E-health: which services are of interest to citizens?

At a time when e-health is developing at high speed, patients suffering from chronic diseases are the first to be concerned and affected by this change. A large survey has just been carried out among the main stakeholders: what services, tools, e-health applications, etc. are they in favour of? Are they inclined to this new way of taking charge of their health? Which pathologies are the most concerned?
Ahe medical desertification is spreading, health insurance continues to run a deficit, the hospital can no longer carry out its tasks normally, and innovative medicines are reaching astronomical prices. Our healthcare system is on the brink of collapse and its future is at the heart of French people's concerns. Digital technology is a key element in the response, as it is a unique vector for improving the supply of care and the quality of life of citizens, optimising territorial coverage, strengthening coordination between players and making budget savings. The B3TS polling institute, through its platform Chronic Panel, conducted a study on patient expectations (1).

Tele-consultation: 1 out of 2 chronically ill people think of using it.

When we talk about e-health, we think first of all of teleconsultation, a new practice recognized today by the health care system, and very recently in experimentation to improve health pathways by the Assurance Maladie. While 2018 seems to give new impetus to telemedicine, only 9 % of respondents to the B3TSI Chronic Panel survey have already consulted a doctor remotely, and only 1 % of respondents practice it frequently.
Among chronic patients who had already consulted remotely, 63 %s did so by e-mail and 54 %s by telephone, in order to obtain a prescription/advice without a prescription in 78 %s of cases, and a prescription/advice with a prescription in 37 %s of cases.
Why did they use teleconsultation? In 37 % of the cases to try it, and in 35 % of the cases because it is easier and without loss of time. Thus, among the people who have already experimented with this practice, 87 % are ready to repeat it.
Among those who have never used teleconsultation, 54 %s are thinking of using it in the future. And when asked why they will consult their doctor remotely, 57 % also think it is easier and without wasting time, 50 % think it will be at the doctor's request... 46 % are still curious and want to try this practice for its innovative aspect.
It therefore seems that, despite the current low use of teleconsultation by chronically ill patients, patients are rather in favour of a more common practice of teleconsultation in the future.

Internet appointment scheduling, a common practice for chronically ill patients

How can we talk about e-health without talking about making appointments on the Internet, which is the real gateway to e-health?
Democratized among others by the Doctolib startup, appointment scheduling on the web is more and more practiced. 58 % of chronically ill people have already made an appointment by internet (including 66 % who have used Doctolib), but only 14 % recognize a frequent practice. Migraine patients make the most appointments via the Internet, perhaps because of the suddenness of migraine attacks.
Unsurprisingly, 96 % of chronically ill patients who have already made an appointment online wish to renew this practice.
Among people who have never used an appointment scheduling platform on the Internet, 69% are thinking of doing so in the future, including 80 % to make an appointment with a general practitioner and 55 % with a specialist doctor (80 % in the case of people with cancer). And the reasons are always the same: in 65 % of cases because it is easier and quicker, and in 42 % of cases to try it.

The web for health information. The mobile remains to be developed

Today considered as a media in its own right, the internet is an important source of health information: 90 % of people with ankylosing spondylitis consult the internet for their pathology, 76 % for cancer, 75 % for diabetes, 68 % for migraine. On the other hand, 47% of people with hypertension never use the web.
e-health also means smartphones, applications and connected objects. 86 % of respondents own a smartphone, but very few use health applications: 18 % of heart failure patients, 11 % of ankylosing spondylitis patients and no COPD or rheumatoid arthritis patients.
As far as connected objects are concerned, the findings are similar: only 12 % of diabetics use them, 5% of hypertensives and migraine sufferers, 2% of cancer patients, 0% of COPD patients.

What about the shared medical record (DMP) in all this?

The DMP is a sea snake launched in 2004, relaunched by the 2016 health law in a modernised version, which should therefore, after much procrastination and euros spent, reach all French people who have a Vitale card. According to the texts, this digital health record will "promote prevention, coordination, quality and continuity of care". Information that will become accessible in just a few clicks by the many health professionals who follow us, thus avoiding duplication and unnecessary procedures and facilitating medical follow-up.
There are seven major files that include our allergies, history, blood type, pathologies and current treatments. We will also be able to store all the X-rays, results of biological analyses, operation reports... But also our wishes in terms of organ donation.
In terms of health data, only 8 %s in the panel have (or know that they have) a pharmaceutical record and 12 %s have a shared medical record (DMP) (25 %s in the case of patients suffering from ankylosing spondylitis). On the other hand, chronic patients are not at all refractory to DMP, since 88 % are in favour of it. When asked about their confidence in the safety of their data, however, only 63 % patients are confident, the least confident being patients with rheumatoid arthritis (23 %).
It seems that the chronically ill are only at the beginning of this new e-health practice, but that they see its potential and are in favour of its development and practice in their care pathway in the future. This is good news for this market, which is tending to develop more and more, and for the DMP, which is expected to become widespread in October.
There are still doctors who, according to a study published on Thursday 6 September by the consulting firm KPMG and the Federation of Swiss Physicians (FMH), are generally positive on the issue, but are not exploiting the possibilities offered, despite the high potential for savings: almost six out of ten doctors (58%) say they are positive or very positive about digital health services such as online appointments, fitness advice or new information options for patients. 38% are skeptical or very skeptical (Source : la liberte.ch).
The public and medical personnel will therefore experience the digital transformation in terms of the benefits offered by the useful and ergonomic services deployed. In order for patients, carers and hospital staff to appropriate the new uses, it is first and foremost necessary to demonstrate the positive effects of the digital transformation on a daily basis and to promote the services to the users who are at the heart of the system, and who must therefore remain in control of their choices and options, while being accompanied.
(1) Survey conducted from 3 to 12 July 2018 using a nationally representative sample of 501 respondents from the Chronic Panel.

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