How e-health could contribute to Health: the french experience Michèle THONNET Ministry for Health and Solidarities - Paris- France Moscou - 29 March 2006

  • View
    216

  • Download
    0

Embed Size (px)

Transcript

  • Slide 1
  • How e-health could contribute to Health: the french experience Michle THONNET Ministry for Health and Solidarities - Paris- France Moscou - 29 March 2006
  • Slide 2
  • The French Health system Some characteristics
  • Slide 3
  • France and health system 540 000 Km2 60 M inhabitants life expectancy : 75,2 M 82,7 W Global Expenditure per capita +2000 1,7 M jobs in Healthcare
  • Slide 4
  • A complex system A multitude of actors health insurance (compulsory complementary ) 300 000 professionals (120 000 doctors), 24 000 pharmacies, 4 000 laboratories 4000 hospitals, 1,1 million employees (50 000 doctors) with a very large autonomy
  • Slide 5
  • 1- A systemthat deserves its appreciative rating... 1- A system that deserves its appreciative rating... The first in the world according to WHO (2000) but with some internal inequalities social geographical
  • Slide 6
  • 2- a high cost... as in Western Europe The national expenditure of health 148 billion uros, 8.8% of GDP, 10% A growth regularly stronger than the GDP + 5,2 % in 2001, Presumptions of inefficiencies adequacy of the offer compared to the needs
  • Slide 7
  • Objectives of the authorities Public policy for e-health in France
  • Slide 8
  • Governments guidelines To develop the assets policy of public health By improving the overall effectiveness by introducting the ICT in Health
  • Slide 9
  • The main goal Make use of the Internet to rationalize the healthcare system for a healthier population => to improve the level and quality of care => by controlling the costs
  • Slide 10
  • Three types of projects a first stage : SESAM-Vitale administrative simplification for refunding health expenses a corner stone project to improve the doctor-patient relationship : DMP electronic health record (EHR) public health issue to manage the consequences of the availability of the information to public (education, protection)
  • Slide 11
  • Four main objectives To facilitate the continuity and the coordination of the health care : telemedicine electronic health records : with protected access, transmission, storage To improve access to knowledge : online state of the art for the professionals quality of e-health sites
  • Slide 12
  • Four main objectives (2) better know the reasons for recourse and evaluate the expenditure piloting information systems better and quicker refunding administrative simplification : SESAM-Vitale
  • Slide 13
  • Public policy : A voluntarist strategy important investments an impact on the whole population 55 million smart cards handed over
  • Slide 14
  • Confidence requirementis key Health is not a product like others Confidence requirement is key Health is not a product like others Public policies for e-health in France
  • Slide 15
  • A specific status for healthinformation A specific status for health information The European Legislation 24 October 1995 (art 8) prohibits any data processing without the consent of the person except for the data absolutely necessary to the health professional or those related to the management of health services, required by people exercing under professional secrecy The french Medical Privacy Act (4 february 2002) transmission of personal information is authorized only between health professionals treating their mutual patients, and only with their prior consent (article L1110-4)
  • Slide 16
  • Confidentiality requirements Key issues to deal with, for the French Government legislative : the Act of March 4th, 2002 the Act of August 13th, 2004 technical : smartcards, secure infrastructure, PKI Internet sites on e-health support self-regulation between bodies involved (users, professionals, economic actors) the project e-health quality
  • Slide 17
  • A technical federator The Health Professionals Card (CPS) authenticate, sign, coding The recipient insurance card : Vitale card The choice of Internet standard technologies, but secured
  • Slide 18
  • Health Professional Card CPS an large roll-out... over 577 000 cards rolled-out (310 260 CPS) a central role in the security of the system authenticate the holder of the card : identity, qualifications, conditions of medical exercise Ssame to reach to protected informations electronic signature protecting and coding messages
  • Slide 19
  • The health insurance card The Vitale card easier identify the holder : 55 million cards handed out to the citizens
  • Slide 20
  • The current situation Public policies for e-health in France
  • Slide 21
  • SESAM - Vitale An increasing use : >80 million electronic invoices issued every month more than 65 % of invoices 180 000 Professionals using the system a smooth and steady implementation
  • Slide 22
  • A main objective: DMP The Personal Electronic Health Record A main objective : DMP The Personal Electronic Health Record Public policies for e-health in France
  • Slide 23
  • The personal electronic health record (EHR) An effective way to manage patients continuity of health care but which must offer all the guarantees of privacy
  • Slide 24
  • To enhance their development The objective: to support the development of EHR information is produced by health professionals reviewed on line with strict conditions on the rights of access of which the use (and contents?) are controled by the patients which are stored in places under very strict conditions
  • Slide 25
  • The role of the Government To support the development of the consensus finalities, contents, control of the uses To encourage experiments To build up the legislative framework To develop incentives, if necessary
  • Slide 26
  • New orientations adopted by the Parlement 13 August 2004 law reform of the health insurance decision of the creation of a personal EHR coordination of care quality continuity prevention
  • Slide 27
  • 13 August 2004 Act DMP ( EHR, EPR,...) 13 August 2004 Act DMP ( EHR, EPR,...) Applicable on July 2007 Strongly linked to the patient act strict security policy & mechanisms patient control on the access adapted authorised access only for HCP habilited direct access to medical data by patient mandatory labellisation of the storage places
  • Slide 28
  • Five question marks ????? Optimal level of confidentiality Identification of the patient Control of the access by the patients Respective Responsabilities Technical options
  • Slide 29
  • Slide 30
  • How to cope with e-health Some lessons learned
  • Slide 31
  • What happened so far ?
  • Slide 32
  • The lessons learned so far always more time than expected resistance to change, daily routine early adopters are not representative always more expensive unexpected borderline effects critical mass point is not easy to reach to be careful on incentives do not underestimate the existing environment conditions & consequences of generalisation
  • Slide 33
  • How to increase the chances of success Define clear objectives with explicit milestones to measure progress based on consensual indicators Involvment of all stakeholders early pre- consultation
  • Slide 34
  • The accompagnying measures Rearrangment of existing measures to maximise integration of the new elements take advantage to reorganise & optimise (hospitals, GP, homecare) Anticipate the needed changes on medical care, on personal behaviour on the HC system, on reimbursement,...
  • Slide 35
  • A way to progress
  • Slide 36
  • Clear objectives in an evolving world Integrate the regional & national evolutions avoid to focus too much on technical issues anticipate negative consequences of a new system or changing in the existing forces balance
  • Slide 37
  • We are part of Europe Take into account the evolution of the other M.S. and other countries to support citizen & patient mobility to be compliant with other systems to anticipate their potential impact on national HC system
  • Slide 38
  • Keep European and open on the world the use of improve & facilitate the use of european & international standards give no long term agreement to proprietary products be present on international arena to anticipate changes
  • Slide 39
  • Thank you for attention Think globally Act locally michele.thonnet@sante.gouv.fr