France's Electronic Health Record - the Dossier Médical Personnel

The centre-piece of the French healthcare IT programme is its national web-based EHR programme, the dossier médical personnel (DMP), to be delivered through six regional consortia.

As well as delivering patient care and patient safety benefits the French government has estimated that that the DMP will cut fraud and save the state Euros 2-3bn per year.

The government allocated Euros1.3bn to the programme in 2006, up from Euros 1.1bn in 2005. However, according to the forecasting institute OPECST, the cost of rolling out the DMP throughout all French hospitals and general practice surgeries may actually exceed Euros 10bn.

The DMP is currently still at the prototype and testing stage. The government aims to roll out the system nationally in 2008.

Three main agencies responsible for DMP

The DMP is administered by a central government agency, the Groupement d'Intérêt Public dossier médical personnel, or GIP-DMP, responsible for planning the programme, selecting vendors and supplier management.

In addition the DMP is also overseen by the National Council for Information and Liberty (CNIL), a government body concerned with civil liberties and data protection.

Finally, in addition to GIP-DMP and CNIL, a third agency, the Groupement d'Intérêt pour la modernisation du système d’information hospitalier (GIP MISH) coordinates at a national level the modernisation and adaptation of hospital information and patient information systems to ensure they meet the national DMP interface standards.

Patient confidentiality

The DMP has been the subject of controversy in France, with an appeal to the Council of State to declare it unconstitutional. The Council rejected the claim, but the government has instituted greater safeguards subsequently.

Clinicians cannot access a patient’s overall medical record. Each health professional is only authorised to view areas strictly relevant to their professional interests. This authorisation is contained in the clinician’s CPS card, which must match the authorisation levels and codes held in central security servers.

Implementation of a regional EPR, accessible through Web services, will be the responsibility of the regional ARH agencies.

DMP Consortia

There are six major consortia involved in the French DMP programme.

They are:

• Cegedim, Thalès

• D3P (RSS, Microsoft, Medcost / Doctissimo)

• France Télécom, IBM, CAP GEMINI, SNR

• InVita, Accenture, La Poste, neuf cegetel, Intra Call Center, Jet Multimedia, Sun microsystems

• Santénergie (Siemens, Bull, EDS)

• Santeos (Atos, Unimédecine, HP, Strateos, Cerner)

Links on French DMP and ehealth programme

http://www.sante.gouv.fr/assurance_maladie/actu/dmp.htm

Ministry of Health

http://www.d-m-p.org/

GIP-DMP

http://www.cnil.fr/

CNIL