With the DMP, patients take control of their healthcare
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
Patient web access: further advancing patient rights
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.