With the DMP, patients take control of their healthcare

Le Mag Article | 23 Jul 2012
In addition to enabling healthcare coordination between various healthcare professionals, the DMP (electronic health record) gives patients new rights of access that they have never before had in healthcare. This makes it the most visible symbol of a new patient concept. A combination of a demand for basic rights to information and patient empowerment*, the DMP, and e-health in general, represent a new paradigm, where patients are no longer an onlooker but an active player in their own healthcare.

The origin of the DMP: patients want to access their health records

Established by the French law of 13 August 2004, the DMP (electronic health record) had its beginnings in the 1990s when society and patient associations made it known they wanted more control over their health records. This demand grew with the development of the Internet and the appearance of the first electronic medical files. Medical bodies also felt they needed to respond to calls to improve healthcare quality. Having medical files should enable a better transfer of information between healthcare professionals. While awaiting new ways of managing healthcare, much thought went into the quality of doctor/patient communications, allowing the process to become more transparent and fluid in response to patients being better informed.

In France, one document will place the patient at the heart of the health system: the law of 4 March 2002 relating to patient rights and healthcare quality. It introduces the right for all people to have direct access to their health records. This law was in response to the 1998/1999 Etats Généraux de la Santé (national French healthcare management convention), which at that time put the focus on information and transparency in the health and health education systems.

Health education and patient empowerment: better-informed patients are healthier patients

Apart from patients' legitimate desire to access their personal details, the DMP forms part of a new approach for managing patients and public health in general, resulting from the idea that better informing and involving patients can help them take better care of themselves. This idea can be linked to the concept of "patient empowerment" which was originally developed in British and American universities and has grown in importance in European public health policies. Put succinctly, it is about increasing patients' involvement in their treatment through educating and informing them about their illness. Even though approaches and definitions may vary between researchers, all agree there is a benefit which goes beyond that gained by simple risk prevention. In fact, empowering is more than just informing. If patients are closely associated with their treatment, it gives them greater appreciation, grows their self-esteem and helps decision-making. For some psychologists1, empowerment is even a process of negotiating reality that helps patients face up to their situation and prevents demotivation, hopelessness, victimisation and ultimately renunciation, which can sometimes hasten relapses in the case of serious chronic illnesses.

With the DMP, patients take control of their health

The DMP has enabled a space to be set up for sharing and exchanging medical data in order to facilitate cooperation between healthcare professionals. Patients who are better informed and more involved in their care can better follow their treatment.
Among the DMP services which aim to facilitate patients' lives by making them players in their own healthcare, automatic vaccination reminders and prescription histories are already in use. Furthermore, just like any IT system, the DMP is continually evolving and integrating new features. As such, prevention applications such as automatic screening and examination, and complication prevention reminders, as well promoting self-monitoring (such as diabetics monitoring their own blood sugar levels), are currently being studied for future versions of the DMP.

Patient web access: further advancing patient rights

In order to make the right to personal health information and the right for everyone to have direct access to their personal health records a reality, an Internet DMP portal called "patient web access" has been created by ASIP Santé (the shared healthcare information systems agency).
In fact, as patients are considered account holders of their DMP, they need to be able to directly access their file. Patient Internet access was launched in April 2011, allowing DMP account holders to directly access the information and documents held in their files, which either they or authorised healthcare professionals have added to.
Using this tool, DMP account holders are equally able to view records of actions taken on their DMP and can therefore verify that access is legitimate. Patients are therefore "masters" of their files. This is one response to problems patients may encounter in exercising their rights.

A summary of patient web access features

With Internet access, patients:
  • can directly access their DMP using: (login name + password + single use code);
  • can view all documents except those deemed to be sensitive by their authors (exceptional cases requiring a consultation to advise of this);
  • can view the log of actions in and access to their DMP; 
  • can mask documents or request a healthcare professional do this: the document remains visible to the patient, its author and the treating physician;
  • can add any information they deem to be useful for their care to their personal expression space;
  • can manage their DMP access authorisations: consult the list of authorised professionals, block those they do no longer wish to authorise, specify their treating physician and oppose access in emergencies (SAMU - emergency services - and "break the glass" situations);
  • can request a copy (CD-ROM or printed) of their DMP;
  • may request the destruction of a document;
  • may close or request the destruction of their DMP.

1- Eliott T.R. et al, (1991), Negotiating reality after physical loss: Hope, Depression and Disability, Journal of Personality and Social Psychology, 1991, Vol. 61, n° 4, pp 608-613.
Source: http://www.uclouvain.be/cps/ucl/doc/reso/documents/dos18.pdf

*Patient empowerment : Education du patient