Everything you need to know about access to the shared medical record in 2022

By Nathalie Boudet-Gizardin, counsel and Charlotte Denis, intern

In 2018, the President of the Republic announced a global overhaul of the health system implemented as part of the “My Health 2022” project. 

Nine main projects were identified in the preparatory work and deployed in law no. 2019-7774 of July 24, 2019 relating to the organization and transformation of the health system:

1. Territorial structuring of care
2. The adaptation of vocational training
3. The gradation of care and the evolution of regional hospital groups (GHT)
4. The evolution of managerial skills (especially medical) in the hospital
5. Regulation and unscheduled care
6. The diversification of working conditions and career paths
7. The quality and relevance of care
8. digital health
9. Financing and pricing

Among these projects, a central place is given to the digital transformation of patient care in the city and/or in the hospital. In addition, the digitization of the patient's care pathway has become an imperative in the context of the current epidemic where the use of telehealth has proven essential to guarantee the continuity of care in our territories. 

In order to support patients and healthcare professionals in this digital shift, it has become more necessary than ever to effectively centralize the patient's medical information within an accessible and practical digital medical record, better known as "shared medical record" (DMP). 

As we previously mentioned in an article published in the Practitioner's Review in 2020¹, accessible on our website², the digitization of the patient's medical file is not a recent creation. 

Indeed, the law n°2004-810 of August 13, 2004 instituted for the first time a computerized medical file, also called " personal medical record ". This file was intended to trace all of the patient's medical history and was only accessible by the patient and his caregivers via the Internet. With only 400.000 files opened in 2014, the project to create a personal medical file is a failure. Too complex to implement, the legislator decided to modernize it, by law n°2016-41 of January 26, 2016, by establishing the " shared medical record whose implementation is entrusted to the Health Insurance. Each beneficiary of the Health Insurance can therefore have a DMP, subject to his express consent. Another failure: very few DMPs are opened by patients, and they are generally undersupplied by caregivers.

Anxious, however, to continue this digital shift initiated in 2016, which has become essential, the DMP has been the subject of recent modifications³ by decree no. 2021-1047 of August 4, 2021, the provisions of which have been in force since January 1, 2022.

What is the content of the DMP? 

The DMP remains a digital health record in which are recorded: 

• The results of the patient's examinations, 
• his allergies, 
• The history of the care he received, 
• The treatments he took and followed, 
• Data relating to his trusted person, 
• His advance directives, 

Etc 

How do I access my DMP in 2022?

All health insurance beneficiaries can have a DMP. 

You can only access your DMP through a digital health space (ENS⁴),protected and secure, grouping, in addition to the DMP, the administrative data of the patient holding the file, his health constants, and access to secure messaging. the patient will therefore only be able to access his DMP via his ENS⁵.

Who is responsible for creating my DMP?

Since January 1, 2022, a shared medical record should in principle be created automatically by the Caisse Nationale de l'Assurance Maladie for each beneficiary of the Assurance Maladie⁶. 

In addition, the opening of the ENS allowing access to its DMP will be done gradually. between January and March 2022. 

To do this, the beneficiaries of the Health Insurance will receive an individual e-mail⁷ detailing the methods of setting up their ENS and specifying its articulation with their current DMP, if it exists.

Can I refuse the creation of my DMP?

Although the creation of a DMP is in principle automatic, it is not necessarily mandatory. Indeed, any beneficiary of the Health Insurance can, upon receipt of this letter, choose to activate his ENS or, on the contrary, exercise his right of opposition to the creation of this space.⁸. The terms and conditions of this right of opposition are specified on the ENS portal and its implementation is carried out through an online process.

Who can access my DMP?

The terms of access are circumscribed and strictly framed by the Public Health Code⁹. 

Thus, can have access to the DMP: 

• The patient holding his DMP, 
• Health professionals contributing to the care of the patient in the city and in the hospital.

However, access to a patient's shared medical file by healthcare professionals is always subject to the patient's prior consent.¹⁰. This consent may be obtained by any means, including electronically. 

When the professional is a member of a care team in a healthcare establishment, access to the DMP is authorized within the framework of the effective care of the patient. It is deemed authorized for all professionals who are members of the same care team.

On the other hand, the sharing, between professionals who are not part of the same care team, of information necessary for the care of a patient again requires his prior consent.

With his professional card and his patient's vital card, a city doctor can therefore, with his agreement, access and feed his patient's DMP by connecting to the site dmp.fr or using its patient management software.

In addition, the patient can also oppose access to one or more health professionals of certain data in his medical file, by going to the " policy » and by activating the function « hide from a healthcare professional ". On the other hand, he can at any time reconsider his decision. 

Can information from the DMP be made temporarily inaccessible to the patient? 

Article R. 1111-53 of the CSP provides, exceptionally, the possibility for a healthcare professional to make temporarily inaccessible to his patient, data on his state of health, entered in the DMP, when he considers that this information " should not be brought to the patient's attention without accompaniment ». 

The information is then made inaccessible until the implementation of a patient announcement consultation. 

Within two weeks following the entry of inaccessible data in the DMP, and in the absence of the announcement consultation, the patient is informed by any means, including electronically, of an update of his DMP, inviting him to consult a health professional, in particular his attending physician, to find out about it. 

If the ad consultation has not taken place one month after the entry of the data in the DMP, this information then becomes after one month, " automatically reachable to the patient.

The main objective of this overhaul of the DMP is to improve the quality of patient care, by allowing optimized and better coordinated monitoring of the care provided to him, between community medicine and the hospital. Still, the effectiveness of these new measures depends on the use that will be made in practice of the DMP by both patients and caregivers. Even if this digitization seems inevitable, we know that it can be complicated to implement in practice, due to the digital divide affecting certain impoverished territories and certain categories of users who are still unfamiliar with these new digital communication methods. Let's hope that this third legal step will allow a real improvement in the care of patients.

For any specific questions regarding the health law, you can contact the firm.