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Introduction
The digital transformation of the healthcare sector has profoundly altered medical and administrative practices. Among the major developments, the electronic patient record ( EPR) has become a central tool for monitoring and coordinating care.
It is gradually replacing traditional paper files, and is part of a wider drive to improve the quality of care, streamline exchanges between professionals and enhance secure access to medical data.
How does it work? What is its purpose? And above all, how can we guarantee the security and regulatory compliance of the health data it contains? This article sheds some clear, practical light on the subject.
1. What is a computerized patient record?
Definition and terminology
The Electronic Patient Record (DPI) is a digital system that centralizes all a patient's health information in a secure electronic format. The DPI should be distinguished from the Dossier médical partagé (DMP), two distinct approaches to the patient's medical record, which is a specific initiative of the French healthcare system, providing patients with a centralized digital space accessible via the Assurance Maladie.
Typical content
A computerized patient record includes, for example :
- Patient's complete medical history
- Biological and imaging test results
- Hospitalization and consultation reports
- Prescriptions and medication orders
- Known allergies, antecedents and contraindications
- Administrative data (contact details, health insurance, attending physician)
2. Why use a computerized patient record for patient management?
Benefits for healthcare professionals
The use of a computerized patient record brings significant benefits to healthcare professionals. Rapid access to a complete medical history enables more informed decision-making during consultations. Care coordination is improved thanks to easier sharing of information between different specialists and facilities.
Benefits for patients
Patients benefit from better care thanks to the continuity of medical information, particularly when changing doctors or in emergencies. Reducing medical errors is a major benefit, as computerized health data limits the risk of misinterpretation associated with handwriting.
Reducing the number of redundant examinations also represents both an economic and medical benefit for patients.
3. How does a computerized file work?
Hosting and data security
Computerized patient records must be hosted by certified Healthcare Data Hosts (HDS) in France, guaranteeing a level of security commensurate with the sensitivity of medical information. Security is based on data encryption, strong authentication of connections and traceability of access.
Integration with business software and healthcare services
The effectiveness of a digital healthcare system depends largely on its integration with existing practice management software (local or online). Interoperability between different care structures enables a fluid exchange of information, avoiding data re-entry and guaranteeing information consistency.
4. Regulatory framework in France
Legal frameworks
The deployment of electronic patient records falls within a strict regulatory framework in France. The 2016 healthcare system modernization law strengthened obligations relating to the dematerialization of healthcare data.
The GDPR, applicable since 2018, completes this scheme by imposing specific rules for the processing of health data, considered to be sensitive data requiring enhanced protection (Article 9).
Public initiatives
The " Ma Santé 2022″ program marked an important step in the digital transformation of the French healthcare system. The digital health space, deployed progressively since 2022, aims to give every French citizen secure access to their healthcare data.
These public initiatives support healthcare establishments in their digital transition, while harmonizing practices at national level.
A European vision with EHDS
The electronic patient record is also part of theEuropean Health Data Space (EHDS), a European Commission initiative designed to facilitate the secure sharing of healthcare data between member countries, for the purposes of care, research and innovation. In particular, the EHDS provides for:
- enhanced interoperability,
- common standards,
- and cross-border file portability.
Establishments need to anticipate these developments to ensure that their systems are compatible on a European scale.
5. Best practices for integrating a CIO into your facility
Choosing the right tool
The selection of a computerized patient record must meet several essential criteria. Regulatory compliance is an essential prerequisite: HDS certification of the hosting provider, GDPR compliance, and compliance with security guidelines.
Adaptation to the specific needs of the facility (medical specialties, size, organization) also guides the choice. System scalability and the quality of technical support are decisive factors in long-term investment.
Raising awareness and training care teams
A structured change management plan facilitates adoption of the new system. This begins with raising awareness of the benefits of electronic patient records, followed by progressive training tailored to different user profiles.
Identifying digital referents within medical teams helps to support colleagues who are less familiar with digital tools.
Setting up data governance
Accountability for health data management must be clearly defined within the organization. The appointment of a Data Protection Officer (DPO) is often mandatory for healthcare establishments.
Traceability of access and modifications to patient records is an essential regulatory requirement. Clear procedures must define who can access what information, and under what circumstances.
Conclusion
Computerized patient records are a key element in the modernization of the French healthcare system. Its benefits justify the necessary investments and a methodical approach that integrates technical, human and regulatory aspects.
FAQ (Frequently Asked Questions)
1. What is the difference between a DMP and a DPI?
The DPI (Dossier Patient Informatisé) is an internal system within a medical establishment or practice, while the DMP (Dossier Médical Partagé) is a national initiative enablingthe DMP to be populated by different professionals and information to be shared between all French healthcare professionals.
2. Who can access a patient's electronic file?
Only healthcare professionals involved in the patient's care can access his or her file, in compliance with medical secrecy and the need-to-know principle.
3. How is IPR data protected?
Data is protected by encryption, strong authentication, access traceability and hosting with HDS-certified service providers. The GDPR strictly frames their use.
4. Can a patient refuse to have his or her data computerized?
No. Health data is collected and processed without explicit consent, as its processing is necessary for the care mission provided by healthcare professionals (Article 9.2.h of the GDPR)
On the other hand, the patient must be informed of this processing and retains certain rights (access, rectification, etc.).
5. Is PGD mandatory in healthcare establishments?
No, it's not legally required, but it's highly recommended. The HAS certification standards certification standards require that patient records be kept in a rigorous, secure and accessible manner. The CIO is the most suitable solution for meeting these criteria. Without a CIO, a facility runs the risk of not being certified, which could undermine its credibility.
6. How to choose an IPR system
The choice should be based on regulatory compliance, adaptation to business needs, ease of use, interoperability, total cost of ownership and quality of technical support.
7. What are the risks of misusing IPR?
Risks include breaches of confidentiality, medical errors due to incorrect data, regulatory sanctions and loss of patient confidence. Appropriate training and clear procedures limit these risks.
Need help with GDPR compliance for your computerized patient record?
As an external DPO registered with the CNIL (National Commission for Information Technology and Civil Liberties) and an expert in the healthcare sector, Dipeeo handles GDPR compliance for more than 150 healthcare players in France.
Our legal experts can help you:
- Impact analysis (DPIA) specific to computerized patient records
- GDPR compliance tailored to healthcare data
- Drafting of procedures and privacy policy
- Training teams in data protection best practices
- Patient rights management (access, rectification, portability)
- Relations with the CNIL (National Commission for Information Technology and Civil Liberties) and support in the event of an inspection
- Ongoing regulatory monitoring of changes in the healthcare legal framework
Why choose a specialised external healthcare DPO?
- Sector expertise: in-depth knowledge of healthcare issues
- Cost-effective: 100% control over fixed monthly costs
- Reactivity: immediate availability in the event of an incident or question
- Objectivity: an external, independent view of your practices
Secure your transition to electronic patient records today by drawing on our recognized expertise in the healthcare sector.
Anaïs Guilloton
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