The Institut Montaigne has just published on June 18, 2020 its report * on the potential of e-health in France called “E-health: let’s increase the dose!”. This think tank devoted to public policies estimates that the development of this sector is likely to bring, at least, between 16 and 22 billion euros per year. To reach this potential, annual healthcare spending will have to be around 217 billion euros.
Five areas of transformation
“To quantify the gains from e-health, we did a literature review in terms of the impacts of technologies without making a plan on the comet. We looked at what already existed and not what was going to exist“said Thomas London, associate health and public sector director for the McKinsey consultancy and co-chairman of the working group, when asked by The Digital Factory.
He goes on to detail “five axes of transformation“necessary to reach this potential: patient empowerment, dematerialization of exchanges, telemedicine, automation of logistics processes and support for medical and paramedical decisions.”The gains are not necessarily lower costs. It’s better patient care, better quality of the health system…“, he specifies.
This “New deal“Health rests on two pillars: the exploitation of health data and the structuring of the sector.”The French healthcare system is rich in data but poor in information“, notes the working group. The report regrets the lack of connection between the various organizations which manage data at national level. For example, the Health Insurance has data related to invoicing but does not know anything about the quality ‘medical care. “If the healthcare system were a human body, the data would be its blood“, Thomas London compares. Indeed, data is essential to develop technologies such as algorithms for decision support or detection of certain diseases.
A third way between sharing and protection
However, the exploitation of health data is strictly framed by European law via the General Data Protection Regulation (GDPR). Today, the challenge is to find a balance between sharing and protecting the privacy of patients. Thomas London regrets that the answer too often lacks nuance. “There is a demanding middle way with protective rails, he believes. You have to get out of control and blocking a priori.“
He pleads for a control procedure based on that which applies to medicines: the National Agency for the Safety of Medicines and Health Products (ANSM) compares the benefits and risks of the new molecule. “In some cases, the lack of data sharing is a loss of cure for patients“, laments Thomas London.
The Health Data Hub, an “essential brick”
The Health Data Hub aims precisely to gather a maximum of data within the same national database. Created by the law of July 24, 2019, this operating platform raises many concerns because its hosting has been entrusted to the American company Microsoft. About fifteen organizations and personalities have recently filed a summary liberty before the Council of State considering that this choice was dangerous.
For its part, the working group is more in favor of this tool. “A balance had to be struck between keeping full sovereignty over this strategic asset and the need to be quick and agile“, notes the expert who refuses to settle the debate on the merits. The Health Data Hub remains”an essential brick“in the transformation of the health system, he admits. This future database will be able to interconnect with its European equivalents.
This is very good news for Thomas London, who specifies that this strategy of supranational sharing must not prevent France from acquiring a “ambitious vision“cruelly absent.”The digital health roadmap has speeded things up considerably, but it is not enough. We do not have a clear vision of where we want the system to be five or ten years: what data, what framework …“, he regrets. Reason why it is time to create a real digital industry in health.
The need to structure the sector
The second cornerstone of health transformation in France is the structuring of the industrial sector. The working group discussed at length with players in the aeronautics sector to find avenues for improvement to be inspired. “In aeronautics, the different players know each other very well, they collaborate on the implementation of large-scale projects and above all they are aligned with a common ambition: the presence of France in the export markets. “
According to the report, there is an urgent need to get out of the culture of mistrust of the private sector. “I will give you a revealing example: the commercial use of data is very often considered to be contrary to the general interest. Now if there is a commercial demand, it is good that there is an interest for society“says Thomas London. Once this distrust has been overcome, a common ambition should be defined which could be”a presence in export, an improvement in support.. “. Finally, public and private actors will have to define large ambitious projects where”public hospitals, city medicine, industry, start-ups, etc.“will collaborate.
The example of telemedicine
Like any change, professionals will have to be acculturated to understand the potential that e-health offers via new technologies such as AI, teleconsultation, e-prescription … “When you grow up in a model where technological tools do not exist, there is a work of discovery to do“, declares Thomas London. This work must be based on traditional mechanisms such as initial training, an increase in wages, diversifying career paths …”It is also an opportunity to create bridges between the public and the private, he estimates and continues, the public sector must find profiles capable of coming up against innovative approaches to the private sector.“
And sometimes it is exceptional events that cause the long-awaited change. This is the case with telemedicine. Widely shunned by doctors, she has experienced renewed interest since the health crisis where travel to medical offices was prohibited except in emergencies. In April 2020, Health Insurance accounted for 1.1 million acts. The acceleration was partly made possible by a softening of the regulatory framework by the adoption of two decrees (100% treatment of acts, exemption from the obligation that the consultation be carried out by a doctor already consulted in the last 12 months, telephone consultations). The Institut Montaigne is also calling for these flexibilities to be made permanent.
An envelope of three billion more per year
Thomas London concludes on the need to give itself the means of its ambitions. “As part of the implementation of the digital sheet, there were envelopes of a few hundred million euros dedicated to acceleration. But it is not on the scale of what is necessary“, he believes.
France spends “less than 2% of digital healthcare spending“against 4% in some countries. How can we put more resources behind these transformation tools?”In view of the value creation potential, we would be in extremely strong and rapid returns on investment “, answers Thomas London, who pleads for an envelope of three billion more per year.
*Methodology : the works were launched in September 2019. The steering committee was made up of around twenty experts. More than a hundred people specialized in the health sector were interviewed during the work of the working group.