Five hundred million euros. That is the sum spent on the personal medical record between 2004 and the start of 2014, for a result that even its designers struggled to defend. By January 2, 2014, only 418,011 records had been opened in France, far from the five million initially targeted. An internal report to the National Council for the Quality and Coordination of Care, consulted by Le Parisien, laid out precise figures for what already, ten years after the project’s launch, looked like an administrative fiasco.
- 500 million euros were spent on the shared medical record between 2004 and 2014.
- Only 418,011 records were opened instead of the initially targeted five million.
- Physicians did not adopt the tool, leaving almost half of the records empty.
A project launched in 2004, a disastrous outcome ten years later
It all began in May 2004, when the health minister at the time, Philippe Douste-Blazy, announced the creation of a universal digital health record intended to accompany every French citizen throughout life. The ambition was clear: centralize analyses, hospital discharge summaries, prescriptions, and medical history in a single space, accessible to the health professionals involved in following the same patient.
By early 2014, around 400,000 records had been created, with about 500 million euros invested since 2004, mainly by the national health insurance. The document revealed by Le Parisien specified that these 500 million euros had been paid since 2004, according to an internal document of the National Council for the Quality and Coordination of Care. Ten years of effort, ten years of budgets committed, for a system that almost all French people had never opened.
The gap between the target and reality is staggering. Five million records were planned, against only 418,011 actually opened. Twelve times less than anticipated.
Healthcare professionals who never adopted the tool
The problem was not limited to the number of records created. A ministerial reply published in the National Assembly acknowledged the difficulties in deploying the DMP, mainly because health professionals did not appropriate this shared record. Even where records existed, doctors simply did not use it on a daily basis.
This professional disengagement helps explain the emptiness of the content. A parliamentary question raised during the 14th legislature noted that the medical information feeding open DMPs remained very limited, with nearly half of them being empty or containing only a single document. A medical file with no medical data inside: the initial promise of a rich and exploitable digital health record collapsed on itself.
The Minister of Social Affairs and Health at the time, Marisol Touraine, acknowledged the dead end. In April 2013, she already spoke of the need for a second-generation DMP, while the government, lacking a ready-to-use new strategy, was forced to extend the existing contract by one year, adding 7 million euros for the year 2014 alone. The fiasco thus continued to be costly, even during a period of reevaluation.
What the Court of Auditors’ report had already revealed
The Court of Auditors had sounded the alarm a year earlier. In a report published in February 2013, it estimated the cost of implementing the DMP between 2005 and 2011 at 210 million euros, while noting that including additional investments required for its operation, the total could exceed half a billion euros. The 500 million figure revealed in early 2014 thus joined the estimates already put forward by the financial magistrates a year earlier.
The Court’s finding was severe. It pointed to failures indicating an abnormally lacking strategy and a grave failure of methodological continuity in the implementation of a tool presented as essential to the structural reforms of the health system. A judgement rarely as stark coming from an institution accustomed to measured conclusions.
In response to these repeated criticisms, the management of the project eventually changed hands. Article 25 of the Health Law of April 13, 2015 entrusted the leadership of the system to the National Health Insurance Fund, replacing the Shared Health Information Systems Agency, which had been responsible up to then. The name also changed: the “dossier médical personnel” became the “dossier médical partagé,” the one we know today.
A paradox: the French were in favor
The failure cannot be explained by popular rejection of the principle. According to a 2013 survey, 83% of the French were in favor of the very idea of the shared medical record. The problem was not distrust of the tool in general, but a faulty technical and organizational implementation, unable to convince doctors to truly integrate it into their daily practice.
This paradox aptly summarizes a decade of digital health public policy: a broadly supported idea on paper, erratic leadership on the ground, and a price tag that grew year after year without corresponding usage. The issue remains current today, as French health authorities attempt, through new digital devices, to persuade patients and caregivers where the original DMP failed.
Sources: assemblee-nationale.fr | franceinfo.fr | ccomptes.fr
