eHealth Barometer 2020: The authorities need to guide us to the heights of digitisation

To reduce uncertainty, it is important to gain first-hand experience with the EPR without delay


The eHealth Barometer survey has been compiled 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 (Bundesgesetz über das elektronische Patientendossier, EPDG) in summer 2015, the groundwork has now been laid for the implementation of the EPR in Switzerland. In 2020, the focus is now on its introduction and implementation: this will start in hospitals, then continue in nursing homes and, ultimately, be applied across the nation’s entire health care sector (with implementation being voluntary in the outpatient sector). The introduction of the EPR is complex, requires a great deal of clarification and needs cooperation between numerous stakeholders in the health care sector.

The study is based on the “eHealth Switzerland strategy” and the basic investigations of the European Commission 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, Gesundheitsförderung Schweiz.

Details of the sample and methodology can be found in the information box at the end of the cockpit.

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Information sources and use of electronic offers

Switzerland’s health care sector matters to the country’s population. On the one hand, access to the health care sector, along with the quality of the services provided, is of the utmost relevance for every single person. “How well am I looked after when I’m ill?” is a question everyone asks. On the other hand, the increase in health care costs is a growing political issue, and, as a result, partly responsible for the fact that health-related questions have become firmly established as the top worries felt by Swiss people. In line with the great significance of the health care sector, a majority, amounting to a total of 74 percent of the population, were interested in questions related to health care provision in Switzerland (combined total of all people who were very/rather interested).

Conversely, just one in four people (25%) showed no interest in this.

However, the proportion of people not interested in such questions has slowly but steadily increased since data collection began (+8 percentage points since 2013). People aged over 65 are also more than three times more likely to state they are very interested in questions related to heath care than people under 40 (11% vs. 38%). In 2013, when data was first collected, the difference amounted to being 1.5 times more interested (22% vs. 32%).

The majority of the population make use of both traditional sources of information and new sources, for example, using the internet for health-related topics. While the use of daily newspapers and magazines is reducing, in line with the media’s transformation away from linear forms and towards more on-demand sources, there is an astonishing increase in the importance of radio and television.

Age plays a role here, too, once again:

89% of people aged over 65 list the radio and television as sources, compared to significantly fewer younger people (67% of people under 40). Younger people, who are less interested in health-related topics in general, instead state that they use the internet more often as a source. It is striking that apps relating to health-related topics have diminished in importance, after peaking in 2017.

While the technical possibilities have increased, the use of apps as sources of information is not simply increasing, too. Even in terms of specific electronic products, it is not possible to identify a universal uptick in the population’s awareness of these products. Quite the opposite: the time series from 2015 onwards seems to suggest that certain products are continuing to gain in popularity while others are not able to break through, at present.

The majority are now aware of emergency call apps, as well as apps for fitness and movement. Around twice as many residents are familiar with the option of measuring vital signs via an app as five years ago, and people are also becoming better acquainted with the electronic patient record. Conversely, apps that remind people to take medication, or even apps that identify illnesses and allergies, have not seen a greater impact since 2017.

In this regard, fewer people stated that they had heard of these options previously.

Those who are familiar with an electronic product can, in most cases, also imagine using it in future or even already make use of it. Compared to the last year when a survey was carried out, the number of residents who can at least imagine using an electronic product has reduced somewhat. The exception is apps for measuring vital signs and the electronic patient record. The few people who have already heard of apps for identifying illnesses and allergies, can, in turn, imagine using these diagnostic tools to a greater extent.

Electronic exchanges between patients and health care professionals

For eHealth to become a success, cooperation from and between health care professionals and patients is required. All the efforts in this direction are grounded in the readiness to save data electronically.

This remains the case for the majority of the population, with 57 percent of residents currently stating that they are fundamentally in agreement with their health data being saved. However, this figure has significantly reduced since 2013.

The reduction in the fundamental willingness to save one’s own electronic health data goes hand-in-hand with increasing reservation in the public sphere towards data being exchanged between the health care professionals treating a patient. The proportion of residents who agree with these exchanges unconditionally hit a new low of 47% in 2020, falling under the majority level of 50% for the first time.

However, it is not that the fundamental opposition to exchanges is growing: rather, there is an increase in the proportion of residents for whom it boils down to specific rules for these kinds of exchanges. There is a clear difference between people who are already of pensionable age (with 17% stating it “depends on the rules”) and people who have not yet retired (with 45% stating it “depends on the rules”).

