Digital access to the medical record

This spring, Aargau became the first canton in Switzerland to introduce the electronic patient dossier (EPD): Interested residents have been able to open an EPD since the beginning of May. Anyone who wants to have their health file recorded digitally in future will have to go to the post office here, as it provides the technical platform and sets up the digital patient file. At the counter, you will be given a personal patient identification number to avoid dangerous confusion. To date, however, this is only possible at the main post office in Aarau and in Baden. By the end of the year, two more locations - Muri and Rheinfelden - are to be added, promises the Stammgemeinschaft eHealth Aargau (SteHAG). The aim is to enable acute hospitals, rehabilitation clinics, psychiatric clinics and other healthcare facilities, as well as general practitioners and pharmacies, to open an EPD for patients at a later date, says Arthur Immer, project manager at SteHAG, which is behind the project. More than 80 healthcare providers in Aargau are affiliated with it. SteHAG coordinates and develops the organizational and technical basis for the electronic patient file, which is being implemented in Aargau under the name "emedo - My electronic health dossier". Last November, the organisation was the first ever to receive EPD certification.

Southeastern and Western Switzerland are also making progress

Southeastern Switzerland is also getting closer to the EPD. The eSanita association also has the successful EPD certification from KPMG AG in its pocket since the end of 2020. eSanita covers the EPD supply region with the cantons of Graubünden, Glarus, St. Gallen, Appenzell Inner- and Ausserrhoden. If everything goes according to plan, citizens will be able to have their personal EPD with the associated certified log-in set up free of charge in 24 hospitals and clinics and at around 20 post offices in the five cantons from autumn 2021, as eSanita promises.

In French-speaking Switzerland, the association Cara is responsible for the EPD with the cantons of Fribourg, Geneva, Jura, Vaud and Valais. This association has also had certification for a few months. As a result, since the end of May, anyone can create such a digital dossier using their AHV number - which only has to be presented at the opening together with an identity document. In French-speaking Switzerland, this is currently only possible online, according to Cara. Later, the member cantons would set up opening points according to their own strategies. According to information, in the first two weeks after the launch, around 370 people have made use of the possibility. Various other organisations are currently in the certification process, according to information from the federal and cantonal competence and coordination agency, eHealth Suisse. Cantons with large populations, such as Zurich and Berne, will have to wait a little longer: There were complications in the certification process of the corresponding XAD master community, which covers the catchment area of 14 cantons. Residents in these cantons will probably not be able to open their first digital health records until next year.

What advantages?

Mr and Mrs Swiss can store all the health-related documents they want in their electronic patient dossier. However, health professionals do not record all electronically recorded health information in the EPD, but only that which is relevant for other professionals and for further treatment. In addition to the EPD, health professionals continue to keep a personal medical record for their patients. This contains far more information than the EPD.

The advantages of a digital solution also become apparent in this case at the latest: If someone is brought to hospital with flashing blue lights, things may have to happen very quickly. The attending physician accesses the accident victim's EPD and thus quickly obtains an overview of the patient's health situation and any contraindications. In this way, the physician may gain crucial minutes - or prevent incorrect decisions because the patient, who is no longer responsive, is unable to provide him with important information. According to the Federal Law on the Electronic Patient File, it is always the patient who decides which documents and data are stored in the EPD. He can delete documents from the EPD for whatever reason. The patient has sovereignty over his or her patient files, as is also the case in the analogue case.

With the digital solution, healthcare professionals can quickly access all of a person's important health information, regardless of time and place. The EPD should ultimately help to improve the quality of treatment, make the treatment process more efficient and, not least, make it more cost-effective.

Criticism from FMH doctors

The professional association of Swiss doctors, the FMH, is anything but happy about the current solution. "In its current form, the EPD is hardly practical for doctors and is likely to generate a lot of additional work," the organisation announced at the beginning of May. Due to its legally prescribed architecture, the EPD is a static container designed to store documents. The support of other processes in everyday medical treatment, for example the creation of an electronic prescription or the compilation of an overview of a patient's previous and current medication, is currently not possible.

"At the present time, the EPD is not yet in a position to map or significantly support the processes of medical treatment," according to the criticism. Furthermore, the FMH criticises that the EPD is currently not suitable as a communication tool for health professionals, as it does not allow direct communication with other health professionals. Whether the criticism of the FMH doctors is justified or not remains to be seen. Arthur Immer of eHealth Argau provides an appropriate answer when he says: "The launch of the basic system is a step in the right direction. Now the further developments can start."

Who has access to the dossier?

As with the analogue medical record, the same applies to the voluntary electronic patient file: what is stored in it is extremely sensitive information. It must therefore be clearly regulated who can access it and when. This is determined solely by the patient and is regulated accordingly in the federal law. For each individual document, the owner of the EPD can choose between three levels of confidentiality: "Normal access", "Restricted access" and "Secret". Only the patient has access to the latter, but not the doctor - not even in an emergency. You can even create a "blacklist" for your health record. This means that the patient can exclude individual, named health professionals from access. Insurance companies, employers and the state naturally have no access to a person's EPD.

The FMH is also not satisfied with the concept of access rights. For the medical profession involved in the EPD, this means that - except in an emergency situation - they cannot access patients' documents if they do not have access rights. The concept includes the definition of confidentiality levels for individual documents or document types and for health professionals or groups of such professionals. "The resulting possible combinations of options for granting access rights are correspondingly complex and thus prone to error. For patients, this makes it difficult to keep track of a larger treatment team and to see which healthcare professional they should and would still like to authorise access to," the professional association emphasises.

The interest in health data is great, because data is the new gold. Therefore, only the highest security standard is good enough for electronic patient records. How is this ensured? Interested parties can find out more here https://bit.ly/3q6LSa2 

What does the eHealth Barometer say?

The Swiss eHealth Forum has once again surveyed all relevant players in the healthcare industry about eHealth in Switzerland. The topic is also the electronic patient dossier (EPD). Although the introduction has been delayed, some hospitals have been able to gain initial experience with the EPD, writes the Forum. The "Swiss-eHealth-Barometer" 2021 shows that the use of the EPD is curbing the original euphoria. Based on the survey, 52% of those responsible for IT in hospitals think that the EPD is a rather good or very good thing - this means that approval has fallen by 17% compared to the last survey. Among other healthcare professionals, however, the EPD continues to be perceived as a predominantly good thing, according to the forum. At 83%, support for the introduction of the EPD among hospital doctors is high.

Among the respondents who are not obliged to offer an electronic patient file, pharmacists (79%) are particularly in favour of the introduction, but Spitex people (71%) also like it. In contrast, support among general practitioners is relatively low (54%).

According to the survey, awareness of the electronic health record is increasing among the population, and approval is high: 80% find it a rather good to very good thing. According to the Swiss eHealth Forum, the EPD is generally in a critical introductory phase. Training courses could make an important contribution here. 75% of hospital doctors would like training in eHealth for themselves or their employees.

For more information: www.e-healthforum.ch/studienergebnisse-2021

More topics here: Alliance "Digital Transformation in Healthcare" founded