Implementing the electronic patient record (EPR): regional providers, uniform standards

From hospital discharge summaries and prescriptions for glasses through to vaccination certificates, an EPR means that patients always have all their health information to hand, while a standard information channel is being made available for the first time for the exchange of health information. In 2017 the Confederation therefore passed the EPRA, laying down the legal framework for the introduction of the EPR system.

The EPRA forms the basis for digital exchange of data in a standardised national system. Although the cantons are responsible for healthcare, the EPR is being implemented regionally, rather than cantonally, by seven reference communities and one community. Whereas communities address their services to professionals and healthcare institutions only, and provide them with a connection to the EPR system, reference communities make EPRs available to the Swiss population.

CARA, an initiative by the cantons of Fribourg, Geneva, Jura, Valais and Vaud, and Mon Dossier Santé (canton of Neuchâtel) are two certified reference communities that have been established in French-speaking Switzerland. Emedo (canton of Aargau), Sanela, eSanita and Abilis are reference communities whose services are primarily intended for German-speaking Switzerland, and Associazione e-Health Ticino (ehti) is the provider in Ticino. Persons wishing to open an EPR may select the provider freely. Healthcare professionals and institutions are also free to choose between the eight providers.

The (reference) communities must all comply with the same legal, technical and organisational certification requirements. A body recognised by the Swiss Accreditation Service carries out the formal EPRA certification process and conducts regular checks. The official EPR certification mark is awarded only to EPR services that have obtained certification and implemented the rigorous security requirements specified.

Since all the certified EPR providers comply with the same rules, the different systems are interoperable with one another. This means that their platforms are networked according to the same set of rules, and data can be exchanged throughout Switzerland via all the certified platforms and connected healthcare institutions.

The (reference) communities provide the EPR platform and carry out technical implementation measures with regard to managing patient records and linking healthcare professionals with their patients. The processes, particularly for opening an EPR, are still too complicated at present, according to Patrice Hof, General Secretary of CARA and President of the Conference of (Reference) Communities: “Although we are seeing interest, and a willingness to use our platform, setting up and using an EPR is still insufficiently attractive. Establishing their identity, for example, is too time-consuming for most people. In order to simplify this process, we have introduced identification by video recognition in French-speaking Switzerland.”

Working with EPRs is still time-consuming for health professionals, too. “The IT systems used by health professionals are not yet connected to the EPR system, so documents have to be manually uploaded to the EPR platform,” says Hof. “Software developers need to establish these connections urgently so that more healthcare professionals can use EPR.”

The regional structure has many curity, since the data in the EPR is encrypted and stored in several different locations instead of one central location. Another advantage is that the regional particularities of the federal healthcare system can be taken into account, which would not be possible if a single national system were adopted. The cantons and regions are thus able to cater to the specific requirements of their residents, according to Patrice Hof. And yet: “On the other hand, it has the disadvantage that a lot of technical coordination is needed between the reference communities.”

Extra work is caused by the certification process, for example, and the introduction of exchange formats (structured data) which have to be implemented on multiple occasions because of the decentralised structure. Unlike unstructured documents (such as those in PDF format), exchange formats such as the electronic vaccination record allow information to be passed seamlessly between different IT systems used by healthcare professionals.