1. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 1 Study tour in the French National Electronic Medical Record (DMP) Project Denis Mrejen, MD, PhD GIP – DMP info@sante.gouv.fr A major innovation to improve the Healthcare quality

2. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 2 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

3. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 3 Introduction DMP, 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

4. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 4 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

5. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 5 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

6. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 6 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-ordination co-management of the project local steering committees evaluations (added value, condition of empowerment…)

7. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 7 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

8. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 8 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

9. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 9 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)

10. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 10 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)

11. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 11 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…)

12. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 12 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

13. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 13 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...

14. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 14 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

15. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 15 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?

16. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 16 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

17. Denis MREJEN GIP DMP HIMSS San Diego Feb 2006 17 Behind every difficulty, lies an opportunity Albert EINSTEIN