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Interoperability & regulatory awareness

What a clinical record has to plug into in France, what this demo actually implements, and what a real deployment would still need.

HL7 FHIR R4 — implemented subset

FHIR 4.0.1 · NestJS · PostgreSQL JSONB · /fhir/metadata serves the CapabilityStatement

Resource	read	search	create	update	_history	Search parameters

Every resource carries meta.versionId; updates require If-Match and fail with 412 on a stale version. Every write produces a Provenance; every read and write produces an AuditEvent. Provenance and AuditEvent are server-generated only, append-only.

French e-health landscape

FR Core — Interop'Santé / ANS

What it is: The French base FHIR profiles (Patient, Practitioner, Organization…), published as an implementation guide by Interop'Santé.
In Anamnesis: Own profiles, shaped after FR Core naming and slices; validated server-side. Not conformance-tested.
For real: Declare FR Core profiles in meta.profile, pass the official validator, use national value sets (NOS).

INS — Identité nationale de santé

What it is: The mandatory identity for referencing health data since 2021: an identifier (NIR or NIA) plus five reference traits, retrieved through the INSi teleservice, with an identity status (provisional, retrieved, validated, qualified).
In Anamnesis: Synthetic ANM- identifiers only. The banner layout reserves room for the INS traits and status.
For real: INSi integration with a CPS / e-CPS card, identity-vigilance procedures, FRCorePatientINSProfile.

DMP / Mon espace santé

What it is: The shared medical record, now part of the citizen's Mon espace santé. Professionals' software feeds and consults it.
In Anamnesis: No connection. Documents are local DocumentReference resources with synthetic PDFs.
For real: DMP integration per the ANS specifications (structured CDA documents), qualified INS, professional authentication.

Ségur numérique

What it is: The national programme funding the generalised sharing of health data. Software is “référencé” by the ANS against requirements (INS, DMP, MSSanté, Pro Santé Connect).
In Anamnesis: Not referenced. The architecture keeps each national service behind a local interface so it could be swapped in.
For real: Meet the requirements of the current wave for the target corridor (hospital, primary care…) and pass ANS conformity checks.

HDS — Hébergeur de données de santé

What it is: Certification required to host personal health data on behalf of others. Version 2 of the certification referential (2024) adds data-sovereignty requirements.
In Anamnesis: Hosted on a standard server: acceptable only because every record is synthetic.
For real: HDS-certified hosting (infrastructure and managed services), encryption at rest, backup and reversibility clauses.

What it is: Health data is a special category (Art. 9). Processing needs a legal basis, minimisation, access traceability and usually a DPIA, under CNIL oversight.
In Anamnesis: No personal data. The read-and-write audit trail shows the traceability principle in practice.
For real: DPIA, records of processing, role-based access, retention rules, patient access to their own audit log.

LOINC

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