Electronic patient dossier in Switzerland: it is ailing
Is the tricky registration process to blame for the stagnation of the Swiss e-patient dossier, or the lack of obligations? A look at the Swiss healthcare system
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In Switzerland, the electronic patient record, or EPR for short, is heading for a major overhaul: a total revision. The EPR has been on the health policy agenda of the cantons and the federal government since 2007. The relevant federal law (EPDG) came into force in 2017 and the legislators gradually introduced the EPR from the end of 2020. However, the e-patient dossier has not yet achieved widespread use.
On September 27, Elisabeth Baume-Schneider announced news on the status of the EPR and an upcoming major revision ("total revision") somewhat earlier than expected. Baume-Schneider is a Federal Councillor in the Federal Department of Home Affairs and therefore also responsible for health issues.
Centralization of IT systems planned
The government's current plans include the centralization of IT systems that has been proposed and demanded by many. The different technical infrastructures of each (parent) community are to be standardized in the future on a central technical platform provided by the federal government. The Confederation intends to launch a tender for the procurement of this infrastructure. The operating costs for the use of the central technical platform are to be passed on to the parent communities as usage fees.
Reducing complexity
With this step, the Confederation wants to reduce the complexity of the system and the number of interfaces. It promises to improve interoperability between the EPR players and data exchange, and to make the further development of the EPR simpler and faster. In the medium to long term, centralization should also be financially advantageous, argues the Federal Council.
According to many stakeholders, there are incompatibilities between the medical IT systems, which have only been partially resolved. Most experts agree that all of this, as well as a relatively complex opening procedure, have contributed to the EPR's limited distribution and usefulness to date. This is set to change with the revision of the EPR.
With the Federal Council's current decision to have a central IT infrastructure for all (parent) communities set up and operated under its own leadership, a new page is now being turned in the EPR genesis.
Government wants total revision
Due to many of the above reasons, the Federal Council has been planning to initiate a comprehensive revision of the EPDG Act since 2021. This was originally announced for summer 2024. To this end, a consultation was first held in summer/autumn 2023, in which all stakeholders were invited to comment. It was heard that there was also a lot of criticism of the status quo of the EPR, but that the stakeholders took the "revision" requested by the Federal Council to heart. For the time being, however, only a partial revision of the EPDG was decided, which came into force on October 1, 2024.
Health insurance companies without access
This partial revision brings only a few changes. Above all, it was decided to anchor the EPR as an instrument of compulsory health insurance (OKP) in future "in order to achieve a higher quality of treatment and better cost efficiency", according to the FOPH. It is emphasized that health insurance companies will not have access to the EPR. Neither do other insurance companies, employers and authorities.
From opt-in to opt-out
The plan was for the Federal Council to decide on how to proceed with the total revision of the EPDG, a FOPH media spokesperson told heise online. The "double voluntary principle" is to be dropped as part of the total revision. This means that the EPR will be switched to the opt-out and will be automatic. The voluntary nature of the EPR connection for outpatient healthcare services is also to be dropped so that all service providers can usefully participate in the EPR.
"In the future, the EPR is to be used on a mandatory basis along the entire treatment chain," the federal government announced on Friday, September 27. In any case, the plans will first be submitted to parliament next spring. In any case, slowly but (almost) surely, the general EPR revision is scheduled to come into force in 2028 – at the earliest. This means that everyone involved has more than enough to do for now, as the past few years have shown.
No connection to the European Health Data Space
Switzerland's negotiations on a new, updated framework agreement with the EU have also been going on for many years; after a previous break-off and long pause, a new round of talks was initiated in the spring, including a bilateral healthcare agreement. However, one thing is not on the table for the Swiss: the European Health Data Space. "This is not part of the current negotiations between Switzerland and the EU," says the FOPH.
However, everything is still a project and both chambers of parliament are scheduled to vote on the total revision anyway. This is planned for spring 2025 and "if everything goes as planned", says the head of the FOPH, Anne LĂ©vy, "the new, revised law can come into force". Which should be in 2028.