EPR: working together to achieve success
Oct. 2023The electronic patient record
Leitartikel. The electronic patient record (EPR) is constantly being refined.This benefits everyone, from health professionals to the general public, because the more easily and securely health data can be accessed, the better for patients, their families and the medical staff caring for them.
Stephanie goes cycling in the Bernese Oberland. Unfortunately, she has an accident when taking a bend imprudently and breaks her leg. X-rays are taken at a hospital in the Bernese Oberland, and Stephanie is given prescriptions, medications and various reports when she is discharged. If she has an EPR, she can store all these documents in it – and when she visits her family doctor for a check-up on her return to Zurich, the doctor can look at all the documents even before the appointment. Stephanie could also give her pharmacist access, so that the pharmacy team can check her medication list.
This example shows how an EPR works: it groups all the information in one place and makes it accessible at all times, linking healthcare professionals in different cantons, improving the treatment provided and reducing duplication of effort.
The EPR system places patients firmly in the centre. They decide what goes into their EPR and who should have access to it. Up to now, this information was often kept at the family doctor’s surgery, in the hospital archives and in the physiotherapist’s files. An EPR brings all this data together in one place. The better the overview available to patients, the more competent their healthcare decisions will be.
In this issue, we take a look at various questions having to do with the EPR system: What will it achieve? How far has it progressed? What additions are due to be made to EPRs?
Fragmented system
The EPR did not have an easy start to life. The Swiss healthcare system is highly fragmented. All the different bodies involved have their own IT systems. This makes it difficult to exchange data and presents a challenge for the EPR system, which is supposed to link all the institutions with one another. Nevertheless, a number of successes have already been achieved. Since August 2022 it has been possible for every individual in Switzerland to open an EPR. The system is operational throughout the country.
It is important to note that the EPR system rests on a solid legal foundation, the Federal Act on the Electronic Patient Record (EPRA). Among other things, this states that patients themselves decide who may access their EPR; it also defines the tasks of the providers and ensures the highest security standards. Patient data is stored in Switzerland by the eight EPR (reference) communities, which are certified as conforming with all the legal requirements. The EPR is also the only platform offering interoperability for all EPR providers and all healthcare institutions in Switzerland.
Nassima Wyss-Mehira, Head of Digital Transformation and Steering Directorate at the FOPH, advises everyone to open an EPR now. “The EPR gives me access to all my medical documents, and I myself can decide who to share them with. The infrastructure is in place. Things are moving forward.”
Das EPD hatte keine einfache «Geburt». Das Schweizer Gesundheits- wesen ist stark fragmen- tiert. Alle Akteure verfügen über eigene IT-Systeme.
Schnittstellen definiert
Gestützt auf diese Grundlagen wurden bereits viele Massnahmen umgesetzt. Die Pandemie hat der Digitalisierung zusätzlichen Schub verliehen und gezeigt: Digitale Grossprojekte auf nationaler Ebene sind in der Schweiz möglich. Davon profitiert auch das EPD. In den vergangenen Jahren wurden die Basis und die Infrastruktur geschaffen, um das EPD umzusetzen.
Nassima Wyss-Mehira, Leiterin Direktionsbereich Digitale Transformation und Steuerung im Bundesamt für Gesundheit (BAG), rät allen, jetzt ein EPD zu eröffnen. «Mit dem EPD habe ich Zugriff auf meine medizinischen Dokumente und entscheide selbst darüber, mit wem diese geteilt werden. Die Infrastruktur steht. Jetzt geht es vorwärts.»
Covering the entire treatment chain
Hospitals, maternity clinics and care homes are now required to introduce EPRs and enter all treatment-relevant information in them. At present, about half the hospitals in Switzerland have done so, and the number is steadily rising. Hospitals have made the most progress. But things are moving forward in retirement and care homes, family doctors’ practices and pharmacies. Nearly 15 per cent of doctors’ practices and five per cent of pharmacies have now signed up.
The amendment to the draft EPRA revision that the Federal Council released for consultation in June 2023 is intended to ensure that EPRs are used throughout the entire treatment chain: in other words, doctors, pharmacists, physiotherapists, chiropractors and other providers of outpatient services are required to use them. They too will have to join a (reference) community and store treatment-relevant medical documents in the EPR.
Fördert auch die Prävention
Manche Leserinnen und Leser werden sich nun vielleicht fragen, was denn das EPD mit Gesundheitsförderung und Prävention zu tun hat? So einiges. Zum Beispiel wenn es um Impfungen geht. In Zukunft soll das EPD als elektronischer Impfausweis dienen. Auf diese Weise wird das Impfbüchlein in Papierformat überflüssig. Auch Daten von Vorsorgeuntersuchungen können ins EPD eingebunden werden. Und: In Zukunft soll es möglich sein, dass Daten zu Puls oder Blutdruck direkt aus einer Smartwatch ins EPD integriert werden können.
The role of the FOPH and eHealth Suisse
Meeting the targets will require the involvement of all participants – and, of course, good coordination and information. The latter role is being undertaken by the FOPH and eHealth Suisse. The FOPH prepares the legal basis for the Federal Council and Parliament (including monitoring and evaluation) and provides information about the EPR system. However, since the cantons are responsible for healthcare, there is a need for a central hub to coordinate between the federal government and the cantons. This task falls to eHealth Suisse.
Next steps
In order to tap the full potential of EPRs, the system must be continuously refined. The revision released by the Federal Council for consultation in June 2023 proposes various additions for this purpose. In future, for example, an EPR is to be opened automatically for each individual residing in Switzerland. Anyone who does not wish this to happen will be able to decline (optout model). As well as extending the system to all healthcare professionals providing outpatient care, the Federal Council proposes the release of data in an appropriate form for research purposes, if the patients want this to happen.
