Despite the obligation: the majority of hospitals do not provide electronic patient files

The low rate does not fit the image of proper Switzerland. But it fits into the twisted, drawn-out history of the electronic patient record. The hospitals are obliged to participate in this project for three years. According to the Federal Office of Public Health, only 44 percent have done so. In some cantons the rate is considerably lower.

More than half of the hospitals are in error with the legal obligation. How can that be? If you ask around the various players, you will get a unanimous answer: the electronic patient record in its current form is not exactly the yellow of the egg.

Yvonne Gilli, president of the Medical Association FMH, puts it this way: “In its current form it is of little use and is therefore not used.” And the H+ hospital association criticizes that the connection of hospitals to the patient file has cost “exorbitant sums of money” without yielding any benefit.

In fact, the electronic patient file, EPD for short, is intended to serve both the patient and the healthcare provider by bundling all relevant information about the patient. All specialists have access, if the patient allows it. This should, for example, give a doctor a quick overview of previous examinations. This should also improve the quality of the treatment.

But the EPD suffers from several problems. Firstly, the technical link is complicated because hospitals use different systems. In addition, thanks to federalism, there are several EHR providers. Thirdly, the functionalities leave much to be desired. And finally, population dispersion is low — about 21,000 people have opened an EHR so far.

It’s a vicious circle: as long as it’s widespread, it’s not very attractive – both for patients and healthcare facilities. This is also reflected in old people’s homes and nursing homes. For a year now, they have also been required to join a provider – but only a third have met the requirement so far, according to the federal government. The general director of the Curaviva association, Anna Jörger, explains this, among other things, with the deep distribution. It will be a while before residents arrive with an EPD, she says. “This circumstance has little motivating effect.”

As is often the case in Switzerland, the number of hospitals already using the EHR varies greatly by canton. Neither the FPS Public Health, nor the coordination office eHealthsuisse, nor the Conference of Health Directors can provide an overview. However, inquiries at various cantonal health departments reveal the differences.

So far, only a few hospitals in different cantons can actually use the EHR. In the canton of Lucerne, for example, all nine hospitals have a contract, but the EPD may only be used actively in the spinal cord injury center in Nottwil. All hospitals in the Canton of St. Gallen also have contracts, but only two are fully affiliated (Canton Hospital St. Gallen and the Valens Clinic). Basel-Stadt also says that all hospitals are connected, but many of them cannot yet read or edit the EHR.

According to reports, quotas are low in many Swiss German cantons. Aargau is completely different: Eight of the nine hospitals and all rehabilitation clinics and psychiatric clinics are connected here. One reason for the spread is probably the provider: the community of Aargau was the first to start with the patient record in Switzerland.

Graubünden also stands out. All hospitals in the canton of Graubünden are connected, says Richard Patt, director of the provider eSanita. It was originally founded in southeastern Switzerland, but now has members from all over German-speaking Switzerland. “The hospital needs to be on benefits to participate in the patient record — and with as little effort as possible,” says Patt. That is why eSANITA offers a double solution: on the one hand a digital network platform for secure document and data exchange. For example, a hospital can use this to send the discharge report to the general practitioner. At the same time, the report is archived in the electronic patient file – without any effort for the hospital, Patt emphasises.

Now the cantons have to get the hospitals moving. The conference of cantonal health directors wrote to its members in June about the low connection rate, spokesman Tobias Bär explains. She was asked to remind the institutions of their legal obligation.

Hospitals currently have little to fear other than words of warning. That should change: the Bundesrat wants to introduce fines, as recently announced. In addition, he wants to oblige medical practices and pharmacies to use the EPD in the future. And in Switzerland, a patient file should be opened free of charge for everyone, provided they don’t object. These are just proposals – Parliament will decide one day.

At the same time, the functions of the EPD are being expanded, albeit at a slow pace. The introduction of a vaccination certificate is planned for this year. A doctor or pharmacist must be able to see at a glance which vaccinations have already been given – and also note the new spades. Medication plan and allergy passport, among other things, will follow in the coming years, as was recently announced at a media conference.

In the short term, the government is trying to improve the dissemination of the file with a campaign. In a first phase, this is aimed at healthcare workers. While the hospital association H+ supports the campaign, the doctors’ association FMH stands aside. President Yvonne Gilli calls it a “pure advertising campaign for an EHR, which in its current form neither increases patient safety nor is it useful to the medical profession”. The FMH focuses on supporting continuous improvements.

So there is even disagreement about the campaign. This also fits in with the twisted story of the electronic patient file. (aargauerzeitung.ch)