Health service defends digital patient file after criticised as “flop”

With more than 900,000 shared care records and more than 4.4 million documents shared within the PHR, the director of the eSanté agency rejects the LCGB's analysis that it is a "flop". (Photo: Shutterstock)

With more than 900,000 shared care records and more than 4.4 million documents shared within the PHR, the director of the eSanté agency rejects the LCGB's analysis that it is a "flop". (Photo: Shutterstock)

Hervé Barge, director of the eSanté Agency, has responded to the LCGB's criticism of the shared medical file (dossier de soins partagé, DSP), a digital database that aims to improve care by enabling patients to share records between different doctors.

Described as a "flop" by the LCGB trade union at a press conference at the end of September, Barge responded to the criticism in an interview. "Talking about a flop makes no sense. What is a flop? What is a success? Compared to what and to whom," he said, saying the LCGB did not have the numbers needed to carry out an analysis.

"Part of my job is to make a cold analysis of the figures. In the case of the DSP, there are three neutral indicators to take into account," he said. "The first indicator is volumetric. It simply serves to know whether there are shared care records or not. For Luxembourg, and this is probably the reason why politicians have spoken of a 'success,’ we achieved our two-year target in one year," Barge said.

“By December 2021, the agency's challenge was to set up 850,000 shared care records. In December 2020, i.e. 18 months after its launch phase, we had already reached more than 900,000 shared care records that can be used by healthcare professionals. I would remind you that the DSP has two interests. Firstly, it can be used by health professionals in the interest of the patient, who can manage his or her DSP. It is not a patient or health professional file. It is a record that can be used by health professionals in the case of a therapeutic relationship and managed by the patient if he or she so wishes," the eSanté director said.

"Politicians gave me the mission to deploy 850,000 DSPs in two years. This has been done in one year. I'm not going to talk about success, but this first indicator is green. In the case of a deployment, if this first indicator is not good, we can talk about failure. This is not the case here," the director said.

As for the second indicator: "It is also a volumetric indicator," said Barge. "It is the number of documents that are put in the DSP. In some countries, after 10 years of deployment, 50% of the DSPs are empty and the others have an average of one to two documents. Here again, not knowing the framework or the objectives, I cannot speak of failure or success. On the other hand, in our case in Luxembourg, we had provided 1.5 million documents in 18 months. Currently, we are at 4.4 million documents shared within the DSP. So this second indicator has exploded since we have almost tripled our objective with a very positive growth rate. Here again, without talking about success, this indicator is more than positive," said Barge.

Covid-19 pandemic impact

Such a growth in documents could be explained by the covid-19 pandemic and the numerous virus tests carried out by the population. But here again, the director of the eHealth agency is adamant. "You would think so. But that's not the case. We might have expected a drop in the number of documents exchanged with the end of large scale testing. Well, this is not the case. In fact, the opposite is true, since the growth is constant. Since this summer, medical imaging has also been able to integrate the functions of the DSP," he said.

Finally, the third indicator concerns the usage rate. "Six months after the roll-out phase, we were averaging 270 consultations per day. I don't know if this is a success. But, overall, we already had a small usage. 18 months later, we are at 10,000 consultations per day. I don't know if we can call it a success, but an evolution from 270 consultations to 10,000 consultations per day in 18 months, that's not bad," said Barge.

These three indicators are used by the director of the eHealth agency to compare the Luxembourg DSP with what is done in other countries. "In a comparison exercise with our neighbours, I am already wondering whether they have a DSP for 150% of their population", he said. "The medical practices of our neighbours are relatively the same, so we could estimate the number of documents in the DSP systems in other countries. In France, there should be about 440 million documents and in Germany about 570 million documents. Currently, Germany does not have a DSP system despite several attempts. The French are a long way from the 440 million documents," he said.

“We cannot therefore talk about a flop,” Barge said.

The last criticism of the CSP is the length of time it took to develop the project, which was launched in 2015 and has only been in the generalisation phase since last year. "The pilot phase lasted five years. But we took the time to talk, to listen, to discuss with a very large number of people. During that time, we worked on reference systems and a national interoperability framework and on setting up health data exchanges," said Barge. 

This story was first published in French on Paperjam. It has been translated and edited for Delano.