eHealth: slow rate of development meets growing interest
EPR as an opportunity for improved networking
InfoSocietyDays
Team: Lukas Golder Cloé Jans Daniel Bohn
The eHealth Barometer survey has been complied and prepared as part of InfoSocietyDays since 2009. It incorporates the answers of both health care professionals and the resident population and investigates the current status and developments in the area of eHealth in Switzerland. This report presents the results of the resident population.
With the adoption of the Federal Act on the Electronic Patient Record (EPR) in June 2015, Switzerland’s parliament has now set a milestone in the implementation of eHealth in the country. The (core) associations, the future providers of the EPR, are currently at the development stage. The federal government and cantons anticipate that the EPR will be available in all regions of Switzerland from spring 2020. The introduction of the EPR is complex and requires cooperation between numerous players in the health care sector.
In many respects, the EPR represents the spearhead of eHealth efforts in Switzerland. The topic is therefore a special focus area of the monitoring activities. The study is based on the “eHealth Switzerland strategy” and the basic investigations of the European Commissions on the monitoring of eHealth. The Swiss eHealth Barometer is supported by the following partners:
Main partners: Federal Office of Public Health (FOPH), Swiss Medical Association
Co-study partners: CURAVIVA Switzerland, pharmaSuisse, eHealth Suisse, Swiss Spitex Association, Careum Foundation, Ärztekasse, Department of Health of the Canton of Zurich, Department of Health of the Canton of St. Gallen, eHealth Interest Group
Details of the sample and methodology can be found in the information below at the end of the cockpit.
Information sources and use of electronic offers
In 2013, a small majority of 56 percent of eligible voters in Switzerland stated that they obtained information on health topics via the Internet. At this time, it was still far more common (75 percent/71 percent) for traditional media such as daily newspapers and magazines or the radio and television to be used for this purpose. It was in 2013 that Edward Snowden also revealed the widespread monitoring of data streams by the American secret service.
This led to increased scepticism with respect to the Internet and marked a watershed moment in the progress of the digital age. Also driven by the increasing media transformation, the importance of the Internet with respect to health issues increased once more from 2016 and in 2019 has never been more significant.
As a source of information, the Internet is today just as important as broadcasting.
Together with the growing importance of the Internet as a source of information, knowledge about electronic apps in the area of health care is also increasing. Offerings relating to fitness and exercise as well as emergency apps are playing a pioneering role here. Over time, these are setting themselves apart ever more with respect to their prominence as measured against other applications such as apps for measuring blood sugar, the taking of medication or the saving of an electronic organ donor card.
In almost all areas, levels of awareness with respect to apps in 2019 are, however, clearly above those ascertained at the first time of measurement in 2015. The exceptions here are offerings for the identification of illnesses and allergies, which are failing to have a real widespread impact.
Those who are familiar with an app can in most cases also imagine using it in future or even already make use of it. Here too, a clear increase in the willingness to use such apps has been observed across the five investigated measurement times.
Apps for the identification of illnesses and allergies not only enjoy the lowest level of awareness, they are also the only offers for which a decline has been recorded as regards people’s willingness to use them. In contrast to an app such as the online patient decree, which primarily has the character of an electronic information repository, the recognition of illnesses is tied to specific consequences: for example, the taking of medication or the commencement of certain treatments. It is apparent that there is currently not much confidence in the functioning of an app for this purpose.
Electronic exchanges between patients and health care professionals
The Internet is not only playing an increasingly important role as a source of information or for the provision of health apps, but rather is also shaping exchanges between health care professionals and patients. In the eyes of the population, however, not all forms of online communication between those providing treatment and those receiving treatment are equally as important.
The option to arrange a doctor’s appointment online or request a prescription via the Internet is becoming more important.
Today, 69 percent and 67 percent of the population state that these two factors are very important or quite important when selecting a doctor. The option to communicate with a doctor via e-mail, SMS or WhatsApp, to clarify the need for certain treatment via the Internet or to report an emergency are, however, not a priority.
The possibility to have an online consultation rather than have to visit the doctor’s surgery for a personal consultation is, in contrast, only a concern for around 30 percent of the population.
With the increasing demands with respect to the digital networking of health care professionals, the willingness of the population to share their own data with them is also rising. This is especially true for highly specialised persons of trust such as general practitioners, doctors providing treatment and pharmacists.
In the case of less precisely specified health care professionals, the willingness of the population to provide access to their own data is slightly lower. However, more than 60 percent of the population also stated here that they would be in agreement.
Particularly striking is the clear increase in the 60 percent approval rate recorded for pharmacists in 2016 to 82 percent in 2019. The clear jump between 2017 and 2018 took place at the same time as the change in the survey’s methodology which saw it switch from questioning eligible voters to residents. The separate consideration of both groups, however, shows that this is not the reason for the increase. A possible explanation could therefore be the revision made to the Therapeutic Products Act and the associated expansion of the competencies of pharmacists.
