- The Federal Council should examine the cost-benefit ratio of the electronic patient dossier (E‑PD) and, if the result is positive, support its rapid introduction.
- The full benefits of E‑PD require nationwide participation; funding gaps (especially among the self-employed) jeopardize its widespread introduction.
- Training of big data specialists in the medical field is necessary; the federal government and cantons are promoting corresponding training and further education measures.
Postulate Béglé (18.3368): Electronic patient dossier: better and cheaper healthcare
Submitted text
The Federal Council is instructed to examine the cost-benefit ratio of the electronic patient dossier (E‑PD) in a report together with the cantons and, if this turns out to be positive, to provide the instruments so that it can be quickly introduced across the board.
The expected benefits of the E‑PD, both in terms of quality of care and reduction in health care costs, are expected to far exceed the implementation costs in the medium term. However, the effectiveness of the E‑PD depends on whether the weakest link in the system gives up its resistance: Some of the self-employed physicians, pharmacists and laboratories will be very late in introducing the E‑PD because they will have to bear the costs themselves. However, only the widespread introduction of the E‑PD will enable its full benefits to be realized.
At the same time, consider how to address the shortage of Big Data professionals in the medical field.
Justification
The Federal Electronic Patient Dossier Act (EPDG) came into force on April 15, 2017. The cantons have three years to introduce the E‑PD in hospitals and five years to introduce it in nursing homes. The activity report of the cantons from December 2017 shows that the cantons are taking very different paths.
Thanks to the E‑PD, it should be possible to improve the quality of care and contain health care costs. The E‑PD would lead to fewer hospitalizations and fewer interventions (inappropriate multiple treatments, similar examinations and prescriptions). It would also allow progress to be made toward “integrated care,” which, according to Curafutura, could bring savings of three billion.
The E‑PD is only useful if it contains the complete medical history of a patient. Now, however, independent physicians, pharmacists and laboratories must finance the E‑PD themselves. The U.S. estimates that the initial funding required for 10 years will amount to 22.5 billion dollars. Translated into Swiss terms, this amounts to about 60 million Swiss francs at American prices. For the EPDG, the federal government has currently earmarked 30 million for three years. This is not enough.
The introduction of the E‑PD requires Big Data specialists in the field of medicine who would have to take care of which data are collected in which form for which level of confidentiality, who their addressees are, and which medical statistics are compiled. The Federal Council should promote domestic training in this specialist area.
The E‑PD should lead to greater efficiency and lower costs, provided everyone gets on board.
Statement of the Federal Council of 23.5.18
The electronic patient dossier (EPD) is intended to improve patient safety, the quality of treatment and the efficiency of healthcare, as well as to strengthen the health literacy of patients. As the regulatory impact assessment carried out as part of the legislative work has shown, the main benefit of the EPD will accrue to the population. In particular, patients suffering from a chronic disease (around 1.7 million people in Switzerland) are expected to see a tangible benefit just a few years after the EPD is introduced. However, since this will primarily manifest itself in improved patient safety, better treatment and greater health literacy, it is very difficult to quantify. For this reason, the federal government is supporting the establishment of home communities and communities with a total of up to 30 million Swiss francs. Since the federal government only provides financial assistance to projects that are co-financed by cantons or third parties to at least the same extent, it is likely that around 60 million Swiss francs will be invested in the development of stem communities and communities.
The question of obliging all healthcare professionals to offer an EPD was addressed by the Federal Council on March 29, 2018, as part of the discussion on the status of implementation of the measures proposed in the report of the expert group “Cost containment measures to relieve the burden on mandatory healthcare insurance”. It believes that with the entry into force of the Federal Act of June 19, 2015, on the Electronic Patient File (EPDG; SR. 816.1) on April 15, 2017, and a transition period of three years for hospitals to connect and five years for nursing homes to connect, a change at this time would be premature. Particularly since, when adopting the EPDG, Parliament explicitly advocated maintaining the voluntary nature of the system for healthcare professionals working in outpatient settings.
Within the scope of their responsibilities, the Confederation and the cantons are working to ensure that the specialists required for the implementation of the electronic patient file are trained. The “Action Plan for Digitization in the ERI Sector in 2019 and 2020” of the State Secretariat for Education, Research and Innovation, which the Federal Council took note of on July 5, 2017, also aims to promote the education and training of professionals in the field of digitization.
In addition to the ongoing accompanying evaluation, which is intended to continuously optimize the introduction of the EPD, the EPDG will be subjected to an evaluative legal evaluation after the first years of operation (probably in 2025). For this reason, the Federal Council is refraining from conducting a further study at the present time.