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
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
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
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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