Digital Health Space and DMP

What is the Digital Health Space (ENS)?

It is a personal and secure digital space that allows each person to access digital data, tools and services related to their health and to manage their health data. The goal is to give the patient the opportunity to become more involved in their health.

Consent to the creation of his ENS?

The law allows for the automatic opening of the digital healthcare space unless the person objects. This means that no consent is requested before the opening of the digital healthcare space.

In practice, since January 2022, Sygesikring has sent each associated person a letter or an e-mail informing them of the opportunity to benefit from the digital health space and inviting them within 6 weeks of receiving e-mail or e-mail:

  • Either to activate their health space;
  • Either to oppose its creation.

The person can change his mind at any time and close his health room or activate it.

What does ENS contain?

The content of the digital health space is defined in the article R. 1111-27 CSP. It contains :

  • Holder’s administrative data (surnames, first names, etc.);
  • His Joint Medical Journal (DMP);
  • Secure health message to communicate with health professionals and institutions;
  • Data on reimbursement of health expenses.

During 2022, it will be completed with the following services:

  • A health diary to manage medical appointments and receive reminders on key check-up dates (check-ups, mammograms, vaccinations, etc.);
  • A catalog (or store) of applications that bring together digital tools and services referenced in the field of health and wellness, developed by public or private actors.

Smaller and ENS

Can a minor benefit from a digital health space? What happens to their digital health space when they come of age?

The health insurance informs the parent to whom the minor is attached about the possibility of activating or opposing the creation of the minor’s digital health space.

The holders of parental responsibility perform all actions on the minor’s digital health space on behalf of the minor. There is no provision for direct access for the minor.

A minor who wishes to keep his state of health secret has the right to request that certain information not be mentioned in his digital health space, in the cases provided for by law (especially with regard to contraception, abortion, STI screening) .

At the age of majority, the health insurance informs the person that their digital health room remains open, unless he or she objects. Holders who have grown up can request the closure of their digital healthcare space.

What data is contained in DMP?

DMP, which is integrated into the digital healthcare space, contains (art. R. 1111-42 CSP):

  • Holder identification data;
  • Data relating to prevention, health and medical, social and medico-social monitoring, in particular vaccinations, medical and paramedical summaries, letters of association in case of hospitalization, medical biological reports, medical imaging studies, diagnostic and therapeutic procedures and prescribed treatments;
  • The data necessary for the coordination of care as a result of reimbursement or reimbursement procedures kept by the compulsory health insurance organization to which each recipient belongs;
  • Drug dispensing data, taken from the drug file;
  • Organ or tissue donation data;
  • Expiration directives;
  • The identity and contact details of the trusted person;
  • Identity and contact details of relatives to be notified in case of an emergency;
  • Identity and contact information of the treating physician;
  • The list of professionals, health care institutions, institutions or social or medico-social services that are authorized to access the DMP, and access permits granted by the holder.

How is the DMP operated?

The healthcare professionals involved in the treatment of the holder of the DMP report in their DMP the diagnostic and therapeutic elements necessary for the coordination of the care.

Any professional participating in the care of the holder of the DMP may, provided that the latter’s consent has been informed in advance, access his or her DMP and provide it. The subsequent feeding of DMP by the same professional is subject to simple information from the person (art. L. 1111-7 CSP).

The holder of the DMP can also supply it himself by adding his health documents.

It may make certain information inaccessible (art. L. 1111-15 CSP, penultimate paragraph.).

DMP does not replace the file maintained by every healthcare professional, regardless of their practice, healthcare institution or military hospital in the care of a patient.

Who has access to DMP?

Access to DMP is reserved for professionals who are authorized by the patient who has the DMP or are considered authorized because they are members of the patient’s care team.

Access by these professionals is limited to the only data strictly necessary for the patient’s care. The access rights of the various health professionals are determined according to an authorization matrix linked to their profession or their specialty. Specifically, this means that e.g. a doctor, an optician or an podiatrist-podiatrist, depending on their profession, does not have access to the same types of documents.

The patient who has the DMP can change the list of professionals with access to his file at any time (art. L. 1111-19 CSP).

The attending physician has a special right of access to the patient’s DMP. He can access all the information contained in the DMP, including the documents that the holder has hidden.

All access to the DMP is tracked and these tracks can be consulted by the holder of the DMP at any time. The latter is also notified in any way of any initial access by a healthcare professional to his DMP.

Any access outside the aforementioned rules is illegitimate and exposes its author to oppressive action by the CNIL, but also to criminal prosecution and disciplinary proceedings in the ordinary courts.

Who can access DMP in an emergency?

Two cases are planned:

Access, in the event of an emergency, to the DMP for a person who is unable to express his or her wishes by healthcare professionals. This is intended to allow any healthcare professional to consult DMP for a patient whose condition poses an immediate risk to his or her health. In the settings, the DMP holder must indicate whether he allows this access in case of an emergency.

The holder of the DMP must also indicate whether he accepts that the regulatory physician at Samu-Center 15 may consult his DMP during an emergency call concerning him.

Hosting and data security

How is the data hosted and secured in the digital healthcare space?

The National Health Insurance Fund (CNAM) and the responsible Ministry of Health, represented by the Ministerial Delegate for Digital Health, are jointly responsible for the processing of data carried out within the framework of the digital health space.

The data is hosted in France by two subcontractors, Certified Health Data Hosts (HDS), in accordance with Article L. 1111-8 of the Public Health Code:

  • Worldline through its subsidiary Santeos, regarding shared medical record data (DMP).
  • Atos regarding other data in the digital healthcare space

The National Commission for Computing and Freedoms (CNIL) has supported and will support the Ministry and CNAM, joint leaders of the digital health space, in all phases of its design, to guarantee respect for rights and freedoms. It has already issued several opinions on the texts governing its functioning and will be invited to monitor their implementation.

Data security depends in particular on:

  • Support from the National Information System Security Agency (ANSSI);
  • Approval of “My Health Room” in the General Safety Guidelines (RGS).

On the user side, every activation and every connection to “My Health Room” is subject to a high level of security.

  • For activation, verification of 3 personal identification data: preliminary code, social security number, serial number on the Vitale card.
  • Subsequently for each connection, entering a unique password, received by e-mail or SMS, in addition to entering the username and password.

Evaluation of the environmental impact of the ESA

The environmental impact of digital health was the subject of a report from the Ministerial Delegation for Digital Health in May 2021, available in by clicking on this link.

Texts and references

Public Health Code:
Articles L. 1111-13 to L. 1111-24 : digital health space and common journal
Articles R. 1111-26 to R.1111-39 : digital health space, content, creation and access
Articles R. 1111-40 to R.1111-64 : creation, content, terms of access to DMP and the rights of the holderHealth insurance
– My health room, a new digital service personal and safe
– My health room: who can access the data?
– My health room: Terms of service
The Joint Journal (DMP) in practice

National Commission for Computing and Liberties (CNIL)
The Digital Health Room (ENS or My Health Room) and the Joint Journal (DMP): Questions and answers

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