Author: Mario Voge

Electronic patient file in Switzerland - What's the issue?

If you look at how people often communicate in the health sector today, the need for a secure, digital solution becomes obvious. But instead of using the electronic patient file, it is still common to fax or even WhatsApp to exchange medical data in 2023. Mario Voge, Head of Growth Management at Swisscom Trust Services wonders if the electronic patient file is too complicated and bureaucratic

On the FMH website, you read:  "Since 2020, the electronic patient file (EPD) has been gradually introduced in Switzerland. The opening should be simple and, above all, secure ...". As far as the simplicity of the opening is concerned, things unfortunately still look different in practice.

On the patient side, it starts with the fact that there are different providers of EPDs, which in turn work together with different providers for electronic identities. This electronic identity is absolutely necessary in order to assign a patient to his or her EPD securely and without any doubt. Health professionals, in turn, must use a different identity provider. For them, the HIN ID of Health Info Net AG is mandatory. Regardless of the provider, a comparison with the real identity of the user is necessary. This means that anyone who wants to open an EPD (or use it as a doctor) must identify themselves once. Today, this is usually done in person, i.e. patients have to show their ID. An online identification such as video identification is also allowed.

However, both procedures have the disadvantages that they are tied to fixed opening and working hours and require a lot of personnel and increase costs. Originally, the federal government (FOPH) discussed a cost ceiling that would cover the entire value creation, including the operation of the ePD, to make the stakeholders, suppliers and users more secure and transparent. Since the financing was still unclear, a new attempt is now being made enabling all sides to share the costs in an acceptable way between hospitals, parent communities and cantons. We will see the result then, we remain curious whether we will now push digitalization. If the new structure is to be implemented, we must consistently focus on as much automation as possible in the process, otherwise growing personnel costs could quickly put a spanner in the new cost accounting and allocation.

Ideally, existing data can be used for identification. If you want to open a bank account, you have to identify yourself. With the BankIdent procedure, this data basis can be used for identification with other services. Thanks to artificial intelligence, it is now also possible to scan identification documents automatically during a video transmission. These types of identification have the advantage that they run completely automatically and are therefore practically infinitely scalable. And not only that, they are available 24x7 at any time and possible from any location, even from the ski slope. Currently, video and NFC-based automated reading of passports are still the options under discussion. But even these are neither nationwide (passport coverage approx. 40%) nor highly available. So here, too, penetration and rapid acceptance are a long way off.

According to the study 'Swiss eHealth Barometer', only about seven percent of Swiss respondents own an EPD. The authors even put real usage figures in the per mille range. For the desired nationwide introduction, millions of Swiss citizens would still have to be identified. This is another reason why it is important to have a procedure that is easy to scale, otherwise the system could be overloaded, and not only in terms of costs.

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