|Creation of an IT-based health care platform|
|Implemented in this survey?|
In June 2007 the Federal Office for Public Health outlined a national e-health strategy for Switzerland at the request of the Federal Council. Following the presentation of this document an ?e-health? office for coordination between the Confederation and the cantons was created. In 2009 the electronic card will be introduced for the insured. After a trial phase, characterized by the realization of regional IT platforms, finally the e-health strategy will be implemented at national level.
In October 2004 the Federal Assembly set down the legal bases for the introduction of an eletronic card for the insured, by creating a specific article of law (42a) in the Federal Health Insurance Act (FHIA) [see ref. 1]. In February 2007 the Federal Council then presented a decree regulating the application of the law and the details on the functioning of the card [see ref. 2]. How the new system, which should come into force in 2009, will function was recently illustrated even more clearly than in the decree by the Federal Office of Public Health in a policy paper dated 1st April 2008 [see ref. 3], while the technical requirements are contained in a second decree of application dated 20th March 2008 [see ref. 4]. The instrument adopted by Switzerland corresponds to an "extended insured's card" where not only administrative data necessary to optimize the transactions from a management point of view are stored, but also some personal health care data of great benefit in emergency cases (blood group, allergies, drugs currently being taken, the patient's biological testament such as organ donation). However, it is still not a proper "patient's card" able to grant access to his/her own eletronic health records through an internet platform for example. For the moment the objectives of the "insured's card" are limited to improving administrative efficiency, increasing the quality and safety of an intervention in case of emergency (thanks to access to the personal health care data by the health care operator) and to the empowerment of the patient, who is called on to exercise his/her own responsibility by means of the decision to register certain personal data on the card or not. However, the Confederation hopes that leeway will be left to the cantons to try out solutions which move in the direction of a real eletronic health record through decrees enacted at cantonal level and of temporary valence, so that in time the insured's card will change into a fundamental part of the Federal Council's e-health strategy. Therefore the insured's card is inserted into a wider context, that of an e-health strategy at national level.
|Medienpräsenz||sehr gering||sehr hoch|
|Implemented in this survey?|
The guidelines for the e-health strategy adopted by Switzerland are contained in a policy paper drawn up by the Federal Office of Public Health on the mandate of the Federal Council and presented in its final version on 27th June 2007 [see 5]. The cantons also helped to develop the strategy through the Conference of the Cantonal Directors of Public Health.
After confirming the central position of the individual in the Swiss public health care system, thus making it clear that developing new technologies does not represent an objective in itself as much as a support instrument to create value for the patient, the strategic plan defines the boundaries within which the electronic health services will have to develop in the next few years and the relative networking, establishing a clear set of priorities.
The aim of e-health is not so much to reproduce the present health care processes in the digital sphere as to define new ones, if possible better than the present ones, thanks to ICT support. In this way the added value of the whole operation should lie in the improved coordination of the health care providers and of the health care processes, which is necessary to overcome the present fragmentation of the Swiss health care system.
Vision of the strategy
The spirit of the strategy is expressed by the underlying "vision", which thus summarizes the aims of the initiative:
Three fields of action
The strategy is divided into the following three fields of action:
- By 2008: definition of the standard for the electronic extraction of the relevant information from the local information system of single providers which must be shared to make the health care process efficient.
- During 2009: introduction of the insured's card, which allows for the life-saving data to be stored.
- From 2009: encouraging the cantons to experiment with new electronic services on the base of the insured's card.
- By the end of 2010: introduction of a secure authentification system of all health care providers and of electronic signatures, to be used in the electronic exchange of data.
- From 2012: electronic authentification of all citizens (with the option of an electronic signature).
- By the end of 2012: electronic transmission of medical data in a structured way among the main players in the health care system (acute hospitals, integrated networks of care, the majority of medical practices), without data loss and interruptions, by means of the electronic extraction of relevant data from the respective local information system.
- By the end of 2015: all people in Switzerland have access to their own electronic health records at any time and in any place.
- By the end of 2009: definition of the quality standards to set up an on-line database on health.
