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.
With the adoption of the Federal Act on the Electronic Patient Record (Bundesgesetz über das elektronische Patientendossier, EPDG) in June 2015, Switzerland’s parliament has now set a legislative milestone in the implementation of eHealth in the country. The Federal Act on the EPR has been in force since April 2017, with hospitals being the first required to implement the EPR from 2020. Nursing homes and birthing centres are obligated to introduce the EPR from April 2022. The (core) associations, the future providers of the EPR, are currently at the development stage. The EPR is being introduced gradually over the course of 2020, with its introduction being complex and requiring 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 eHealth Barometer. The study is based on the “eHealth Switzerland strategy” and the basic investigations of the European Commissions on the monitoring of eHealth (OECD questions). 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, Spitex Switzerland, Careum Foundation, Ärztekasse, Department of Health of the Canton of Zurich, Department of Health of the Canton of St. Gallen, Gesundheitsförderung Schweiz, eHealth Interest Group.
Details of the sample and methodology can be found in the information box at the end of the cockpit.
Digitisation affects the Swiss health care sector on many levels. The shift from analogue to digital is proceeding rather gradually, whereas the transformation is taking place quicker in other areas of life. This has various causes, such as the sensitive nature of the health care sector, hurdles to digitisation in the medical field, and Switzerland’s federal system.
However, the use of the internet for health care information is already widespread. This year, all the health care professionals see it either as somewhat an opportunity or a major opportunity for the health of the population.
This is most frequently the case for hospitals, at 78 percent, but the 2020 figure is slightly less than last year (-7 percentage points). All the other health care professionals agree at least as strongly or stronger than in the previous year. This also affects doctors with their own medical practices. Last year, the majority of them did not believe that the use of the internet for health information represented an opportunity for citizens and their health (+8 percentage points).
A major topic in the digitisation of the health care sector is the topic of data protection, as patient data needs to be handled with particular care. The majority of doctors working in hospitals (58%), pharmacists (60%), old people’s homes and nursing homes (53%)
and hospital-based nursing staff (66%) trust that data protection will be adhered to by bodies working with patients’, clients’ and residents’ data. Conversely, the proportion of doctors with their own medical practice (42%) and Spitex (50%) who are convinced of this do not represent the majority.
The Federal Act on the Electronic Patient Record (Bundesgesetz über das elektronische Patientendossier, EPDG) was passed in 2015, laying the groundwork in terms of eHealth in Switzerland. This is particularly noticeable for hospitals:
the number of hospitals who have an eHealth strategy or are working towards one has remained almost constant since last year (81%, -1 percentage point). The situation is similar for hospital-based nursing staff, who work in the same environment and are experiencing this change at close quarters, with there hardly any change for this group (72%, -1 percentage point).
A slight upward trend, however, can be identified for the other groups of health care professionals: since 2016, the proportion of old people’s homes and nursing homes with an eHealth strategy (+13 percentage points) has increased, in particular, but the same is true of Spitex (+7 percentage points) and pharmacists (+3 percentage points).
Electronic documentation is becoming ever more established and is gradually replacing analogue methods used for the documentation of health data. While in the previous year, hospitals and pharmacists were the groups who most commonly had an electronic system for saving and managing data, this year it is Spitex and doctors working in hospitals (both 91%).
The trend for both groups has been growing since 2014, with a negative long-term trend only being evident for pharmacists. Since 2014, the proportion of pharmacists with an electronic system for saving and managing data has dropped by 11 percentage points.
Electronic systems for saving and managing patients’, residents’ and clients’ data offer various functions. It is good to recognise that the range of functions included in the (electronic) systems for all groups of health care professionals and health care facilities has increased since 2014.
The systems used by doctors with their own medical practices, doctors working in hospitals, and hospitals most frequently offer warnings and information about medication interactions or contra-indications (doctors with their own medical practices 56%, doctors working in hospitals 72%, hospitals 69%).
At old people’s homes and nursing homes, functions for having a doctor review medication data are the most common (50%). Systems used by Spitex most frequently contain structured order sets (43%), and those for hospital-based nursing staff most often provide patient information (72%).
The electronic vaccination record has been enjoying increasing popularity among health care professionals and health care facilities since 2016. In particular, pharmacists (85%), hospitals and members of the medical profession working at hospitals (both 75%) recommend it to their patients.
Even the majority of doctors with their own medical practices, who were rather sceptical towards the electronic vaccination record until 2018, recommend it in 2020. This is not the case with Spitex and hospital-based nursing staff (38% and 47% respectively).
Alongside functions such as displaying warnings of medication interactions, one key aspect of electronic systems is the option to exchange the saved data with other health care professionals and health care facilities.
Since 2014, the electronic exchange of various types of medical data has increased among most health care professionals.
