E-health in the Canton of Zurich

Efficiency and safety in health care

Digitalised health care is coming, albeit more slowing than planned. In Zurich, a canton-wide platform is being created for efficient data exchange between service providers.

Urs Binder

Zurich Oberland, July 2026: 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 dossier and is immediately available to the doctor.

 

At the moment, it’s still a long way off

This is what a patient history could look like in ten years. Digitalisation is transforming health care. There is an electronic patient dossier (EPD) 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 and modify the data. Used correctly, this digitalisation brings real benefits:

  • Seamless data exchange between the service providers.
  • Avoidance of errors in recording.
  • More efficient processes, both within the practice or hospital, and between service providers – no time wasted waiting for the post.
  • Better quality of treatment along the entire treatment chain – important above all for chronically ill or polymorbid patients.

 

This last point is particularly important: if the wrong drugs are prescribed as a result of insufficient consultation, there is a risk of dangerous interactions, as Thomas Bähler, head of Solutions at Swisscom Health, knows: “The consequences can be fatal. In Switzerland, more deaths are caused each year by the wrong medication than by road traffic, flu and HIV combined.”

 

But perhaps the most important thing is this: “With the EPD, citizens are for the first time in history being given the opportunity to really exercise their right over their own medical data.” These are the words of Dr. Samuel Eglin, acting general secretary of the Department of Health in the Canton of Zurich and president of the ZAD support association. The patient already has the aforementioned right. However, it is a struggle to request all the data individually and put it together to form a complete picture – and most of what you get is on paper.

 

Canton-wide platform in Zurich

Zurich decided to set up a standardised communication infrastructure for health care. It is the largest e-health project to date in Switzerland. Under the leadership of the Department of Health the associations of the service providers have joined forces in the Zurich Affinity Domain (ZAD) support association. Its task is to build up a regular community across the entire canton in accordance with the government’s e-health strategy, see box. “The trigger was an e-health forum in 2011,” says Samuel Eglin, describing the background. “Then we held intensive discussions with the service providers for two years. It was a long process. But now we have a stable support body with high acceptance.”

“Patients won’t want to undergo two examinations just because their GP is not willing to use electronic communication.” 

Dr. Samuel Eglin, acting general secretary of the Department of Health in the Canton of Zurich

Some cantons start with a small pilot project – Zurich is going all out from the very beginning. “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 them a comprehensive network solution.”

In the summer of 2015, a public WTO invitation to tender was held for the technical realisation. Following a detailed evaluation, Swisscom Health was awarded the contract. The Swisscom Health Connect platform serves as the basis, and has already proved its worth at over 200 hospitals and 2000 medical practices in other cantons. The latest encryption and authentication methods are used for secure communication. Patients can access their dossier via the Evita portal. 

 

Self-financing solution

“We wanted a partner that could offer secure and large-volume ICT solutions. And that would adapt to our strategy and draw up a business model with us,” says Eglin. In the Canton of Zurich, the goal is for operation of the platform and the EPD to run without state subsidies. “That is unique throughout Switzerland, and it’s the only thing that makes sense for the long term.”

 

To finance operations, ZAD offers service package subscriptions for the service providers. “The price of these packages must be attractive, and they must offer a real benefit. After all, we cannot force anyone to participate,” says Samuel Eglin. Different packages are planned for doctors, home care organisations, pharmacies and other players. The precise make-up of the packages is still in development. To this end, an introductory project with selected service providers will commence in the summer of 2016. The launch for the whole canton is planned for 2017. If everything goes to plan, around 4000 service providers will then be able to use the new infrastructure.

 

The University Hospital Zurich will play a central role in supporting the project and assisting the other service providers. The hospitals will in general play a very important part: they are the first ones obliged to carry out electronic communication and therefore assume a pioneering function.

 

New clinic, the latest technology

The Cardiance Clinic in Pfäffikon SZ is an example of how things could look. It is the first outpatient cardiac clinic in Switzerland, and it is fully digitalised. The clinic offers diagnosis, treatment, rehabilitation and prevention. “Today’s technology makes it possible to perform practically all catheter procedures ambulantly. A lot of doctors aren’t aware of this,” administrative board president Dr. Thomas Mattig explains. It is good for patients to not have to go to a large hospital and possible stay the night.

 

The Cardiance Clinic was completely restructured. “As a result, we were able to deploy the latest technology and did not have to take account of the existing infrastructure.” The results from the examination equipment flow directly into the clinic information system. The software also helps in administration: reports are generated automatically where possible. “The gains in efficiency are so obvious that in the medium term, every clinic and doctor’s surgery should switch,” advises Mattig. In the future, the aim is to digitally support patient communication outside the consultation sessions as well, for example for lifestyle advice during rehabilitation. 

 

The Cardiance Clinic was completely restructured. “As a result, we were able to deploy the latest technology and did not have to take account of the existing infrastructure.” The results from the examination equipment flow directly into the clinic information system. The software also helps in administration: reports are generated automatically where possible. “The gains in efficiency are so obvious that in the medium term, every clinic and doctor’s surgery should switch,” advises Mattig. In the future, the aim is to digitally support patient communication outside the consultation sessions as well, for example for lifestyle advice during rehabilitation. 

The GPs are putting up resistance

The majority of GPs aren’t there yet. At the moment, information is digitally documented by a minority, somewhere between twenty and forty per cent, depending on the source. The fax, which has practically disappeared from other industries, is still ever-present in health care. With fatal consequences for data security: according to Thomas Bähler, one to two per cent of faxes don’t arrive at correct recipient. “Projected over several hundred thousand faxes, a substantial amount of medical data ends up at the wrong place every year.” 

“Many faxes containing medical information go to the wrong recipient.” 

Thomas Bähler, head of Solutions, Swisscom Health AG

In principle, practically no one has anything against electronic documentation, digital communication and EPD, 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. “The changeover to typing on a computer slows things down a lot and costs time,” is how the argument goes. “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, e-health expert at the Institute for Communication and Management (IKF) and prorector of PH Luzern, highlighting a further factor.  

 

“In health care there is no motivation to change. All make a good living and are overrun with patients.”

Prof. Andréa Belliger, head of IKF Lucerne

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.

 

Digitalisation will come

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 EPD. 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. E-health is much more than just digital communication and the EPD. 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”. 

 

The government’s e-health strategy

As early as 2007, the Federal Department of Home Affairs formulated an “e-health strategy for Switzerland”. According to the Federal Council, e-health should help give the population access to a high-quality, highly efficient, highly secure and cost-effective health care system. “E-health” therefore stands for the integrated use of information and communication technologies to support all stakeholders and processes in health care.

The strategy set ambitious targets. For example, electronic data exchange between the service providers was to have been established by the end of 2012. By the end of 2015, everyone in Switzerland should have been able to use the electronic patient record. These targets were not achieved.

In June 2015, Parliament passed the federal law on the electronic patient dossier (EPDG). It comes into force in 2017 and stipulates the introduction of electronic data exchange and the EPD. Hospitals and homes must be connected at the latest three years after the law comes into force, home care services have five years to complete the changeover. Participation is optional for doctors and patients – the principle is known as “double voluntary action”.

Digital health for a healthy Switzerland

Thanks to innovative ICT-based solutions from Swisscom, doctors, hospitals and insurance companies can save valuable time and money. Patients gain an insight into their data and profit from efficient collaboration between their service providers.

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