Background, constraints and challenges

In the face of a changing health care system and both regulatory and economic constraints (budget compliance, quality of patient care), information systems need to evolve in order to provide effective support for the strategy adopted by health care institutions and their environment (municipality, region, health care networks, etc.). In particular, France's law of 4 March 2002 (on patient rights and the quality of the health care system) defines each patient's rights as well as the conditions under which patients may view the items in their records and under which authorized professionals may view items in a patient’s records.

The law of 13 August 2004 (and specifically those articles relating to the coordination of care and the DMP1) requires the opening of the information systems maintained by health care institutions. In particular, they must make it easier for health care professionals to communicate (i.e., share and exchange information) as part of a cooperative effort to coordinate the care given to the patient, in order to ensure continuity of care both within the health care institution itself and with regard to other health organizations (in the private sector, specialty care networks, etc.) while maintaining the security of the information provided.

France’s 2004 social security funding act implementing the CCAM2 and the T2A3 programmes determines the financing and operational methods available to health care institutions based on changes in operational tracking and billing methods.

The HCIS4 must generate the indicators on financial management (defining and monitoring activities, financial and human resources, etc.) and service quality that are needed for the purposes of running the institution.

Information systems must offer reliable performance that responds to the need for quality information, whether this involves personal medical data (i.e., the patient's health information) or relevant indicators taken from operating data with which the institution’s operations can be monitored on a day-to-day basis.

Moreover, HCISs must stay abreast of regulatory developments such as national plans (e.g., France’s Cancer Plan, the Plan Urgences [emergency care services plan], etc.) and regional plans (SROS5).

Finally, hospital information systems are complex insofar as they provide support for the numerous functional processes that take place within the institutions. In addition to the very wide range of care-giving procedures, these include administrative, logistical and managerial procedures as well as several procedures that are less clearly identified relating to research, training, social welfare activities and other fields of activity.

To respond to these challenges, technological upgrades to information systems must be coupled with an institutional policy for providing support to personnel (i.e., direct and indirect users of the IS) in adopting the new operating procedures these upgrades entail.

1 DMP: Dossier Médical Personnel [Personal Medical Record], defined in Article L. 161-36-1 ff

2 CCAM: Classification Commune des Actes Médicaux [Common Classification of Medical Acts]

3 T2A: Tarification à l’activité [casemix-based hospital financing system]

4 HCIS: Health care institution information system

5 SROS: Schémas régionaux d’organisation sanitaire [Regional health organization plans]