Country profile: France

The French healthcare system is organized on the local as well as the national level, with financial responsibilities delegated to the health insurance/social security system. While the state enforces health policies and oversees their implementation, regional and local entities govern the healthcare organization under the national legal framework.

ICT use and eHealth strategy

On average, 82.8 % of the GPs in France use a computer. In European countries, the average use of computers in this area totals 87.4 %. In France, the average use of IT support amounts to 75 % and is slightly higher than the overall European average of 74 % 

Internet use is more developed than computer stand-alone usage. In France, 72,3 % of the GPs make use of Internet services, compared to other European countries with an average Internet-usage of 68.8 percent.

For Electronic recording and storage of individual administrative patient data, 74,2 % of the GPs use an electronic Patient Record (ePR) compared to 79,5% in other European countries.

The Ministry of Health determines the French health policy. The French e-Health department, “Healthcare Computerisation System Mission” (Mission pour l’Informatisation du Système de Santé –MISS), is ranked on the General Secretary Level, and is in charge of the global e-Health strategy.

The French e-Health Policy mainly aims at contributing to:

• broader public health objectives (healthcare equity, coordination and continuity of care, patient safety)
• national planning objectives, especially regarding proximity healthcare
• the education and training of HCPs
• curbing problems arising from demographic changes for all stakeholders
• mastering costs

Based on these fundamental aims, France has implemented a great number of solutions in the domain of e-Health. While French HCPs have been using an ID / e-Signature card for a long time (CPS, introduced in the early 90s, together with a secure telecom network), the introduction of the health insurance card (Carte Vitale) has vastly improved the efficiency of the French social security system and significantly simplified administrative workflows in French HCP practices. Many more specialized e-Health solutions, such as the DCC (Dossier Communiqué Cancer), as well as a number of regional implementations and pilot projects contribute to the complexity and diversity of the French e-Health landscape.

The Ministry of Health leads several public agencies with diverse missions.

ASIP Santé manages projects delegated to it by the Ministry of Health as well as the implementation of the French electronic medical record (DMP).

ASIP Santé need to define, to propose and to promote guidelines, products or services that aid interoperability, security and the use of healthcare and e-Health IT systems, under the approval of the Ministry of Health.

Legal framework

France has implemented a number of legal measures meant to advance electronic healthcare and the access and use of patient data. The CNIL law of 1978 prohibits data processing without consent while maintaining an exception for data absolutely necessary for medical treatment (which is consequently covered under professional secrecy legislation). Medical privacy was regulated further in 2002: the Medical Privacy Act provides ownership rights of patient data and reaffirms the need for consent in order to transfer said data among health professionals.

e-Health is specifically regulated in the Healthcare Insurance Act of August 2004, which includes a number of provisions regarding telemedicine as well as the legal and organizational basis of the DMP Public Interest Group, assigned to develop and introduce the so-called French EHR Solution. In 1996, the Ordonnance Juppé became the first keystone of the legal policy framework of French Health Information Systems. These systems contain the legal mandate to introduce a standard-compliant and safe electronic data transfer infrastructure for the health system.

In the summer of 2009, the HPST Act (Hospital, Patients, Health and Territory) was implemented. Thereby the global healthcare organisation was updated, and the GIP DMP (e-Patient record) was renamed into ASIP Santé, creating ANAP for supporting hospital performance. Moreover, new regional agencies (ARS) were created.

All these public agencies are Public Interest Groups (GIP) lead by the Ministry of Health.