Medical knowledge was transmitted first orally and then by hand. We are now entering the digital age. The medical staff, with all possible guarantees, lead practitioners to more method in knowledge sharing, organizational practices and cooperation with other health professions.
The entry into the digital age broke tradition based medical oral transmission of knowledge from a master to his pupil. When sworn in, the young doctor still says: “I will give their children the education that I received from their fathers.” We are therefore familiar with the origin, in a teaching relationship in a given location, the physician must apply to a patient the principles and knowledge that went elsewhere draw based solely on memory. Then, with the spread of writing, the practitioner will begin to record their observations at the bedside and to correspond with long letters, often highly literary, with his colleagues. This is true in 1947 that the code of medical ethics requires practitioners to hold a medical card with their comments for each of their patients.
Medicine continues to change: the handwriting was gradually abandoned in favor of digital writing. This requires the practitioner to more structured thought. Computerization also requires a disciplined group: each physician must enter data on a given mode, concisely and objectively, so that another colleague who knows the patient can not navigate.
Today the acceleration of technological advances impacting abrupt ways to exert different health professions and how they cooperate. While medical informatics on post dedicated beginning to stabilize, new mobile technologies fall already in the computer obsolescence 2000s and its uses.
The fascination experienced by our societies to feats that allow the information technology and communication must not outweigh the ethical considerations applied to their medical uses.
The College of Physicians is not the guardian of tradition. It is, cons, the guarantor of the preservation of medical ethics and professional ethics in this new digital world of health.
Three areas will be processed and positively: the exchange of medical correspondence by e-mail, shared electronic medical records, the practice of telemedicine.
Messaging. The secrecy of correspondence is a principle of public policy, breach of criminal law is. Such secrecy naturally applies to electronic correspondence. When it comes to personal data for health include the extension of ethical and regulatory principle: positive identification and authentication of the sender and receiver, data encryption circulating the acknowledgment logic Notarization and flows, non alteration of data during transfer. To support the development of professional messaging in the context of medical ethics, the National Council of the Order will ensure compliance with these principles. In addition, it supports the rule of interoperability messaging tools and propose any physician enrolled in the tables in order to secure a mail box as the firstname.lastname@example.org it lodged. These emails are meant to be fed directly into the computerized patient record and future WMD.
The computerized medical records. They are now a reality in both surgeries and in health facilities. They may become multi-disciplinary or multi-professional structures in ambulatory care. DMP will one day, the Personal Medical File, provided by law, in which every citizen can centralize its personal health data in summary form and structured.
In all these situations, the patient must give explicit consent to open a file on a computer, it should also withdraw this consent and to exercise a right of objection or a “right to the forgetting “some episodes of care. It must also and above all, give himself clearances for access to professionals that they had access to his record as reading and writing. This is only to implement in the digital space on patient choice and the “de facto veto” he currently does not say everything about him. These points are technologically easily soluble. What are the procedures to follow which will be a strategy of supporting professionals? In this respect, as every physician can become an expert in computer security, ethical, legal and the National Council of the College intends to become for him the trust corporation in the digital health. It will shortly publish a doctrine document on “dematerialization of health data, building trust to promote the informatization” which is associated with a guide of good practices in security.
Telemedicine. The law HPST (Hospital Patient Health Territories) recognized that medicine could be fully exercised at a distance without physical contact of a patient and a doctor, thanks to technologies of computerization and communications. The National Council of the Order has strongly supported this legislation and is now helping in the drafting of its implementing decree. In fact, telemedicine is a means to improve equity in access to care: it can bring medical expertise at any point in the territory without moving the patient required. It will also remotely monitor and maintain their places of life of patients suffering from chronic diseases or suffering from critical electronic devices such as pacemaker and defibrillators, for example.
Through the practical application of computing devices for telemedicine, we see that the safety of information systems is as much robustness and availability in need of health coverage and the protection of personal data and confidentiality.
We must therefore find the right tradeoff between what technologies can do and everything should be preserved on the inner life of people. The freedoms of individuals must be defended. Technological devices and tools must guarantee them confidentiality. At the same time, the safety of care requires that data necessary for quality medical care should be taken quickly accessible. This debate is a debate. It can thrive under the viewpoints of professional bodies, the National Commission on Data Protection, the National Consultative Ethics Committee, patients’ associations … The Medical Association is in any case near to participate: to live the medical ethics and professional ethics in the life of today and tomorrow.