The digitalisation of healthcare is progressing. Zurich and Bern are setting up the biggest eHealth platform in Switzerland for efficient data communication between service providers. And Northwestern Switzerland is also moving forward with confidence.
Urs Binder, published on 24 March 2016, updated on 25 January 2018
Zurich Oberland, July 2027: I suffer from type-2 diabetes, high blood pressure and elevated blood fat values. My doctor prescribes me medication and urgently advises me to make lifestyle changes. Lose weight, take more exercise, eat more healthily. Blood sugar levels and blood pressure, as well as my efforts to improve fitness, must be monitored regularly. However, my life isn’t disrupted by the need to take blood samples or go for check-ups: a sensor implanted in my contact lens constantly measures blood glucose values and warns me if my blood sugar is getting too low. A wearable motivates me to take more exercise. All the data is automatically transferred to the electronic patient record and is immediately available to the doctor.
This is what a patient history could look like in ten years. Digitalisation is transforming health care. There is an electronic patient record (EPR) for every patient who wants one. The GP records the patient’s medical history electronically. Thanks to a central communication platform, all service providers, from the hospital to the home care services, can access the data provided the patient has given the requisite consent. The patient remains the owner of the data and decides who can view the data. Used correctly, this digitalisation brings real benefits:
This last point is particularly important. If the wrong medication is prescribed due to insufficient consultation, there is a risk of dangerous interactions, as Thomas Bähler, Head of eHealth at Swisscom Health, is aware: “The consequences can be fatal. More deaths are caused in Switzerland each year by incorrect medication than by road traffic, flu and HIV combined.”
But perhaps the most important thing: “With the EPR, for the first time in history citizens have the opportunity to actually exercise their right to their own medical data.” These are the words of Dr. Samuel Eglin, CEO of Axsana AG, the operating company for the rollout of the EPR in the canton of Zurich. Although the patient does already have the aforementioned right, it takes a lot of work to request all of the data individually and put it together to form a complete picture – and most of what the patient receives is on paper.
Zurich decided quite some time ago to set up a standardised communications infrastructure for healthcare. Under the leadership of the Department of Health, the associations of the service providers have joined forces to form the Zurich Affinity Domain (ZAD) support association. Its task is to build up a community across the entire canton in accordance with the government’s eHealth strategy (see box). “It all started with an eHealth forum in 2011,” states Samuel Eglin, describing the background. “After that we conducted intensive discussions with the service providers over a period of two years. It was a long process. But now we have a stable support body with high acceptance.”
“The patient does not want to be examined twice just because their general practitioner doesn’t engage in electronic communication.”
Dr. Samuel Eglin, CEO of Axsana AG
Some cantons are starting with a small pilot project; Zurich is going full steam ahead. “We actively decided against a bottom-up approach. We know that the technology works. We wanted to have all the users on board from the word go and offer a comprehensive network solution.”
Swisscom Health was awarded the contract for the technical implementation after a WTO invitation to tender. The tried and tested Swisscom Health Connect platform forms the basis, with the latest encryption and authentication methods providing secure communication. Patients can gain access to their records via the Evita portal.
Since spring 2017, the canton of Zurich is no longer alone on its ambitious journey, as it has been joined by the canton of Bern. Together with Swisscom Health the two most populous cantons are setting up the biggest eHealth platform in the country – to the benefit of around 2.5 million people. They aim to create an equitable, partnership-based solution that will also be open to other cantons. This will enable the EPR to achieve its full potential and promote integrated treatment in the healthcare sector.
Why was Swisscom the chosen technology partner? “We wanted a partner that could offer secure, large-volume ICT solutions, one that would be right for our strategy and draw up a business model with us,” says Eglin. In the canton of Zurich, the goal is for the platform and the EPR to be operated without state subsidisation. “This is unique throughout Switzerland, and it’s the only thing that will make sense in the long term.”
