The title of this article will not appeal to all those who are fighting for the development of the electronic patient record (EPR), but this question could not be more serious. Will the DEP really allow the citizens of this country to be better cared for?
The concept
The intentions of the electronic patient file are indisputable: to allow patients to be better cared for by giving health professionals access to all the necessary medical information, but also to make patients more active by allowing them to have access to their health data. . The problem is that we do not heal with intentions and we have no idea of the impact of this tool on the health of its users. Will I find in the DEP the information that I currently lack to treat my patients? I’m not sure, most often I’m missing information because the doctor who saw my patient at the hospital hasn’t written a discharge letter yet or his psychiatrist hasn’t thought it useful to tell me. report its findings. In these situations, the DEP, as long as my patient has created one and that it is updated, will be useless to me.
A laborious birth
We can read in an article published on March 30 in Le Temps the following sentence: « On one point, everyone agrees: the electronic patient record (EPD) has so far been a monumental flop. At the beginning of each passing year, the most optimistic predict that it will finally take off only to end up disillusioned twelve months later, because hopes have been dashed. ». On the other hand, CARA, the community which brings together all the French-speaking cantons except Neuchâtel, seemed at the time of his press conference rather optimistic in stating that « 7,500 electronic files are opened at CARA, which represents nearly 90% of files opened throughout the country ». CARA recognizes all the same that “Improvements are needed”. Even if this figure of 7500 files is more than respectable, the opening of files is not an end in itself. The goal remains that these files are useful, and we are still far from it. CARA supports future actions to improve DEP, including those proposed by the Federal Council on April 27. Among the proposed measures, some make it possible to understand the weakness of the initial project, others leave you wondering.
A mandatory file?
The Federal Council is putting two variants in consultation for patients: maintaining the optional nature and introducing an opt-out model, which is favored by the Federal Council. The DEP will therefore be compulsory by default and the citizen will have to act himself if he does not want to have one. For health professionals, it will simply be mandatory. The positive side is that it will allow the DEP to be more complete, the negative side that it will represent a considerable overload of work for medical practices. Not all physicians have a computerized medical record and for those who do, the vast majority are not able to automatically transfer data to the DEP. We can read on the pages of the State of Vaud website dedicated to this project “At practice software publishers, integration work with the DEP has begun in order to automate the consultation of the DEP from the practice software and the transfer of data into the DEP. To date, this automation is in the development stage for existing software”. In development ? I remind you that the DEP law dates back 7 years already.
When a tool like the DEP must be made mandatory for it to be used, there is a problem.
A project for the future?
It is possible that this project should not be evaluated on its current usefulness, close to absolute zero, but as a tool of the future which will reveal its usefulness in a few years when the DEP will be more used and more complete, but I have doubts.
The problems
They are unfortunately multiple. I have already mentioned the cautious interest of citizens and health professionals. There is complexity for the opening and for the use of the DEP. There is a work overload for health professionals. There is also the question simply of the medical usefulness of this tool. There is also the fact that if it is useful, it will be for a minority of the population, those suffering from chronic illnesses. To interest the whole population, it would perhaps have been necessary to imagine a useful tool for the promotion of health, for prevention, in the DEP there is nothing. There is also the exorbitant cost of this project. Finally, there is the fact that the DEP monopolizes all the energies, whereas it is only a small part of the innovations that our health system needs.
Stopping this project is probably impossible for political reasons. If we think about its current and future medical usefulness, I think we have to seriously ask ourselves the question.
For now, don’t rely on DEP to stay healthy.
PS: Read on Heidi.news, the electronic patient record is (finally) becoming a real national issue.
Other articles (more or less) related to this article and published on this blog:
Electronic patient record: will you be better cared for?
The digital revolution in medicine: are we ready to reinvent the way we work?
The challenge of integrating digital into our health systems
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