Country Brief: Switzerland - EHealth Strategies
Country Brief: SwitzerlandAuthors: Adrian Schmid, Stefan Wyss, Sarah GiestOctober 2010European Commission,DG Information Society and Media,ICT for Health Unit
SwitzerlandAbout eHealth Strategies and this reportThe eHealth Strategies study analyses policy action and implementation progress of eHealth in EUand EEA Member States, with a special emphasis on barriers and enablers beyond technology.Progress with regard to specific applications such as patient summary and ePrescription isassessed. In addition, legal and regulatory facilitators and financing and reimbursement issues arealso dealt with.DisclaimerNeither the European Commission nor any person acting on behalf of the Commission isresponsible for the use which might be made of the following information. The views expressed inthis report are those of the authors and do not necessarily reflect those of the EuropeanCommission. Nothing in this report implies or expresses a warranty of any kind. Results from thisreport should only be used as guidelines as part of an overall strategy. For detailed advice oncorporate planning, business processes and management, technology integration and legal or taxissues, the services of a professional should be obtained.AcknowledgementsThis report was prepared by empirica on behalf of the European Commission, DG InformationSociety & Media. empirica would like to thank Jos Dumortier, Time.lex CVBA for the legal review ofthis document and Professor Denis Protti (University of Victoria) for valuable feedback.ReviewerAdrian SchmidContactFor further information about this Study or eHealth Strategies, please contact:empiricaGesellschaft fürKommunikations- undTechnologieforschung mbHOxfordstr. 2, 53111 Bonn,GermanyFax: (49-228) 98530-12eHealth Strategiesc/o empirica GmbHOxfordstr. 2, 53111 Bonn,GermanyFax: (49-228) 98530-12eHStrategies@empirica.comEuropean CommissionDG Information Society andMedia, ICT for Health UnitFax: (32-2) 02-296 01 81eHealth@ec.europa.euinfo@empirica.comRights restrictionsAny reproduction or republication of this report as a whole or in parts without prior authorisation isstrictly prohibited.Bonn / Brussels, 20102
SwitzerlandTable of contents123Introduction to the report . 61.1Motivation of the eHStrategies study . 61.2Survey methodology . 71.3Outline. 8Healthcare system setting . 92.1Country introduction . 92.2Healthcare governance . 102.3Recent reforms and priorities of health system/public health . 11eHealth Strategies survey results . 123.1eHealth policy action. 123.2Administrative and organisational structure. 153.3Deployment of eHealth applications. 163.43.53.3.1Patient summary and electronic health record (EHR). 163.3.2ePrescription . 183.3.3Standards . 193.3.4Telemedicine. 20Technical aspects of implementation. 213.4.1Unique identification of patients . 213.4.2Unique identification of healthcare professionals . 223.4.3The role of eCards . 22Legal and regulatory facilitators. 233.5.1Patient rights. 243.6Financing and reimbursement issues . 253.7Evaluation results/plans/activities. 254Outlook. 265List of abbreviations . 276References . 283
SwitzerlandExecutive summaryThe current Swiss eHealth strategy is based on a revision of the “Strategy for an information society inSwitzerland” from 1998. eHealth was addressed in 2006 by the added chapter “Health and healthservices”. This was done after an evaluation by the Centre for Research and Technology Studies in2002. The strategy includes plans on infrastructural issues and conceptual elements. Anotherimportant document is the “eGovernment Strategy”, as here eHealth is seen as one key factor to keeppace with international competition.Adhering to the decentralised political structure of Switzerland, national projects do not originate fromthe eHealth coordination office, rather the office links and coordinates regional and cantonalapproaches.In order to understand Switzerland’s position in relation to key eHealth objectives this report haslooked at various different aspects but particularly patient summary and electronic health record,ePrescription, standards and telemedicine. Here is an overview of Switzerland’s position:At present a standardised patient summary does not exist in Switzerland, the establishment of one isplanned for the end of 2015.ePrescription is one of the planned eHealth applications in Switzerland. Current regional initiativesinclude ePrescription as part of eHealth pilots, but there are no large-scale or national projects as ofyet.eHealth Suisse coordinates the activities of several professional associations and advocacy groupsdealing with standards. However, this institution can only formulate recommendations, like it did in thedocument “standards and architecture, first recommendations” (March 2009) not enforce them.Various telemedicine activities take place at a canton level including teleconsultation, remoteconsultation, videoconsultation, mobile telehealth and evisits. There is no national initiative.4
