Jacques Lucas: "The objective is to serve the patient"

Points de vue | 21 Jun 2010
The view of Jacques Lucas (CNOM)
Responsible for upholding the code of professional conduct and good medical practice among doctors, the CNOM is actively contributing to the development of principles for exchanging and sharing data with all stakeholders. 

Jacques LucasWhat are the principles underpinning the CNOM's activities in terms of ethics and professional conduct?

Ethics and professional conduct are two distinct but interdependent concepts. Ethics is a set of values shared by healthcare providers in general, and doctors in particular, designed to serve the sick. These values are extremely transcultural in nature, and centuries old. In 1945, the French authorities deemed it necessary to use these ethical values to create a body of rules.

This is the code of professional medical conduct which sets out the duties of the medical profession with regard to the rights of the patient, and also covers the relationship that must be maintained between doctors, and between doctors and other healthcare professionals. It can only be updated by the CNOM, to reflect the social and cultural changes that have affected the profession since the first code was drawn up in 1947. After that, there is a high-level legal consultation with the French Council of State, because the articles in the code of professional conduct are incorporated into France’s public health code, and are then subject to a decree from the Prime Minister. It's too long to go into in depth.

What I will say is that medical confidentiality, which was enshrined in the code in the interests of patients, is a central value in medical practice. Confidential medical information has to be shared increasingly frequently, because of the growing complexity of healthcare and the need for the various healthcare providers to cooperate with one another. As such, information systems must guarantee that the patient's confidential personal data is protected, whilst keeping track of the people who have entered or read it. 

What guarantees do you expect from ASIP Santé?

The CNOM has been thinking about bringing health information systems into medical practice for many years. Which is why we are developing a doctrine to safeguard the quality of healthcare, based on the principles of pragmatism and responsibility. We are also drafting a report entitled "The computerization of medical data: creating trust". In consultation with the CNOM, ASIP Santé must create a Reference Frameworks Repository (RFR) to ensure that information is exchanged securely, which is essential, both in terms of IT and professional conduct.

It needs to educate patients and doctors, and emphasize how important that education is when it comes to protecting freedoms and providing secure healthcare. And if people fail to abide by the rules, when they are punished the authorities must make an example of them, although these cases are bound to be rare. This combination of pragmatism and rigour will create universal trust. Health information systems must be configured in such a way that it is possible to find out who has had access to which data, and when, and whether they were actually authorized to access it, in all health and medico-social sectors.

How are you working with ASIP Santé?

Very actively, and we would like to do even more. For example, we are awaiting publication of a guide to methods for acquiring patient consent, which we have worked on with the French health associations group (CISS) and France's data protection commission (CNIL). The idea is to simplify and homogenize the procedures. The CNOM representative should be chairing the ethics and professional conduct council provided for in the ASIP Santé constituent agreement. All of this means that we have a great deal of work ahead of us.

We are also involved in other ASIP Santé projects and are fairly confident in the strategic choices that have been made so far, which should take shape in the months to come in areas like the exchange and sharing of health data, and telemedicine. The objective is not simply to set up health information systems, but to serve the patient and to help improve the quality of medical practice through new technologies.

Jacques Lucas, Vice-president of the French medical association (CNOM), and head of health information systems.