Swiss agree compromise e-health strategy

After extensive political wrangling the Swiss Bundesrat – federal parliament – has endorsed a national e-health strategy, based on the implementation of electronic medical records by 2015.

The adoption of the 58 page strategy was severely delayed due to protracted power struggles both between the federal and the regional governments and between regional governments and health professionals.

What is now on the agenda is a compromise which leaves much room for interpretation and tries to hurt nobody. “It is salami slicing, but it is the optimum that we were able to reach”, says Adrian Schmidt, project manager at the “Bundesamt für Gesundheitswesen” (BAG).

The BAG is the national ministry of health in Switzerland. It has, however, very limited power due to the heavily federal structure of the country. “The federal structure encourages bottom-up solutions that work in real life, but it makes the creation of a standardized national system very difficult”, explains Schmidt.

The Swiss e-health strategy has two main points: First, it gives a somewhat vague roadmap for the nation-wide implementation of regional EMRs. In addition, it suggests that the objective should be to build up a web-based nation-wide electronic health platform by the year 2012, with the aim of providing high-quality medical information to the public.

The Swiss e-health strategy says that electronic medical records, which are called “patient dossiers” in Switzerland, should be available for all citizens by the year 2015.

These EMR will be patient-centred, but no details are given of how this will work in practice this point. The vision appears to be a smartcard based system analogous to what is planned or being implemented in France, Germany and Austria.

But key uncertainties remain: Even the adoption of simple identification smart cards for all citizens with health insurance has met with difficulties. The roll-out of these cards is far from finished, in spite of a federal law which mandated they should be introduced three years ago.

To meet the schedule of the e-health strategy, the federal government is suggesting that the Swiss regions (“cantons”) each launch pilot projects for smartcard-based electronic health services from 2009 onwards. The hope is that these initial pilot projects will be the nuclei for a roll-out of fully-fledged smartcards which would then replace the current smart cards.

To coordinate the efforts of the different cantons, a general written agreement between the cantons and the federal government is scheduled for later in 2007. It is planned that this will lead to the creation of a new joint agency, the “Koordinationsorgan Bund-Kantone” which might fulfil some of the functions of national health-IT-organisations in other European countries.

All in all, the Swiss e-health scene does not seem to be particularly happy with what is considered a meagre result for some 15 months of work. Who has to take the blame is debatable, though.

Like in other German speaking countries, doctors fear a loss of influence on therapy when patient data is accessible via an EMR and tend to block everything which leads into this direction. But the federal government, too, is criticized for not yet having invested enough money into the whole project and for not being steadfast enough to confidently face down the opposition.

Link

The Swiss e-health strategy is available on the internet in German, French and Italian language