Speech by Roselyne Bachelot-Narquin Minister of Health and Sports - Bordeaux, 22 July 2010

Politique publique | 15 Sep 2010

Speech by Roselyne Bachelot-Narquin

Minister of Health and Sports

-Thursday 22 July 2010-
at 2.30pm
Subject to pronouncement
The Chief Administrative Officer, Mr Dominique Schmitt, 
The Director General of Care Provision, Ms Annie Podeur, 
The Director General of the Aquitaine Regional Health Agency, Ms Nicole Klein, 
The President of ASIP Santé, Mr Michel Gagneux, 
The Director of Aquitaine Telehealth, Ms Noëlle Saint-Upéry, 
Ladies and gentlemen,
Proposing care paths that are less compartmentalized and better coordinated, to better meet the needs of the French population, has been one of my health policy priorities for the last three years.
The law on hospital reform and on patients, healthcare and the regions was designed for this purpose, and is an important stage in the development of medical practice, reframing the relationship between patients and healthcare professionals that lies at the heart of the healthcare system.
In the collective unconscious, and in reality, medical care and treatment are still often thought of as the only time that doctor and patient get to talk to one another alone
I cannot stress enough how essential this time is, and will always be, for the treatment of sick people. 
This is the crux of it all: the relationship of trust that each of us has with our own doctor. 
But in order to be fully effective, doctors increasingly need to be able to exchange and share information. 
The rise in the use of technology in medicine means that interprofessional cooperative arrangements have to be developed. These arrangements are an essential means of improving the quality of healthcare, as has been proved, for example, by the widespread use of multidisciplinary consultations in cancer treatment. 
These practices also respond to the aspirations of doctors, who are increasingly expressing their reluctance to deliver healthcare in isolation.
Yet these far-reaching changes to our healthcare system cannot be achieved without the significant benefits provided by information systems.
These technologies must in future offer new services for our health needs and help to improve the service provided to users, to ensure easier access to healthcare of identical quality throughout the country. 
It was on the basis of these convictions that I relaunched the electronic health record project in June 2008. 
The DMP is the foundation for these new practices, which our healthcare professionals are awaiting, and for a guarantee given to our fellow citizens – to have permanent access to their medical data. It is a major public health project, and I am extremely attached to it. 
I made a commitment to launch the DMP in 2010, and I will honour that commitment.
We are just months away from rolling out the first version.
This is why I wanted to give an overview of the DMP here, in Aquitaine, one of the regions that has been on board since this project began, and has persevered in spite of the obstacles along the way. 
So I would like to take this opportunity to congratulate everyone who has worked on this pilot project in Aquitaine. The various presentations we have just seen are a good illustration of just how much investment it has required.
As soon as I took on this role, I emphasized that the launch of the DMP would involve three essential strategic elements
  • Reinforcing the management of the project;
  • Creating the necessary conditions to guarantee the interoperability of the tools and the security of the data;
  • And finally, making the DMP part of a trajectory that allows new services to be continuously trialled, for both healthcare professionals and patients.
These three elements have acted as a common thread between all of my activities.
In terms of project management, first of all, as per my commitment, ASIP Santé was set up in 2009, and now has a wider scope of responsibility for health information systems. In just a few months, it has become a key player and is highly reputed. 
Here I would like to pay tribute to the remarkable work it has done under the aegis of its president, Michel Gagneux, and its director, Jean-Yves Robin. 
It was also vital to facilitate the mobilization of the stakeholders, particularly on the ground, and to do this in a coordinated way. 
This is why I wanted a joint partnership to be put in place between ASIP Santé and the regional health agencies in every region.
With this aim in mind, contracts worth over 4 million euros are currently being signed between ASIP Santé and each region, under the aegis of the regional health agencies. 
Beyond the institutions, the necessary technical conditions for the DMP have also been created. 
Over the last few months, ASIP Santé has been working hard to create the conditions that will make the DMP a success, particularly by:
Publishing the first interoperability framework for all health information systems, after consulting with all of the software developers involved; 
Defining a national health identifier which is already being used in several projects as it is here, in Aquitaine;
Implementing provisions covering data hosting approval. More than a dozen candidates have been assessed, and I have already approved eight companies. This is an essential measure which guarantees that the storage of citizens' data will be fully secure.
Security is the motivating factor for numerous projects – most notably a new health professional card which will be ready in January 2011. However, this card alone cannot meet all security needs, be they related to the DMP, to telemedicine, to hospital files, to doctors' surgeries or even to medical services for out patients. 
All citizens must be entitled to know with certainty who is able to access their medical file and be entitled to block access to it if they so wish. It is their right, and I am convinced that this is one of the guarantees that will make the DMP a success. 
The third strategic choice I wanted to mention to you is making the DMP part of a trajectory which ranges from trialling new services within pilot projects to the rollout of these services.
The regional pilot projects have been relaunched within a renewed framework created by ASIP Santé, and I would like to thank the main regions who have conducted them.
These projects, in Franche-Comté, Picardy, Rhône-Alpes, Alsace, and of course here in Aquitaine, have demanded a great deal of work and the mobilization of both volunteer healthcare professionals and patients, all centred around teams that are directly in charge of each regional project. 

