by Jean-Christophe GUILLERM, MD, Paris France
Executive summary: In France, digitization drives a significant part of innovation and economy. However, despite tremendous political, economic and medical expectations, digital health only represents 1% of total healthcare market, yet one of the most innovative sectors of the French economy. In this article, we will deep dive into the different categories of digital-health solutions developed in France, the added-value they could bring to health care system, and originally map them according their respective business models before drawing value perspectives for 2022/23. Interviews and robust recent primary sources support this analysis.
Digital health is the
convergence of digital technologies and health, aiming at enhancing healthcare
efficiency and making therapeutic options more personalized and precise. Digital
technologies relate to the use of computerized devices and may integrate artificial
intelligence, block-chain, connected devices (Internet of Things) or interfere
with pharma industry 4.0.
As a result of the review, E-health was estimated to generate in France a turnover of 2,67 billion euros in 2017. Six different business models of digital health were identified: Access to medical data, access to health care professionals, access to patients, access to medicines, access to digital therapeutic solutions and access to personalized medicine through pharma industry 4.0. A value-creation of 1.5 billion euros is expected to be created by 2022/2023. Nevertheless, further push is clearly needed to overcome gaps, mainly for the implementation of digital therapeutic solutions, and concrete proposals could help business and policy makers to remove barriers: Involve patients and multidisciplinary teams from the early phase of development; Ensure from the authorities clear, transparent and consistent rules for development; Favor early binding agreements between companies and payors to ease market access. In this context, e-health carries promise to improve the efficiency of French healthcare system and to create significant value by 2022/23 in an otherwise flat health care market.
As a result of the review, E-health was estimated to generate in France a turnover of 2,67 billion euros in 2017. Six different business models of digital health were identified: Access to medical data, access to health care professionals, access to patients, access to medicines, access to digital therapeutic solutions and access to personalized medicine through pharma industry 4.0. A value-creation of 1.5 billion euros is expected to be created by 2022/2023. Nevertheless, further push is clearly needed to overcome gaps, mainly for the implementation of digital therapeutic solutions, and concrete proposals could help business and policy makers to remove barriers: Involve patients and multidisciplinary teams from the early phase of development; Ensure from the authorities clear, transparent and consistent rules for development; Favor early binding agreements between companies and payors to ease market access. In this context, e-health carries promise to improve the efficiency of French healthcare system and to create significant value by 2022/23 in an otherwise flat health care market.
Introduction: Digital is disrupting French economy and
may indubitably disrupt healthcare.
Digitization drives a
significant part of innovation and economy, impacts social behaviors and shifts
traditional business models everywhere in the world, including France.
French consumers are
highly invested in digital technologies, 74 percent of them using the internet regularly,
above European-average (Arcep, 2017). In France, e-commerce’s turnover reached
82 billion euros in 2017, representing 5.5% of the gross domestic product (GDP)
and the fifth worldwide market (Dicharry, 2018). Besides these relatively good
figures, there is still a long way to fully capture the value digitization could
bring to the French economy, with great variations across its different sectors.
Among the latter, healthcare clearly lags behind (Figure 1, extracted from
McKinsey, 2016).
Figure 1: Index of digitization
according to countries and economic sectors
Healthcare is, in France,
one of the leading economic sectors, representing a global turnover of 286
billion euros, equivalent to 11,1% of the national GDP and ranking 5th position
among OECD countries (O.C.D.E., 2017). Within this sector, pharma and medtech markets,
with respectively 54 and 28 billion euros, represent very dynamic segments,
generating both innovation and value, and being the third source of French
exports (Leem, 2017; Snitem, 2018). In contrast, the extent to which health
care providers and traditional pharma companies have used digital to redefine
business models or their labor forces is today still relatively low. Recently, digital
health was evaluated to generate a turnover of around 2,7 billion euros in
France, ie less than 1% in market
share of the total French healthcare market (Pipame, 2016).
As this emerging and
promising market is permanently evolving, and that very few figures are available,
a “deep-dive” approach was initiated to draw a comprehensive picture of its
economic fabric in France. To our knowledge, no extensive review regarding this
topic and the description of its business models was already published.
Definition of digital health and objectives of the
report
To define the subject, “digital
health (or e-health) is the convergence of digital technologies with health,
health care and society to enhance efficiency of healthcare delivery and make
therapeutic options more personalized and precise” (Bhavhnani, 2016). Digital
technologies relate to the use of computerized devices, most of the time
connected, and digital data. These technologies may now integrate artificial
intelligence, block-chain, industry 4.0 or Internet of Things (IoT)... In this
report, we will review the different categories of digital-health solutions
developed in France, the added-value they could bring to care, and map them
according their respective business models before drawing value perspectives for
the five years to come. To be precise, as consolidated figures only exist for
2017, forecasts will be made for 2022/23. Recommendations to maximize the value
created by these strategic segments will then be formulated.
