DMP: the French EPR

The DMP, or personal medical file, is the centre-piece of France's health IT programme. This will be a single unified computer health record. It will hold all relevant medical information, which will be centralised into a national data centre. The DMP will include medical files and notes, drug prescriptions, order communications, pathology results and clinical imaging reports.

At present it is in its early stages. The architecture for the future record is under discussion at present, and requests for tender will be sent out in the New Year. But the new record has already created a storm of protest.

The DMP has come under attack by a range of patients' rights, civil liberties and trade union organisations, as well as from members of the judiciary. The influential civil rights organisation, Ligue des droits de lhomme (LDH), made headlines in France when it described the DMP as "dangerous to the fundamental rights and liberties of the individual".

Objections centre on government plans to centralise all a patient's information into a single health record that will be held on central computer servers. Activists believe that this leaves the system wide open to abuse. There is equal concern that doctors and health workers will be able to access a patient's complete health record over a lifetime. Opponents say that that the health record should be modularised and distributed onto separate servers to reduce the chances of abuse of the system.

The government counters this by saying that no doctor can access the health record without the patient's direct consent, given by handing over the Vitale 2 card. Critics argue that this is a fig-leaf: that back-door access to central records would be easy for people and departments within the system.

There is also concern that the government itself could make future use of the new health record to link in to other departmental systems to create a Big Brother super database. The government's new ADELE system already provides the infrastructure for such link-ups.

When originally introduced, DMP had stood for Dossier Médical Partagé — or Shared Medical File. But the implication of this — sharing with whom? Revenue Service, Social Security, police, the local town hall — all of whom are plugged into ADELE — caused a swift renaming to the more politic Dossier Médical Personnel, or Personal Medical File.

The government faced stiff resistance getting its healthcare reform bill through Parliament in June 2004. Opposition focused on the clause setting up the DMP system. A group of 120 Socialist Party deputies opposed the bill, arguing that EPR represented a potential attack on civil liberties. One deputy described the EPR provisions as "ignoring the right to a private life and contravening the right to social protection".


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