There was tension in the air on Wednesday at the headquarters of the AMMD not far from the capital's centre.
“We have had confirmation that the global vision of the digitalisation of the health sector that we have been developing for the past three years, the one that we have always tried to convey, to argue, to raise awareness with the eSanté Agency, well, the latter does not want it...,” says Alain Schmit, president of the AMMD. “The dialogue is broken between us and the Agency!”
This is a harsh statement for a situation that seems no less harsh. The reason for this is a difference in vision between, on the one hand, the agency whose mission is to develop and implement digital solutions that can make the healthcare system more efficient, and on the other, the medical association.
“We look more at the screen than the patient”
At the centre of the debate is the famous DSP (shared care file), the personal and secure electronic health record.
“This is a database where a patient's medical documents arrive and are stored. But the basic idea, for us, was not to store these documents. Rather, the idea was to share them between the patient and the health professionals who needed them. However, this idea of sharing has, in our opinion, been forgotten,” emphasises Schmit. “Today, it is more like a kind of safe that has nothing 'living' about it. Nothing user-friendly. Quite simply because the design was left to computer specialists who do not know how a doctor works. Everything is far too cumbersome in terms of the steps to be taken. The doctor ends up spending more time looking at their computer screen than their patient. There is a reason why the use of the PHR is minimal today.”
To give an idea of the rift that seems to have developed between the eSanté Agency and the AMMD, the latter listed and developed, on Wednesday in front of the press, seven essential grievances that demonstrate, according to it, the “current serious dysfunctions” of the agency.
These range from the reproach of “not having developed anything itself” (eSanté has called on foreign service providers and is therefore dependent on them) to the rejection of “a solution created by doctors for the benefit of citizens”, while not forgetting to highlight the absence of an electronic signature in the documents on the PHR.
“The eSanté Agency says that these documents have been identified and that it knows who provided them. This is true! At least as long as we stay in this bubble that is the PHR. On the other hand, if you take out a document, it loses its validity because it is not signed,” says Schmit.
A situation that has been festering for a long time
Although this conflict between the AMMD and the eSanté Agency had not yet been made public, it does not seem to be a recent development. And it manifests itself especially in the relationship between the two directorates. “The affair had been somewhat hushed up, but in 2018, we had asked for the resignation of the director of the agency, Hervé Barge. The latter had opened 23,000 PSDs without a legal basis. For us, this was inconceivable”, says Mr Schmit. He added that today the same director of the eSanté Agency is “confined to his own world, dependent on the French firm (the AMMD points to Maincare, a creator of health software and digital solutions, editor's note), which delivers its technological solutions to him, without probably giving him those that we would really need.”
"The situation has deteriorated over time," adds Schmit. But, according to him, he still had hopes that the AMMD's vision of the digitalisation of the health sector would prevail. At least, that was the case until he received an e-mail two or three weeks ago that clearly took away his last hopes. “We then said to ourselves that we had to warn the (general) public,” says Alain Schmit. He now hopes that having the issue out in the open will finally make it possible to move things in the direction hoped for by his association.
Director Hervé Barge's defence
Hervé Barge, director of the eSanté Agency, had already been challenged at a press conference by the LCGB, but he then replied point by point and defended his work on the PHR tooth and nail.
“Talking about a flop makes no sense. What is a flop? What is a success? Compared to what and to whom?" he told Delano's sister publication Paperjam last October.
“The politicians gave me the task of deploying 850,000 PSDs in two years. This was done in one year. I am not going to talk about success, but this first indicator is positive. In the case of a deployment, if this first indicator is not good, then we can talk about failure. Here, this is not the case […] In Luxembourg, we had provisioned 1.5 million documents in 18 months. Currently, we are at 4.4 million documents shared within the CSP. So this second indicator has exploded since we have almost tripled our objective with a very positive growth rate. Once again, without talking about success, this indicator is more than positive,” he said.
As for the use of the PHR, the third indicator: “Six months after the roll-out phase, we were averaging 270 consultations per day. Eighteen months later, we are at 10,000 consultations per day. An evolution from 270 consultations to 10,000 consultations per day in 18 months, I think that's not bad,” said Barge.
This story was first published in French on Paperjam. It has been translated and edited for Delano.