Tremendous political, economic and medical
expectations for digital health
E-health raises tremendous
aspirations. They can be political, economic, medical and sociological. French
President Emmanuel Macron for example recently stated: « France must become the leader
in some battles of tomorrow: The internet of things, artificial intelligence
... and the convergence between digital and healthcare. These battles are the
new technological frontiers. The state will invest heavily in it” (Elysée,
2017). When not expressed at the highest levels of
French government, expectations are recurrently formulated in financial press,
inspired by large consulting firms or even included in the vision of large
French pharma companies. Sanofi, Servier, Ipsen, Urgo and Guerbet all refer to
the need for digital transformation and the development of e-health. For
example, Sanofi and Google, via Verily, announced last year to join their
forces in a project named “Onduo” to develop a digital platform for diabetic
patients (Paillé, 2017). Servier and Urgo also recently developed specific
entities dedicated to digital health (respectively WeHealth by Servier and
Urgotech).
A fact is that
important unmet medical needs could be significantly improved through
digitization. In particular, digital health could be a game changer in mainly 6
domains.
E-health could first
dramatically ease the access to personal medical data, improving timeliness of
care and avoiding waste of money. Second, digital health could improve access
to HCPs, notably via telemedicine and teleconsultation. Third, e-health could
improve access to medicines via online purchasing and home delivery. Fourth,
digitization could improve access to peers (patients) and favor better exchange
and knowledge about disease and treatments, thus enhancing patient empowerment.
Fifth, e-health could improve early detection of medical signals, triggering
early adaptation and better efficiency of treatments, ensuring better follow-up
of chronic disease through the use of wearable connected devices and of deep
learning algorithms. Sixth, digitization could help to improve the delivery of
medicines, by optimizing the agility and efficiency of pharma production, maybe
including ability to produce personalized medicines though the implementation
of pharma industry 4.0.
These expectations meet
a large proportion of French medical needs. Chronic diseases represent in
France the leading causes of death (Figure 2, adapted from Dress, 2017) and an
improvement of their follow-up through efficient digitization could lead to
significant mortality reduction.
Figure 2: Leading causes of death
in France, adapted from DRESS, 2018.
For example, in
hypertension, the leading contributor to cardiovascular death, whereas
treatments are highly effective and could control the disease in most cases,
only 60% of patients regularly take their drugs. Coupled with medical inertia,
this situation results in a poor control of blood pressure, typically where
digital solutions could add effective support (Perrine, 2018). On the same
approach, connected devices could also lead to a better detection of small
signals of pharmacovigilance, possibly decreasing iatrogenic death which is
still responsible for 10 000 deaths in France (Le Monde, 2018). Improving the access to
care via teleconsultation has also become a French health imperative in a
context of relative medical desertification and difficult access to
specialists. Finally, digital health
represents also an economic opportunity for better cost-effectiveness of care,
treatments and pathways in a context of permanent cost-containment.
Deep dive into 6 business models of digital health in
France: from reality to value perspectives.
According to the review
performed, 6 different business models of digital health were identified in
France. Each of them has specific sources of revenues with specific clients and
involves different economic actors and fabrics. These business models
interestingly fit with the 6 expectations mentioned above: access to medical
data, access to HCPs, access to patients, access to medicines, access to
digital therapeutic solutions and access to personalized medicine through
pharma industry 4.0. All these domains were ranked according to the value
recently created in terms of turnover (euros). Perspectives for potential
value-creation are based on extrapolations, in the absence of unexpected
innovation.
Access to medical data and its
storage: more than 2,3 billion euros per year.
With a yearly turnover
above 2,3 billion euros, recently evaluated by a robust interdepartmental
mission this business-model represents 86% of the total current turnover
generated by digital-health in France (recalculated from Pipame, 2016),. It
relates to the storage and monitoring of data generated by healthcare
activities, including access to personal medical information. This “Systèmes
d’information”(SI) market has been in France mostly sponsored by public funds
and hospitals and is highly fragmented. It involves more than 300 medium to
small-size companies, mainly SSII such as Enovacom, recently acquired by Orange
Health Care (Dumoulin, 2018) and also digital technologic consulting companies
such as Acsantis, Effigen, Keyrus or Viseo (Rapport du Sénat 2007; Aubin, 2017;
D.G.O.S., 2017). Data (ie number and
nature of medical acts) are mainly generated by HCPs (ie 300 000 in France) and care-units (ie 3 000 hospitals and clinics) for the benefit of the Système
National d’Information Inter-Régimes de l’Assurance Maladie (Sniiram), a sub
entity of the French national health insurance (l’Assurance Maladie). For both
HCPs and care units, data are used to price the medical acts performed.