To finance the operation, the service providers are offered subscriptions to supplementary services that go beyond the EPR. “These service packages have to be attractively priced and offer real benefits. After all, we can’t force anyone to participate,” says Samuel Eglin. Different packages are planned for doctors, home care organisations, pharmacies and other participants. The packages will digitalise routine processes, making them more efficient. These networking and communication services will be developed and implemented together with the users (hospitals, care homes, doctor’s practices, pharmacies, home care organisations) – that is, solutions will be prepared by service providers for service providers.
The University Hospital Zurich will play a central role in supporting the project and assisting the other service providers. Hospitals in general will be playing a very important part, as they are the first participants legally obligated to offer an EPR and will thus assume a pioneering function.
In Northwestern Switzerland preparations for the rollout of the EPR are also progressing fast. A number of service providers in the canton of Basel-Stadt have already been running an eHealth test model for the last few years in a limited number of application scenarios. The Northwestern Switzerland eHealth Support Association founded in January 2017 has converted this test model into a new project phase, the “EPR Pilot for Northwestern Switzerland”. Participating in this pilot are the service providers of the three cantons of Basel-Stadt, Basel-Land and Solothurn. The goal is to have the EPR already implemented and piloted in 2018 on the basis of cantonal law and in agreement with the cantonal data protection authorities. In 2019 the EPR Pilot for Northwestern Switzerland will be converted into a certified community, and thus into regular operation.
The majority of general practitioners remain sceptical about eHealth and the EPR. Only a minority currently documents information digitally, between 20 and 40 percent depending on the source. The fax, which has practically disappeared from other industries, is still ever-present in healthcare with fatal consequences for data security: according to Thomas Bähler, one to two percent of faxes fail to reach the correct recipient. “When you extrapolate this to several hundred thousand faxes, a substantial amount of medical data ends up in the wrong place every year.”
“Many faxes containing medical information are sent to the wrong recipient.”
Thomas Bähler, Head of eHealth, Swisscom Health AG
In principle, practically no one has anything against electronic documentation, digital communication and EPR, except that some doctors seem to find the idea of greater transparency – the “transparent doctor” – a little uncomfortable. Some heated discussions in the GP associations show that doctors are primarily concerned about costs. Software for the medical practice is expensive. Data input takes time, and the TARMED tariff structure does not contain a settlement item for this. “In health care, there is no intrinsic motivation to change. All make a good living, are overrun with patients and don’t really need to move,” says Prof. Andréa Belliger, eHealth expert at the Institute for Communication and Management (IKF) and prorector of PH Luzern, highlighting a further factor.
The experts agree on one thing: doctors’ scepticism is also a generational problem. Many GPs who still document information on paper are a few years away from retirement and do not want to change their practice. For young doctors who train in hospitals today, on the other hand, electronic documentation is taken for granted. Most joint practices also work with electronic medical histories from the outset.
Subscribable cloud solutions make it possible to spread the costs for practice software over a long period, so a doctor does not have to make a large one-time investment. In any case, doctor’s surgeries will not be able to avoid digitalisation, because without a digitalised practice and automatic data transfer, it is immensely time consuming to maintain the EPR. Patients are increasingly revealing a desire to electronically access their data, as Samuel Eglin stresses: “Ultimately, the decisive pressure will come from the patients. They won’t want to undergo two examinations just because their GP is not willing to use electronic communication.”
Andréa Belliger adds: “People want to be involved, to communicate openly and to have transparency. eHealth is much more than just digital communication and the EPR. It’s arising from the increasing organisation of our world into networks.” For Belliger, this includes web-based communities such as patientslikeme.com, for example, where patients with particular disorders exchange information “and perhaps thereby achieve a better result than if they were to just talk to a doctor”.
As early as 2007, the Federal Department of Home Affairs drew up an “eHealth strategy for Switzerland”. According to the Federal Council, eHealth was to help guarantee the population’s access to superior and economical healthcare in terms of quality, efficiency and security. The term was to represent the integrated use of information and communication technologies to support all of the participants and processes in healthcare.
In March 2017 the Federal Law on the Electronic Patient Record (EPDG) came into force, initiating the launch of the EPR. Hospitals must offer an EPR within three years of the law entering into force, and care homes within five. For doctors, other outpatient service providers and patients, participation is optional – this principle is known as “double voluntary action”.
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