the results of trials conducted in early 2009, followed by an in-depth audit of each project. Alsace was also granted additional funding through an addendum at a later stage.

A budget of €8.5 million has been set aside for these projects; goals for each region to achieve are set out in an addendum. These initiatives are being funded as part of the creation of France’s digital health environments (ENRS).
The same analysis grid was used for all of the funding requests, to assess the capacity of these experimental projects to create the right conditions for convergence towards the national framework for the deployment of the future DMP. The regions had to demonstrate that they had incorporated the Reference Frameworks Repository (RFR) and were supporting healthcare professionals and patients through the change process.

Four other projects have also received additional funding via an addendum – the French national union for training and assessment in cardiovascular medicine (UFCV), and the Auvergne, Midi-Pyrénées and Provence-Alpes-Côte d’Azur regions. The agreement signed with ADPIM, the French association for the medical imaging health record (a radiology project) will remain in force until October 2010.

Initiated and led by the Regional Union of Independent General Practitioners  (URML), the Alsace project was implemented by the Alsace-DMP Association. This project has been supported from the outset by the regional institutions, and in particular by the regional hospital agency (ARH). In concrete terms, this is a shared medical file service, built on top of an infrastructure developed by Cegedim, the historic partner of the project.
The project aims to optimize the coordination of patient treatment, by using a specific tool (the Alsace DMP), and by ensuring that regional healthcare professionals are involved. Since it began, numerous change management activities have meant that over 300 independent healthcare professionals and two health institutions, including the Strasbourg University Hospitals, have signed up to the project.
After some initial difficulties in mobilizing the stakeholders involved, the project has now entered a phase of substantial growth, which commenced in early 2009. As a measure of the success of the mobilization, all of the stakeholders in the region have now agreed to develop the governance of the project into a wider, stronger framework, by transferring it into the e-health cooperation grouping. This health cooperation grouping (GCS) is intended to be the driving force for the implementation of the regional strategy.
On this basis, a further step has been taken, in conjunction with ASIP Santé, to support the process of convergence towards the national DMP information system, and to prolong the support provided to healthcare professionals, with the aim of facilitating and increasing the use of health records in day-to-day medical practice.

The DMP project in the Aquitaine region is based on the Aquitaine tele-health (TSA) platform, a project designed to encourage the deployment of e-health services among healthcare professionals and patients in the Aquitaine region. With the support of ASIP Santé, a TSA team was put together to coordinate the actions required for the DMP to be deployed in Aquitaine. The objective is to consolidate the use of the DMP by encouraging the stakeholders in the healthcare chain to share files continuously and to set up a mechanism that complies with the RFR. By the end of 2009, 323 medical professionals and 10 health institutions were participating in the Aquitaine DMP project. Over 18,000 DMPs have been created.

The Brittany region has had an operational tele-health platform since 2004. Accessible over the Internet, the platform provides services for the exchange of medical information. The project uses various existing resources (patient information portals, service portals for healthcare professionals, computerized files within health institutions, etc). A health cooperation grouping (GCS) is managing the project. The objective is to encourage information exchange via secure messaging between hospitals and outpatient services (hospitalization and general practitioner records, and analysis results) to prepare for the arrival of the DMP. 200 medical professionals, 5 health institutions and 2 healthcare networks are involved in the project.

The Franche-Comté DMP project (DMP-fc) incorporates health information from hospitals and local doctors. The second version of a regional tool was introduced in 2002; this DMP project has the backing of the EMOSIST-fc GCS (Franche-Comté health cooperation grouping for the modernization of health information systems and telemedecine), which is working with over 40 healthcare institutions and 23 healthcare networks. This is the only regional shared file that is accessible to patients. The work underway will enable the RFR provided by ASIP Santé to be integrated into the project, by incorporating the national health identifier (INS) and the interoperability framework, and ensuring compliance with the hosting conditions. The aim of this project is to manage the connections between 2,000 healthcare professionals and 19 health institutions.

In the Île-de-France region, the regional association for the deployment of data sharing tools (ARDOC) and the association for the rollout of the DMP in the Île-de-France (AGDMP-IDF) are preparing to roll out the DMP and implement a solution that is interoperable with the national framework. ARDOC is helping medical practitioners to supply data for the future DMP by deploying secure messaging tools. AGDMP-IDF is helping institutions to prepare to communicate information via secure messaging and to supply information for the DMP. AGDMP-IDF is continuing to fulfil its remit to produce DMPs and deploy messaging services in 44 health institutions and healthcare networks. Following a deployment phase involving 1,500 healthcare professionals, over the course of 2010 ARDOC will be integrating the new messaging service launched by ASIP Santé.

The association for the implementation of the DMP (AMP-DMP) in Languedoc-Roussillon aims to implement the DMP in concert with all healthcare stakeholders. Developed after a trial conducted in 2006, the Languedoc-Roussillon DMP project is built around six pathology networks, including a cancer network, and also involves outpatient, generalist and specialist medicine. 3,500 healthcare professionals are expected to come on board. The main objective of the project is to be of use to patients who need a combination of medical services and therefore require coordinated care.

The healthcare stakeholders in Picardy wished to prolong the success of the experimental Picardy health file (DSP) in 2006. The primary aim of this project is to encourage the exchange of medical data between local doctors and hospital practitioners. It is organized around four main elements: a multiaccess platform of shared services; practice management software packages offering connectivity to the DSP; upgraded hospital information systems; and access to the files of ambulant patients. The project leaders are preparing for the arrival of the DMP by providing support to users. The region has put together a team within the Picardy e-health GCS, tasked with deploying the project among all healthcare stakeholders and integrating the national DMP interoperability and INS frameworks. By the end of 2010, it is expected that the project will incorporate 143,000 DMPs, involving 530 general practitioners and 27 health institutions.

The development of the Rhône-Alpes health information system (SIS-RA) platform has accelerated since 2006, due to the activities of the SIS-RA GCS, which is creating tools and connecting local doctors with regional health networks and structures. Within the framework of this project, the shared and distributed patient file (DPPR) offers professionals access to medical data indexed by the platform. Part of the project involves moving towards technical convergence with all the national frameworks established by ASIP Santé (interoperability, INS, etc). The convergence process should be complete by the summer of 2010, and will enable data to be entered into the DMP and the DPPR. At the end of 2009, SIS-RA contained over 450,000 files, and 810 general practitioners had already signed up.

To find out more, see the projects chart