Hospitals and clinics also use “les systèmes d’information hospitaliers” for
business intelligence purpose. The data collected by the Sniiram contribute to
the monitoring of “l’Assurance maladie” financial balance, and also to the
tracking of patient pathways and medical practices, ensuring global assessment
of health-care policies (L’assurance Maladie, 2016).
One of the critical
-and highly debated- aspects of this sector is certainly the management of
personal medical data. According to a survey performed in march 2018, 65% of
French patients support the use of a digital medical dossier (Carenity, 2018).
At the same time, only 10 % of them are aware that such a tool already exists,
explaining why only 600 000 “Dossier Medical Partagé” (DMP) were already
opened in France (Ministère de la Santé, 2018). Initiated in 2004, partially
available in pilot regions since 2017, the “DMP” aims at allowing access to
personal medical data, both for patients and HCPs in order to improve care
efficiency (ie for example: immediate
access to key information such as allergy, treatment prescribed, former exams
in order to save time, outcomes and money). Its access should be generalized in
October 2018 (Mon-dmp.fr).
Its total development cost, supported by public funds, was estimated between
200 and 500 million euros, according to different “La cour des comptes” audits
and generated significant business for SSII companies (AFP, 2014; Ministère de
la Santé, 2018). The DMP’s deployment will also generate new business
opportunities for certified “Hébergeurs de Santé” companies.
“Hebergeurs de Santé”
companies, by ensuring safe and certified storage of personal medical data,
will become a growing actor of digital health market. Recently, 57 % of public
care entities declared that they would prefer externalizing such activities
(Wawestone, 2018). In France, 120
companies have been recently listed by « L’Agence française de la santé
numérique » as ISO 27001 certified (ASIP, 2018). One of the main actors of
this domain is a company named « Claranet e-santé », generating a
turnover of 27 million euros. Recently, Orange but also Microsoft declared
their willingness to enter that promising domain (Ronfaut, 2018). According to
the large-scale development of DMP (+ 20 million files planned for 2020), the
trend for externalization, the need for certification and maintenance, value
creation could reach here up to 50 million euros in the 5 coming years
(Beckrich, 2018). The added value brought by Block-chain technology has not
been extrapolated here according to the lack of already published business
cases.
In parallel with this
growing market trend, SI’s heterogeneity, with more than 300 solutions
available, represents both an obstacle to an effective data sharing but also a
fantastic opportunity for growth for SSII companies. Recently, a report from
“La Direction Générale de l’Offre de Soins » (DGOS) clearly set up that
only 13% of SI systems were ensuring full interoperability (Moreaux, 2018). 400
million euros, coming from public funds, should be allocated to solve this
issue, offering significant business perspectives (Hospitalia, 2017). Moreover,
growing needs for easy access to data, notably on apps, will also generate new
opportunities, not only for hospital dashboarding but also probably for
personal DMPs (Aubin C, 2017).
In total, it could be
extrapolated that value creation in this domain will exceed 450 million euros
within the 5 coming years.
Access to HCPs and business support : 270 million
euros per year.
This second business
model gathers scheduling software providers, health software publishers and
telemonitoring solutions providers. Clients and payers are here directly HCPs.
As revealed in July 2018, Doctolib recently acquired Mon Docteur. Altogether,
these 2 digital medical scheduling providers help patients and HCPs to
virtually and rapidly agree on appointments. With 55 thousand HCPs as
clients and a monthly fee of 109 euros, this new merger will generate a
turnover of approximatively 70 million euros per year for 600 employements
(extrapolated from A.F.P., 2018). With a market share of 43% among private
practitioners, 18% among total doctors and of only 10% of total HCPs,
perspectives for growth in this domain remain important (A.F.P., 2018). Value
creation could here reach 100 million euros within the 5 years (data extrapolated with 25% obtained market
share among total French HCPs).
Other digital services
directly bought by practitioners are prescription softwares. 265 certified
publishers are listed in France, generating a global turnover of around 200
million euros per year, growing by +4% a year (Sesame, 2017). Among them, 2
leaders (Cegedim and Compugroup) represent a market-share of 30%. If 85% of
general practitioners and 75% of pharmacists already use a prescription
software, only half of care-units and of total HCPs do so. Here again,
potential for value creation is significant, notably at the level of care units
and nurses. It could be extrapolated a value creation of 80 million euros
within the 5 years to come (data
extrapolated, reaching a 75% market share in total HCPs population).
