French Ministry of Health Examining Adoption NHS Direct in France

While all the world's health systems share the same objectives of improving the health of their population, the regulation and organization of care is national and reflects many local factors (demography, genetics, environment, diseases, culture, resources, history of public policy...). Nonetheless, as many developed economies hit up on the same challenges of insufficient resources, budget deficits, unequal quality of care, benchmarking is becoming more common? The recent Health 2.0 Europe conference is a case in point of the potential synergies amongst European health innovators.

The May 20th edition of the French daily Le Figaro   explains a recent benchmarking development;  the French Health Minister is considering establishing a single govermental portal with a national telephone answering service akin to NHS Direct. The dual program would have several goals a)  to ensure the provision of quality information b) to reduce the inequality of population access to quality information c) to reduce unprogrammed visits to emergency rooms, thanks to nurse/patient phone conversations, distance medical consultations, and an appointment service,  d) to reduce the overconsumption of medications. 

But there are many factors to take into consideration.

The May 20th edition of the French daily Le Figaro   explains a recent benchmarking development;  the French Health Minister is considering establishing a single govermental portal with a national telephone answering service akin to NHS Direct. The dual program would have several goals a)  to ensure the provision of quality information b) to reduce the inequality of population access to quality information c) to reduce unprogrammed visits to emergency rooms, thanks to nurse/patient phone conversations, distance medical consultations, and an appointment service,  d) to reduce the overconsumption of medications. 

But there are many factors to take into consideration.

 NHS Direct was created in the UK, 13 years ago, in 1997, with the initial launch of an experimental phone service and then extended through the country in 4 years. The NHS Direct website was also launched with some basic content a few years later, and has been improved since. Recent figures are that NHS Direct receives:

• 1.5 million information-seeking visits per month,  
•  9 million calls per year, including 5 million for information and 4 million for other services. 20% of calls are for perceived emergencies.  
• 75 000 calls per week regarding hospital appointments

A 2008 study showed that 41% of callers were advised to remain home. 75% of them would have otherwise gone either to emergency rooms or to a consultation. 

Satisfaction for the phone service is high; only 1 in 10 000 complaints/

The cost of managing a call in 2008 was cited as 25 pounds, or the price of a consultation (although an avoided emergency room visit is much more costly). What is the figure today?

NHS Direct employs 3 400 including 1 400 nurses, located in 34 local offices.

                                     Questions for France:

1 If NHS Direct were to be created now, would it be the same?

 In 2000, NHSDirect needed to install touch-screen kiosks. Now ubiquitous flat screens, iPhones, social media, and 2.0 tools have changed the landscape. How would this change the conception of the service?

There is no unique or exclusive health site. New sites are created regularly and the Internet's  long train is alive and well in health care in the UK.

2 How long will it take to start from scratch the implementation in France as well as to make the service known to and adopted by the population? -- not to forget that the temptation would be to improve the service in the process. Major public administrations cannot "hurry". US counterparts such as  FDA,  CDC, Pubmed/Medline  began early and have had the time to develop several generations of web sites as well as to get involved in social media.

3. What about France's official medicines portal presented by the Ministry of Health in 2009 and which Silber's Blog wrote about. This potentially interesting project has remained a  page with three links: to the French medicines agency l'Afssaps, to the  National Payer's selected medication data base, to the French HIgh Health authority. None of these sites is up to current standards of usability. This is corroborated by user statistics.  

4. How does this project integrate with  other  health information systems:  telemedicine, telemonitoring,  online patient record, electronic prescription, hospital systems, mobiles, and not to forget Health 2.0 tools and collaboration.

 The advantages of an NHS Direct in France are definitely worth exploring, but so are other European tools and solutions. Could a configuration with more collaborative, 2.0 type tools be more appropriate?

• 1.5 million information-seeking visits per month,  
•  9 million calls per year, including 5 million for information and 4 million for other services. 20% of calls are for perceived emergencies.  
• 75 000 calls per week regarding hospital appointments

A 2008 study showed that 41% of callers were advised to remain home. 75% of them would have otherwise gone either to emergency rooms or to a consultation. 

Satisfaction for the phone service is high; only 1 in 10 000 complaints/

The cost of managing a call in 2008 was cited as 25 pounds, or the price of a consultation (although an avoided emergency room visit is much more costly). What is the figure today?

NHS Direct employs 3 400 including 1 400 nurses, located in 34 local offices.

                                     Questions for France:

1 If NHS Direct were to be created now, would it be the same?

 In 2000, NHSDirect needed to install touch-screen kiosks. Now ubiquitous flat screens, iPhones, social media, and 2.0 tools have changed the landscape. How would this change the conception of the service?

There is no unique or exclusive health site. New sites are created regularly and the Internet's  long train is alive and well in health care in the UK.

2 How long will it take to start from scratch the implementation in France as well as to make the service known to and adopted by the population? -- not to forget that the temptation would be to improve the service in the process. Major public administrations cannot "hurry". US counterparts such as  FDA,  CDC, Pubmed/Medline  began early and have had the time to develop several generations of web sites as well as to get involved in social media.

3. What about France's official medicines portal presented by the Ministry of Health in 2009 and which Silber's Blog wrote about. This potentially interesting project has remained a  page with three links: to the French medicines agency l'Afssaps, to the  National Payer's selected medication data base, to the French HIgh Health authority. None of these sites is up to current standards of usability. This is corroborated by user statistics.  

4. How does this project integrate with  other  health information systems:  telemedicine, telemonitoring,  online patient record, electronic prescription, hospital systems, mobiles, and not to forget Health 2.0 tools and collaboration.

 The advantages of an NHS Direct in France are definitely worth exploring, but so are other European tools and solutions. Could a configuration with more collaborative, 2.0 type tools be more appropriate?

Comments

[generic drugs]

On the surface, it appears that health insurance reimburse medical care providers less in France than in other European countries.

[Denise Silber]

Thanks Clare. I'm going to post your interesting post on the French version of the article as well (in English) on http://www.denisesilber.com

[Clare McKitrick]

An interesting post Denise - I work for Digital Public, and we've helped NHS Direct develop and implement online tools that patients use to triage their own symptoms. Our evidence shows that in an age when Googling your symptoms is endemic, there is a key place for trusted, well-evidenced online services that help patients work out what to do next - whether that's have a webchat with one of NHS Direct's nurses, visit their GP or take a couple of painkillers and rest. So while NHS Direct started as a telephone-based service, they are now spearheading online service innovation and achieving great results with it - both for patients and in terms of effiency. If France were to adopt a similar concept, it would present a great opportunity to start with a 'web first' assumption, preserving the more intensive channels like telephony or face to face contact for those patients who really need it.