SwitzerlandList of figuresFigure 1: Important features of primary healthcare organisation in Switzerland . 11Figure 2: Swiss policy documents related to eHealth . 15Figure 3: eCards in Switzerland. 235
Switzerland1Introduction to the report1.1Motivation of the eHealth Strategies studyFollowing the Communication of the European Commission (EC) on “eHealth – makinghealthcare better for European citizens: An action plan for a European eHealth Area”,1Member States of the European Union (EU) have committed themselves to develop andissue national roadmaps – national strategies and plans for the deployment of eHealthapplications addressing policy actions identified in the European eHealth Action Plan.The 2004 eHealth Action Plan required the Commission to regularly monitor the state ofthe art in deployment of eHealth, the progress made in agreeing on and updating nationaleHealth Roadmaps, and to facilitate the exchange of good practices. Furthermore, inDecember 2006 the EU Competitiveness Council agreed to launch the Lead MarketInitiative2 as a new policy approach aiming at the creation of markets with high economicand social value, in which European companies could develop a globally leading role.Following this impetus, the Roadmap for implementation of the “eHealth Task Force LeadMarket Initiative” also identified better coordination and exchange of good practices ineHealth as a way to reduce market fragmentation and lack of interoperability.3On the more specific aspects of electronic health record (EHR) systems, the recent ECRecommendation on cross-border interoperability of electronic health record systems4notes under “Monitoring and Evaluation”, that “in order to ensure monitoring andevaluation of cross-border interoperability of electronic health record systems, MemberStates should: consider the possibilities for setting up a monitoring observatory forinteroperability of electronic health record systems in the Community to monitor,benchmark and assess progress on technical and semantic interoperability for successfulimplementation of electronic health record systems.” The present study certainly is acontribution to monitoring the progress made in establishing national/regional EHRsystems in Member States. It also provides analytical information and support to currentefforts by the European Large Scale Pilot (LSP) on cross-border Patient Summary andePrescription services, the epSOS - European patients Smart Open Services - project.5With the involvement of almost all Member States, its goal is to define and implement aEuropean wide standard for such applications at the interface between national healthsystems.Earlier, in line with the requirement to “regularly monitor the state of the art in deploymentof eHealth”, the EC already funded a first project to map national eHealth strategies – theeHealth ERA "Towards the establishment of a European eHealth Research Area" (FP6Coordination Action)6 - and a project on "Good eHealth: Study on the exchange of good1European Commission 20042European Commission 20073European Communities 20074European Commission 20085European Patients Smart and Open Services (epSOS)6eHealth Priorities and Strategies in European Countries 20076
Switzerlandpractices in eHealth"7 mapping good practices in Europe - both of which providedvaluable input to the present eHealth Strategies work and its reports. Member States’representatives and eHealth stakeholders, e.g. in the context of the i2010 Subgroup oneHealth and the annual European High Level eHealth Conferences have underlined theimportance of this work and the need to maintain it updated to continue to benefit from it.This country report on Switzerland summarises main findings and an assessment ofprogress made towards realising key objectives of the eHealth Action Plan. It presentslessons learned from the national eHealth programme, planning and implementationefforts and provides an outlook on future developments.1.2Survey methodologyAfter developing an overall conceptual approach and establishing a comprehensiveanalytical framework, national level information was collected through a long-standingEurope-wide network of national correspondents commanding an impressive experiencein such work. In addition, a handbook containing definitions of key concepts wasdistributed among the correspondents to guarantee a certain consistency in reporting. Forthe report on Switzerland the Swiss eHealth Coordination Office, Adrian Schmid andStefan Wyss, provided information on policy contexts and situations, policies andinitiatives and examples for specific applications. Since 2008, Adrian Schmid has beenthe Head of the eHealth office in the newly established coordinating body of the Swissfederal government and the cantons (“eHealth Suisse”8). Before that he was projectmanager at the sickness and accident insurance if the Federal Office of Public Health(BAG). In this position he was responsible for work on the regulation of the healthinsurance cards and the eHealth strategy of Switzerland.The key