Nevertheless, there is still no group that is able to exchange all kinds of data. In 2020, the health care facilities whose systems permit electronic data exchange most frequently include hospitals and Spitex, as well as doctors with their own medical practices. Exchanges remain at a low level for pharmacists and old people’s homes and nursing homes, but this latter group, in particular, has seen a somewhat larger increase compared to 2019.
Using an internationally comparable set of questions from the OECD, the status as regards internal and external networking within the surveyed groups of health care professionals was investigated. In this respect, internal networking refers to the option of recording and exchanging patient data within one’s own organisation. Correspondingly, external networking shows the extent to which patient data could be made available to stakeholders outside one’s own institution. Both types of networking have increased in recent years. The internal networking index reveals that stronger networking has not taken place since last year, if all respondents were viewed together. Rather, the opposite (from 45 to 40) has occurred. The upward trend with respect to the external networking index has not continued from last year (from 20 to 19).
Generally speaking, it is still only possible to exchange around a fifth of the data with other health care stakeholders. When the two networking types are compared, it becomes apparent at first glance that internal networking, in particular, is at a comparatively advanced stage with most health care professionals and facilities, while external networking is at a visibly lower level. Hospitals are at the top of the list in both indices, closely followed by the two groups working within hospitals, namely members of the medical profession working at hospitals and hospital-based nursing staff. Here, hospitals’ pioneering role in the digital networking of Swiss health care becomes clear. As pharmacists’ processes tend to be aimed at medication data and less at other data types, their values are still significantly lower than those of the other groups of health care professionals.
For the indices, every person surveyed was assigned a value. The person received one point for every type of clinical data that was recorded or exchanged internally. These points were added up and divided by the number of clinical data types investigated (i.e. the maximum possible figure). The mean value was then calculated from all the people within a group. The external networking index was calculated in the same way.
For all groups, the channels used to exchange information for treating patients overwhelmingly relate to electronic data exchanges via email or messaging services such as WhatsApp.
The use of the telephone for these exchanges took second place. Fax machines are used particularly frequently for exchanging treatment information among pharmacists and doctors with their own medical practices, compared to other groups (73%).
The EPR is being introduced gradually over the course of 2020. It is to be gradually offered in Swiss hospitals from April 2020, and must be provided in old people’s homes and nursing homes from 2022 onwards.
While the electronic patient record is to be offered in hospitals from this year onwards, not all the hospitals have joined an association or a core association yet. At present, 83 percent of hospitals are part of one of these associations, but old people’s homes and nursing homes are somewhat further off, with 22 percent already being part of a (core) association. Hospital-based nursing staff state that 41 percent of them are part of a (core) association, while significantly lower values are seen for Spitex (24%), pharmacists (16%), doctors with their own medical practices (9%) and members of the medical profession working at hospitals (4%).
The questions related to joining have been clarified to a great extent in hospitals, but there are large swathes of the remaining groups of health care professionals who answered the question about joining with “don’t know”.
The low values for hospital-based nursing staff and, above all, among members of the medical profession working at hospitals, could be attributed to the fact that hospitals have not yet carried out internal training sessions on the EPR. As a result, they have not provided their employees with the latest updates regarding joining an association or a core association. This is also indicated by the high proportion, amounting to 44%, of members of the medical profession working at hospitals who responded to the question with “don’t know/no answer”.
One factor that impacts Spitex as far as the joining figures are concerned is that some Spitex cantonal associations have joined a (core) association. However, these cantonal associations were not questioned as part of this study.
As was the case last year, arguments in favour of the electronic patient record were weighted highly among all health care professionals and health care facilities. The argument relating to the availability of key information in an emergency sees the most agreement among doctors with their own medical practices (83% tending to agree/definitely agreeing), members of the medical profession working at hospitals (93%), pharmacists (94%) old people’s homes and nursing homes (88%) and Spitex (92%).
At hospitals, the option to save information independently enjoys the greatest popularity (93%), while the argument most favoured by hospital-based nursing staff is that patients can access all their treatment information via the electronic patient record (85%). For cantons, there are two arguments that receive the highest level of support: the arguments that the electronic patient record does away with unnecessary clarification, and that treatment errors can be avoided as a result, are both supported by 95% of cantons.
The possibility that the independent storage of information enables patients to be more involved in the management of their own health care data meets with majority agreement for all groups of health care professionals, apart from doctors with their own medical practices and hospitals, in particular.
All the groups of health care professionals, apart from doctors with their own medical practices, offered the strongest support for the arguments in favour, while agreeing with the critical arguments the least.
Handling digital data and information requires specific skills from health care professionals, on the one hand, and patients, on the other. The various groups of health care professionals have varying estimations of the ability of their patients, residents and clients to make decisions about health care professionals’ access to their data, although the majority consistently assess this ability at a low level.
This is particularly clear for old people’s homes and nursing homes, which is probably due to the fact that the target group is, on average, older and more used to analogue systems. Hospitals assess their patients’ skills with the highest figure, at 36 percent.
