Since 1 April 2020, the electronic patient dossier (EPD) should be available nationwide in Switzerland. However, things look different, and the project is still stuck in the pilot phase. It is unlikely that it will be introduced this year. The delays in digitization are not an original Swiss problem; Germany is facing almost identical issues. On the other hand, other countries have already made considerable progress, such as Denmark with its central portal "sundhed.dk".
Where do we currently stand?
The first e-health strategy for Switzerland dates back to 2007, so the topic has been on the agenda for a long time. For example, Switzerland can be seen as a pioneer in Germany. Nevertheless, the interplay of cantonal federalism, data protection concerns, bureaucratic processes, disagreements between the service providers themselves, and other factors have created a complexity that is difficult to penetrate. The service providers have (as of today) joined together to form eight so-called parent communities, each of which must be accredited individually - only two have achieved this so far. In the meantime, however, the certification procedures are underway again. Audits, resource bottlenecks, and lack of clarity in the entire process of audits were and are not conducive to this. The technologies are ready; service providers, suppliers, and hospitals are highly heterogeneous in their readiness to deliver and receive. By spring 2021, every Swiss citizen should be able to open an EPD, according to the current roadmap. It remains exciting.
One must hope that this new deadline will be met and that more momentum will generally be brought to the topic of the digital health system. Because of the background of current developments, e-health is not a luxury but a pure necessity. On the one hand, this is happening at the macro level: Switzerland already has one of the most expensive healthcare systems and, like almost all industrialized nations, is confronted with an aging society. In the face of cost pressure and growing demand for care services, automation can help solve this dilemma. In the future, we cannot afford to waste scarce human resources on routine, bureaucratic work.
At the micro level, doctors and patients are individuals in a digital world accustomed to convenient offers and services from the net. With various apps and gadgets, this world is also increasingly penetrating health. However, the interface to the "official" state health system is missing. It is appropriate to ask where all the intelligent device data resides. It is up to the user to decide whether or not to use such services. Another problem, over which patients no longer have any influence, arises when doctors digitize on their own due to a lack of alternatives. If, for example, patient information is transmitted "through the official channels" via messenger or the familiar fax machine to a colleague, there is no longer any need to talk about data protection. We, therefore, need secure, institutionalized, and controlled alternatives that give patients complete control - without degenerating into bureaucratic complexity.
Where do we want to go?
In a digital health system of the future, we will be able to provide patient information centrally in one place. The advantages of this are clear: patients, their authorized relatives or representatives, and hospitals and doctors (provided they receive clearance from the patient) can access the entire medical history and documentation entirely, digitally, and securely. This means that not only diagnoses, findings, and final reports can be viewed, but also medication plans, therapy information, and prescriptions can be made available. A centralized collection of patient documents is exciting for people who may have complications regarding the completeness and order of their documentation, such as elderly patients or patients with dementia.
Patients can also store disposition information in the EPD, which can include emergency contacts or information on illnesses or allergies relevant to first aid. The fast on-demand access makes it possible to make the documents of one attending physician available to another without delay. This is to prevent possible multiple diagnoses and treatments by different doctors, which serves as a better overview and saves unnecessary, avoidable treatment and therapy costs. In this way, all processing and shipping costs are also eliminated. Patients can have prescriptions conveniently transmitted to an app or sent directly to the pharmacy of choice - in real-time. We are already seeing individual developments in the direction of health insurance companies covering the costs of specific apps or gadgets. This could be expanded further, including their data integration into the EPD. However, this holistic approach is still in its infancy, as the corresponding incentives are too low for all stakeholders involved, or not all stakeholders (e.g., health insurers) have been integrated into this vision. The real winners are the health insurers, as they will participate in the cost savings.
Secure identification and two-factor authentication: two central pillars of e-health
One must not be under any illusion: The more data in the network, the more potential for misuse. That is why it is so essential that we pay attention to security in all considerations regarding user experience for patients and rely here on robust solutions for unambiguous identification of patients, as well as on documentation that can be traced beyond doubt. On the one hand, access to the EPD is regulated by available procedures for the means of identification; on the other hand, medical documents such as referrals or electronic prescriptions must be able to be assigned to an issuer without any doubt to prevent fraud. This is where solutions of secure two-factor authentication and a qualified electronic signature for the verified authenticity of a document come into play.
In the context of non-EPD-relevant processes, which continue to exist in hospitals and with general practitioners, service providers can already establish modern methods that do not necessarily require the EPD. This refers, among other things, to "B2B transactions" between hospitals and specialists, laboratories, and other research institutions. Here, digital processes can already be set up today that optimize the healthcare system's processes so that costs can be reduced and efficiency increased.
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