Submitted text
The Federal Council is instructed to submit a legal basis to Parliament that provides for both the medical patient documentation to be kept electronically in a structured form and for documents relevant to treatment, such as prescriptions, referrals and examination reports, to be transmitted electronically in a structured form.
Justification
The report of the expert group “Cost containment measures to relieve the burden on compulsory health care insurance” provides for the abolition of the double voluntariness with regard to the use of the electronic patient dossier with measure 38. Regardless of whether the EPD becomes mandatory for physicians or not, for service providers the obligation must be created, Keep patient documentation electronically and exchange data relevant to treatment electronically. For coding and structuring, international common standards are to be applied as far as possible.
The obligation to maintain electronic patient documentation relates solely to the maintenance of an electronic medical history in a so-called primary system such as a practice information system. It forms the basis for coordinated care and creates the technical prerequisite for electronic networking of the outpatient sector. It creates the possibility for the EPD to be used at all.
Switching from handwritten to electronic data increases the efficiency and quality of service delivery, contributes to patient safety, and curbs costs. Inefficiencies such as duplicate recording of the same data, queries in the case of illegible handwriting or resulting medication errors can be avoided. The right of patients to receive a copy of their medical history can also be guaranteed more easily. With the implementation of the motion, the goal of the Federal Council of the Health 2020 Strategy to avoid medication errors and to ensure patient safety can be achieved.
Electronic medical records as well as the electronic exchange of relevant patient data contribute to quality assurance, which is required by KVG Article 58 and will be enforced in a binding manner with the KVG revision “Quality and Efficiency”.
Statement of the Federal Council of 5.9.18
Compared to other countries, the Swiss healthcare system is only digitized to a limited extent. This applies in particular to the outpatient medical sector. Only 35 percent of medical practices keep treatment documentation completely electronically. This is problematic insofar as digitization in the outpatient environment is supposed to contribute to increasing the quality of treatment. In a study published in 2015 for Switzerland, 57 percent of all physicians documenting electronically said that the quality of their work increased when the practice was digitized (Sima Djalali et al, Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange, in International Journal of Medical Informatics, 2015). Other countries required physicians to digitally document care years ago (e.g.: Sweden, Canada). An evaluation study of the benefits of digital health information from Canada shows positive impacts in terms of quality, access, and productivity (Gartner: Connected Health Information in Canada: A Benefits Evaluation Study, Report Prepared for Canada Health Infoway, April 2018).
The objective of the motion is in line with the health policy priorities of the Federal Council to promote the quality of services and care by strengthening eHealth in particular (Strategy Health 2020 of January 23, 2013). The joint strategy of the Confederation and the cantons, eHealth Switzerland 2.0 of March 1, 2018, is derived from the Health 2020 strategy, which in particular promotes the introduction and active promotion of the electronic patient record. The cantons are thus actively involved in the ongoing work in the area of digitalization of the healthcare system.
The duty of care of medical professionals under Article 40 letter a of the Federal Act of 23 June 2006 on the University Medical Professions (MedBG; SR 811.11) also includes the duty to document and keep a medical history. It serves to protect patients and is motivated by public health considerations. Health police regulations are the responsibility of the cantons based on the constitutional division of competences (Art. 3 Federal Constitution of 18 April 1999 of the Swiss Confederation; SR 101). Accordingly, the cantons have already regulated treatment documentation on various occasions. It is therefore up to the cantons to transpose the digitalization promoted in the eHealth Switzerland 2.0 strategy into their own law.
In terms of health insurance law, these thrusts can be achieved with the bill on the Partial revision of the Federal Health Insurance Act concerning the licensing of service providers (18.047), which is currently being discussed in parliament. In future, the Federal Council is to impose requirements in the outpatient sector, particularly with regard to quality and efficiency. One possible element of quality management could be the electronic medical history.