Nathalie Beslay is a lawyer who specialises in e-Health. She was one of the speakers at the Doctors 2.0 & You event which took place on 5-6 June in Paris. In conversation with L’Atelier, she describes the legal, regulatory and practical issues in the health sector that will need to be addressed when medical data is dematerialised and the health sector moves into the digital era.

[Doctors 2.0] There is a need to "categorise and rate apps to help doctors prescribe the right one"

What are the advantages of dematerialising medical data and what are the issues involved in such changes?

Demateralising data enables access to and therefore sharing of data, which will in the long term – as long as people act in compliance with the regulations – foster better understanding of health practices and promote better patient care. Another related issue here is the need to achieve cost reductions, which comes under the wider imperative of limiting overall health expenditure. The preventative approach is also of huge importance. Knowing yourself means you’ll know the risks you may be facing. The therapeutic benefits are that it will help to achieve the best results, optimising the treatment process and promoting innovation. The new technologies may also help to solve the problem of some geographical areas being starved of medical support.

Do you think the medical community is ready for the transformation that the shift to digital technology will bring about in the health sector?

That depends on the type of healthcare practitioner you’re talking about. Some medical fields are more ready than others to incorporate digital technology. Take for instance pharmacists, who’ve been using computers for a long time now. So they’ll be able to incorporate digital technologies into their business quite easily. But it will also depend on people’s individual preferences. The ability to innovate and integrate digital technology into your professional activity largely depends on whether you like using the technologies. So this should expand with the younger generation.  It’s clear that among healthcare practitioners there are geeks, people who are avid users of the new technologies, but there are doctors who still don’t use computers. They won’t be very inclined to prescribe mobile apps! Today it’s difficult for healthcare practitioners who are not clued-up digitally to judge which mobile app is a good one, to know about e-Health services, what connected objects are all about, and so on. They may be worried about who may be using their patients’ personal data. Lack of knowledge may lead to anxiety. There are no real benchmarks, though some companies are now starting to assess and rate apps. All these issues are still somewhat opaque among the healthcare community, but it’s obvious that it is a good idea to differentiate between the wellness type of app and apps with real therapeutic value.

Is there a way to train healthcare practitioners so they feel less inept in the face of this transition?

Well, it would be a good idea to set up a repository of information on the apps right away. This should be independent, objective, and use clear and efficient criteria. It will take a year to draw up the criteria, categorise and rate all the apps to help doctors prescribe the right one for the patient at the right moment. We need to be pragmatic. Physicians must be able to use the tools easily. For example, if the patient is a diabetic, the doctor should have a list of apps and be able to recommend the best one, i.e. the one that best suits the patient’s needs. At the present time however we are a long way from this situation, though I should stress that there are a number of private initiatives underway in this area.

What are practitioners most worried about?

Healthcare practitioners are well aware of the issues both around data privacy and as regards the impact of the treatment. Then I would say that there’s a good deal of concern about the legal aspects of e-Health, because here in France the legal framework is very strict. The measures provided by the current regulation ensure that data privacy risks are very slight indeed. We should be focusing instead on the progress that digital tools can bring in terms of innovation, value creation, the help that these technology tools can really offer patients and their potential for solving demographic problems for example.

In other words, you’re saying that the legal framework is adequate to ensure confidentiality…

Yes, I think the legal framework is adequate and it’s already restrictive enough. On the other hand, there’s no doubt that it doesn’t quite suit the current evolution in technology. When it comes to connected objects, we’ll be asking ourselves where’s the data now, where’s it going to, is it being shared between servers, and so on. New issues are being raised. In fact the legal  framework probably shouldn’t be changed. It would be better if the authorities in charge of regulation – in particular the CNIL, [the French national body that oversees regulation on the use of personal data in digital systems] and ASIP santé [the French government agency for shared information systems in the health sector] – acted pragmatically and showed flexibility in their approach to the work they do. The CNIL certainly has a vital role to play. Many service providers have in fact succeeded in meeting all the criteria. The recently published report on connected objects and the ‘quantified self’ clearly demonstrates that these bodies are aware of their role in terms of educating the players and interpreting the rules so that the service providers can do their job properly. They shouldn’t just be seen as obstacles or merely be playing the policeman. We do need to ensure that they help to clarify the rules as they apply at the operational level.

New practices are emerging and the number of Health websites is growing. Are some of them likely to disappear?

It’s difficult to say but I don’t think there’s enough room for everybody and there are now a great many players in this field. The risk is that we’ll have too many apps. The number is already excessive and only some of them will make the grade.

What do you think will be the next disruptive idea in e-Health?

I think the e-Health booth is a fabulous idea. Being able to get in touch with a doctor, no matter where you happen to be in the world, and obtain treatment, or at least obtain some care in a confidential, secure and efficient environment is a great concept that really deserves to be developed.

By Lucie Frontière