The shared oncology record (DCC): first record for a specific condition in the DMP
Points of view | 15 Mar 2012
Point of view by Agnès Buzyn, chair of INCa.
Feedback on a partnership that will enable the DCC to be rolled out generally in 2013.
Why is the DMP the best vehicle for the DCC?
• The electronic health record (DMP) is the only patient record to be enshrined in the legislative framework. It is a general tool, which covers all types of disease, and involves individuals in the management of their own care pathway, and simplifies management while ensuring professional confidentiality and patient privacy.
• Oncology has been part of this change. The shared oncology record and the DMP are first and foremost both designed to be tools for individual patients, with the aim of improving care quality and promoting co-ordination and the exchange of information between healthcare professionals who are granted access to these records by the patients themselves. It seemed more useful to make the DCC the "oncology" part of the DMP, rather than having them as competing systems.
From 2007, in order to facilitate this co-ordinated development of the DCC and the DMP, INCa began to work more closely with the public interest group responsible for the DMP (GIP-DMP), and signed a partnership agreement to this effect. Then in December 2009, INCa signed a partnership agreement with ASIP Santé for the development of the DCC, and the national DCC/DMP framework was published as a result of this.
The DMP offers the DCC:
- a robust legal framework, relating to (for example) confidentiality of health data;
- optimal security in data hosting; and
- a technical solution, in particular a definition of interoperability requirements.
To what extent will the DCC change cancer management? What advances have occurred with the implementation of the DCC in 2011?
• The DCC was an aspect of the 2003-2007 Cancer Plan, and began with four regional trials in 2004(1) and resulted in the production of a set of specifications in 2006 with a view to rolling it out generally. It was designed as a patient-centred specialist tool dedicated to the sharing of information between those involved in oncology care, in order to improve co-ordination, particularly with general practitioners, and ensuring continuity of care for cancer patients, during and after the acute phase of treatment.
Currently, the DCC, which is promoted by regional oncology networks (RRC)(2), together with regional contracting recognized by the regional health agency (ARS), is ahead of other "specialist" records that deal with various conditions, in terms both of creation and of the level of organization that is essential when implementing this type of record.
A particular advance seen with the DCC is the regional process that has led to the development of standard practices. This has been achieved by providing ongoing support for RRC co-ordination teams, with close contact with users. This close support is a driving force behind the rollout of the DCC/DMP. The first shared oncology document was the record of the multi-disciplinary team meeting (RCP), for which the minimum requirements(3) were defined by INCa and implemented within healthcare facilities by RRCs. In addition to the RCP record, other documents are starting to be shared in oncology, for example results of anatomical pathology and cytopathology tests and the personalized care programme (PPS).
• The DCC is a tool that is offered to patients with cancer, and is particularly useful for developing information sharing between healthcare professionals who manage such patients, improving care quality and safety and avoiding duplication of effort.
What do you expect the outcome to be in the seven pilot regions in which rollout of the DCC is being trialled? How has the initial feedback from this experience been?
Before the general rollout of the DCC/DMP, which is planned for late 2013, a pilot phase was carried out by INCa and ASIP Santé in 2011-2012. Seven regions volunteered to take part: Alsace, Aquitaine, Lorraine, Midi-Pyrénées, Pays de la Loire, Picardie and Rhône-Alpes. Exchanges between these regions and ASIP have been very productive; for example, they have enabled the RCP record to grow.
The pilot phase should enable:
- joint work to establish principles underlying the DCC service, in connection with the DMP;
- checking and finalization of technical and organizational aspects;
- rollout of information sharing to the whole of the cancer care network, via the DMP;
- preparatory work for this service to be rolled out into non-pilot regions. The results of this phase will establish the procedures for future rollout of the DCC.
The French National Cancer Institute (INCa), the national agency for the medical and scientific study of cancer, was created under the law governing public health dated 9 August 2004 to co-ordinate cancer care. INCa has implemented the Cancer Plan, and leads 63 of the 118 projects that are part of this plan. It promotes co-ordination between those involved in cancer care, produces expert reports, supports research and innovation in order to quickly translate scientific advances into benefits for all patients, and produces reference information regarding cancer and oncology. www.e-cancer.fr
(1) Aquitaine, Basse-Normandie, Pays de la Loire, Réunion.
(2) The promotion of communication tools in the regions, including the DCC, is one of the missions of the RRCs, as defined in an ad hoc reference standard attached to the DHOS/CNAMTS/INCa circular dated 25/09/2007.
(3) These are needed in order for doctors from different disciplines to create a treatment plan for the patient.
Extract from the ASIP Santé's Annual Report 2011.
Extract from the ASIP Santé's Annual Report 2011.