- By the end of 2010: the information offered by the Confederation, the cantons, municipalities and international organizations, are accessible through a single health care web site.
- By the end of 2012: quality insurance (EBM) of the information offered on the web site, into which also private bodies could be integrated in time.
- By the end of 2015: secure access for citizens to their own electronic health record through the web site, with the opportunity to call up specific information in a structured way.
- Creation of a coordination group Confederation-cantons, already operative from the beginning of 2008.
- By the end of 2008: clearing the juridical questions still open in order to continue with the carrying out of the strategy, in accordance with the legislative competences of the Confederation and the cantons; definition of a process for the progressive expansion of "e-health" architecture on a national scale; definition of the juridical framework to realize the PPP (Public Private Partnerships); assessment process of the cantonal trials; process of a systematic collection of best practices at international level; definition of a process for the transfer of scientific research results carried out at national and international level to the project management
- Beginning 2009: Creation of an on-going training plan for health care providers in the field of e-health.
- By the end of 2013: inserting "e-health" and computer courses into the basic training of medical faculties, of nursing schools and other health care professions.
Finally new models of financing in the health care sector can be imagined, able to encourage the diffusion and development of e-health.
|Federal Council||sehr unterstützend||stark dagegen|
|Federal Office of Public Health||sehr unterstützend||stark dagegen|
|Conference of cantonal health ministers||sehr unterstützend||stark dagegen|
|Physician Association (FMH)||sehr unterstützend||stark dagegen|
|Swiss hospital association (Hplus)||sehr unterstützend||stark dagegen|
|santesuisse||sehr unterstützend||stark dagegen|
The strategy defined by the Federal Council does not meet with the favor of the main players in the system, for whom realizing e-health means assuming significant costs to finance the change. All the players criticize the authorities for the late involvement of the stakeholders in drawing up the strategic plan.
According to the Swiss hospitals [see ref. 8] Switzerland would need a health care strategy rather than an e-health strategy. The creation of a coordination office between the cantons and Confederation appears superfluous in their opinion while it has not been clarified enough who will bear the costs of the strategy. The opposition of the FMH, the head organization of Swiss physicians [see ref. 9a and 9b], is even more structural and substantial; they fear that the information of a clinical nature put onto the insured's card could be exploited by the health insurers and do not think that the protection of personal data is guaranteed. Finally although in principle the health insurers are in favor of a national e-health strategy, they deplore the lack of clarity concerning the costs and financing of the whole operation, in the fear which is probably justified that they will be called on to bear a significant part of these costs [see ref. 10].
|Federal Council||sehr groß||kein|
|Federal Office of Public Health||sehr groß||kein|
|Conference of cantonal health ministers||sehr groß||kein|
|Physician Association (FMH)||sehr groß||kein|
|Swiss hospital association (Hplus)||sehr groß||kein|
The task of implementing the e-health strategy was given to a new organ which was set up on 1st January 2008 on the basis of an agreement stipulated between the Confederation (the Department of Home Affairs) and the cantons (the Conference of Cantonal Directors of Public Health) [see ref. 6]. For the moment the new organ, whose activity is foreseen until 31st December 2011, with the possibility of an extension, is an e-health office for coordination between the Confederation and cantons with a somewhat limited budget; its decisions will not have legal force but only advisory value. The office submits to the indications of a steering committee, which the management levels of the two signatory institutions are part of. With the signing of this agreement the Confederation and cantons declare their commitment to collaborate in implementing the e-health strategy in the interest of a general solution at national level. On 10th April 2008 the steering committee defined six sub-projects required to implement the strategy and clarified the governance structure [see ref. 7]. The six sub-projects are: (1) juridical bases, (2) technical standards and architecture, (3) training, (4) trialing and PPP, (5) on-line services, (6) reimbursement and incentive mechanisms.
As with every management instrument, e-health also presents some risks and different opportunities.
The advantages expected from the e-health strategy are the following:
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
|Creation of an IT-based health care platform|
Process Stages: Strategiepapier, Pilotprojekt
Proof-reading by Mary Ries