From the 15th
of September 2018, teleconsultation will be authorized and reimbursed in France
as well as tele-expertise (concomitant expertise in presence of a second HCP)
(Martos, 2018). This represents an important opportunity for isolated patients
living in so-called “medical desert”, but also to decrease useless
displacements, and why not greenhouse gas emissions. It also represents an
important opportunity for GPRD-certified teleconsultation software makers (HAS,
2018). Consulting a professional catalog allows to count dozens of already
available products emanating from different companies, Cisco appearing one of
the most established. A recent survey, commissioned by the French ministry of
Health assessed a potential for 25 million teleconsultations a year in France (ie representing a market share of 5% of
total consultations) (Management en milieu de santé, 2017). A credit of 525
euros per medical doctor being already provisioned for such activities, value
creation could be extrapolated from 70 to 100 million euros reaching only 50%
of projections within the 5 years to come.
In total, a value
creation of 280 million euros could be expected in France in digital HCPs
business-support.
Patient websites and patient apps: 50 million euros
per year
In this business model,
users are patients, most of the time using the services for free, while
revenues are generated through traffic, direct and indirect advertisements but
also, more and more, through the access to user’s data.
Surfing
on patient forums has become an important social trend. Indeed, the creation of
Doctissimo in 2000 by Malhuret and Alexandre dramatically changed the access to
medical information, allowing interactions and direct discussions between patients,
not only regarding their disease but also their treatment, which was initially
not allowed so far. With 9 million “unique visitors” in 2018, Doctissimo is the
leading French website dedicated to health (Médiamétrie, 2018). Recently,
Doctissimo was sold by Laguardère to TF1 for 15 million euros (ie approximately equivalent to one year of
turnover) an amount 9 times lower than its purchase value in 2000 (Verif,
2012 ; Bfm, 2018). The business-model of such websites seem mainly based on
revenues coming from traffic and advertisement. Recently, Carenity developed a
new web activity by developing communities among chronic patients, using the
model initiated by “Patientslikeme” in the US (500 000 patients in the US). This approach potentially allows
patients to have more specific exchanges about their needs, their disease,
their treatment or their support. It also allows to have access to
crowdsourcing data and to perform anonymous surveys on specific patient groups
to generate revenues with pharma industry, scientific societies or even
marketing consulting companies (Harvard business school, 2017). Even if
Carenity did not publish any figure except 160 000 users, its turnover could
be estimated around several million euros. Perspectives for growth could be
here reasonably expected, according to the importance of chronic disease
patients in France. Other social networks, notably among HCPs, like Sermo in
the US, never really broke in France. Launched in 2016, the French sites
HeyDoctor, or Medpics, could however progress, notably in the context of
tele-expertise deployment, where effective networks will be critical.
Surprising
as it seems, free patient apps belong still today to this business model. Users are patients, most of the time using the
services for free or for very little amount of money, while revenues are
(possibly) generated by a third party. According to a recent market research,
more than 300 000 apps are available worldwide, with more than 70 000
new comers each year... (Health apps, 2018). One would have thus expected this
business to be highly profitable... Reading headlines of specialized articles
may provide a good overview of the situation: from “Les applis santé: un juteux
bénéfice” published in 2013 to “E santé: des modèles économiques difficiles à
mettre au point”, everything may be said (Google, typing for “business modèles
des applications en santé”, 2018). In fact, the most downloaded “health”
applications regard in France mainly fitness or weight loss and generate some
revenues (Google, 2018). For the free-apps allowing a better follow-up of
chronic diseases, most of them have been developed by pharma industry, in order
to sustain products and improve customer experiences. Here figures are
confidential, but always far below expectations (professional sources
interviewed in 3 pharma companies). Even if some
services are based on common sense and could be useful, as supporting
observance for example, these apps are rarely used in the long term.
Importantly, these
free apps have to be differentiated from the “Dispositifs médicaux”, ie digital solutions with demonstrated
impact on outcomes and with paid subscription, and most of the time reimbursed
in France. They will be further detailed. Nevertheless, even without any
tangible impact, the development of such apps is still pushed by many pharma
companies. A reasonable extrapolation could estimate the yearly turnover
generated by SSII companies around 30 million euros (ie 1 app developed every 2 years by each of the TOP 100 French
pharma companies integrating costs for local adaptations, low assumption
according to interviews).
To
conclude, perspectives of value creation in this domain could reasonably be
estimated around 150 million euros for the 5 years to come.
