Idealistic Fiction or Functional reality?
The current version of the EPD – a failure! At least, this seems to be the opinion of a large – not so silent – minority. The following reasons are cited again and again:
- Lack of leadership by the federal government and cantons
- Self-interest of the involved stakeholders
- unresolved financing problems
- Inadequate management of infrastructure and services
Another question arises for many: to what extent is the lack of dissemination of the EPD to date due to the double voluntary nature of opening and maintaining a patient dossier for insured persons and independent practitioners? In addition, there is a general lack of clarity about data protection risks.
When I moved back to Switzerland from the U.S. in 2016 after more than 16 years, I was privileged to witness the passage of the Federal Electronic Patient Dossier Act (EPDG) in 2017. I read the text of the law and many of the materials that led to the passage of the EPDG. And as a lawyer, I was fascinated and pleasantly surprised by the progressive nature of the new legislation – which took a clear and positive stand for the patient.
A few years later, back at UZH for an Advanced Certificate in Medical Law, I realized how the many missed deadlines were impeding the progress of this monumental, culture-shaping project. The skepticism that has grown in the Swiss population over the past few years and the simple refusal of many physicians and other health care providers to get involved with the new system have led to the current burning question: Is the entire EPD project an idealistic paper tiger or does the EPD have a realistic claim to usefulness and perhaps even indispensability in the future?
In its current form, the EPD is a result of innovative legislative processes and – typical for Switzerland – characterized by compromises
The Federal Law on the Introduction of Electronic Patient Dossiers (EPDG) was enacted with a view to a self-directed, hyper-personalized and truly patient-centered healthcare system – the overarching goal of the federal government’s “eHealth strategy”! The legally and technically complex undertaking was complicated from the outset by Switzerland’s federalist traditions, four official languages and great cultural diversity.
The successful implementation of this legislative project was only possible thanks to innovative processes, involving informed stakeholders throughout the consultation period and contributing their expertise. The weaknesses resulting from trade-offs – mainly related to political/technical feasibility – and unresolved issues regarding financing were clearly underestimated and were barriers to swift implementation.
Due to the remarkable delay in the implementation of the EPD, alternative and proprietary applications for the electronic exchange of personal medical data have proliferated without regard to the EPD
Since the EPDG came into force in 2017, not least because of the significant delay in its introduction, some private medical technology providers (e.g., amétiq AG) have expanded their practice software systems to include a ‘homegrown patient dossier’. Likewise, various private and public hospital service providers (e.g. LUKS and the Hirslanden Group etc. – keyword ‘Compassana’) have invested heavily in patient portals with comparable functions to the EPD in recent years. ‘Well’ or ‘Cuore’ from the post office have similar offers in the offing.
Similarly, the most important home care provider in the greater Zurich area – SPITEX ZÜRICH – does not see the EPD as a valuable support for its services and considers the future development of the EPD to be rather questionable. Alternatively, SPITEX ZÜRICH is working with a primary system for patient information, which is also available on a mobile basis if required, and on a pilot project with health insurance companies for automated vital data recording.
But it is not technology or digital refusal on the part of physicians and/or patients that are the real problem areas
These efforts show that all stakeholders in healthcare have the same desire – to have personally relevant medical information (data) as widely available as possible when needed. The fact that nothing works without digitization is now a generally accepted reality – in healthcare as well as in all areas of life. However, the transition to a digital-centric healthcare system is a complex change process that requires investment in technology and training; and a profound shift in mindset among individuals and institutions.
Today, we are in the midst of this change and are challenged as individuals and as a society as a whole not to deviate from a “patient-centered” course. And this is exactly the purpose article contained in the EPDG: Promoting the health literacy of Switzerland’s resident population – in other words, enabling and empowering patients! Only with the widespread distribution of the EPD among the Swiss resident population will we come a significant step closer to the goal of a nationally networked healthcare system.
The electronic patient dossier serves all stakeholders in a digitized healthcare system
Conclusion
The problem of the currently insufficient acceptance of the EPD therefore does not lie in the digitization of the healthcare system, the EPD or the underlying legislation (EPDG), but in an insufficient attractiveness, i.e., in the lack of recognizability of an immediate and obvious benefit for the population and a not (yet) matured idea of what is meant by health literacy or even digital health literacy.
Digital health literacy (often referred to as eHealth literacy), encompasses the empowerment and activities of the individual user to take responsibility and control for her health and to be able to access digitally offered health services through digitally supported peer-to-peer communication with health professionals of her choice, independent of time and place. Achieving the required eHealth competency is the key challenge; a true legal-cultural change management project!
It is a great achievement of Parliament and the Federal Council to have created a good and secure basis for these contemporary processes with the introduction of the EPD. The amendments currently under consultation will improve what is already good. The existence of a functional and secure EPD enables a majority of the Swiss population to acquire and use eHealth competence; a competence that has become a necessity in the Digital Age.
If you have any questions about the Electronic Patient Dossier, please do not hesitate to contact us.
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