Digitalisation in the Swiss healthcare system
In an interview, President of the Swiss Medical Association (FMH) Yvonne Gilli explains where and why more work is needed.
Yvonne Gilli is the newly elected President of the FMH, Chair of the AD Swiss Board of Directors and a practising doctor with a strong flair for digital technology. In the following interview, she explains where and why the Swiss healthcare sector has some catching up to do when it comes to digitalisation.
Ms Gilli, at the end of October you were digitally elected as the new President of the FMH. Congratulations! Before you became President of the FMH, you worked for the association on its digitalisation dossier. At the same time, you are a doctor and run your own medical practice. How digital is your practice?
Yvonne Gilli: We’re very digital. Like most younger doctors, we carry out all our correspondence and documentation digitally. We send invoices digitally and record medical histories digitally, too.
When it comes to digitalisation, the latest publication by the Swiss Health Observatory indicates that Swiss GPs have some catching up to do. According to the studies cited, this applies to the older generation in particular. Where does this lack of enthusiasm for digital technology come from?
Yvonne Gilli: I wouldn’t call it a lack of enthusiasm. It’s more a distorted image that prevails in the public eye. This distortion is not specific to Switzerland – other countries are also struggling with the same problems. It is not due to doctors’ lack of enthusiasm or a lack of affinity for digitalisation. It is due to the benefits they perceive as arising from digitalisation. They need to see and experience benefits in their work. But these benefits are not always there.
According to a study conducted by the consulting firm KPMG in 2017, digitalisation could save the healthcare system CHF 300 million a year.
Yvonne Gilli: This is contrary to international studies. The continual development and maintenance of the infrastructure alone costs a great deal of money. However, there are various areas where we can certainly save money and improve the quality of treatment, for example in the field of e-medication. That’s why I take advantage of digital opportunities myself. But you can’t say that as a general rule.
It is often argued that reservations about data protection and data security are factors that make doctors sceptical about digitalisation. Where does this mistrust come from?
Yvonne Gilli: Again, I would not call it mistrust, but rather a great sensitivity and sense of responsibility when it comes to health data. Information about hereditary changes related to cancer diagnoses affects not only the patient themselves but also their relatives and their offspring. This data will be relevant for their whole lives and may, of course, be of interest to a variety of insurance providers when calculating health risks. Which is why this data is very sensitive and needs to be protected. Hospitals are also frequently targeted by hacker attacks. Human lives depend on this data being secure.
Nevertheless, the coronavirus pandemic has given a boost to digitalisation. How is this reflected in a GPs’ day-to-day work?
Yvonne Gilli: There are a lot more video consultations, for one. This type of consultation helps to break chains of infection. However, there are also tools that allow for certain examinations. What is more, during the pandemic, the medical association held its first digital meeting. Sometimes we have to be coerced into tackling change (laughs). People often make decisions based on their experience, and in some cases this is still lacking when it comes to digitalisation.
Do you think that electronic patient records will act as a further boost for digitalisation?
Yvonne Gilli: The impact of EPR should not be overestimated. This project is putting the cart before the horse somewhat. For example, Estonia – which is very far ahead in terms of digitalising its healthcare system – began not by digitalising the whole complex healthcare system, but just by simplifying administration for its citizens. In Switzerland, not every resident even has an electronic ID yet.
What exactly do you mean by that?
Yvonne Gilli: All we really need from the government are the general conditions for digitalisation. In other words, the option of a secure e-ID and e-authentication, as well as the prerequisites for interoperability, etc. We do not need the government to deliver a product that has been designed down to the minutest detail, as is being attempted with electronic patient records. EPR will only bring real benefits if it generates added value for healthcare professionals. If the general conditions are right, the market will play ball. On the other hand, I’m aware that it is always easier to criticise than to offer constructive suggestions. Digitalisation in the healthcare sector is a complex issue.
You are the Chair of the Board of Directors of AD Swiss, which, as an association, is offering outpatient service providers access to EPR. Despite your criticism, are you in favour of obligating GPs to adopt EPR?
Yvonne Gilli: This obligation essentially already exists. With the revision of the Health Insurance Act regarding registration management, parliament has obligated all doctors who apply for a new registration to adopt EPR.
You now have a double role. You are also President of the FMH. What are your thoughts on this obligation from your perspective in this role?
Yvonne Gilli: We believe that an obligation for outpatient service providers is not necessary. As has already been mentioned, doctors generally have an affinity for technology. This is due to the nature of medical studies, which are highly scientific. If there is a good product that offers added value, doctors will use it.
What do you think is needed to drive digitalisation forward?
Yvonne Gilli: In addition to the aforementioned general conditions that the Federal Government needs to establish, I am convinced that we need to start with education. This, too, is a public task. We need training at university level that combines medicine and IT. Because digitalisation in the healthcare sector is like culture: just because I can speak French doesn’t mean I can automatically translate a book by a French author – for that, I also need to be familiar with and understand the culture of the language and the country.
“Doctors have an affinity for technology”
Yvonne Gilli, President FMH
Yvonne Gilli is the first woman to head the FMH. She specialises in general internal medicine and runs her own practice in Wil. Prior to her election as President of the FMH, she was a member of the management board and responsible for the digitalisation dossier. Gilli was also a National Councillor for the Green Party from 2007 to 2015.
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