HealthManagement, Volume 3 / Issue 2 / 2008
From the Eiffel Tower through the tail-free delta wing Mirage III fighter jet to the TGV supertrain, France has an enviable reputation for taking an iconoclastic, but surprisingly successful approach at the cutting-edge of high technology. Today, when the Internet becomes as commonplace as a dishwasher in Western households, it may be salutary to look briefly at a precursor technology, France’s Minitel system. Unlike similar initiatives elsewhere (Germany’s Bildschirmtext and Britain’s Prestel), this French project enjoyed resounding commercial success.
Launched 25 years ago, the Minitel is essentially an online videotexting service designed for access through the public telephone system. To build a critical mass of users in what was then (and still is) a very ‘dirigiste’ top-down techno-political culture, millions of Minitels were handed out free to both private phone subscribers and business enterprises. This was of course, still possible in the age of Europe’s Post, Telephone and Telecommunications (PTT) monopolies, before they were split a decade later into separate telecoms and postal units.
The Mid-1980s Internet Experience
By the mid-1980s, subscribers in France could use the Minitel to search the phone directory, determine prices on the French bourse, make certain purchases, book reservations on airlines and trains, and even chat online – indeed, very much like the modern Internet, but predating it by well over a decade.
In the late 1990s, Minitel users (including those accessing it through personal computers) were estimated at some 25-30 million (or about half the total population of France). In the mail-order catalogue business, in particular, the success of Minitel was astounding: it accounted for almost 15% of sales at La Redoute and Les Trois Suisses, France’s biggest mail order companies
Down But Not Yet Out
Though the speed and convenience of the Internet has nibbled steadily at Minitel use, news about its death still remain slightly exaggerated.
In 2006, there were still about 4 million terminals retained by users. Overall, the Minitel system generated some 300 million calls, and though revenues had fallen from their peak of over 800 million Euros in the late 1990s, they still accounted for a respectable 200 million Euros.
According to France Telecom, key Minitel deployments comprise banking and financial services, largely due to its (wellproven) security features – a factor which many Internet users (especially the elderly) are not yet wholly comfortable with. Indeed, nothing better illustrated the residual loyalty of French Minitel users than the compliment by US Internet giant Yahoo Inc., which in 2001 began its own Minitel service called 3615 Yahoo, and allowed its e-mail subscribers to send and receive mail via the Minitel. More crucially, Yahoo acknowledged that its analysts were studying (and learning from) Minitel’s billing and fee-for-service models.
e-Health and the Minitel
Healthcare has been no exception to the reach of Minitel. In the 1990s, more than half French doctors used it for consulting services. More recently, France Telecom states that 12 million updates to the stateof- the-art Vitale personal health card have been made via Minitel.
Indeed, in the health and e-Health context, Minitel arguably made some of the first demonstrations of operational
telemedicine. One example was NutriExpert, a diet self-monitoring tool for diabetic patients, which provided access to patients via Minitel and featured intuitive elements of information, instruction and gaming. It was designed by the CHU (Centre Hospitalier Universitaire) Rangueil in Toulouse under the leadership of the late Prof. Jean-Pierre Tauber, who might be called an icon of modern e-Health. An evaluation project of the Minitel/
NutriExpert system called DIABETO found measurable and clinically significant improvements on the part of users – for example, a drop in HbA1 from 11 to 9.9%, and fructosamine from 5.00 to 4.57%, within the space of six months.
Marrying Minitel to the Net and Beyond to
Chinese Tourists
Over the years, France Telecom has sought to increase the shelf life of Minitel and retain its relevance. It firstly provided users with a dial-up Internet gateway called i-Minitel.
In April 2005, the company extended Minitel access to its broadband ADSL network. France Telecom also continues to emphasise the upfront/in-built security and anonymity aspects of the Minitel network. Nevertheless, use levels will inevitably taper off, and sometime in the next decade, it is very likely that Chinese tourists pick up discarded Minitels on the flea markets in Paris.