The analysis shown below reveals that the increasing significance of digital solutions in the health care sector is being greatly driven by the younger generations. The members of so-called Generation Y were born between 1980 and 2000 and are thus now aged between 18 and 39.
The level of scepticism that developed within this population group as regards data protection was particularly great in the period following 2013.
As a result, the percentage of individuals stating that they were in agreement with the exchanging of data between those providing treatment fell from 72 percent to 45 percent in 2017. Since then, however, an equally large increase has been observed in just a short space of time.
The changes in attitude towards the exchange of data in the population groups aged 40 and over (Generation X and baby boomers) were considerably less marked during this time.
Attitudes toward the EPR
A majority of 78 percent of the Swiss population views the electronic patient record as a good thing to date. Compared to 2018, this represents an increase of 9 percentage points.
However, there is no decrease in the camp of sceptics. Rather, those who were previously undecided (don’t know/no answer) are now forming an opinion.
In 2019, a majority of 55 percent of the population stated for the first time that they themselves would open and use an EPR.
This figure was just 34 percent in 2014 but there has been a steady increase in the level of willingness to use the EPR since 2016.
As before, the majority of the population wish to open their electronic patient record with their general practitioner. At present 68 percent of individuals state they would open an EPR on their own initiative or on the recommendation of a health care professional.
As before, the majority of the population wish to open their electronic patient record with their general practitioner. At present 68 percent of individuals state they would open an EPR on their own initiative or on the recommendation of a health care professional.
Desired EPR functions
In the eyes of the population, there are certain additional services desired alongside the electronic patient record. First and foremost, these include the option to register with a general practitioner or specialist online, followed by the ability to obtain health information via the Internet and the provision of a reminder function for medication.
These three functions are tending to grow in popularity over time. Other options, such as a selection of health apps, platforms for exchanges with patients or the provision of advice by interest groups were, however, met less warmly. The demand for further electronic functions reveals that the population does not want an excessive range of offers, instead tending to place its focus on core offers and processes relating to patient care.
The willingness of the population to save data in the electronic patient record has been increasing since 2016. This applies to all surveyed areas with the exception of data for health and fitness apps, where the opposite is the case.
Similar to the desire for additional functions, it can also be seen accordingly that there is a focus on the essential when it comes to the willingness for data to be saved in the EPR. Things that are more related to leisure than illnesses should not be a focus for the EPR in the eyes of the population.
First interpretation
Acceptance of digital future
Following 2013, there was great uncertainty with respect to the issue of data protection. The aftermath of the revelations of Edward Snowden in the US also left its mark in Switzerland. In the health care sector, data is especially sensitive and personal, a fact that is also reflected in the Swiss eHealth Barometer. Since 2016, however, the level of willingness to in future also make use of digital solutions in the health care sector has clearly increased. The low point with respect to digital willingness has been passed and there is broad acceptance of the fact that the future is digital – in all spheres of life.
The majority would open and use an EPR.
The electronic patient record is enjoying increasing popularity. An ever-greater percentage of the population believe that the electronic saving of their own information makes sense and can imagine creating an EPR themselves. Here, a focus on the essential is important to them. There is a desire for a serious solution approved by the authorities that is also flawless as regards data protection. Leisure and illness need to be separated. A link to apps that are not essential for treatment is not a focus for the population.
There is a growing willingness among the population to move their own information into the digital sphere.
Although the population believes that apps in the area of leisure should not necessarily be linked to the EPR, they remain the pioneers with respect to digitalisation in the health care sector. For a long time, digital solutions have primarily served as a source of fun and entertainment. In contrast, there tended to be fewer applications actually supported by the authorities. This is now increasingly changing. The government and administrative bodies are also offering ever more digital solutions in fields such as health and finance (e.g. the online tax declaration). The level of trust and the willingness to move data into the digital sphere is thus increasing.
Generation Y as the driver
The term digital natives is being used for the first time in connection with Generation Y. The oldest members of Generation Y are now almost 40 and account for around one-third of the population. While Generation X and baby boomers are tending to struggle with the transfer to the digital sphere, the members of Generation Y are key drivers of this development. Nevertheless, among those aged over 65 in 2019, a record figure of 68 percent declared they would be in agreement with the exchange of electronic data between the health care professionals providing them with treatment. This must also be borne in mind during the conception of the EPR and the related communication.
Methodological details
Company: InfoSocietyDays
Survey population: Swiss resident population (eligible voters up to 2017)
Survey area: whole of Switzerland
Origin of the addresses: Swisscom telephone directory (pooled)
Data collection: by telephone, computer-assisted (CATI)
Type of sampling procedure: at random
Survey period: 3 to 12 January 2019 (mean survey date: 7 January 2019)