Over a million DMPs have already been created. 

These pilot projects have directly helped to define the national DMP, the first version of which will be ready at the end of the year. These projects have blazed the trail. 
A new and decisive stage is now beginning for the DMP. This December, the DMP will be launched right across France, and this rollout will continue throughout 2011. 
Patients will have direct access to their DMP via the Internet. Direct access will be rolled out progressively during 2011
In concrete terms, this first version of the DMP will present the electronic health record in the form of documents, and will gradually be supplemented by other data such as: 
  • Medication prescribed, using information from the pharmaceutical record;
  • Radiology reports;
  • Biology test results;
  • Hospital reports;
  • Significant outpatient treatment activities. 
From the outset, this medical record will also give an overview of the patient's care path, enable access rights to be managed, provide alert services when new documents are entered into the DMP (which the doctor may or may not choose to activate for certain patients), include the patient's wishes with regard to organ donation, and more.
All of these services will be supplemented progressively from 2011 onwards, via a gradual structuring of the data. A secure correspondence service between the patient and the healthcare professionals that patient has authorised to access the DMP will also be trialled. 
Each patient will therefore be able to access their own medical file and each healthcare professional will be able to create DMPs for their patients, add information into them and consult them.
Our fellow citizens will be given clear and complete information. All they will need to do is give their consent for the creation of their own DMP, and then give their consent for the health institutions and healthcare professionals treating them to access it.
Patient consent will be in electronic form and certified by the healthcare professional, thus paving the way for the future when patients will be able to open their own DMPs further down the line.
By the same token, patients have the right to access their medical files, although this right is often extremely difficult to implement. Thanks to the DMP however, via a simple click, this right will finally become a reality.
But also, and most importantly, I want to develop new services, which will be trialled by some people at regional level. The services could include: 
  • For patients: automatic reminders about vaccinations, screenings, examinations, or the prevention of complications; and services that encourage self-monitoring (for example encouraging diabetics to monitor their blood sugar levels); 
  • For healthcare professionals: giving hospitals the ability to notify doctors when their patients are admitted to or discharged from hospital. 
There will also be trials on DMPs for children, follow up care for diabetics, coordinated cancer care, and even electronic prescriptions.
This list of services that will be linked to the DMP is not exhaustive – in fact it needs to be supplemented, and priorities will have to be established with the input of healthcare professionals and patients. For example, I will be heavily reliant on doctors becoming more involved in the treatment of cancer patients, to the extent that they will be able to access elements of the oncology record; other examples are the development of personalized care paths and telemedicine. 
The DMP will play a key role in the development of all cooperative practices and, from 2011 onwards, will be an indispensable service for healthcare groupings and multidisciplinary health centres.
The success of the DMP cannot be assured by decree: it has to be responsive to the needs of healthcare professionals and patients, and be continually adapted as those needs evolve.
Thank you.