Digitisation of the Swiss healthcare system
Where is eHealth heading?
Preparations are under way in a number of cantons to introduce electronic patient records (EPR). Service providers are working on internal digitisation projects. Health apps can be found on virtually every smartphone. But where does Switzerland really stand on eHealth? A search for clues at federal and industry level.
Text: Roger Welti, 23 August 2018
The OECD’s assessment is not very flattering: Switzerland lags behind countries such as Poland, Spain and Estonia when it comes to the digital use of health information. At least 70% of primary care providers and acute care hospitals were recording diagnoses and treatment information in electronic health records in 18 out of the 30 OECD countries surveyed as far back as in 2016. In Switzerland, this figure is unlikely to be achieved for quite some time despite the introduction of electronic patient records. Does the outlook for working in modern and digital form in Swiss doctors’ practices, hospitals and homes really look so bleak? We enquired at federal and industry level.
The federal government has a strategy – at least for electronic patient records
Adrian Schmid is the head of eHealth Suisse, the Swiss Competence and Coordination Centre of the Confederation and the Cantons responsible for electronic healthcare services. In response to the question of whether Switzerland has any plans at all for digitising its healthcare system, he refers to the “eHealth Switzerland 2.0 Strategy” adopted by the federal government in spring 2018. This comprises three fields of action with no fewer than 27 goals. “We aim to promote digital applications that coordinate digitisation and empower citizens to be responsible and risk aware in their handling of digital health data”, says Schmid. The federal government gives them a tool for this purpose – their personal EPR. Their widespread use is also the primary goal of the above strategy, which is currently scheduled for realisation by 2022. “We have deliberately not made it a comprehensive strategy to accompany the digital transformation of the health system,” specifies Schmid.
The industry association demands an overarching approach
But that’s exactly what Urs Stromer is calling for. The President of the eHealth Community of Interests thinks that the paper issued by the Federal Office of Public Health (FOPH) fails to live up to its title “eHealth Strategy 2.0” and has too great a focus on EPR. “EPR and the Health Insurance Act are not what are digitising our health system. If we are going to tackle the issue, we need an inter-disciplinary discussion and a strategy that includes education and finance”, demands Stromer. A sound target and actual analysis is needed, as well as mutual dialogue between the federal government, health facility experts and technology suppliers.
Working collaboratively and constructively on digitisation seems to represent a major challenge for all the parties involved in the healthcare system, however. Urs Stromer sees one of the main reasons for this being the silo financing of our healthcare system. Hospitals, GPs, specialists, Spitex and homes are optimising and digitising their own respective areas in isolation. The problem is that nobody has an overall perspective of a patient’s treatment pathway. “Its optimisation would require the collaboration of all the parties involved. But this will never happen as long as nobody has an incentive to do so”, says Stromer. Instead, many GPs in Switzerland prefer to keep paper-based patient records because they see no need for digitisation and still view their practices as stand-alone entities. Stromer smiles: “Practice staff view this a lot more realistically as they are the ones who have to exchange information with other service providers and patients all day long.”
Urs Stromer calls for less of a silo mentality
Resolutely pressing forward with EPR
eHealth Suisse keeps track of the status of the implementation of eHealth or at least of EPR. The coordination office publishes a regular overview of activities at cantonal level. Adrian Schmid notes: “It turns out that more progress has been made in building up communities and rolling out EPR in cantons where the public sector is actively embracing eHealth issues, especially EPR.”
Time is running out for the country’s hospitals, however, as they only have until 2020 to become affiliated with an EPR community. There doesn’t seem to the same level of awareness about the preparatory work entailed across the board. “We find that sometimes people underestimate the effort required to connect primary systems to a community”, says Adrian Schmid. He therefore calls on all those involved to resolutely continue their work on EPR.
Urs Stromer is throwing – at least part of – this ball back to the federal government’s court. “It won’t be technology that causes EPR and eHealth to fail”, he says. However, the FOPH has also underestimated the complexity of the work required on the specifics and can probably not stipulate any mandatory specifications in ordinances until mid-2019. That said, quality is more important than quantity in this case – unlike at the onset.
Long absence of pressure to increase efficiency
Hospitals and some doctors are proceeding with digitisation in their everyday workflows faster than with EPR. The use of efficient practice software and B2B services such as electronic referrals or digital report dissemination is gaining in popularity. The federal government welcomes services such as these. Nevertheless, Adrian Schmid from eHealth Suisse stresses: “During implementation, care must be taken to ensure that these applications operate across Switzerland and that no digital borders are created between the regions – networking and interoperability must be guaranteed.”
Urs Stromer has a simple answer to the question as to why the healthcare system didn’t digitise its processes years ago and thereby render them more efficient: “The hospitals weren’t required to optimise their work processes until a few years ago.” They only started to change their way of thinking in 2012 with the advent of case-based payments. “Hospital managements have since been investing in enhancing efficiency within their financing regimes. For example, they are using active referral management to ensure the full occupancy of their establishments, while making increasing use of digital tools”, says Stromer.
Adrian Schmid welcomes B2B services
Political pressure and patience
However, the eHealth Community of Interests doesn’t want to rely on service provider initiatives alone, but places great hopes on a series of political initiatives that are currently progressing through parliament. These deal, for example, with a doctor’s obligation to use electronic and structured documentation or a patient’s right to a medication plan. Further parliamentary initiatives on the subject of eHealth are in the planning stages.
Urs Stromer is convinced that “This regulated system needs more motions by parliament to ensure that eHealth in Switzerland gathers speed.” The debates in parliament will show whether politicians are willing to apply the necessary pressure.
Fight for more digitisation in our healthcare system
The eHealth Community of Interests wants to speed up the implementation of eHealth in Switzerland so as to plug any quality and security treatment gaps and improve administrative processes. It outlines approaches to quality improvement and cost containment in a booklet on the digital transformation of the healthcare system.
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