A portal built on opt-out

Launched in January 2022, Mon Espace Santé is the government's attempt to give each resident a single, unified view of their health history — consultations, prescriptions, lab results, vaccination records — held in one secure, state-hosted space. Rather than asking people to sign up, the health insurance body Assurance Maladie created an account for virtually every person covered by the system and sent a notification by post or email. Recipients had a short window to opt out; everyone else was automatically enrolled. By design, the default was participation.

The portal sits inside the same ecosystem as the carte Vitale and the broader Mon Compte Formation-style ambition to digitise public services. At its core is the Dossier Médical Partagé (DMP) — a shared medical file — which France had been trying to build in various forms since 2004. Mon Espace Santé absorbed and replaced those earlier attempts, adding a messaging service for communicating with professionals and a catalogue of approved health apps.

Professionals can push documents directly into a patient's space: a cardiologist's report, a discharge summary, a pharmacist's dispensing record. In principle, a GP seeing a new patient can consult the shared file rather than relying on a paper referral letter. The electronic health record promise, long delayed, finally has infrastructure behind it.

Adoption is the harder problem

The technical architecture works better than its predecessors did. The adoption figures tell a more complicated story. Awareness among patients remains uneven, and the rate at which clinicians actively consult or populate the records varies widely by region and speciality. Many older residents — precisely those with the most complex histories — are the least likely to have navigated the activation steps or know what the portal contains.

The government has pushed Mon Espace Santé through successive digital-health drives, and uptake has grown steadily if not dramatically. Feeding data in depends on professionals using connected software; not all do yet. The opt-out model was deliberately chosen to avoid the near-zero voluntary sign-up rates that plagued earlier iterations — but an account that exists and an account that is used are two different things. Closing that gap remains the system's unfinished work.

Repères — the sequence

  1. 2004first legislative push for a national shared medical file (DMP)
  2. 2022Mon Espace Santé launched with opt-out enrolment, replacing earlier DMP iterations