On-line drug seller sites: 50 million euros per year.
On-line drug selling is
strictly regulated in France, and is restricted to true pharmacies, established
on the streets, for the sale and the distribution of medicines that can be
delivered without medical prescription (Ordre national des pharmaciens, 2018).
Today, the turnover performed on-line is estimated around 50 million euros (ie 2% of total French sales of medicines
deliverable without prescription) (Lentschner, 2017). Recently, the Court of
Justice took the decision to allow Doctipharma, subentity of Doctissimo, to
keep on delivering on-line medicines for the benefit of true pharmacies.
Amazon, recently established in the US for the selling of medicinal products,
but also Leclerc, could possibly push to enter that domain despite the
vigilance and protection exercised by l’Union des groupements des pharmaciens
d’officine. Here, reasonable assumptions would predict that market share for
on-line pharma sales would reach the level of other domains (ie 5,5% of market
share in over-the-counter drugs)(Berger, 2017). Without any law modification,
value capture could here reach around 100 million euros.
Digital therapeutic solutions: promising but still
emerging market.
This domain is
probably towards which converge the highest medical and financial expectations
for the years to come. Projects are indeed numerous. In Paris, 17 e-health
start-ups are incubated by Techcare (Techcare, 2018). In Agoranov or in other
dynamic incubators, about 15% of projects are also digital health solutions, However,
ability of such innovations to reach the market, get reimbursement and generate
revenues takes time (Bietry, 2017). Digital therapeutic solutions can be
considered as part of Medtech. They are considered in France as “Dispositif
médical”, meaning a digital equipment aiming at improving healthcare in another
way than by pharmacological or immunological treatments, but being possibly
supported by them (Code de la santé public, 2018). Concretely, these solutions
could address various situations: from better disease detection, better patient
monitoring to improvement of disease management and patient-journey. In this
domain needs are tremendous. Whereas high blood pressure is still one of the
main causes of death and strokes, only 50% of French patients are effectively
controlled by their treatments (Perrine, 2018). A situation, mainly due to
therapeutic inertia, that could be typically improved by automated
telemonitoring solutions, integrating deep-learning treatment algorithms. In
diabetes, challenges are the same and explained why Diabeo was among the first
innovative digital solutions to be developed in the 2000s, with first patients
enrolled in clinical studies in 2007. Whereas the “Haute Autorité de Santé”
(HAS) recently issued a favorable opinion, Sanofi and Voluntis are still
waiting for the results of ongoing real-life and medico-economic studies before
getting their digital solution reimbursed. In this case, time to market would
have been long as for medicines, a duration that seems hardly compatible with
the relatively short life-cycle of digital products. It is unfortunately a high
price to pay for pioneers to open new frontiers. Even improvable, evaluation processes have positively
evolved in 10 years, gaining in
clarity and harmonization. The new ETAPES process, established 4 years ago,
aims at assessing in real life telemedicine and digital therapeutic solutions
before larger use at national level (Etapes, 2018). “ETAPES has improved the
way solutions are now assessed, focusing in domains where there are important
unmet needs such as diabetes, heart failure, renal insufficiency or also for
patients needing cardiac telemonitoring” declared Patrick Jourdain, Professor
of cardiology and former DGOS adviser. Nevertheless, process is long and “up to
now, no experimentation succeeded in scaling up” declared Olivier Gryson, Head
of digital marketing in Servier (Gryson, 2018). In any cases, dozens of
experimentations will end in 2019, with the hope to see positive results and
solutions reimbursed at national level. In terms of value creation, it could
guess that 6 to 10 major projects will get reimbursement at national level by
2022 to improve important unmet needs such as in diabetes, heart failure or
hypertension.
In total, value creation could be extrapolated here around 300 and 400 million euros.
In total, value creation could be extrapolated here around 300 and 400 million euros.
Pharma industry 4.0 :
promising perspectives
In France, 271 manufacturing sites yearly generate a pharma production
equivalent to 20 billion euros (Leem, 2018). These competitive production
capabilities rank at the 4th position worldwide. By integrating
cyber physical systems, industry 4.0 aims at progressively enhancing the
efficiency of pharma production delivered today. It relies on 4 pillars: real
time production, with improved workflows, decentralized, machine/IoT-controlled
production for finally customized production (Fottner, 2017). Clients of this
business opportunity are Pharma manufacturers. Among French pharma companies, Sanofi, for example, is bringing digital
transformation to its manufacturing facilities. Each of the company’s digital
plants will have a digital twin connected directly to the sensors and data in
the physical plant. “The data flows to these digital twins, giving managers a
real-time view into the plant’s operation. Simulation on the model provides the
level of manufacturing modularity and future flexibility required to support
personalized medicine,” Sanofi said in a 2017 press release (Sanofi, 2017). It
is still difficult today to extrapolate what is the value created by pharma 4.0
in 2017, nevertheless future value creation could be estimated around 200
million euros in France in the 5 coming years (Extrapolated from (LEEM, 2014), with a mean investment per site and per
year of 1 million euros).
