The Idea Behind the Dossier
France's push for a national electronic health record began in 2004 with a project called the dossier médical personnalisé, or DMP — a digital file intended to follow every patient through the system, regardless of which doctor, clinic or hospital they visited. The goals were clear and genuinely compelling: give every clinician treating a patient instant access to a consistent, complete picture of that person's history; eliminate duplicate tests and redundant prescriptions; enable secure information exchange across institutions; and generate population-level data for epidemiological surveillance and prevention programmes. The projected savings on paper, postage and repeated investigations were put at around €3.5 billion over time — though that figure always depended on adoption happening at scale.
By the mid-2000s the state had committed around €500 million to the project. What followed was a long lesson in the distance between policy and practice.
Where the Plan Ran Into Reality
The first wave of friction was technical. Doctors, hospital managers and administrative staff reported that the software was slow, cumbersome and poorly matched to the rhythms of a real consultation. The interface ate time rather than saving it. Successive IT providers came and went without ever producing a system that clinicians found genuinely usable, and the investment in training rarely kept pace with the investment in infrastructure.
Underneath the technical problems lay a structural one. Much of the data-entry burden fell on general practitioners — the professionals least likely to benefit directly from the system in its early form. A hospital specialist ordering a scan might eventually see a colleague's results; a GP entering a patient's full medication history was largely doing administrative work for other people's benefit, unpaid and unacknowledged. Without financial incentives or a meaningful reduction in workload, enthusiasm was predictably thin. By 2015 — more than a decade after launch — only around 500,000 dossiers had been created across a population of roughly 65 million. Uptake among professionals hovered around 6,000 active users nationally.
The DMP's stumble was not unique to France. Across Europe, national health record projects have repeatedly discovered that getting disparate institutions, software systems and professional cultures to align around a single standard is far harder than designing the standard itself.
Governance, Consent and the User in Control
The project was significantly rethought in the years that followed. One of the most important shifts was philosophical: moving the logic of data governance away from institutions and toward patients themselves. In the current model, individuals have meaningful control over what appears in their record, who is permitted to see it and under what circumstances.
That control is not trivial. A patient can, for instance, choose to exclude mental health records from the sections visible to a new clinician. The consequence is real: a practitioner opening the file will have no sight of information the patient has chosen to conceal. Privacy advocates see this as essential; clinicians sometimes argue it introduces a blind spot that could affect care. The tension has never been fully resolved, and it probably cannot be — it sits at the intersection of two legitimate interests.
This patient-controlled model now lives inside Mon Espace Santé, the broader digital health space launched nationally in 2022, which incorporates and supersedes the older DMP framework. Every person covered by the French health system has a space created automatically, with the ability to opt out. Mon Espace Santé brings together the health record, a messaging service and a directory of connected health apps — an attempt to make the record not just a repository but an active part of a person's relationship with their care.
Still a Work in Progress
Adoption has grown since the early years, but the record remains unevenly filled. Many files exist on paper in the system; the richness of what they contain depends heavily on how engaged both the patient and the treating clinicians are. The médecin traitant — the registered GP at the centre of coordinated care — is well-placed to anchor the record, but only if the incentives and tools make that role practicable.
France is not alone in this. The electronic health record is one of those ideas that looks straightforward in a policy document and proves, in practice, to be a renegotiation of how an entire profession works — and of what patients are willing to share, and with whom. Twenty years on, the file is open. Filling it in remains the harder task.
Repères — the sequence
- 2004DMP (dossier médical personnalisé) created by law
- 2015only ~500,000 records created; adoption widely judged a failure
- 2022Mon Espace Santé launched, incorporating and replacing the DMP framework