EHR : THE FRENCH «DOSSIER MÉDICAL PERSONNEL» (DMP)

Transcription

1 ehealth Conference Berlin 2007 EHR : THE FRENCH «DOSSIER MÉDICAL PERSONNEL» (DMP) Manuel Bloch GIP DMP FRANCE 1

2 A few figures concerning France 60 M inhabitants Healthcare environment Expenditure : more than 10 % GDP (~ 175 G ) Healthcare Professionals (GP's and specialists) in ambulatory care inside Hospital hospitals (both public and private) IT in Healthcare Expanditure : around 2 G per year 80 % of GP's are using a computer 15-20% of GP's are using a computer for medical purpose (EHR) EHR in hospital 1/3 common EHR for the hospital, 1/3 EHR per service inside hospital, 1/3 No EHR Smartcards professional cards (CPS) smartcards with PKI 50 million patient cards (Vitale card), moving to e-authentication and e-signature ( ) 2

3 What is DMP? DMP is a private medical electronic record under the patient's control (i.e. the patient manages its access) hosted by a provider chosen by each patient paid by GIP DMP (i.e. free of charge for the patient) Designed to favour coordination, quality and continuity of care shared by Healthcare professionals under patient authorisation granting confidentiality Accessed by patients using a Web browser By healthcare professionals using their own HER application to maximize ergonomy and avoid time-consuming DMP is a national project budget : 1.2 to 1.5 G within 5 years 3

4 The DMP Medical content The DMP contains documents grouped in 5 sections General medical data Care delivery Prevention data Digital images Personal expression, where the patient can write Documents are labelled using the IHE-XDS profile + standards as DICOM, HL7, LOINC, SNOMED Data may be structured Documents will be signed by their author using the CPS card certificate The patient can hide any document. Nothing indicates to HCP that some document has been hidden 4

5 Principle of operations Level 1 support level 2 support Portal Patient (Owner) Request for level 1 support Authentication Smartcards Sesam Vitale Revocation control Supervision platform DP Pharmaceutic al electronic record Operation information transfer National directory (CNAVTS) Id control Portal techn. support Authentication Diffusion Platform references standards Health networks Cancer,... HCP Directory (GIP CPS) Revocation control Level 1 Support prof. soft. Authentication Request for level 1 support Biologic analyses laboratories Access to the DMP Access to the DMP Access to the DMP Hos pital IS Health prof. + Authent Card CPS Transfer from level 1 to level 2 Hosts DMP Level 2 techn. Suppor support t Host 5

6 Planning DMP itself : August 2004 : Law creating DMP Second semester 2006 : Experimentations in 13 regions ( DMP, 100 hospitals, GP's) Specifications for DMP portal : March 2007 Call for tender for the reference host : launched in March 2007 Interoperability framework for DMP (V1) : March-May 2007 Validation platforms : end of 2007 Beginning of generalization : Spring 2008 Projects connected to DMP National medical number for patient (INS) : Q «regional platforms» : Q to Q Healthcare professional workstation : National specifications for architecture and services : Q Beginning of commercial availability : Spring 2009 Generalization of HCP card (CPS) in hospital :

7 Interoperability framework (1) Standard choice for each domain Electronic data transfer Web services, SOAP, Presto, IHE-XDS, etc. Internet HTML, HTTP, ISO, PDF, JPEG, etc. Health data format IHE, HL7 CDA, CEN EHRcom, DICOM, etc. Content and semantics Structured data Regulation framework Lows, ordinances, etc. Implied by Professional exchanges (health data) Technical exchanges (protocols) 7

8 Interoperability framework (2) Specifications Content, format, syntax Definition of the roles of the actors Providers of components, Test environment Compliance control Certification procedure Validation protocol Etc.? Agreement between the actors Responsibilities Procedures Service level Management Planning Coordination of the public and private actors Involvment of the actors Published on our site 8

9 Initial lessons Three major topics are to be adressed : Number of actors, with different IT systems : Nationwide project is more complicated than a regional one Interoperability framework must be defined and applied EHR is not «alone» in the field DMP is considered as a service, but also as an infrastructure Thinking globally for the needs, but acting locally to avoid unpilotable projects (for example : consider hospital IT as a blackbox, excepted for security) Phasing the project Impossible to get everything done at the same time for everyone, Necessary adaptations of the system with feed-backs of actors Real issues are not technical, as DMP implies : Changes in doctor/patient relationship Juridics threats (DMP : juridic proof?) Transparency in professional practice Confidentiality patterns 9

10 Conclusion Current step : to implement DMP all over France Internal hospital IT system Next step : to think wider Links with tele-monitoring and tele-health, Cross-border interoperability International level on interoperability framework and standards 10

11 THANK YOU FOR YOUR ATTENTION 11