Medical Device Daily Contributing Writer

BARCELONA — Ironically, the most headstrong and sometimes nettlesome member state of the European Union, the United Kingdom, has emerged as the key reference for overhauling a national system of care.

"Six years ago no one would have dared let the British speak at a healthcare congress," Volker Amelung, managing director of the German Managed Care Association (Berlin), said during the recent World Health Care Congress Europe. "Their system was a case study for disaster, with terrible infrastructure and delivery. Today they have a tremendous experience and knowledge that is showing everyone the importance of information technology, and for empowering patients within the system. It is impossible to have a conference without them."

David Nicholson, chief executive for the UK's National Health Service (NHS), said, "Anyone reading an English newspaper will see daily the pain and anger of the transformation of our system."

Nicholson said the NHS "massively invested in capacity, which has meant more doctors, more nurses and new and better hospitals and clinics," but he added: "This investment alone, capacity alone, is not enough."

The boldness of the British e-health program, Connecting for Health, shows the kind of courage needed in Europe, according to keynote speaker Viviane Reding, the EU commissioner responsible for the EU Directorate for the Information Society.

"We need a greater sense of urgency to attack health budgets to prepare for the crisis that is coming," she said. "Spending is growing faster than gross domestic product and only IT can help to keep down the costs and to help reorganize the delivery of services. The Commission believes profoundly in IT and we have set ambitious goals."

Reding added, "My frustration with e-health is that we are seeing great results but on a limited scale, with limited prospects for a wide-scale deployment anytime soon."

Despite the widespread admiration for British pluck in using a nationwide IT structure to force upon the entire healthcare system, no other European nation is following the lead.

The only European nation with the political structure to mandate national change is France, which presented at the World Health Care Congress Europe here, a carefully designed plan for outflanking the expected resistance from the healthcare establishment to any large-scale change.

The head of IT development for the French Ministry of Health, Jacques Sauret, told the conference the long-delayed dossier m dical personnel (personal medical record, or DMP) would go public in 2008, though he said the request for proposals from network hosts for constructing the infrastructure is not expected before mid-April.

The France-based operations of IBM, Atos Origin, Bulle and Thales are the probable bidders for the project, Sauret told Medical Device Daily.

France will select three providers, with one required to serve as a back-up service capable of recovering the files of the other two in the event of a system failure.

In the end the DMP will not be an electronic health record (EHR) but instead will be issued as a "service." The 60 million smart cards to be carried by French citizens starting in 2008 will serve as a key to unlock a file managed by the patient providing information for urgent care, medications, potentially medical imaging and documents, but not clinical data

"We are thinking big regarding the needs but acting small to avoid unpilotable projects," Sauret said. "Phasing the project is essential because it is not possible to get everything done at the same time the way the English are trying it."

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