Broken down into specific individual areas, the majority of the population are willing to share their own data with health care professionals, with one exception: a new development sees just 44% of residents agree to share or make their own information available for research purposes, whether in full or in part.

There is a clear increase in people’s readiness to permit health care professionals to view their own electronic vaccination record.

The results of the 2020 survey of the population show that the population reacts in a more nuanced way than in previous years to the entire bundle of issues relating to digitisation and the associated use of their health care data.

This new caution may well be rooted in the population’s greater insecurity as to their own skills in evaluating these questions. While in 2013, just 21 percent felt poorly qualified to decide about giving access to their own data, this figure has now almost doubled to 41 percent.

Attitudes toward the EPR

Today, a majority of 64 percent of the Swiss population views the electronic patient record positively. This is a clear reduction compared to 2019, with the proportion of undecided respondents showing a noticeable increase from 7 percent in 2019 to 26 percent in 2020.

The upcoming implementation in hospitals sees the EPR turn from an abstract concept to a tool with direct personal demands and consequences for the population. This, along with the hurdles to its implementation discussed in the media, may well contribute to the fact that the population’s need for information is increasing.

Since 2015, the proportion of the population who would open and use an electronic patient record themselves has steadily increased, but this trend is coming to an end for the time being in 2020.

Just like with assessing the EPR in principle, it is not the number of opponents who have grown, but rather the proportion of people who state that they are uncertain about it.

Desired EPR functions

As the implementation of the EPR in hospitals draws closer, along with the broader engagement of the population that goes hand-in-hand with this, it appears as if the wheat is being separated from the chaff when it comes to assessing additional functions for the EPR. Registration with a general practitioner or specialist is (still) a function that is very clearly requested.

Similarly, the option of saving health information is just as welcomed as a reminder function for taking medication and (much more frequently than in 2019) the template for a health diary. Conversely, a range of health apps that offer advice from consumer or patient organisations, or a patient forum, are not desired.

First interpretation

Reality check for the digital future

The future is digital: there is no getting away from it. The residents of Switzerland also share this view, with the news full of reports on self-driving cars, facial recognition or robots that help with providing care. In an era when the media report on the possibilities offered up by data day in, day out, the whole extent of this new digital world is just being revealed. This understanding of the power of data comes hand-in-hand with a certain feeling of powerlessness, too. In times when the population is becoming increasingly uncertain as to their own skills in handling data, health care professionals and authorities need to act as explainers and intermediaries who guide individuals through the data jungle and pave the way for them.

Reducing interest comes with a new challenge in terms of communication

The transition in the media away from linear forms of news and towards a greater “on-demand” approach and strongly selected content (key words: filter bubble and echo chamber) manifests itself in a reducing interest in politics, society and health care. This development has implications in terms of communication with the population. Against the backdrop of the introduction of the EPR, it is key that the dialogue with the population is handled effectively.

The majority would open and use an EPR

The electronic patient record is in the critical phase of its introduction. The majority of the population supports these efforts, as before, and can imagine using an EPR themselves. Levels of insecurity are increased by the challenge being faced at the moment in terms of its introduction, as well as the fact that few people currently have personal experience with what the EPR offers. To ensure that this insecurity remains temporary and does not become a hurdle for the EPR in the long term, the population must quickly gain first-hand experience with the EPR, and dialogue with the population must be sought out, to encourage this positive perspective to be buoyed up.

The challenge of the generation gap

While young residents are skilled in handling data and digital tools, as so-called “digital natives”, they are becoming increasingly disinterested in health-related issues. Conversely, older people are indeed interested in the health care sector, but they have a more sceptical attitude towards electronic solutions. The challenge now lies in finding the way and the means to put across the value of the EPR in a manner that transcends generational divides.

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), RDD Dual Frame (20% mobile)

Type of sampling procedure: at random

Survey period: 3 to 15 January 2020 (mean survey date: 7 January 2020)

Sample size: minimum 1,200, actual 1,207 (nDCH: 700, nFCH: 307, nICH: 200)

Margin of error: ± 2.9 percentage points at 50/50 (and probability of 95 percent)

Quota characteristics: gender/age interlocked

Weighted for: language, gender

Survey length: average 20.4 minutes (+/-4.9 minutes)