Synthesis and perspectives: 1530 million euros
expected to be created in digital-health in France by
2022/2023.
As a result of the
review, e-health generated in France in 2017 a turnover of 2,67 billion euros.
When allocated according to the 6 different business models previously defined,
access to data and data storage appears to be, by far, the most important
sector (86% of total turnover) (cf Table 1). In terms of value creation, 1,53
billion euros are expected to be created in digital health in France by
2022/2023. Among the different sectors, access to data and data storage will
still lead the value capture (+ 450 million expected), but followed by HCPs
business supports (+ 280 million euros) and digital therapeutic solutions (+
350 million euros), the latter focusing the main expectations in terms of
medical added value. In total, e-health sector would represent 4,2 billion
euros by 2023, ie 1,4 % of total
French healthcare market (extrapolation made with 1% CAGR for total health
market). Even if this progression is under expectations, it has to be put in
perspectives with the growth framed by the “Plan de Financement de la Sécurité
Sociale” for the French medicine market (+0,5% CAGR)(Leem, 2018). If respected,
this plan would result in a value creation around 1,4 billion euros within the
5 years to come, ie less than the
value creation expected for digital health.
Table 1: Value created by digital health in France in
2017
and expected to be created by 2022/23 (in million
euros)
Limitations may come
from extrapolations formulated for potential value creation, and also from the
harmonization of the methodology used to estimate generated turnovers, in
particular at hospital level (pipame, 2016).
This review
demonstrates that if digital health may generate important value creation by
2022/23, it will not yet reach the level of other economic domains. This
situation is mainly due to digital therapeutic solutions that still lag behind,
with still uncertain ability to reach market. Further push is clearly needed to
overcome this gap and concrete proposals could help business and policy makers
to remove barriers. First, the quality of digital solutions developed should be
undisputable, with clear demonstrated impact on unmet medical needs achieved in
studies performed in real life and versus cohort populations. To produce solutions
that will meet practical expectations, teams should mix from the beginning talents
coming from various horizons, combining medical and engineering background, but
also including inputs of real patients at each step of the development. This
may dramatically improve the probability of successfully penetrating the market.
Second, transparent rules for development should be clearly expressed by
authorities, and an early binding agreement should commit the two parties in
the long term. If the demonstration fulfils the requirements, the solution will
reach the market at the price initially negotiated. This key condition, not
effective today, would ensure more transparency and consistency between parties,
ie French health authorities and
companies. Third, innovation should be favored and rules should be strictly and
impartially applied. As digital solutions are hardly patent protected, any new
entrant should ensure the same level of demonstration than its precursors to
reach the market.
To conclude, e-health carries promise to
face medical challenges and to create significant value by 2022/23 in France,
in an otherwise flat health care market. Our review allows a better
understanding of its different business models, which represent for each of
them significant opportunities to improve the efficiency of French healthcare
system, from a better access to care to a better patient journey.
I address special
thanks to Dr Olivier Gryson and to Prof Patrick Jourdain
for the time they dedicated to the interviews that help me to consolidate this review.
for the time they dedicated to the interviews that help me to consolidate this review.
Bibliographie :
Aubin
C. « Décideurs hospitaliers: Vos tableaux de bord directement sur
smartphone et tablettes ». 2017. https://halshs.archives-ouvertes.fr/halshs-01519466/document
AFP. Doctolib rachète son concurrent mon docteur. 2018. https://www.maddyness.com/2018/07/12/doctolib-rachete-son-concurrent-mondocteur/
Afp.
« Dossier médical personnel 500 millions d'euros
pour 418 011 dossiers » . Le Parisien. 2018. http://www.leparisien.fr/laparisienne/sante/dossier-medical-personnel-500-millions-d-euros-pour-418-011-dossiers-04-01-2014-3461813.php
Arcep. L’état d’internet en France. 2017. https://www.arcep.fr/uploads/tx_gspublication/rapport-etat-internet-france-2017-mai2017.pdf
Asip. Hébergeurs de
données de santé agréés. 2018. http://esante.gouv.fr/services/referentiels/securite/hebergeurs-agrees
Beckrich, J. Journal
télévisé de France 2. 2018. https://www.francetvinfo.fr/sante/dossier-medical-partage-les-objectifs-de-l-assurance-maladie_2788849.html
Bhavnani,
Sanjeev P.; Narula, Jagat; Sengupta, Partho P. (7 May 2016). "Mobile technology and the digitization of healthcare". European Heart Journal. 37 (18): 1428–38. doi:10.1093/eurheartj/ehv770 .
