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eHealth publifocus and the electronic patient file

EHealth

An electronic health card to identify patients, an electronic file grouping together all past and present data relating to our health, an online service to give citizens a sense of responsibility: what sort of welcome will citizens give to this new “eHealth” strategy that has been adopted by the Swiss Federal Council?
To respond to this question, TA-SWISS had conducted the eHealth publifocus. A public debate had been opened on this issue in order to find out what the citizens’ views are. The publifocus enables us to pick out the opportunities and risks of this new strategy, and to make recommendations to the politicians.

The project

Why hold a publifocus on “eHealth”?
The eHealth strategy was adopted by the Federal Council in June 2007. Distribution of the electronic health card will begin in 2008, and the electronic health file from 2010. The project is in its early stages, so there is still time to pass on information on this subject, and to make recommendations for its application to political groups.
In addition, the eHealth strategy adopted by the Federal Council has left a great many questions unanswered. The publifocus is the ideal opportunity to try to answer some of those questions.

Aim of the publifocus
The principal aim of the publifocus is to review, with the citizens, the opportunities and risks of the electronic patient file, and to find out what their views and needs are and whether they will accept it, because up to now there has been too little consultation with citizens on this subject. This publifocus is also a good opportunity to clarify certain points of the strategy that are still somewhat unclear.

The main questions for public debate are:

Has this eHealth strategy been well received by the citizens?
Do citizens want information about their health to be recorded on an electronic file?
Do citizens feel that the government is spending its money wisely?
What is the use of this project?

Basic information

What is the “eHealth” strategy that has been adopted by the Confederation?

This project was conceived jointly by the Swiss Federal Office of Public Health (FOPH), the Federal Office of Communications (OFCOM) and the Swiss Conference of the Cantonal Ministers of Public Health (GDK/CDS). It was approved by the Federal Council in February 2007.
The term “eHealth”, or “cyberhealth”, is used to refer to the use of information and communication technologies (ICT) to organise, support and network all processes and partners involved in the public health system. (Based on the definition by the Swiss Federal Office of Public Health FOPH)

The eHealth strategy focuses on three spheres of activity:

The insurance card and electronic patient file: From 2009, the strategy is expecting to record administrative data (e.g. name of insured person, social insurance number) onto a card which will enable patients to be identified electronically. Patients will then be at liberty to add medical data, or to request that such data be removed (e.g. blood group, chronic illnesses, allergies, medical history). This card will be the first step towards the electronic patient file that every Swiss citizen will possess by 2015.

Creation of a coordinating committee: As part of the application and development of the strategy, the government is planning to create a coordinating committee in parallel with the setting up of the above elements, and to set up a framework agreement from 2007 to clarify the legal issues.

Online information and services: The basic objective is to use these to improve the skills of the population in the health domain: protection of health, prevention of diseases, rights of patients, management of health crises, etc. To this end, the government wants to use the Internet portal to distribute information that can be understood by non-specialists. This information must be balanced, correct and reliable, and meet quality assurance criteria.

Opportunities and risks of the electronic patient file
At the moment, medical information relating to patients is fragmentary. Once the strategy is in place, doctors, hospitals and pharmacies will be able to record data electronically when they issue their invoices, and to consult patients’ medical data on the electronic file.

The aims of this new system are to raise the level of administrative efficiency by reducing administrative tasks to reduce the cost of services, to improve the medical quality and safety of treatments, and to give those insured a sense of responsibility (they will decide the extent and use of personal data). The card should also make it easier to exchange information, irrespective of the place and time. From a practical point of view, this card should prove especially useful in emergencies, because it should enable treatment to be given quickly and effectively.

The introduction of this new system does, however, give rise to a certain number of questions, the answers to which are still rather hazy:
- Will the confidentiality and protection of the data be respected?
- What will this new strategy cost? How will it affect citizens?
- Will the electronic file be reliable to use? Could it pose risks to health? (Incomplete or inaccurate data)
- Who will have access to these data?
- Who will manage the data?

Results

Results of the publifocus
Für ein effizienteres Gesundheitswesen. Bericht zum Dialogverfahren "ehealth publifocus und elektronisches Patientendossier. pdf-publifocus-Bericht
Pour un système de santé plus efficace. Rapport du prossesus de dialogue publifocus ehealth et le dossier électronique du patient. Berne 2008. pdf - rapport publifocus

Procedure

Method
The idea of the publifocus is to initiate a debate on a controversial subject between panels of ten or so citizens in different regions of Switzerland, and between the different panels.

To prepare citizens for this debate, TA-SWISS will send them in advance a fully detailed booklet describing the strengths and weaknesses of the eHealth strategy, and of the electronic patient file in particular.
TA-SWISS is responsible for selecting the citizens from different parts of Switzerland to take part in one of the publifocus events.
The publifocus events are held in different towns in Switzerland under the direction of a moderator.
The discussions are recorded in writing and will be the subject of a final report.

Timetable
Start of the project: summer 2007 | end: spring 2008

Downloads

Media information
available in German and French

Newsletter
available in German and French

Information brochure
available in German, French and Italian

Final report
Für ein effizienteres Gesundheitswesen. Bericht zum Dialogverfahren "ehealth publifocus und elektronisches Patientendossier. pdf-publifocus-Bericht
Pour un système de santé plus efficace. Rapport du prossesus de dialogue publifocus ehealth et le dossier électronique du patient. Berne 2008. pdf - rapport publifocus

Events

publifocus
Four publifocus will take place next year (in spring 2008)

Contacts

Supported by

Centre for Technology Assessment (TA-SWISS), Sergio Bellucci
Federal Office of Communications (OFCOM), Ka Schuppisser, Information Society Coordination Service
Swiss Academy of Engineering Sciences (SATW), Dr Michel Roulet, eHealth Projet
Swiss Academy of Medical Sciences (SAMW), Dr Hermann Amstad

Persons participating

TA-SWISS Project Supervisors

Dr Sergio Bellucci, TA-SWISS. e-mail
Nadia Ben Zbir, TA-SWISS. e-mail

Supervisory group

Dr Bruno Baeriswyl, préposé à la protection des données du canton de Zurich, Zurich
Dr Iva Bolgiani, collaboratrice au département de la santé, canton du Tessin, University of Geneva
Prof. Dr Alberto Bondolfi, professeur associé d’éthique, University of Lausanne
Fritz Britt, manager of Santé Suisse, Soleure
Prof. Dr Luca Crivelli, professeur agrégé à la Faculté des sciences économiques, University of Lugano, manager Net-MEGS
Pia Ernst, directrice de l’Organisation suisse des patients (OSP), Zurich
Dr. med. Max Giger, membre du comité central de la FMH (Fédération des médecins suisses), Winterthur
Edith Graf-Litscher, Conseillère nationale, Agentur ÖKK, Thurgovie
Prof. Olivier Guillod, directeur de l’Institut de droit de la santé, Université de Neuchâtel
Markus Nufer, manager of Governmental Programs, secteur de la santé et de l’eHealth, IBM Suisse, Gümligen
Andrea Nagel , cheffe de projet pour le projet eHealth, Office fédéral de la santé publique(OFSP) , Berne
Ann Schwarz, rédactrice, Tages-Anzeiger, Zurich
Walter Stüdeli, directeur de eCH, eGovernment Standards, Berne
Hanspeter Thür, Préposé fédéral à la protection des données et à la transparence, Berne
Dr Rosmarie Waldner, journaliste scientifique, Zurich (Présidente du groupe d’accompagnement

Communication

Susanne Brenner, TA-SWISS. e-mail