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Voice of G_NIUS: Hundred Days to Success. This is the podcast of G_NIUS, the Guichet national de l'innovation et des usages en E-santé. Around Lionel Reichardt, meet E-health innovators and key experts to help you succeed in your projects.

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Lionel Reichardt: Hello everyone, you're listening to one hundred days to success, the podcast aimed at innovators and entrepreneurs in digital healthcare, but also at anyone curious about this field. This podcast is produced by G_NIUS, the Guichet national de l'innovation et des usages en E-santé. For this 20th episode, I have the pleasure and honor of welcoming an exceptional guest, Dominique Pon, General Manager of the Pasteur Clinic in Toulouse and Ministerial Responsible for Digital Health. Dominique Pon Hello.

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Dominique Pon: Good morning.

00:00:53
Lionel Reichardt: In 2018, as part of the strategy to transform the healthcare system, you co-signed the report Accelerate, the digital shift and then joined the Ministry of Health and Prevention to implement the resulting national strategy. Could you begin by reminding us why it was essential to focus on digital technology to transform our healthcare system? And what have been the major stages of operational implementation since 2018?

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Dominique Pon: The starting point was a report I wrote with Anne-Laure Coudray in 2018, which basically said that for the past twenty years, as someone who's been in the field, with my hands in the dirt, digital healthcare has been a mess. For the past twenty years, due to a lack of determination and pragmatism on the part of the French government on digital healthcare issues, we've allowed software to flourish everywhere among doctors, hospitals, EHPADs, biologists and radiologists, without a common interoperability framework, without very precise security rules, and so the result is that in the care pathway for a healthcare professional, digital has not provided access to fluid information because the software is not interoperable.

00:01:56
Dominique Pon: So, there's frustration on the part of healthcare professionals and then on the part of French citizens, over the last twenty years, we still haven't been able to give the French back their healthcare data. Everyone's data is scattered to the four winds, and the gynecologist, the pharmacist, the biologist, the radiologist, the attending physician - we haven't been able to digitally restore the health record to all French citizens. This double failure, in fact, initiated the principle of a roadmap which basically consisted in saying that the State is taking back control. The State takes back the reins, refixes the rules, imposes interoperability standards on software publishers.

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Dominique Pon: The French government is back in charge of building the basic digital infrastructures that enable all software to communicate within the same framework, i.e. a national healthcare identity, extended RPP directories, secure messaging, healthcare terminology servers and, also, the health space platform. In ten years, we're putting 2 billion on the table, we, the State, to ensure that all healthcare software in France is modified, brought up to standard and connected to national public infrastructures so that digitized healthcare information circulates both for healthcare professionals and for citizen patients, and that's what we've been working on, doing for three years, in a logic where I never believed there would be any providential guys or gals.

00:03:23
Dominique Pon: I've always believed in the need for a collective dynamic, and what I think is so beautiful about this highly technical adventure at the heart of the digital roadmap is that we really have a sacred union between manufacturers, public authorities, professional orders, professional unions and patient associations, and even a citizen's committee to say this is no longer possible. We can't go on like this in France. And that's basically what the roadmap is about, with the opening of my health space 15 days ago, so it was one of the flagship actions of the roadmap.

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Lionel Reichardt: Fittingly, you've mentioned several times my health space which has just been launched for French citizens. But at the start of this crucial, or at any rate important, stage of the roadmap. How would you sum up these three years?

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Dominique Pon: It was too much fun, too good to imagine that in a report, I set out the diagnosis and the vision, saying the State is going to take back control, the State is going to build infrastructure, the State is going to create a digital space for all French people, to say three and a half years ago, we're going to do it before April 2022 and it's done. All the actions outlined in the report have been carried out. They weren't just carried out by the State, they were carried out by a collective of the entire digital healthcare ecosystem in France. And that's fantastic. So, that doesn't mean that everything is settled. It doesn't mean that there aren't a thousand problems, but it does mean that it's possible in France to conduct a public policy hand in hand with all the players in an ecosystem, and I find, moreover, within a framework of values which, I believe, guarantees a form of humanism, even if it's a very technological subject, an ethical framework, a sovereign framework, a citizen framework. I'm very happy with what we've done collectively over the past three years.

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Lionel Reichardt: So 2022 is a pivotal year. You mentioned my health space in particular. What are the major milestones of this year and what are the major challenges ahead?

