Doctors who fax patient files come up against fully digitalised hospitals. Worlds are colliding with the introduction of the electronic patient record. In the middle of it all: Stefano Santinelli, CEO Swisscom Health AG.
Stefano Santinelli ,
Dialogue magazine: Swisscom is a telecommunications company hugely involved in health care. How come?
Stefano Santinelli: There are two mega-trends in the health sectors: one is the digitalisation of processes and information. This has already taken place in some industries, such as in the banks. Secondly, we are seeing a certain consumerisation of health care. Patients no longer see themselves as being at the mercy of the health care system. They increasingly want to have a say and use all the opportunities provided by digitalisation: Internet searches, wearables that measure various health parameters, and so on.
And where is Swisscom positioning itself?
For us, there are four fields of business. First of all, doctors, pharmacists and home care services need a digital solution for the patient record. Second, many hospitals are in the process of digitalising their information and processes. Thirdly, many medical-quality wearables are available to consumers and offer high benefit. In Switzerland, we are talking about half a million wearables – from pure sports trackers through to devices for diabetics, cardiac patients and so on. All these devices provide data that is also important for doctors.
Does Swisscom sell these devices?
We sell sports devices ourselves. For the medical devices, we work with partners. For example, we have been working with the TopPharm pharmacies since last autumn. The focus here is not on selling the devices, but rather on the solution itself. Specifically, a digital health check via the iPad.
Does Swisscom have an interface in the device, or is the data transmitted?
That is one of our strengths: we link up all the possible devices for patients, doctors, pharmacies or hospitals. We currently offer interfaces to 250 devices from the area of fitness and medicine. The added value is that we integrate all devices that store data centrally and format this appropriately for the individual patient. This data can in turn be linked with the solution for the doctors and naturally with those in the hospitals.
Where is this data located?
The data is located in Swisscom data centres and – this is very important – it belongs exclusively to the users themselves, i.e. the patients. Swisscom has no marketing or evaluation rights relating to this data. This is a big difference compared to the Apple smart watches, for example.
Yes, but general terms and conditions can be quickly changed, as we know from Google or other providers.
That’s true; in the wearables, for example, the handling of the data is laid down in the general terms and conditions. This is also a question of trust. Swisscom will not abuse this trust – we simply can’t afford to. We will not make use of this data; that is not one of our business models. The data of the patient record is clearly protected by law. The rules relating to today’s paper-based patient files are much less clear and the situation is harder to control. The introduction of the digital patient record provides patients with far greater legal certainty.
“The data belongs exclusively to the users themselves”
Of the four fields of business you referred to earlier, one hasn’t been mentioned yet.
Right, that’s the traditional information and telecommunications business. All data requires a professional infrastructure: hosting, operation, security, managed services, integrated solutions, stability. We have also been providing these services for years for other industries.
Swisscom is not the only provider for the patient record. Could we be facing chaos when it comes to the standards?
No, there is just one generally valid standard for the patient record in Switzerland. The law on standardisation and the corresponding certification procedure will arrive in 2017. Today we are indeed still seeing a lot of stand-alone solutions. Ultimately, however, all records will be compatible.
What is the advantage of all this data capture anyway – except that it generates business for the providers?
There are three approaches: digitalisation of the processes between doctor and hospital leads to a direct increase in efficiency. We investigated how much the process costs when the doctor transfers the patient to the hospital, the patient is admitted and then discharged. Today, it costs between 30 and 60 francs per document that is sent back and forth.
“Digitalisation of the patient file alone saves 190 million francs”
Why does it cost so much?
Because the fax is still an important means of communication in many doctors’ surgeries. Printing, faxing, post, manual recording, all this costs a lot of money. If everything is digitalised, it costs just 3 to 7 francs – and that includes the required investments. That alone means a saving of 190 million francs for the Swiss health care system. If all processes are that efficient, it leads to a saving of two to three billion francs per year.
Many other industries have already completed the process of digitalisation or are driving it forward – not least under massive economic pressure. In health care, the fax is still used for communication. I’m shocked. Why is this the case? In other areas, health care technology is cutting edge.
There is a certain lack of symmetry surrounding the incentives: doctors would have to invest, but the main beneficiaries would be the hospitals. In addition, health care only invests around 1.5 to 2 per cent of revenue in IT. Compared to other industries, this figure is very low. But it is precisely here that Swisscom can offer added value: with this 1.5 to 2 per cent, we can provide a professional and modern infrastructure.
Do the patients have anything to gain, apart from somewhat lower premiums perhaps?
One example: 75 per cent of cardiac patients in rehab who were fitted with a weighing scale, pacemaker and blood pressure monitor hugely improve their risk factors within three months. This constant motivation through wearables and apps is extremely valuable. There are studies that estimate a long-term saving in health care thanks to wearables at between three and six billion francs, made possible thanks to better prevention. The doctor should also be able to provide improved care as a result of a gap-free patient record. At the moment, though, these benefits are very hard to quantify.
How far have we already travelled along the route towards digitalised health care?
Today, around 20 per cent of doctors use a modern practice information system and a modern medical history system.
That’s depressing …
Yes, but for us, it also means that our offer is very timely. Three years ago, the figure was just 5 per cent. Young doctors want to digitalise procedures. They don’t want a server under the desk and a medical office assistant who takes the back-up tape home every evening. Software as a Service, cloud infrastructure and mobile data access are the daily bread for these doctors.
What is the situation in the hospitals?
We expect a large wave of digitalisation up to 2020. By then, around half of all hospitals – including all the large hospitals – will have digitalised their data and processes.
And what do the customers, the patients, think about this wave of digitalisation? Would they go along with it?
Yes. 80 per cent of Swiss people would like to have access to their electronic health data. Unfortunately, the system is not yet quite that advanced. But this is certainly not the consumers’ fault. . Swisscom is also involved with health insurance providers and offers solutions. In my opinion, Swisscom has a conflict of interests here: the interests of health insurance providers are very different from those of doctors and hospitals.
“The legislators should define the underlying conditions, not the technology”
We offer completely different services for health insurance providers. They relate to ICT services and outsourcing. This business has nothing to do with medical data. We also offer services for settlement. And we offer a few innovations, for example a bonus programme based on health data captured by the wearables. However, the health insurance providers cannot view this data; it is hosted and managed by us. To reiterate, all the data belongs to the patient or the consumer. It belongs neither to us nor the health insurance providers.
What is the biggest threat that could cause introduction of the electronic patient record to be delayed further?
I very much hope that the legislators define the underlying conditions, and will not want to regulate the technology. The legislators should not stipulate that identification should take place by means of a card. The correct approach should be for the legislators to formulate expectations relating to the technology: identification must be secure. They can leave the rest to the solution providers.
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