How French healthcare IT is progressively moving to international standards

1. How French healthcare IT is progressively moving to international standards François Macary : GWI Medica France - Chair of HL7 France

2. Year 2000: standard technologies are popping up in national standards • HPRIM  New message formats based on XML schemas, transport by secured email (S/MIME, ESMTP) • Intra-hospital medication workflow using DTD based XML messages • National Social Security network (Sésam-Vitale) uses secured email with a PKI for claims and reimbursements. • Each electronic invoice is signed by the care provider with his professional chip card (CPS) in conjunction with the patient insurance card. • The patient card (Vitale) delivers up-to-date insurance information.

3. 2000 - 2003: Move to international standards • 2001: Arrival in Europe of the IHE initiative (Integrating the Healthcare Enterprise) • Radiology intra-hospital workflow based on DICOM and HL7 v2 • Strongly promoted in Europe by a French public body: GMSIH • New domains launched and driven by France: Clinical laboratory (2003), Pathology (2005) • IHE was the key that opened the door of French hospitals to HL7 standards • 2001 - 2003: AFNOR (the official French standardization body) Gathered all the healthcare IT actors • Study of HL7 v3 published by AFNOR in 2002 • Decision to build the HL7 France affiliate

4. August 2004: Creation of HL7 France affiliate, based on the transformation of the HPRIM association • Why? • Thousands of operational links based on the HPRIM standards • HPRIM members had recognized the limits of national standards • How? • New name: HL7 France HPRIM • New bylaws: From a vendors association to an even representation between vendors and the other categories (users, consultants, general interest) • New policies and procedures (board election, ballots…) • Who joined in? • Public bodies: GMSIH, a university, many public hospitals • Professional societies: SFIL (clinical biologists), SFR (radiologists) • One professional trade union, some individual users

5. HL7 France H’: Two activities = Two TCs • HPRIM TC (low level activity): • Maintenance of the legacy HPRIM standards • Facilitate the migration to HL7 standards • HL7 France TC (high level activity): • Promotion of HL7 standards • Participation to 3 professional events in 2005, including conference in the “Sénat” for CIOs,in October 2005 • Promotion of CDA R2 to the stake holders of national projects (Healthcare ministry, National Social Security) • Education and translations • Translation of the primer to V3 by Andrew Hinchley (1000 copies printed) • 150 attendees to 8 one-day education sessions on V3: Introduction + CDA

6. HL7 France TC activities (continued) • Support to initiatives using HL7 (IHE) • New IHE “Patient Administration Management” (PAM) profile based on HL7 V2.5 ADT. • Cooperation with other European HL7 affiliates • IHE PAM profile includes “Historic Movement Management” option, built in cooperation with HL7 Germany. • Support national projects (Production of CDA implementation guides) • “Dossier Communicant en Cancérologie” (DCC): A national project to organize multi-disciplinary cooperation around a cancer case • Dossier Médical Personnel (DMP): The national EHR.

7. Le Dossier Médical Personnel (DMP)Legal framework • Legalization of digital signature (with X509 certificates + PKI) • Modernization of the national registry for all healthcare professionals. Personal chip card (CPS) encoding id, certificate, profession, specialty… • NIS: An upcoming national healthcare identifier for each French citizen. • A new chip card for each person registered to the National Social Security: “Vitale 2” is an insurance card containing the insurance information and the NIS. • “Le médecin traitant”: The primary physician for the patient (except for emergencies). The patient can delegate the management of his EHR to him.

8. Le Dossier Médical Personnel (DMP)Major orientations • Document oriented: Sharing of electronic documents: • Human readable • Persistent • Considered as a whole (wholeness) • Authenticated • Manageable (stewardship) • Access rights potentially supervised by the patient • Access through the patient chip card Vitale 2 • Possible delegation to the primary physician • Or explicit consent given by the patient for a care episode • Web based access and management (7 days, 24 hours)

9. Le Dossier Médical Personnel (DMP)Schedule • Spring 2005: Constitution of the GIP DMP (the public instance managing the project) • July 2005: Tender for “1st experimentation” • October 2005: Selection of 6 industrial consortium • Nov 2005 – March 2006: 6 Pilot sites, period of evaluation • A local healthcare community: Hospital(s), clinics, labs, GPs, radiology centers… • 5 000 real patient records each • March 2006: Tender for the national solution • One to 6 host sites

10. Retrieve Document Document Repository Document Source DMP: Candidate tools and standards for infrastructure One host Key to the patient folder: Patient NIS + Host id IHE XDS profile: Cross Enterprise Document Sharing A care provider or a care setting Document Consumer Document Document Query Documents Consumer Registry A care provider or a care setting Provide&Register Document Set Submission set: Soap with MIME attachment Transport: http POST or SMTP

11. DMP: Candidate standards for content • First documents required • Volet médical (= Care Record Summary for French Realm) • Hospital discharge letter • Laboratory report • Examination report • Structured • CDA R2 • Unstructured • pdf, rtf, html

12. HL7 France contributions to the DMP • Implementation guide for use of the CDA R2 header in the French realm, common to all electronic documents • How to represent all the participants to the document (author, legal authenticator, custodian, record target, patient…) • Identifiers for care providers, care settings, patients • Rules for document update (only replacement is authorized) • Localized vocabularies: • Acts are coded according to the French vocabulary “CCAM”) • Care providers functions are coded according to the vocabulary of the professional chip card (CPS)

13. CDA R2 implementation guide for the care record summary in the French realm

14. Next work items of HL7 France TC • Write CDA implementation guides for • Pathology reports (13 reports, one per organ)  needed by the national project DCC (specialized patient record for a cancer case) • Laboratory report in cooperation with IHE Laboratory committee  needed by both projects DMP and DCC

15. Thank you for your attentionThanks to HL7 UK for its kind invitation Some “French connections”: HL7 France: www.hl7francehprim.org IHE information from GMSIH: www.gmsih.fr/ihe DMP: www.d-m-p.fr François Macary : GWI Medica, chair HL7 France