Central or decentralized?: The e-patient file divides opinions

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The electronic patient file (EPD) is a slow seller. The Federal Council’s proposal is intended to give the instrument, which is not widely used, a head start. However, important circles are now expressing doubts in the consultation: they think it makes little sense for eight operators to continue to manage the file decentrally. The Health Directors’ Conference criticizes that this has not worked so far. Centralization in one hand is necessary.

Other points in the revision are less controversial, as emerged from the consultation on the proposal that concluded on Thursday. Only the SVP announces frontal opposition. The majority of opinions agree that the EPD needs to move forward. There is little debate about the obligation for all service providers to maintain an EHR.

Much criticism of core communities

What is largely clear is the authorization for the automatic and free creation of such a file for anyone with compulsory health insurance. There is no opposition to the opt-out option via an objection to the canton, except from the SVP. The research data must also be available in anonymized form.

There is criticism of the core communities. They manage the files and operate the EPD systems. The Federal Council intends to maintain this and support it with transitional funding until the revised Federal Law on Electronic Health Records comes into force.

The criticism of the Conference of Cantonal Health Directors (GDK) was clear. The decentralized approach therefore proved unsuccessful. The conference demands that the EPD be controlled and financed centrally and in a uniform manner. The GDK wants to merge the currently eight EPD operators – five regional and three national. If they want to be retained, they need clear guidelines, the GDK demands.

Doctors demand proof of the usefulness of EPD

Health insurer Santésuisse supports the financing, with the cantons paying the same as the federal government. The reimbursement as a lump sum per EPD provides incentives for the further dissemination of the file and ensures cost-efficiency for the core communities.

The Association of Swiss Doctors (FMH) quickly demands concrete proof of the usefulness of the EPD. She complains that the proposal contains hardly any incentives for voluntary use, but rather disproportionate penalty provisions.

The concept of accessing the data is too complicated for the population. Physicians should be free to choose which core community they join. They should also be compensated for their efforts.

SVP wants to send the template down the drain

The SVP is strictly against the revision. The template shows an absolutist understanding of the state that infringes on personal freedom for “moralistic reasons.” As long as the objection solution remains in the template with an entry in an objection register, the SVP will categorically reject any change in the law.

Everyone has the right to the protection of their personal data. By registering with the cantons, those who refuse to do so can be publicly pilloried.

Easily accessible with the highest security standards: this must be the EPD for the SP. The data must be understandable to patients. It would therefore be necessary to investigate whether patient organizations can offer corresponding services through a service mandate. According to SP, there is no need for multiple core communities. This only fuels competition and increases costs.

Core communities with ‘design flaws’

The center welcomes a clear demarcation of powers between the federal government and the cantons, but doubts whether the revision will be successful. The cantons will probably decide on a regional core community. The question arises whether national operators remain viable.

The Greens regret that the proposal does not address a major design flaw in the EPD: the system of individual core communities. Centralization becomes necessary.

The Green Liberal Party calls for a user-oriented and data-based EPD instead of tinkering with the ‘current model’. At most, the review is food for thought. (SDA/oco)

Source:Blick