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Dominique Pon: My health space is an infrastructure with enormous power to transform the healthcare system, but the uses and levers we'll be able to use with this platform will arrive little by little. And so, step by step, we're going to build digital sovereignty in healthcare in France, by giving citizens a real link and real access to healthcare data and coordination with these professionals. So, in the next stages and at the beginning of May, loop out, that is to say, the automatic creation of my health space for all French people who are not opposed to my health space. This is already a huge first step. We may be going from 10 million DMPs taped up over the last 15 years to perhaps 60 or 65 million digital health spaces created in France. First step.

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Dominique Pon: Second step for me is that we're going to enhance my health space, which today consists of two bricks, a digital health data vault known as the medical record and a secure messaging system, to which we're going to add a health diary and a catalog, a store of digital health applications developed by the entire Start-up ecosystem, by manufacturers, by everyone, by state-approved hospitals, but which will in fact enhance my health space with services. A key year-end milestone, it's the start of the Segur program's success.

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Dominique Pon: By the end of the year, we should start to see deployments of standard healthcare software among biologists, radiologists, hospitals and general practitioners, and therefore with automatic health data feeds into my health space. So, for me, the next steps are three major ones. Then, there's a whole roadmap of functional developments. Adding a child's health record, a vaccination record and so on. I'll give you the key points.

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Lionel Reichardt: And what's at stake? Once we've got these steps, is developing usage the biggest challenge in the coming months?

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Dominique Pon: For me, the first issue is data collection. First of all, it's about not spreading ourselves too thin, not fantasizing too much, being humble, pragmatic and moving forward. The first step is to collect accessible data in one place, with patient consent management. We really can't afford to spread ourselves too thin, so we need to mobilize everyone. We're going to have to put a bit of pressure on everyone, publishers, professionals and establishments. That's the first step, and for me, that's the main challenge for 2022. I'd say the first slightly refined use cases, pre-hospitalization, care pathways, coordinated care, and so on. I'd rather see it in the first half of 2023, when we'll really be working on use cases. But I don't think we should make the mistake we always do, which is to fantasize and then get frustrated because we can't achieve our fantasies. Humbly, as in a mountain walk, we're taking another step, and the very big step we're already taking is collecting data.

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Lionel Reichardt: Finally, Dominique Pon, a question about G_NIUS. So the Guichet national de l'innovation et des usages en santé. And let me remind you that this podcast, 100 Days to Success, is produced by the G_NIUS platform. How does G_NIUS contribute to the development and deployment of digital technology? And why was it important to make this one-stop shop available to healthcare innovators and entrepreneurs?

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Dominique Pon: What's essential to understand in our vision of digital healthcare in France is that it's not the role of the State to drive innovation. The State's role is to set the framework, to establish the basic platforms, a bit like in a city where the State writes the town planning code and builds the roads and bridges. It's not the State that builds buildings and houses, so it's the same in the digital world. The ones who will create the real value of innovation are the startups. They are the industrialists. They're all the people who are going to come up with crazy ideas for digital applications. And they're France's gold. But for them to work, several things are needed. First of all, the State had to reframe things so that they could have a playground and access to data, in particular. That's the first point. Secondly, that there be funding.

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Dominique Pon: These are all major state programs. The Ségur numérique program to catch up, and what we call the digital health acceleration strategy, with all its innovation aspects, support for digital therapeutic innovation, artificial intelligence, third-party innovation sites, etc. And the third point is the French government's commitment to digital health. And the third point is to finally make what the State is doing understandable for grassroots startups who want to enter the digital healthcare field. That's what G-NIUS means to me. It's that link, that one-stop shop. In fact, it was built with the people in the ecosystem, so that the creators of innovations that will, in fact, make up the digital health of tomorrow, can more or less find their way around, understand what funding they can access, what is expected, what are the requirements, who to contact? This is essential, because they're the ones who'll be creating tomorrow's innovation. It's not the State that's going to do it.

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Lionel Reichardt: Thank you very much Dominique Pon. Thank you for all these elements. We'll be seeing you soon at the many events we're organizing all over France, particularly as part of the Digital Health Acceleration Strategy you mentioned earlier. Our episode is coming to an end. Thank you for listening. Thanks again to our guest for his availability. Don't hesitate to subscribe to the podcast on your listening platforms. We look forward to seeing you soon for a new episode of One Hundred Days to Success.

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Voice of G_NIUS: Those who make the E-health of today and tomorrow are on the G_NIUS podcast and all the solutions to succeed are on gnius.esante.gouv.fr.