Two hundred and ten million euros. That is the amount a project intended to revolutionize French medical monitoring had already spent after seven years, for barely 158,000 records created, more than half of which were completely empty. Twenty-two years after its launch, the medical record that became My Health Space posts a financial picture that spins the head, and a history of successive reminders, missed targets, and a 2022 technical shift that changed the game without solving all the problems.
Key takeaways
- Colossal investment since 2004: how 210 million euros vanished within a few years
- The major shift of 2022: a miracle solution or simply a scale-up of the same problem?
- Opened files vs live files: the gap that persists two decades after the initial promise
Toulouse, 2004: the promise of a file for everyone
Health Minister Philippe Douste-Blazy presented at the Pasteur Clinic in Toulouse the shared medical record, a central element of a reform of the health insurance system aimed at generating 3.5 billion euros in annual savings. It was May 24, 2004, just a few months before the August 13, 2004 law would enshrine this personal medical file in French law. The ambition on paper was straightforward: a single digital health notebook, accessible to all professionals, that would prevent redundant exams and duplicated prescriptions.
The reality took a completely different course. Put on hold in 2012, the project still managed to spend 210 million euros in investment for 158,000 records created, with more than half of them entirely empty. A report from the Court of Auditors, released on February 19, 2013 and commissioned by the Finance Committee of the National Assembly, confirmed the scale of the fiasco. The Court estimated that the development and deployment of personal medical records, in various forms, probably cost more than half a billion euros by the end of 2011, while lamenting the lack of a clear strategy in steering the initiative. At the pace observed at the time, it would have taken more than a century to cover the entire population covered by the social security system.
Repeated follow-ups, a rising tally
The personal medical file did not die in 2012; it simply changed hands. Its upkeep cost 35 million euros each year according to the Court of Auditors, until it was revived in 2015 by Marisol Touraine, who entrusted its management to CNAMTS. Two years later, another attempt: in 2017, the health insurance pushed the project across nine departments and obtained encouraging initial results, claiming the creation of 10,000 shared medical records each week, actually consulted by health professionals.
But the gap between announcements and reality remained wide. A written question addressed to the National Assembly recalled that at one point the official site for the personal medical record announced barely 418,247 opened records, i.e. barely 8% of the initial objective. A figure that alone underscores the disconnect between institutional communication and actual use of the system. And behind this number of opened records lies a deeper problem: the input of medical information into records that had been opened was very limited, nearly half of them being empty or containing only a single document. Opening a record is ticking an administrative box. Filling it with notes, analysis results, or vaccination history requires a doctor, a laboratory, or a hospital to take the time to upload the information, which was never automatic before 2022.
2022, the automatic switch
The decisive turning point comes with the “Ma Santé 2022” law, enacted in 2019, whose implementing decree provides for the automatic opening of a “Health Space” for all French citizens starting June 1, 2021. In practice, the Health Insurance changes its method: instead of waiting for voluntary action, it reverses the logic. From January 31 to March 28, 2022, all insured under the French health insurance system were progressively informed by email or letter about the opening of the service Mon Espace Santé and the modalities for activation. After a six-week period from the dispatch of this notice, and in the absence of opposition, the profile was created automatically, these automatic creations occurring from mid-March to early May 2022.
The result, automatically scaled up, is significant. According to a report from the National Health Insurance Fund, the number of registrations to the Mon Espace Santé platform reached 11.2 million as of May 31, 2022. The refusal rate remained marginal: according to CNAM, the opposition rate to opening the space stood at 1.48%. In plain terms, almost no one said no, but saying yes by default does not mean using the service. It’s exactly the same gap as in 2012, but on a multiplied scale: opening automatic millions of accounts is a logistical feat, keeping them alive is another challenge.
Opened automatically, fed manually
To bridge this gap, the state put resources to work. An unprecedented two-billion-euro investment was committed to modernizing the professional software used by clinicians—private practice, hospitals, and the medico-social sector—with the aim of making the data entry into the file almost automatic on the professional side. A few years after the switch, usage indicators were improving but not exploding. In January 2024, 450,000 logins were recorded, between 100,000 and 200,000 medical records were consulted monthly by healthcare professionals, and 45,000 general practitioners were sending documents to Mon Espace Santé. Today, more than 95% of insured individuals have Mon Espace Santé, a figure that starkly contrasts with the mere hundreds of thousands of records created over fifteen years since 2004.
One question remains that official figures do not clearly settle: how many of these tens of millions of opened records today contain more than an automatically generated reimbursement history? Between a technically active account and a health notebook truly useful in an emergency at the other end of the country, the distinction remains, two decades after Toulouse, the same as in 2004.
Sources: esante.gouv.fr | sante.fr | reseau-hopital-ght.fr
