Medical Billing Software

The new technologies of information and communication (NTIC) know, since several decades, a quick development.  The sector of health, in particular, saw to multiply itself very numerous applications.  The TV medicine (TV diagnosis, TV supervision, TV supervision) modifies in depth the medical practices and the relation between the general practitioner and his patient.  The senate (information and benefits on the net one, online management of the medical billing software…) offers to the general practitioners and to the patients, sources of information and new services.  The cards to fleas (Vital card, card of the professional of health) allow the computerized transmission of the leaves of cares and will be able, to average term, be the support of other services and procedures.  These evolutions are considerable carriers of progress for the system of French cares and the quality of the returned service to the patients.  Nevertheless, they give rise to numerous interrogations from the users of the system of health and professionals, that it is a matter of the respect of the medical ontology and rights of the person (in particular the secret concerning personal electronic medical records), transformation of the professional practices and relation of confidence between the patient and his general practitioner, quality of information and proposed services on the Net, or again end same of these new tools.

Seized by the Prime Minister on the body of these questions, the economical and social Counsel a coherent body of measure that will allow more better to accompany the development of the applied NTIC to the sector of health, in the respect of the rights of the person and in a perspective of improvement of the system of French cares.

A QUICK DEVELOPMENT OF THE APPLIED NTIC TO HEALTH

Many computer applications developed since about ten years in the sanitary domain.  They induce important upheavals in the behavior of the actors of the system of health.

The TV medicine allows henceforth the practice many medical activities from afar.  By beyond the very publicized initiatives of TV surgery, one records the development many other applications in the framework of the networks of cares: the diagnostic, the TV supervision, the TV supervision or again the TV formation medical.  It suits to underline the international dimension of certain ones of these applications: the professionals of French health can establish contacts with foreign professionals and benefit from a supplementary expertise; they can participate more efficiently to sanitary actions abroad, for example in crisis position.  From the standpoint, the contribution on “The TV medicine spatial by satellite”, retrieved by the Professor Alain , in the name of the section of the productive activities, research and technology, and integrated by the section of the social matters to its reflections, puts well in light the issues and the potentialities of the TV medicine at the international level.

The senate is the domain that recorded the evolutions more important, through the development of a multitude of sites devoted to online health.  The professionals of health and the patients can consult portals of health (data banks, directories, links towards specialized sites…) and to have access to interactive sites (discussion forums, online medical health records…).  Benefits and specific services begin being proposed on the Net one, such as the sale of products of health or the online management of the individual medical files.  There again, the international dimension of these tools must be taken into account: notwithstanding the national regulation, that forbids for example the sale out official of pharmaceutical products or the TV consultation, the French patients can have access to foreign sites that propose these benefits.

The cards to applied fleas to the domain of health strongly were encouraged by the administrators of the cash registers and by the French authorities.  The initial objective of the development of the system seam-vital was to allow the TV transmission of the leaves of cares.  If the implement of this program did not realize itself without slowness and apprehension, she is adjourn a reality accepted by the body of the actors: all the assured social are carriers of the Vital card; almost all the professionals is equipped card of the professional of health (CPS) and computer tools allowing carrying out the electronic transmission of the leaves of cares.  The reflection on the architecture of the second generation of Vital card is in course in a perspective of  simplification of the procedures and of better continuity of the cares.

A TRANSFORMATION OF THE BEHAVIORS

These multiple applications have here and now important incidences on the behavior of the different actors.

The professionals of health must familiarize themselves with of new conditions of exercise of their art.  The TV medicine allows them to divide the medical knowledge and also can constitute a trump to preserve a medical offer of proximity.  The continuity and the coordination of the cares equally benefit from the new tools of talks between the general practitioners.  Nevertheless, these new practices are nature to modify in depth the relation of confidence between the patient and the general practitioner.

The users of the system of health are called to become more actors of their own health.  The law relating to the rights of the patients and to the quality of the system of health confers them new rights, in particular in the matter of the property and the personal medical usage of their file.  The new tools of communication offer them innovative solutions to manage this file.  They will give them also a wide access to medical information, through the sites of the senate.  This better information of the patient, provided that his quality is preserved, will modify deeply the relation of the patient with the professional.

The administrators of the disease insurance, the professional organisms and the authorities made the choice to accompany and to encourage the development of the applied NTIC to health.  They work henceforth to what these technologies compete effectively to the improvement of the taken charge of sanitary of the person, in the strict respect of its rights and in a concern of quality of the system of cares.

NUMEROUS INTERROGATIONS

The development of the NTIC in the sector of health, because it touches on the dimension more intimate of the individual, asks numerous ethical questions.  Itself there add many administrative, lawful interrogations or technological.

