E-health is a way forward for community medical services
Doctors in private practice are calling for this. The tool will enable them to emerge from isolation and from a situation in which not enough information is shared between generalists and specialists; this problem has become particularly acute at the interface between hospitals and community medicine. It can also help to provide a complete range of healthcare in some sparsely-populated areas, and is an essential tool for modern medical practice.
E-health is created in two stages, through a shared electronic health record and telemedicine.
Implementation of a computerized patient records system has been very complex and difficult, as the various parties involved worked on the basis not of doctors' actual needs but of their own idea of a perfect system. The result was too cumbersome, too complicated, too technical and barely attainable. Even worse: though it started out as shared, the patient record became personal, and it was forgotten that although records belong to patients – and this idea has never been challenged – they remain tools used in doctors' work. In the meantime, pharmacists have successfully implemented their pharmaceutical record system. It is not spectacular, and was developed from the software that is used in pharmacies. Its attractions are that it is simple to use and robust.
The creation of ASIP santé has meant that the electronic health record project has received much-needed impetus. Now that healthcare professionals are being listened to, a constructive process can begin. The electronic health record can only be a success if it is based on software already used by doctors in private practice, with no duplicated entry, and with structured and hierarchical content. The modest contribution of the confederation of French medical trade union (CSMF) has been to trial a summary medical section, with the purpose of including this section in the future DMP.
The new doctors' contract in France, which was signed in July 2011, prioritizes computerization of private practices via performance-related pay. Doctors are carefully considering the benefits of computerization in terms of quality and co-ordination of care. They will need help with equipment and training. The contract thus promotes rollout of the DMP.
All that remains is telemedicine, which is the second stage in the development of e-health, and which in 2009 was defined in French legislation as a separate medical procedure. This process was not sufficiently advanced to be used in insurance guidelines in the new doctors' contract. It will prove essential, though, to introducing an official nomenclature for telemedicine eventually. Four types of procedure have been identified: teleconsultation, specialist care delivery, remote monitoring and remote assistance.
Telemedicine is without doubt one of the ways in which medicine is going. Doctors in private practice already work in this way, using virtual meetings, and such work is based on pooling of technology and remote specialist care delivery. They are ready to go further.
Telemedicine must be built in stages, by developing tools and systems that are rationally designed and interoperable, and that are part of an integrated care system. Particular care should be taken to avoid the one major pitfall that has already been seen in some trials: the danger of diverting all care pathways to hospitals. The system must be set up with full involvement of doctors in private practice, and must not be left solely to regional health agencies (ARS), which are sometimes unthinkingly hospital-centric.
With the advent of e-health, the concept of community care is being fundamentally reconsidered, and those who wish to practice medicine without geographical limits have new resources to draw upon.