PMID 26873093
Bietry, G. Le segment de la e-santé est encore un marché
émergent. 2017. https://www.ticpharma.com/story.php?story=234Bfm tv. TF1 rachète le site d’informations santé Doctissimo. 2018 https://www.bfmtv.com/economie/tf1-rachete-le-site-d-infos-sante-doctissimo-1488224.html
Carenity. On-line survey.
“Les patients veulent un dossier médical digital». March 2018. https://www.carenity.com/infos-maladie/revue-de-presse/esante-les-patients-veulent-un-dossier-medical-digital-et-partage-893
Code de la santé publique. ART.
L5211-1. https://www.legifrance.gouv.fr/affichCodeArticle.do?cidTexte=LEGITEXT000006072665&idArticle=LEGIARTI000006690281
Dicharry, E. Le e-commerce
passe la barre des 80 milliards. Les echos. 2018. https://www.lesechos.fr/06/02/2018/lesechos.fr/0301257489865_le-e-commerce-passe-la-barre-des-80-milliards-d-euros-de-ventes.htm
Drees. L’Etat de santé de
la population en France. Rapport 2017. http://drees.solidarites-sante.gouv.fr/IMG/pdf/esp2017_5_principales_causes_de_deces_et_de_morbidite.pdf
Dumoulin, S. Orange accélère dans la e-santé. Les echos.
2018. https://www.lesechos.fr/02/02/2018/lesechos.fr/0301231585308_orange-accelere-dans-la-e-sante-avec-le-rachat-d-enovacom.htm
Elysée. Discours du
président de la République. 2017. http://www.elysee.fr/declarations/article/discours-du-president-de-la-republique-au-salon-vivatech-201/
Fottner, Johannes. Interview : « Industry 4.0 ». 2017. https://foerd.vdma.org/viewer/-/v2article/render/22773383
Gryson, O. Who will
kick off the digital transformation of health. Medecine
Science 2018 ; 34 : 587–589. https://www.medecinesciences.org/en/articles/medsci/abs/2018/07/msc170139/msc170139.html
Has. Télé-consultation et
tele-expertise. 2018. https://www.has-sante.fr/portail/jcms/c_2845190/fr/teleconsultation-et-teleexpertise-aucune-situation-clinique-exclue-a-priori
Harvard business school. Patients like me: crowdsourcing patient
platform for health care. https://digit.hbs.org/submission/patientslikeme-crowdsourcing-patient-platform-for-healthcare/
Health apps. Market research update. 2018. http://www.myhealthappsblog.com/mhealth/research2guidance-market-update/
Hospitalia. E-santé : 500 millions d’euros sur 5 ans
pour la mise en place de 2 programmes. 2017. https://www.hospitalia.fr/E-sante-550-millions-d-euros-sur-5-ans-pour-la-mise-en-place-de-deux-nouveaux-programmes_a1124.html
L’assurance Maladie.
Portail officiel. SNIIRAM. 2016. https://www.ameli.fr/l-assurance-maladie/statistiques-et-publications/sniiram/finalites-du-sniiram.php
Leem. Observatoire sur les
investissements pharmaceutiques et biotechnologiques en France. 2014.https://www.leem.org/sites/default/files/ADL%20Enquête%202014%20sur%20les%20investissements%20productifs%20-%20Etude%20ADL%20-VF%20%28intégration%20invest.%20LFB%29.pdf
Leem.
