Denis MREJEN GIP DMP HIMSS San Diego Feb 2006

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Study tour in the French National

Electronic Medical Record (DMP) Project

Denis Mrejen, MD, PhD

GIP – DMPinfo@sante.gouv.fr

A major innovation to improve the Healthcare quality

Denis MREJEN GIP DMP HIMSS San Diego Feb 2006

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Summary

1) DMP (Electronic Medical Record), Major national political decision ( Aug 2004, 13 Law )

2) DMP Practical implementation

3) DMP for a better coordination between health professionnals

4) Contribution of DMP to healthcare quality

5) DMP, a business model to be clarified

Conclusion: DMP, a major innovation for health professionnals

and citizen benefit

Denis MREJEN GIP DMP HIMSS San Diego Feb 2006

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IntroductionDMP, one year after the official launching

• A master piece of the Aug 2004, 13th Law (Healthcare reform)

• A strong expectation of Citizen and Health Professionnals

• A progessive operational onset

•A public Agency (GIP DMP) under the control of the Ministry of Health created to carry out the project at the National scope

Denis MREJEN GIP DMP HIMSS San Diego Feb 2006

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1) DMP, a major innovation brought by the 2004 Aug 13 law

• A strong political willingness

–DMP part of other major innovations: gate keeper, healthcare path, Healthcare National Authority, National Committee of complementary medical insurances

• An ambitious goal for healthcare quality

– A unique Electronic Medical Record available upon request for each french citizen by mid 2007

• A major innovation in the healthcare organisation

– Approved industrial consortiums to host medical electronic record in secured repositories – Right of access to the medical data, controled by the patient

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2) DMP Operational launching - Agenda

• April 2005 : creation of the GIP DMP: National Agency gathering •Government represented by the Minister of Health,

•CNAMTS, (public national health insurance)

•Caisse des Dépôts

• July 2005 : Bid for the feasibility phase

• March - Sept 2006 : Technical evaluation of the six consortium selected to implement real 30 000 EMR over 17 sites, (13 régions)

• End 2006 - early 2007 : Launching of the first phase of general implementation

• July 2007 : - Mastery of the technical issues, - Efficient relations between Health profesionals and

Patients structured by DMP

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2) Operational lauching of the DMP Projet

A Strategic Orientation Committee (COR) 50 representatives of patients and health professionnals in a permanent consultation process

Various working groups: Patient unique identification, medical contend of the EMR, attendant mesures for the habits evolution, evaluation, side effets of medicines, redondancies (investigations, treatments…)

Regional Entitites for DMP local co-ordinationco-management of the project local steering committeesevaluations (added value, condition of empowerment…)

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• A strong and permanently interactive dialogue with industrial partners

• For the present experimental phase

• For the choice of technical standards (IHE-XDS, HL7..) and the inter operability requirements

• For the establishment of the terms of reference of the extention phase

2) Operational lauching of the DMP Projet

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3) DMP: A tool to strengthen co-ordination between Health Professionals

• Medical Doctors

• Inventory : - 2/3 of the medical doctors computerized, - equipement to be upgraded, - many non communicant softwares, - poor real medical purposes use, - strong expectation, - several very outstanding innovations

• Goal : To significantly increase the number of doctors using an EMR every day

• Means: A simple tool, easily appropriated, and definitly useful in the every day work

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3) DMP A tool to strengthen co-ordination between Health Professionals

• Pharmacists

• Inventory :  An information system structured by the wholesale distributors

• Means: An independant information tool,(To choose between a professional oriented software, or an insurance oriented software)

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3) DMP A tool to strengthen co-ordination between Health Professionals

• Hospitals

• Inventory  : Very heterogenous hospital information systems

• Means  : Generalisation of the discharge letter (commonly formated)

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3) DMP A tool to strengthen co-ordination between Health Professionals

• Bridge the existing health information systems with the DMP, and especially:

– specialists pre existing networks

– hospitals

– private clinics (software providers…)

– Public medical insurances (track records of the care refunded)

– other experimental healthcare delivery systems (pharmacists…)

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4) Contribution of the DMP to Healthcare quality

•DMP to decrease iatrogenic diseases and non necessary investigations or treatments (redondancies…)

•DMP for an empowerment of the Patient in the follow up of his health asset

•DMP to facilitate usefull exchanges between Health Professionnals

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4) Contribution of the DMP for healthcare quality

• DMP, stimulator for ressources optimisation (and improvement of the organisation)

• DMP a tool for cost control and savings

– Lack of quality is costfull (15% wasted ?..)– Rationalisation /security of new process, track records of the

various decisions, reduction of iatrogenic diseases and redondancies...

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5) DMP, A business model to be clarified

• Annual overhead cost

Cost breakdown to be clarified (12 18 $ per year, per person ?) (National cost for repository 700 à 1100 M $)

• Initial public funding The launching of the 30 000 EMR (over 13 pilot sites) is financed by public fundings.

At the end of this phase, GIP belongs the various developements implemented

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5) DMP, A business model to be clarified

• At the industrial phase

–The cost will probably be undertaken by the National Public Medical

Insurance

• Overal system possibly based on:

– Freedom left to the patient in the choice of his service provider?

– Selection made at national or regional level to choose the only service

provider allowed to deal with the region concerned?

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Conclusion : DMP, a major national innovation for Patients and Health Professionnals benefits

•DMP to serve Patients and Health Professionnals for healthcare quality improvement

•DMP: a welcome opportunity, to meet the promises of:

• The Information society

• The Co-operation between Health Professionals

• The empowerment and responsability of the Patient-Health-Consumer

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Behind every difficulty, lies an opportunity

Albert EINSTEIN