Electronic saving and management of patient data is becoming ever more established and is gradually replacing analogue methods used for the documentation of health data. For example, the proportion of doctors with their own medical practices who keep electronic records of their patients’ medical histories is continually on the rise. However, the process of digitisation in other areas of the Swiss health care sector is stalling, and this becomes especially clear when we look at networking between health care professionals: the internal and external networking indices have hardly changed in 2020 and external networking, in particular, is still at a low level. The demand among patients for access to and the exchange of electronic health data is not being catered to. There is a gap here that could potentially be filled by digitisation efforts, such as the electronic patient record.
The electronic patient record is to be introduced gradually in hospitals over the course of 2020 and is to be implemented at nursing homes in 2022. The legal obligation has furthered membership of a (core) association, particularly for hospitals, who strongly support the electronic patient record and who have advanced on a digital level across a host of areas. However, not all hospitals have yet reported that they have joined a (core) association. For nursing homes, this development is even less clearly visible, but stronger networking efforts are also present.
As the first to provide the service of the electronic patient record, hospitals have been pioneers of digitisation in the Swiss health care sector for years, in this context. Hospitals enable professionals in the inpatient area to benefit from their data, while increased networking is intended to gradually expand this knowledge to additional groups of health care professionals not engaged in inpatient treatment.
Members of the medical profession
In general, members of the medical professional are gradually opening up to digitisation efforts relating to eHealth and once again take the view that digitisation represents an opportunity for citizens’ health. The proportion of doctors who use electronic patient histories has increased greatly, but there is still potential for members of the medical profession in certain segments of digitisation, particularly in terms of the electronic patient record. Some members of the medical profession do not yet see the benefit of the electronic patient record for their own work. These benefits must be present and clearly communicated so that these members of the medical profession will offer the electronic patient record in the future.
Hospitals are still playing a pioneering role in the digitisation of the Swiss health care sector. The Federal Act on the Electronic Patient Record in the past initiated various processes that have helped to propel hospitals into a leading position, among health care professionals, in the area of eHealth for a few years now. These include, for example, the electronic performance of functions and networking within and outside respondents’ own organisations. The next steps would now involve not only transferring this to other hospital-based health care professionals, but also to professionals working outside the hospital environment.
Pharmacists are leaders in some areas of digitisation, for example, in terms of recommending the electronic vaccination record. However, they are only progressing slowly in other respects, as can be seen in the networking indices. Pharmacists’ need to exchange medication data with other health care professionals and patients remains at a high level.
Old people’s homes and nursing homes
Since the introduction of the Federal Act on the Electronic Patient Record, the first visible efforts in terms of digitisation and networking have slowly taken hold this year, as can be seen in a slight increase in networking indices both internally and externally. An additional uptick was recorded with respect to eHealth strategies. There is a positive attitude towards the electronic patient record, which is reflected in the fact that the arguments in favour of it receive majority support.
Non-profit Spitex organisations
This year, Spitex’s networking increased on both an internal and external level. Electronic exchanges relating to treatment take place most frequently at Spitex, compared to other professionals. In terms of the existence of electronic saving systems, Spitex organisations are also near the top of the tree. As far as the electronic patient record is concerned, non-profit Spitex organisations have one of the highest levels of readiness to join a core association and would also pay the highest average amount for this.
Hospital-based nursing staff
Hospitals’ nursing staff are also benefiting from their hospital-based environment this year in certain areas: alongside hospitals, they are the most likely to have an eHealth strategy, or to join a core association for the electronic patient record. There are slight drops in terms of electronic documentation, and both internal and external networking. Alongside electronic exchanges relating to treatment via email and messaging services, for example, the telephone remains a key component of communication.
The desired organisation of health care professionals in (core) associations is occurring largely on a cantonal and regional level. In terms of the introduction of the electronic patient record, the cantons see their role as financing the construction of core associations, alongside their role as being coordinators and organisers.
Survey population: doctors, people responsible for IT at hospitals, pharmacists, old people’s homes and nursing homes, people responsible for eHealth at cantonal levels, members of Spitex Switzerland, nursing professionals
Survey area: the whole of Switzerland (three languages)
Origin of the addresses: Doctors: Swiss Medical Association, hospitals: InfoSocietyDays, pharmacists: pharmaSuisse, old people’s homes and nursing homes: CURAVIVA, cantons: eHealth Suisse (contact directly via eHealth Suisse), Spitex: Swiss Spitex Association, hospital nursing professionals: Careum Foundation
Data collection: online, also print for doctors
Type of sampling procedure: at random/complete survey
Survey period: 18 November 2019 to 5 January 2020 (mean survey date: 2 December 2019)
Sample size: Doctors: 766 (doctors with their own practice: 607, hospital doctors: 121, hospital doctors also with their own practice: 38), hospitals: 64, pharmacists: 1054, old people’s homes and nursing homes: 413, cantons: 21, non-profit Spitex organisations: 112, hospital nursing professionals: 32