Switzerland is not really one country

If implementing an eHealth strategy, Switzerland faces more complexity than any of its neighbouring countries. Its federative structure, reflected in numerous health systems, health legislations and political organisations, calls for a high level of cooperation among involved stakeholders, explains Adrian Schmid, head of eHealth Suisse.
Interview: Cornelia Wels-Maug

Photo: Switzerland is not really one country

‘Talking about Switzerland,’ says Adrian Schmid of eHealth Suisse, ‘brings us the first challenge. We are not really one country, but a federation of 26 regions or cantons. Nevertheless, we have decided to tackle specific tasks together – but healthcare is not one of them! That means we have 26 health systems, 26 different health laws and 26 health ministers.

‘However, issues such as health insurance, health protection and also e-health can be dealt with at the federal level. This complexity is not only a challenge, but also an opportunity, because we’re not tempted to create a big bang solution. Although we have a nationwide e-health strategy, we count on its regional roll out.

‘Passed by the federal government in 2007, the strategy is a national framework for all activities in the e-health domain. The 26 cantons joined the initiative. Due to our federal structure, the strategy’s implementation is a balancing act between autonomy and commitment.

‘On the federal level, issues such as the provision of central online-services, opting in of patients and out-patient caregivers, as well as data protection and digital identity, are handled. Based on regional needs, each canton decides how to implement the federal e-health strategy.

‘Smaller cantons will probably join projects of larger ones to accelerate implementation.’

What is the eHealth Suisse role?
‘In answer to our federal structure, the Swiss Confederation and cantons set up eHealth Suisse as a coordinating body to drive the nationwide execution of our eHealth strategy. eHealth Suisse is jointly financed by the federal state and the cantons. It brings healthcare stakeholders from four working groups together − devoted to standards and architecture, pilots and implementation, semantic, education − to agree on recommendations regarding interoperability.

‘These recommendations are not legally binding, but are used as a blueprint for formulating further e-health regulations and projects at both federal and regional level.’

What is the state of Swiss electronic health records (EHR)?
‘The electronic patient dossier, or EHR, forms a central element of the Swiss e-health strategy. It will eventually replace the present dominance of fax machines as the main medium for exchanging medical documents. The law regulating EHRs just passed the first of parliament’s two chambers and is expected to come into effect in 2017.’

What type of medical information will be exchanged first?
‘Several cantons surveyed which type of data exchange doctors would prefer to set up first. Discharge letters and medication topped the list, along with diagnosis, allergies and test results − all in electronic form.

‘To enable data exchange, common formats need to be established. In the case of electronic immunisation records, reportable test results and test results needed for transplantations, these formats already exist, whereas those for electronic discharge letters, e-medication or e-radiology are presently being developed.’

What is the overall acceptance of the electronic health record in Switzerland?
‘Two consecutive surveys of the Swiss population, in January 2014 and 2013, confirmed the acceptance of EHRs, although at a decreasing rate. In 2014, 55% of the Swiss population were either “in favour” or “rather in favour” of EHRs, as opposed to 60% a year earlier. The slight drop mirrors the rising awareness that issues such as data protection and privacy cannot by tackled on the fly, but need firm commitment. ‘Overall, we are on the right track, but it will take some time.’


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