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April 2006
Hot topics

“Keeping people informed, training them and supporting them through the change is essential to successfully modernize the State”

Point of view of Jean-Pierre Barbéris,
General Manager, Bull Services and Solutions, on the modernization of the State.
Interview done with the magazine “Cités Numériques”

When it comes to large-scale public sector projects, shouldn’t we learn the lessons from the setbacks encountered during the implementation of the Carte Vitale (the French national health entitlement card), to avoid making the same mistakes twice?
The implementation of the Carte Vitale is an excellent case in point. Today, no-one any longer questions its usefulness, practicality, ease of use or the cost savings it has brought about. Nevertheless, all this has taken almost a decade to achieve. We’re talking about projects which involve tens of millions of users and take a very long time to implement. In parallel, we’ve seen that the system loading increases gradually and slowly until you get to about 50% of the flows. Once you’ve got past that point, there is a snowball effect which rapidly accelerates the deployment.

So do you believe that it will take ten years to introduce the electronic version of the French National Identity Card?
It will have to be faster than that! When the Carte Vitale was introduced, there was no Internet, no interconnected networks, and no real culture of technology. Nevertheless, we must not forget the problem of change management, whether for electronic National Identity Cards or single electronic patient records (DMP in French). Effective change management is a vital element that is too often neglected. Keeping people informed, training them and supporting them through the change is essential for public sector bodies, the professionals involved and users alike. If the new rules are not properly explained and, above all, if public sector staff feels sidelined by the introduction of new technologies, you’ll come up against significant obstacles. In modernizing the State, this is one issue that it is absolutely vital to take into account, and I am still not sure that enough value is being attached to it.

There is a lot of debate about the protection of individual civil liberties. What is your feeling about these kinds of questions?
In France, we are very sensitive to everything involving civil liberties, sometimes even despite the costs to the taxpayer – we need to find technological and technical answers to some of these questions. I find it very interesting to learn from what our neighbors in Belgium have achieved. When it comes to identity management, they have a traceability system that is triggered as soon as any change is made to an individual’s registration. More generally, when it comes to security, it’s no longer enough to have an effective strongbox: you need to think about data access tools and alarms. No system can provide guarantees against disclosure. But if those who manipulate know that they will be identified, then…

Are you in favor of the use of digital fingerprints, the biometric identifier chosen by the French Interior Ministry?
Digital fingerprint technology is at least proven, so it is natural that this has been chosen. More recent technologies – such as iris recognition and facial recognition – do exist, but there are some technical and financial difficulties with them. I believe that a phased approach is needed, with a gradual improvement of the biometric elements. Don’t forget that these new digital cards will have a limited lifespan. So it will be possible to integrate new elements in later generations. And finally, don’t forget that the increasing ubiquity of biometrics, particularly on PCs, will encourage public acceptance.

Don’t you think that it would have been better to bring together the passport and the National Identity Card for this implementation?
Separating passports and National Identity Cards is a reasonable idea. With electronic cards, we have set in motion an interesting modernization program and it is important to think about the long-term evolutions and uses, and not look to do everything at once. As I’ve already indicated, it is essential to change organizations in quite a fundamental way. But it is also important to deliver the initial phase and use that to improve public sector services and launch new electronic services, although there should be no expectation of an immediate return on investment.

That question of return on investment: has it held the project back?
Early on some people believed that it would be possible to fund the new cards by the inclusion of third-party services. It soon became clear that this approach was unrealistic, for a number of different reasons. Firstly, building the infrastructure needed to implement the program is the responsibility of the State. And services can only operate when there is a critical mass of electronic cards in circulation, which will take several years. It is perfectly reasonable for the State to want to make the greatest possible savings. Nevertheless, I think we should take inspiration from the cost savings achieved as a result of the Copernic e-tax project, rather than look for third-party funding.

What do you think of the solution that has been chosen for the implementation of this new card, namely a public-private partnership (PPP), as for the single electronic patient record?
Once again, the implementation of the Carte Vitale sheds light on the situation. That helped us to recognize the difficulty of delegating responsibility for public services. Also, it seems to me to be preferable to replace that approach with a PPP, because it gives all the parties involved greater flexibility when it comes to adapting the proposed plan for the solution to the reality of the market.

When it comes to the single electronic patient record, you are in favor of using an existing personal identification number, rather than creating a new one? Why?
It’s a key point. If you create a new personal identification number, that means you also have to create a new database. That represents a data acquisition cost of between €10 and €30 for each new subscriber. In parallel, using existing data, particularly that provided by the national health insurance scheme (l’Assurance maladie) to fill out the electronic patient record provides a good opportunity to verify that data. Of course, there would be a certain percentage of errors, but it would also be an opportunity to correct them. Add to that the extent of the risks of medical conditions being inadvertently induced by a doctor or healthcare worker, or by medical treatment or diagnostic procedures – because of lack of communication between different medical practitioners or files – which results in thousands of deaths every year. Is it really worth being too scrupulous about protecting individual freedoms if thousands of people are dying each year as a consequence? Obviously not: but it takes a lot of political courage to explain that. What’s more, I believe that creating a new identification number, risks delaying the implementation of the project by several years.

Apart from the National Identity Card and DMP (single electronic patient record), where else do you foresee advances?
The biggest advances will be made in the area of databases, especially in healthcare and in the area of infrastructures: State-sponsored initiatives with significant budgets, but which also, I believe, encourage economic growth. Nevertheless, people’s mind-sets need to change. Just look what has happened with the taxation system in France. It was quite revolutionary to decide that people would no longer have to submit documentary evidence with their tax returns. The tax authorities are now operating under the principle of trust. That’s where the real revolution is taking place, much more in terms of changing hearts and minds than computing technology.

What elements are still missing to ensure that these various initiatives are successful?
As I indicated before, effective change management amongst healthcare professionals is one very important element that needs to be put in place. In parallel, I’m a great believer in trials at a local level. The single electronic patient record will be a particularly interesting catalyst, accelerating computerization in hospitals. It is absolutely essential to carry out pilot implementations as quickly as possible, to find out about all the different issues on the ground. In actual fact, the level of development of computerized records varies widely. I believe that it’s important to get going quickly, and we will gradually find new ways of using the system as it develops.

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