Juerg P. BleuerNovember 2017www.e-health-suisse.ch
eHealth in Switzerland
-Quo vadis ?
Dr. med. Juerg P. Bleuer, MPH
Deputy Head of eHealth Suisse
Swiss Competence and Coordination
Centre of the Confederation and the
Cantons
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
phone
letter
fax
The starting point…
Telemedicine (Call Center)
Pharmacy
Doctor
Hospital
Rehabilitation
Specialist
Homecare
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Telemedicine (Call Center)
Pharmacy
Doctor
Hospital
Rehabilitation
Specialist
Homecare
The Electronic Health Record (EHR) in Switzerland
This is new:
� «Digital» instead of fax and mail;
� «Publish» instead of sending from A to B;
� Patients can see their record and give access rights.
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
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Cantons are responsible for Healthcare
A complex structure with 26 health systems
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Scenery of swiss healthcare actors
� > 300 hospitals (public + private)
� > 10’000 private medical practices
� > 500 ambulatory home care centers
� > 1700 private pharmacies
� > 60 private insurance companies
� 26 cantons as parttime payers and hospital owners
� mandatory basic health insurance plus private exten sions
���� heterogenous healthsystem with high diversity (of IT-systems)
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Are you also introducing «eHealth»?
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
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Legal support from the national level
Cantonal Level
� Establish “eHealth” in the regional healthcare systems.
Federal Level
� Common legal framework for standards and infrastructure.
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Challenges for “eHealth” in a federated system
Major goal: decentralized system
� No central patient registry� � federation of MPIs
� No central document registry� No central storage of any medical data� � federation of registries and
repositories
� Patients self-determination to which information is available for whom
� � fine granular access management
� No central Consent management� � federation of policy repositories
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Outcome: Swiss specific EHR
� Swiss EHR is a secondary system, only for documents with medical content in a push/pull mode
� no single data, only packaged in CDA-documents (due to maturity level in Switzerland; e.g. < 40% of GPs document electronically)
� Swiss EHR is totally patient owned and controlled, e.g. right to hide and delete documents
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
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National Law on an Electronic
Health Record(EHR)
Linking regional projects under national rules
Aargau
Zürich
Genf Wallis
Tessin
GR / GL
St. Gallen
Waadt
Basel
«Community» = Organisation of health care providers or their
institution
Only certified «Communities» are integrated into the «Circle of Trust» of the national Electronic Health Record
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
The law for a nationwide Electronic Health Record (EHR) was adopted by parliament in June 2015:
• Council of States (Ständerat): 45 to 0 votes
• National Council (Nationalrat): 189 to 5 votes
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
According to plan law is valid by 2017
Transition period for health professionals until they have to be connected to a «Community»:
• Hospitals: 3 years(+/- 2020);
• Nursing homes: 5 years (+/- 2022);
• Outpatient care: Voluntary
• Citizens / patients: Voluntary
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
• I want to see your data
Access Dr. Y
Access Dr. X
Access Dr. Z
Access only after patient action
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
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Hospital A /Department XYDr. House/ Dr. Green
Patient must know who has access and who not
Access right
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
HospitalA /Department XY
1515
Access right
Patient must know who has access and who not
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Standards
� for document exchange: IHE profiles (Integrating the Healthcare Enterprise)
� for document interoperability:HL7 CDA
� for semantic interoperability:LOINC, SNOMED CT
� for access management: OASIS standards SAML and XACML
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
� Switzerland full member since 1.1.2016
� primarily usage in the context of EPD-metadata andCDA exchange formats
� big potential is seen in research (secondary usage): e.g. personalized health, precision medicine
� future usage as reference terminology in different domains
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Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Many specifications, and then?
� ISO based certification process by law
� only certified EHR-communities are allowed to participate
� certification of organization, processes and technology
� technical certification done with certification platform derived from reference platform (basis is IHE Europe CAS environment)
� live-testing via ‘Swiss EHR Projectathon’
interoperability in and between EHR -communities secured via certification!
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
Roles will change
Juerg P. BleuerNovember 2017www.e-health-suisse.ch
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Dr. med. Juerg P. Bleuer, MPH
Deputy Head of eHealth Suisse
Swiss Competence and Coordination
Centre of the Confederation and the
Cantons
Schwarzenburgstrasse 157
CH-3003 Bern
www.e-health-suisse.ch
