85% of French people are convinced – the new health-related technologies should be discussed more in political debate. Indeed, eHealth is caught between major socioeconomic issues that have a significant impact on the life of French citizens. How will our elected representatives and the authorities tackle the question of the future of our health system? How does the eHealth policy of our elected representatives stack up?
400 million euros have been allocated for the Hôpital Numérique (Digital Hospitals) programme for 2012-2017. The TSN programme (Territoire de Soins Numérique), launched in 2014, has a budget allocation of 80 million euros. Source: Ministry of Social Affairs and Health
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A new political priority
EHealth: a term that is now commonplace yet still in its infancy, which in less than ten years has become one of the priorities for health policies. It is a very broad term that covers all digital media that affects health either directly or indirectly.
According to the Minister of Social Affairs and Health, Marisol Touraine, the ‘take-off of eHealth is a key issue in terms of both health and the economy. Digital technologies must support our fundamental values, as these values form the DNA of our social model: enabling everyone to access high-quality health care, and supporting cutting-edge innovation’. Since her appointment in 2012, the Minister has sought to continue the work of her predecessors, in order not only to develop the eHealth sector in France, but above all to drive major projects designed to modernise our health system.
Telemedicine, digital hospitals and aging: time to take stock
The development of telemedicine is one of the key areas for action identified by Marisol Touraine in relation to eHealth: ‘it is an effective tool in preventing inequalities in healthcare, the primary objective of the policy that I am pursuing’, states the Minister, who claims that 300 telemedicine projects are currently being rolled out across France, in particular thanks to the trial projects known as ‘Steps for Monitoring of Chronic and Complex Conditions’.
In 2016, these remote consultations were made available to all patients suffering from ‘long-term illnesses’. Telemedicine was defined for the first time in 2009 by the HPST Law 1, and it has recently been given a further boost by an order published on 10 May of this year 2, which sets the fees for consultations and permits reimbursement of those consultations by the social security system. Nine pilot regions may now authorise their healthcare professionals to practise telemedicine, a move that, according to the Ministry of Health, should affect more than 2.5 million patients.
To modernise healthcare institutions, the Minister has relied on the Hôpital Numérique (Digital Hospitals) programme launched in 2012. This is a five-year plan with a budget of 400 million euros, which, according to the Ministry, has made it possible to support the development of digital solutions in more than 500 healthcare facilities. Another large-scale programme designed to decompartmentalise hospital and non-hospital services was also launched in 2014: ‘Territoire de Soins Numérique’, which has a budget of 80 million euros. This programme is financing vast projects in five regions to develop digital platforms intended to improve how healthcare is provided.
This programme also represents a political response to the challenge of the aging population and the growing prevalence of chronic diseases such as diabetes, cancer, Alzheimer’s, heart disease, etc. ‘Digital technologies will allow us to organise the work of professionals as a network, encouraging path-based approaches that are essential for the modernisation of our healthcare services. This will make it possible to better meet the needs of patients who want to be treated at home and who want to have a more active role in their treatment’, states the Minister, who has also called for wider application of the ‘Shared Cancer File’ (DCC), as part of the 2014-2019 Cancer Plan. This system develops the sharing and exchange of medical data among healthcare professionals, both within and outside hospitals, in order to improve the quality of care.
Providing access to and protecting healthcare data, a new political challenge
The rise of digital technologies in the healthcare sector goes hand in hand with a need to provide greater security for information systems and personal medical data, while still creating an open system that enables the intelligent use of those data. In response to this issue, the Ministry has developed a General Policy on the Security of Healthcare Information Systems’ 3(PGSSI-S), which was published in October 2015.
A major project to provide greater access to medical and administrative databases has also been initiated. Since 2013, these databases have been grouped together within a single system: the SNDS (National Health Data System), managed by CNAM. Accessing these data was made more flexible following the law of 26 January 2016 to modernise the French healthcare system 4, which facilitates the use and sharing of medical data, in accordance with data protection regulations, for anyone involved in running a project of public interest. To supplement this approach, Marisol Touraine launched a major consultation (opens in a new window) on 22 April on the site faire-simple.gouv.fr (opens in a new window) 5.
The objective of this process was to gather ideas from internet users about the use of ‘big data’ in the medical sector and their opinions on the conditions for government involvement in this area. A summary of contributions will be sent to participants and incorporated into the Ministry’s discussion process in summer 2016.
An eHealth policy that will stand the test of time
Despite a firm political commitment and the large number of experimental projects implemented, many of the stakeholders concerned (pharmaceutical laboratories, telecoms operators, industrial concerns, health insurance companies, start-ups, insurance firms and healthcare professionals) are not happy with the slowness of eHealth implementation 6 in France and the absence of any long-term strategy.
The difficulties encountered by the Personal Medical File (DMP), a secure health record available on-line created by the 2004 Law on Health Insurance, is a well-known example of this. Despite its relaunch in 2009 by means of the HPST Law, it has never been rolled-out nationally and a mere 400,000 patients have adopted the system.
Last year, Marisol Touraine finally awarded the development of the DMP to CNAM. According to the Minister, CNAM is able to ‘reassure and coordinate the stakeholders within the sector in terms of long-term management of this tool’. In real terms, the DMP should be rolled-out to pilot areas in autumn 2016, with widespread implementation envisaged in 2017.
