The National Digital Council (Cnnum) published this June 11, 2020 a list of recommendations on the place of digital in health in France. Seized in June 2019 by the former Minister of Health Agnès Buzyn and the Secretary of State for Digital Cédric O, the French commission aims to support the government in its objective of digital transformation of the health system. During a year, nearly 75 people representative of the sector were interviewed by the Cnnum and four round tables were organized to collect the expectations of the main actors concerned.
Develop a French model
This 116-page inventory identifies “good practices to remember“and”the pitfalls to avoid“In its report, the Cnnum first calls on the government to develop”a French vision of digital health“and bring it to the European scene.
This dynamic is broken down into four pillars. First, it is imperative to clarify the roles of the institutions to avoid the dispersion of strategic and operational management. France has a tendency to multiply the bodies that interfere with the functioning of the decision-making infrastructure. Second, the advisory commission believes it is time to move on “from a model of care to a model of health“which implies a reflection on the financing of the system and a questioning of the reimbursement of the medical act. Thirdly, it is necessary to succeed in guaranteeing confidence in the systems in order to ensure the adhesion of citizens and professionals Finally, the report highlights the importance of promoting a model “responsible“where issues related to ethics, digital inclusion and environmental responsibility are taken into account.
ENS and t BSP, “the epicenter of the health system“
Several pages of the report are devoted to the Digital Health Space (ENS). Adopted in March 2019 but operational on January 1, 2022, the ENS is part of the “My Health 2022” program. It aims to “bring together, on the same platform, all existing services“so that each user has access”to all of their health data throughout their life“, explained the director general of the Pasteur clinic in Toulouse and president of Health Dominique Pon during the presentation of this future device. Practitioner side,” Ma Santé 2022 “provides for the implementation of the” Bouquet of Services for health professionals ” (BSP) which should allow “save medical time“.
The objective is to move from the current situation with complex, expensive and often fragmented integrations, to unified and simplified access to the various digital services available. It will provide access to both the services offered by public actors (the State, its operators and Health Insurance) as well as to the services offered by private actors. It can be teleconsultation services, online prescription…
The Cnnum notes that the ENS and the BSP must be “the epicenter of the health system“He also recommends finding”a balance between quality guarantees of services for users and simplified procedures for industry“. To do this, the ENS and the BNP must be generalized on a national scale thanks to a strong adhesion of users and health professionals.
Thus the conditions of access to health data in the ENS and the BSP should also be formalized and standardized by the Digital Health Delegation (DNS). In addition, an ENS space should allow citizens to authorize the use of their health data for research. Concerning the development of data, the Cnnum very quickly tackles the thorny subject of the Health Data Hub. For the implementation of health data projects, he simply recommends to “capitalize“on this medical database. For the rest, we will have to wait for a further publication.
Supporting those excluded from digital
The transformation of the health sector should not cause the exclusion of a certain part of the population encountering difficulties with digital technology. The Cnnum proposes that “France Services Houses“serve as places of support. Ideally, each of these structures would benefit from a referent empowered to conduct this support for this type of approach. At a minimum, a support person specializing in digital health issues could intervene at intervals regular by alternating between several houses.
The integration of digital technology in health also requires training. The report recommends developing “digital health skills certifications“on the model of the Pix platform, an online public service for the assessment and certification of digital skills. This first level of certification could be followed by”specific routes “. The commission recommends the creation of a label “digital health professional “. It should be accessible by users and visible on the ENS in order to allow them to choose to consult professionals while being informed of “leur degree of digitality“.
Strengthen exchanges between research and industry
Finally, the Cnnum proposes initiatives to remove the brakes on innovation and “offer a real economic model and a market to digital health businesses“.
In the first place, “the network of innovative structures“must be decentralized and the”e-health lab“must be the keystone of this system. This future structure aims to help the carriers of solutions as well as those who support them by facilitating their journey of innovation.
In addition, the government must deploy mechanisms to integrate health professionals and citizens in the innovation process through the establishment of incentive mechanisms such as a “bank of hours of innovations“This device would allow professionals to devote working time to it, which can be used by colleagues invested in innovation projects, in exchange for an interest in said projects. Particular attention in terms of transparency and ethics is necessary to avoid any conflict of interest.
In addition, the committee calls for a strengthening of the links between industry and research “while ensuring respect for the independence of the latter“A system for industrial and entrepreneurial promotion of researchers’ work must be put in place. Those who show themselves willing to translate the results of their research into entrepreneurship projects themselves must be supported and trained as soon as possible. Haute Autorité de Santé (HAS), responsible for regulating the health system, should be entrusted with an advisory mission in order to best support entrepreneurs in their sometimes complex procedures with administrations.