tool to collect this information from the different national correspondents was anonline survey template containing six main sections:A. National eHealth StrategyB. eHealth ImplementationsC. Legal and Regulatory FacilitatorsD. Administrative and Process SupportE. Financing and Reimbursement IssuesF. EvaluationUnder each section, specific questions were formulated and combined with free text fieldsand drop-down menus. The drop-down menus were designed to capture dates andstages of development (planning/implementation/routine operation). In addition, dropdown menus were designed to limit the number of possible answering options, forexample with regard to specific telemedicine services or issues included in a strategydocument. The overall purpose was to assure as much consistency as reasonablypossible when comparing developments in different countries, in spite of the well-knowdisparity of European national and regional health system structures and services.7European Commission; Information Society and Media Directorate-General 20098Coordination Office Confederation-Cantons7
SwitzerlandUnder Section B on eHealth implementation, questions regarding the followingapplications were formulated: existence and deployment of patient and healthcareprovider identifiers, eCards, patient summary, ePrescription, standards as well astelemonitoring and telecare.The data and information gathering followed a multi-stage approach. In order to create abaseline for the progress assessment, the empirica team filled in those parts of therespective questions dealing with the state of affairs about 3 to 4 years ago, therebydrawing on data from earlier eHealth ERA reports, case studies, etc. to the extentmeaningfully possible. In the next step, national correspondents respectively partnersfrom the study team filled in the template on recent developments in the healthcare sectorof the corresponding country. These results were checked, further improved andvalidated by independent experts whenever possible.Progress of eHealth in Switzerland is described in chapter 0 of this report in therespective thematic subsections. The graphical illustrations presented there deliberatelyfocus on key items on the progress timeline and cannot reflect all activities undertaken.This report was subjected to both an internal and an external quality review process.Nevertheless, the document may not fully reflect the real situation and the analysis maynot be exhaustive due to focusing on European policy priorities as well as due to limitedstudy resources, and the consequent need for preferentially describing certain activitiesover others. Also, the views of those who helped to collect, interpret and validate contentsmay have had an impact.1.3OutlineAt the outset and as an introduction, the report provides in chapter 2 general backgroundinformation on the Swiss healthcare system. It is concerned with the overall systemsetting, such as decision making bodies, healthcare service providers and healthindicator data.Chapter 0 presents the current situation of selected key eHealth developments based ondetailed analyses of available documents and other information by nationalcorrespondents and data gathered by them through a well-structured onlinequestionnaire. It touches on issues and challenges around eHealth policy activities,administrative and organisational structure, the deployment of selected eHealthapplications, technical aspects of their implementation, legal and regulatory facilitators,financing and reimbursement issues, and finally evaluation results, plans, and activitiesThe report finishes with a short outlook.8
Switzerland2Healthcare system setting2.1Country introduction9Switzerland, officially known as the Swiss Confederation, is a federal republic made up of26 cantons. Thus, Switzerland today is composed of 26 entities that are sovereign in allmatters that are not specifically designated the responsibility of the Swiss Confederationby the federal constitution. Each canton and demi-canton has its own constitution and acomprehensive body of legislation stemming from its constitution. The legislative authorityis a unicameral parliament that, in most cantons, is elected by proportionalrepresentation.The political system of Switzerland as an important framework of the healthcare system isprofoundly influenced by a high degree of federalism and by the important role of directdemocracy. The Swiss constitution assigns the legislation in health insurance matters tocentral government and the healthcare sector – with some exceptions – to the cantonallevel. Insofar as the provision of healthcare services is seen as public matter, it is on thecantonal agenda. The different size of the “Kantone” and the split in the assignmentbetween insurance matters and healthcare matters is to some extent a source of microeconomic inefficiency.The Constitution on Health (Gesundheitsverfassung) brings together the principalrelevant constitutional standards to provide a framework for Switzerland’s