PARIS — The vaunted French e-health system, hailed as the miracle that would save the nation’s healthcare system, is dead — except for the paperwork.

Much like the famous scene in the “Wizard of Oz” — where the awesome wizard is exposed as a mere mortal frantically manipulating the machinery behind a curtain — the French government, in an unusual display of openness and transparency, exposed the failings of the Dossier Médical Personalisé (DMP) in a report signed by three ministries.

The news never made the front page, unlike the case when the program was launched with much ceremony in 2004, promising savings up to €6 billion ($8.8 billion) per year.

Instead, strikes by underpaid doctors and staff in emergency rooms, fierce debates over reimbursement for general practice visits, reduced reimbursement for prescriptions and a record deficit of €11.7 billion for the Assurance Maladie (health insurance fund) have dominated the headlines in recent weeks.

Unions representing medical staff are threatening a complete shutdown of hospitals for Jan. 24.

As often predicted, the French health system is on the ropes, sagging under the financial burden, a failure to invest in facilities and equipment and a rapidly aging population demanding greater services.

But the “white knight” expected to ride to the rescue — an efficient electronic management of citizens’ healthcare — never saddled up.

July 1, 2007, was to be the day the champagne corks popped to celebrate the DMP. More than a program deadline, the date was written into the law that authorized the launch of the program in 2004.

By last summer, every citizen in France was to be given access to a new system of electronic medical records showing emergency treatment data, medication histories, radiology images and documents from consulting physicians. Each citizen would control his or her records with a chip-embedded smart card used as a personal electronic key.

Instead, a post-mortem was launched in July when the program failed to deliver as mandated. The special inter-ministerial commission charged with assessing the disaster conducted what it called a diagnosis, and while it reports a classic “brain death,” officially the commission stopped short of killing the program.

Despite the DMP disaster, the commission notes that e-health is essential for the future of the nation’s healthcare system, that such programs are advancing in other nations and that France should save as much as possible from the current program before moving on to a redesigned effort.

After reviewing e-health progress in other nations, the commission said more than 10 years of development time is typically required. In a withering statement, it concludes: “In France, the project was expected to be realized in 26 months, without any precise budget or financing, at a cost projected to be €1.1 billion over five years. Our country was expecting to put in place a project of such complexity three times faster and with from three- to 10-times less money than required in other countries who took on a similar program.”

In its “guarded diagnosis” the commission, formed by the inspectors general from the Finance and Social Affairs ministries and the lead engineer from Telecommunications, blamed the ministries themselves, each with some degree of control over the program.

Despite having three patrons, none of the ministries put forward more than the bare minimum of resources and, the commission notes, the DMP group has just 60 employees, compared to the 600 employed by Connecting for Health, the British e-health program launched at roughly the same moment as the French program.

Yet each of the three ministries exercised some influence over the program in an uncoordinated and episodic manner, resulting in wild shifts in strategy and indirectly causing three changes in the Chef de Mission for the DMP over five years.

The commission recommends that France save the workable elements of the program developed in various pilot tests and technical programs, that the confidence of the key industry suppliers in telecommunication and information technology (IT) be restored, and that the program should be re-launched.

It spells out 12 subcategories of detailed steps, and the commission notes it will be 10 years before France can expect to launch a credible, functioning and legal e-health program.

A famous citation in France holds that a politician once said, “We find ourselves at the edge of a great precipice, and we are taking a bold step forward.”

In re-launching the DMP, France faces precisely this situation and the recommendations of the DMP commission echo like the falling voice of someone who has taken that step over the precipice.

The country is close to bankruptcy, according to a now-famous statement by the current prime minister just a few months ago.

As the commission notes, successful e-health programs in England, Canada and Denmark have turned in costs of between €264 ($390) and €225 ($330) per habitant; France, with some 65 million citizens, is looking at a cost of some €15 billion ($22 billion).

France also faces a labyrinth of legal issues in implementing a medical record system, including a question of whether it is even lawful in Europe to collect and process personal data records. A specific requirement that each citizen can control the records, up to the point of masking information on the record, poses ethical issues for treating physicians who may not see potentially adverse medication reactions nor prior histories of a condition.

Physicians are flat out against such patient control in all events.

Finally, there is the issue of governance. The commission formed by the three ministries concludes that the DMP failed precisely because there were three ministries in charge, leaving none in control.

Borrowing an insight from the recent Expert Meeting on IT for Health conducted at the headquarters of the Organization for Economic Cooperation and Development in Paris in November, where the French DMP disaster was frequently cited, Petra Wilson from Cisco Systems (San Jose, California) said, “It takes political courage to do this, and we need to be mindful we are often asking political courage from someone who will likely not reap the benefit during his or her term in office. This makes it difficult on the political scene to take the big gamble required for healthcare.”

In the face of a political scene demanding courageous decisions in the face of brutal financial pressures, stagnant growth and stalled employment, the French e-health system is not likely to find itself at the top of the country’s agenda anytime soon.