Rapport 2017. https://www.leem.org/chiffre-daffaires
Leem. Evolution du chiffre
d’affaires des médicaments en France. 2018. https://www.leem.org/chiffre-daffaires
Leem. Repères sur la
production pharmaceutique en France. 2018. https://www.leem.org/sites/default/files/2018-04/Reperes-sur-la-production-pharmaceutique-janv2018.pdf
Le Monde. Plus de 10000
morts par an liés aux intoxications médicamenteuses. 22 mars 2018. https://www.lemonde.fr/sante/article/2018/03/22/plus-de-10-000-morts-par-an-liees-a-mauvais-usage-des-medicaments_5274559_1651302.html
Lentschner K. Une brèche
est ouverte dans la vente en ligne de médicaments. Le Figaro. 2017. http://www.lefigaro.fr/societes/2017/12/13/20005-20171213ARTFIG00272-une-breche-est-ouverte-dans-la-vente-en-ligne-de-medicaments.php
Les echos. Doctolib
s’offre Mon Docteur. 12 juillet 2018. https://www.lesechos.fr/industrie-services/pharmacie-sante/0301961412668-doctolib-soffre-mondocteur-2191674.php
Management en milieu de
santé. Existe t’il un véritable marché pour la téléconsultation en
France ? 2017. https://managersante.com/2017/10/30/teleconsultation-medicale-existe-t-il-un-veritable-marche-en-france/
Martos S. Actes de
téléconsultation. Le quotidien du médecin. 2018. https://www.lequotidiendumedecin.fr/actualites/article/2018/08/23/actes-de-teleconsultation-partir-du-15-septembre-cinq-nouveaux-tarifs-de-23-70-euros_860277
McKinsey Global Institute. Digital Europe : Pushing the frontier,
capturing the benefits. June 2016. McKinsey&Company. https://www.mckinsey.com/~/media/McKinsey/Business
Functions/McKinsey Digital/Our Insights/Digital Europe Pushing the frontier
capturing the benefits/Digital-Europe-Full-report-June-2016.ashx
Médiamétrie. Etude 2018. https://www.mediametrie.fr/internet/communiques/audience-internet-global-en-france-en-juin-2018.php?id=1932
Medical expo. Catalogue de
logiciels de teleconsultation. http://www.medicalexpo.fr/fabricant-medical/logiciel-teleconsultation-12362.html
Ministère de la Santé.
Relance du dossier médical personnel qui devient le dossier médical partagé.
2018. https://solidarites-sante.gouv.fr/IMG/pdf/fiche_28.pdf
Ministère de la santé.
Etapes : experimentations de télémedecine pour une amélioration du
parcours de soins. 2018. https://solidarites-sante.gouv.fr/soins-et-maladies/prises-en-charge-specialisees/telemedecine/article/etapes-experimentations-de-telemedecine-pour-l-amelioration-des-parcours-en
Moreaux R. La DGOS dresse
un bilan du programme Hopital Numérique. TIC santé. Juin 2018. https://www.ticsante.com/la-DGOS-dresse-un-bilan-du-programme-Hopital-numerique-NS_4082.html
Moustial, P. France ta
medtech fout le camp. Les échos. 2018. https://www.lesechos.fr/idees-debats/cercle/0301946314229-france-ta-medtech-fout-lcamp-2191140.php
Ordre national des
pharmaciens. Ventes de médicaments sur internet en France. 2018. http://www.ordre.pharmacien.fr/Le-patient/Vente-de-medicaments-sur-Internet-en-France
Paillé, JY. Google et
sanofi prevoient de lancer une plateforme de médecine personnalisée. La
tribune. 2018. https://www.latribune.fr/entreprises-finance/industrie/chimie-pharmacie/diabete-google-et-sanofi-prevoient-de-lancer-une-plateforme-de-medecine-personnalisee-en-2018-740296.html
Perrine, AL. L’hypertension artérielle en France. Article 2018. http://invs.santepubliquefrance.fr/beh/2018/10/pdf/2018_10_1.pdf
Pipame. Etudes
économiques. Prospective. E-santé : faire émerger l’offre française en
répondant aux besoins présents et futurs des acteurs de santé. Synthèse 2016. https://www.entreprises.gouv.fr/files/files/directions_services/etudes-et-statistiques/prospective/Numerique/2016-02-Pipame-e-sante-synthese.pdf
Rapport du sénat. Systèmes d’information de santé. 2007. https://www.senat.fr/notice-rapport/2007/r07-035-notice.html
Ronfaut, L. Microsoft
ouvre 4 centres de santé en France. Le Figaro 2018. http://www.lefigaro.fr/secteur/high-tech/2018/03/14/32001-20180314ARTFIG00122-microsoft-ouvre-quatre-centres-de-donnees-en-france.php
Sanofi. “The Digital Plant: From
Collaborative Robots to Virtual Reality,” Press Release, Oct. 24, 2017.
Sesame-vitale. Panorama
des éditeurs de logiciels de santé pour les professionels de santé libéraux.
2017. https://www.sesam-vitale.fr/documents/10182/13217/PanoramaEditeursPSLiberaux.pdf/4af41118-834d-4873-b369-37daeb6ac212
Snitem. De la filière
industrielle des dispositifs médicaux en France en 2017. 2018. https://fr.calameo.com/read/0006105427ab3c35adc8b
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