eHealth in Switzerland
For some years now, Switzerland has been developing a national eHealth strategy, with the aim to improve overall quality and access to health services. Given the federal structure with 26 quite independent Cantons, this is not an easy feat. Nevertheless, in 2007 a comprehensive "Strategy 'eHealth' Switzerland" was agreed upon. It focuses on three primary fields of nation-wide activity: electronic patient records, online services, and strategy implementation.
The strategy document was followed by the establishment of six working groups of federal and Canton experts developing more detailed plans to cope with implementation issues around these topics: “Standards and architecture”, “Pilots and public-private-partnership (PPP) trials”, “Online services and empowerment”, “Education”, “Legal and regulatory basis”, and “Financing and incentives’ structures”. The work of these sub-projects is coordinated by the national eHealth coordination body, which acts as an intermediary between the national and Canton level stakeholders. The coordination body is an entity under stewardship of the National Health Office.
After the detailed planning documents from the working groups became available in 2009, the Swiss government initiated a series of high level expert reviews and hearings on the overall approach chosen, as well as the detailed recommendations submitted by the six working groups. Some of these reviews, such as a detailed expertise by European eHealth experts from empirica GmbH, enriched the discussion with valuable insights from their pool of international experience. A summary of the sometimes critical points, as well as specific recommendations for ensuring a successful implementation of the Swiss eHealth strategy, were recently published in the Journal Swiss Medical Informatics 2010 (Issue 68, pp. 3-8). A key message delivered to Swiss policy makers is the importance to first formulate concrete healthcare policy priorities and challenges, which guide the development of eHealth solutions, instead of letting eHealth guide healthcare priorities. Another specific suggestion is to link financial and other incentives for all affected stakeholders, not just to the immediate implementation phases, but to comprehensively involve them all already during the planning process and consider their longer-term socio-economic benefits and costs. The latter go beyond purely economic impacts and private gains, into the field of benefits to society as a whole.