Enabling the development of eHealth services
Above and beyond the introduction of this fundamental tool, industrial entities, start-ups and SMEs operating in the connected healthcare sector are waiting for the public authorities to provide a clearer framework and strategy to allow this market to develop in France, in particular they want a financial framework that will facilitate new options such as telesurveillance of elderly patients or telemonitoring of patients suffering from chronic conditions to be codified and covered by the health insurance system.
This is a condition sine qua non in enabling new connected healthcare tools and applications to identify an appropriate economic model for their use. This is also one of the principal recommendations of the report published by the Department for Business (DGE) on the French offering in relation to eHealth 7: ‘to make it possible for services to exist, we must establish a system of fixed-rate pricing rather than the current system of pay-per-use’, notes Aymeric Buthion, the official responsible for digital health and connected objects at the DGE and a member of the monitoring committee for the report.
Faced with a population of patients and professionals with little training in health-related digital technologies, the producers of applications, software and connected objects are looking for political leadership in terms of training of professionals and education of citizens. ‘It is crucial that we improve the training of healthcare professionals, who are familiar with IT but not so much with digital technologies. All practitioners and supervisory staff must soon be trained in the new digital care pathway’, states Mr Buthion.
To ‘educate’ the general public, clarification measures are needed: which services are available, in terms of connected objects and healthcare applications, is still unclear to the average person, who does not understand the distinction between medical devices and wellness applications.
In addition, ordinary citizens do not have a unique point of reference enabling them to verify the reliability of these new tools: these evaluation and approval activities are currently being undertaken by private agencies, such as Medappcare or DMD Santé. While the issue of Government involvement is still up for debate, the parties involved are waiting for the National Health Authority (HAS) to provide, at the very least, a good practice guide for healthcare objects and applications that are introduced onto the market.
From national to regional: eHealth in the Rhône-Alpes Auvergne Region
While orchestrating a uniform eHealth policy may seem arduous for the nation as a whole, major projects associated with digital health are being deployed successfully in the regions and are determining the shape of tomorrow’s healthcare system. Far from limiting this deployment, the regional reforms introduced since 1 January 2016 are apparently contributing to expanding the ambitions of major regions in relation to eHealth.
In the Auvergne, which this year became the Rhône-Alpes Auvergne Region, the goal has been clearly set out: ‘we want the greater region to become a region of digital excellence, in particular by means of a European campus of digital disciplines’, explains Martine Guibert, the elected representative for the Auvergne Region responsible for social policy, health and family affairs. In this context, eHealth is one of her priorities: ‘I'm not holding up the human aspect of health as a negative in terms of eHealth. On the contrary, I believe that e-health is a real advantage for patients and professionals in our region’.
Regional development and expansion of digital services
Since 2014, the regions have been responsible for expansion of digital services, in addition to being responsible for their regional development. These are two key responsibilities for the implementation of eHealth. ‘We cannot consider eHealth unless we create adequate network infrastructures’, explains Ms Guibert. The region is therefore working hard to promote high-speed connectivity for all its citizens, opting for fibre optic technologies, which it is supporting financially to the tune of 46 million euros through investment loans.
In terms of regional development, the region is investing in the creation of multi-disciplinary medical and health centres that are intended to become regional platforms for action, prevention and innovation in healthcare. Thus, in addition to providing local healthcare services for users, these centres will enable healthcare professionals to work as part of a network and to develop telemedicine consultations.
To drive this process further, the greater region will soon be supporting a cross-border experimental project intended for isolated rural populations in Savoy and in the Valle d’Aosta in Italy. The MISMI Project (Integrated Healthcare Model to Promote an Inclusive Mountain) aims to develop social and healthcare services in retirement homes using telemedicine and in the homes of elderly individuals using telesurveillance.
The Greater Region: the challenge of a regional healthcare policy
Two separate regional areas, each with its own specific characteristics and, therefore, very different healthcare policies, were merged on 1 January 2016. ‘Our challenge now is to think in terms of the greater region while still focusing on the specific factors that characterise each of the component areas’, explains Ms Guibert.
This is an administrative and political restructuring that requires more than ever that elected officials ‘analyse the needs, drivers and delivery of projects at the right point while applying the region’s policy approach’, she notes. This is a pivotal role that is all the more important in terms of eHealth, requiring coordination of different stakeholders within regional agencies: executive, digital, economic development, research, innovation, health and training.
Lastly, because the questions of health and healthcare organisation fall under the sovereign jurisdiction of the central Government, the elected representatives in the region are also working in cooperation with the Regional Health Agency (ARS), which is responsible for applying national health policy in the region. Without being the direct leader of the project, the region is therefore supporting the emergence, or indeed the concrete implementation, of eHealth projects undertaken within its territory at the initiative of the Ministry of Health.
Within ten or so years, eHealth has finally become a major political issue, both nationally and regionally, representing a pivotal and important issue for elected representatives in terms of economic and social policy – a very good reason not to ignore the future of medicine in forthcoming elections.
Law of 21 July 2009 on Hospital Reform and on Patients, Healthcare and the Regions.
4 http://social-sante.gouv.fr/IMG/pdf/quyatildans-la-loi-sante.pdf (opens in a new window)
7 http://www.entreprises.gouv.fr/files/files/directions_services/etudes-et-statistiques/prospective/Numerique/2016-02-Pipame-e-sante.pdf (opens in a new window)