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But why does the shared medical record remain an empty shell?

The facelift is not enough. Despite its redesign and its integration into the My Health Space platform, Christel’s shared medical file (DMP) remains empty. Followed by a specialist for a tumor in the intestines, she placed a lot of hopes on the tool. In vain. “My doctor doesn’t consult him, he didn’t even mention it to me,” she sighs. Worse, none of the results of his medical examinations are automatically placed in his file. “For the moment, there are only the documents that I wanted to add myself”, she regrets.

Relaunched with great fanfare by the Ministry of Health in February, the digital health record has nevertheless been brought up to date. Above all, it seems easier to use. The interface is better structured, you can store X-ray or MRI results, but also medical prescriptions that you can find quickly by filtering according to the nature of the examination or medical document. A tab dedicated to the profile allows you to prioritize the patient’s medical information according to several categories (treatments, family history, hospitalizations, vaccinations, etc.). Last novelty, a mobile application of My health space has just landed on smartphone.

Screenshot My health space

But then what is wrong? The problem is that few professionals have taken ownership of the tool. In particular the analysis laboratories, which, as one stopped published in the Official Journal on April 26, are nevertheless obliged to transmit the results of examinations in the DMP. “But for that, the patient must first have an account open on My health space”, recalls Lionel Barrand, president of the national union of medical biologists. Because not all French people have an account open on the platform yet. Contacted by Capital, the National Health Insurance Fund (Cnam) indicates that “more than 66 million notifications have been sent. The automatic openings of profiles will be established gradually over several weeks, at the rate of approximately 1 to 1.5 million openings per day”.

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Biologist in the Grand-Est, Lionel Barrand ensures that the use of DMP has almost become “a reflex” in his laboratory and those of his colleagues. “Just in case, if your health space is open, remember to report it when you arrive at the lab. If it is very busy, the secretaries may forget to ask you. And bring your vital card, we need it for the first connection to your file with your agreement”, advises Lionel Barrand. The latter relies on the mobile application so that patients and professionals adopt “good habits”.

The labs fully operational before the end of the year?

Despite the regulatory obligation, the establishments are not all technically ready. “I know that work was in progress but it was completely slowed down or even stopped by Covid-19”, we confide within a Biogroup establishment based in Courbevoie (Hauts-de-Seine). This network of analysis laboratories nevertheless participates in the various test phases for the deployment of My Health Space.

“We have been a pilot laboratory for five years both for the DMP and for secure messaging (another application available on the platform for exchanges between health professionals and with patients, editor’s note)”, boasts Laurent Kbaier, medical biologist at Biogroup in the south-east of France. He ensures that almost all the laboratories – with the exception of the Ile-de-France region which will be by this summer – are now equipped with the latest compatible software version to connect to the shared medical files of patients. “We have made good progress in recent years. In 2019, we sent 178,000 reports to the DMPs, we rose to 708,000 in 2020 then 1.3 million last year. And over the first four months of 2022, we have already paid 652,000 exam results”, enthuses Laurent Kbaier.

However, the sharing of examination reports in the DMP deserves to be improved. Because in the current state, the majority of the documents submitted are only in PDF format. “For this information to be more usable, software publishers must comply with the reference system that we have established”, underlines Gérard Ximenes, Ségur Numérique project director within the Digital Health Department.

This repository consists of sharing medical documents in the DMP or via secure messaging in the form of “structured data”. Understand information from an examination result, a medical certificate or a prescription for example, which would be accessible in two clicks by performing a keyword search. It is then the information that is entered directly into the tool rather than a frozen PDF document that does not allow the data to be sorted.

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To achieve this, the State has set June 15 as the deadline for business software publishers to file their “proof” of compliance with the new rules in force. If they do not comply, they could lose customers among health establishments and doctors, biologists, pharmacists, who in turn, will end up being forced to feed the digital health record of patients on My space health.

Then, the State will finance the deployment of software versions compatible with the platform so that “laboratories have zero or almost zero remaining costs depending on the obsolescence of the equipment”, specifies Gérard Ximenes. This funding is part of the two billion euros of Ségur which are allocated to digital health. The compliance of business software publishers must have been validated before October 15 to release the funds, so that the laboratories can (finally) be operational in sharing examination results in structured data before the end of the year.

“If it has to be a bureaucratic constraint, it will not work”

Structured data is precisely what Jean-Paul Ortiz, former president of the Confederation of French Medical Unions (CSMF), expects. “Until now we have never managed to have a simple and efficient system despite tens of millions of euros already spent,” he breathes. For this nephrologist, the shared medical record looks like “a library without indexing”. He relies heavily on the sharing of information in structured data: “I could quickly identify all the diabetics in my patient base in two clicks, for example”.

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No question, therefore, that the use of My health space makes white coats waste time. However, attending physicians already have obligations on paper. In particular, they are responsible for writing the medical summary section for their patients. “A colossal task” according to Jean-Paul Ortiz: “certainly, making a medical summary of a young patient in good health can be fast… But for an 80-year-old person, diabetic, with a history of infarction, it is much longer”, explains Jean-Paul Ortiz. As a result, few doctors have taken up the task they must perform at least once a year.

So what can be done to get caregivers to comply with this medical paperwork? The solution is all found by Jean-Paul Ortiz: the Health Insurance should pay more for this work. “For the moment, she has hardly planned anything to encourage doctors to get started… If it must be a bureaucratic constraint, it will not work”, warns the nephrologist doctor. However, general practitioners are only at the beginning of their obligations vis-à-vis My Health Space. Next year, they will also have to upload medical prescriptions into the DMP and send them by secure messaging. This new constraint will formalize the implementation of the next Ségur project: the electronic prescription.

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