healthcarepolicy. Thereby, the Confederation can act only in areas in which the constitution hasgranted it explicit power to do so. Responsibility for issuing and implementing healthlegislation still rests largely with the cantons. In recent years, however, the Confederationhas made greater use of its existing legislative powers and acquired new powers from thepeople and the cantons (Art. 119, 119a and 120 FC). The core of the Constitution onHealth derives from Articles 117 – 120 of the Federal Constitution (FC).The box below summarises the key facts about the Swiss healthcare system:Key facts about the Swiss healthcare system:10Life expectancy at birth: 82.0 yearsHealthcare expenditure as % of GDP: 10.8% (OECD 2007)WHO ranking of healthcare systems: rank 20Public sector healthcare expenditure as % of total healthcare expenditure:59.3% (OECD 2007)9Theurl 1999; Minder, Schoenholzer et al. 2000; Swiss Federal Office of Public Health 2005;Federal Department of Home Affairs 201010Data from World Health Organization 2000; Health Consumer Powerhouse 2008; World HealthOrganization 20099
Switzerland2.2Healthcare governance11Decision making bodies, responsibilities, sharing of powerAt the federal level, the Federal Council and the Parliament are responsible fordetermining health policy in Switzerland. They draft and pass laws and ordinances.Because of the way the country evolved (a federal system), the cantons have wideranging individual responsibilities within the health system, although joint efforts havebeen made for the past few years. The Swiss Federal Office of Public Health (FOPH) hashad a ‘Health Policy’ directorate since the end of 2004, and there is a regular dialogue onhealth matters between the federal government and the cantons.The Federal Office of Public Health (FOPH) is part of the Federal Department of HomeAffairs (FDHA). As the national authority in health matters, the FOPH representsSwitzerland in international organisations and in dealings with other countries. WithinSwitzerland it is responsible – together with the 26 cantons – for public health and thedevelopment of national health policy. This includes the management and developmentof the social healthcare and accident insurance system. The FOPH specifies whichservices are paid for by compulsory health insurance and supervises the socialhealthcare and accident insurance funds.Health is basically the responsibility of the cantons, including those areas regulated bythe federal government.
Switzerland 6 1 Introduction to the report 1.1 Motivation of the eHealth Strategies study Following the Communication of the European Commission (EC) on “eHealth – making healthcare better for European citizens: An action plan for a European eHealth Area”,1 Member States of the European Union (EU) have committed themselves to develop and
Belgium 6 1 Introduction to the report 1.1 Motivation of the eHealth Strategies study Following the Communication of the European Commission (EC) on “eHealth – making healthcare better for European citizens: An action plan for a European eHealth Area”,1 Member States of the European Union (EU) have committed themselves to develop and
page 2. A vision for national eHealth. A key element of the Toolkit is a national eHealth vision. This explains why a national approach to . eHealth is needed, what a national eHealth plan will need to achieve, and how it will be done.
EHR-like systems: The eHealth Action Plan set the objective to "focus on deploying eHealth systems, setting targets for interoperability and the use of electronic health re-cords." Such systems are a prominent element in virtually all national strategies and roadmaps. But usually they are not well defined, often (implicitly) referring only .
2. The aim of the project "Wayside monitoring» : the new very long tunnel in Switzerland 10 Wayside Train Monitoring Systems in Switzerland: no compromises on safety country km in service since Gotthard Switzerland 57 2016 Seikan Japan 54 1983 Channel France-GB 50 1993 Lötschberg Switzerland 35 2007 Guadarrama Spain 28 2007 Taihang China 28 .
A common language and understanding : 2.40 – 3.00 pm. eHealth care of individuals. Prof Branko Celler. 3.00 – 3.10 pm. eHealth care of populations and environment. Dr Nick Osborne: 3.10 – 3.20 pm. Social enterprise, citizen engagement & addressing the digital divide: Prof Teng Liaw . 3.20 – 3.40 pm. Address & launch of WHOCC-eHealth .
VLER Health is the IPO program through which the Departments, as participants in the eHealth Exchange, share expertise and capabilities for the Direct Project. FY 2012 IPO eHealth Exchange and Direct Project Activities include the following: 1. Assisting HealtheWay, Inc., a partner in eHealth Exchange, with new interoperability specifications
Toolkit.6 International developments in the eHealth arena The production of the eHealth Strategy was not an initiative unique to South Africa, but was consistent with developments globally. Over the seven-year per
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