The respect of the rights of the person The development of the NTIC puts, notably through the medicine and the work in network, the major question of the preservation of the relation of confidence between the patient and his general practitioner.  This relation, essential to the success of the taken in charge of the patient, must not find itself impaired by the partnerships that will facilitate the NTIC.  In addition, the question of the property, archiving and usage of the medical file of the patient puts itself with an acuity reinforced: the law on the rights of the patients grants to the patient a total liberty to authorize the professionals of the health to there to have or non-access, to decide the content of the file and usages that are able in to be done.  For their part, the NTIC can facilitate the exercise of this liberty (archiving of the medical data on computer support, possible recourse to contractors called “info med”, consultation from afar of the computerized files…).  But these solutions consisting of of the risks engrave in the matter of the protection of the confidentiality of the file and the usage of the medical data, for example to commercial ends.

The quality of information.  The development of the senate allows the patient and to the professional to have a wide access to medical information.  At present, no device guarantees to the net surfer the quality of the information that is delivered him.  All the same, the senate proposes new services (medical counsel, sale of online products, computerized management of the medical files) outside of any guarantee of quality and of respect of the applicable ethical rules in France; the character transform of internet reinforces again these risks.  More widely, continue to ask itself the question of the equal access of all to delivered information on internet: the broadcasting of the computer tools profits to an again reduced public; all the net surfers are not placed in the same conditions to judge quality of information and proposed services.

The future architecture of seams-vital.  Here and now, it is necessary to engage the reflections on the future architecture of the device sesam-vitale of second generation.  These interrogations concern first of all the methods of transmission of medical information: the improvement of the conditions of reassuring of internet puts thus the question of the permanence of the Network health social.  Of even it will be essential to accomplish the computerization of the professionals of health and their formation to the NTIC.  It suits equally to reflect to the content of the future Vital card II.  Having access to a capacity of superior memorization, she will be able to be carrier of a more important volume of information.  The choice remains to do between several solutions, of which some will have considerable ethical implications: inscription on the card of medical data of urgency and only necessary information to the continuity of the cares, archiving of the medical file of the patient on the card, addition to the card of a function of “timekeeper” …

The questions of computer security.  The computer security accomplished important progress, in particular by the bias of the tools of assessment.  Nevertheless, on a number of applications own to health, the proposed solutions appear not again fully satisfactory (activities of TV medicine, transmission of the personal data, physical protection of computer equipment of the professionals or of the info-med…).

Unresolved lawful problems.  The development of the NTIC drives to study the current rules of the right.  It is first of all the case of the rules of ontology that take not again sufficiently in account the potentialities of internet and could not suffice to guarantee a protective medical exercise of the person.  It is also the case of the right of the medical responsibility that was conceived in the framework of general practitioner/patient unique relation, while the work in partnership is called to develop.

A COHERENT BODY OF MEASURE

Accomplish the broadcasting of the NTIC in the sector health.  The Counsel recommends following the necessary investments to the development of the NTIC: computer equipment of the professionals, TV medicine, engagement of the second generation of the device seams-vital or again interoperability of the tools.

Favor the coordination of the actors of health.  The development of the applied NTIC to health is a timeliness to accompany the development of the work in network that one must encourage to allow a better one taken charge of sanitary of the persons.  It also must allow improving the knowledge as the authorities and the organisms of the disease insurance have system of cares.

Preserve the confidentiality of the medical file.  The economical and essential social Counsel of all to implement for that the computerization of the medical file is done in the respect of the principle of confidentiality of the personal data.  This implies the engagement of the second generation of the Vital card (provided of a function of “timekeeper”), but also actions of information and of formation of the patients in the matter of the management of their file.  A supervision, if possible at the European level, profession of info med is equally essential.

Protect and form the user of the system of health.  The development of the senate must be accompanied of an effort of information and of formation of the net surfers on the usage of the medical internet.  The elaboration of divided charters allowing appreciating ethics and the quality of the sites must be
encouraged.

Assure the biggest security of the tools of information and of communication.  The usage of the better systems of computer reassuring must be encouraged, in particular by a politics of labellings of the contractors and computer equipment of health.

Accompany the health professionals.  The development of the NTIC in the domain of health implies actions of formation heading for the professionals.  It will impose equally to examine the methods of remunerations of certain medical activities and the conditions of responsibility of the general practitioners.  A narrow association of the professionals to the choices that will be realized regarding NTIC is essential.

Assure the equality of the users and territories.  The THESE wishes that the authorities encourage generalized broadcasting of internet, whatever the age, the professional social category or the place of life of the persons.

Promote the place and the role of the public sector.  The public sector must be placed to the heart of the development of the applied NTIC to health, in particular by the emergence of sites internet public of reference.  On the whole, the authorities must work to the definition of a politics of health coherent.