Swiss eHealth strategy 2018-2022 has been released

On December 14, 2018, the Center of Competence and Coordination of Confederation and Cantons, Swiss eHealth, has published version 2.0 of the Swiss eHealth strategy. This version replaces the 2007 version and will be applied until 2022.

With the "Swiss eHealth Strategy 2.0", the Confederation and the cantons intend to enhance the promotion of digitalization in the healthcare sector, whose priority is the introduction and dissemination of the patient's digital record. Health institutions and health professionals will, in the future, be interconnected through digitalization, be able to exchange information electronically throughout the treatment chain and use recorded data on multiple occasions. The new strategy was adopted following the approval by the cantons in November 2018.

This strategy has 25 objectives in 3 scope areas, which are listed below.

Scope A: Encourage digitization

General objective: Implementation of digital applications (and in particular the electronic patient record) within the health system.

Scope A1: Promotion of digitization within the health system in general

Objective A1: The Confederation and the Cantons to raise awareness within the framework of their respective responsibilities of all the actors of the health system to the potential and the risks represented by digitization

• Measure A1.1 - The potential and the risks of digitization, as well as the repercussions of the digital transformation on the health system, are systematically taken into consideration by the Confederation and the Cantons. This is particularly the case when developing and implementing health policy strategies, when creating enforcement procedures, as well as for preliminary work on the design of new legislative projects and for revisions of laws and ordinances

Objective A2: The Confederation and the Cantons to encourage digitization in healthcare institutions and health professionals in order to replace the paperwork as much as possible with digital processes

• Measure A2.1 – The possibilities of promoting the digitization of enforcement procedures are taken into account accordingly by the federal authorities concerned and the cantons. In this context, it is necessary to use existing higher infrastructure to the extent possible
• Measure A2.2 - As part of the service mandates awarded to healthcare institutions, the cantons assess whether their mandates may be linked to the replacement of paper processes by digital processes

Objective A3: Actors responsible for pricing structures and tariffs to ensure that the savings and additional costs of digitization are part of the compensation package

• Measure A3.1 - Tariff partners and approving authorities to ensure that, under the regular tariff updating procedure, changes resulting from digitization, both in terms of infrastructure in terms of benefits, are represented in an economically correct manner
• Measure A3.2 - Swiss eHealth to support the reference communities in the joint development of information financing models of the electronic health record (EHR) and patient counseling. This includes developing approaches to how health leagues or patient organizations can be integrated into information and counseling

Scope A2: Promotion of the electronic patient record

Objective A4: The Confederation and the cantons to commit to ensuring that healthcare institutions and healthcare professionals know and apply the exchange formats prescribed by law or recommended by eHealth Switzerland

• Measure A4.1 - In the development and implementation of health policy strategies, in the creation of enforcement procedures, as well as in the preliminary work of designing new legislative projects and for the revision of laws, regulations, and ordinances, the Confederation and the cantons to take into consideration existing or future exchange formats

Objective A5: Swiss eHealth to regularly check the needs of new exchange formats and to ensure their development as part of a multi-year planning

• Measure A5.1 - Uniform exchange formats are developed at the national level for EHR and related supplementary services. This work is based on the document "Strategy and concept for the definition of exchange formats" of June 13, 2018
• Measure A5.2 - The exchange format determination process is piloted and monitored by the "Exchange Formats Working Group"

Objective A6: The Confederation to update, with the support of Swiss eHealth, the certification requirements for communities, reference communities, and identification media publishers

• Measure A6.1 - Conceptual and technical bases are developed for the further development of the EHR, in particular for integrating mHealth applications as well as primary systems
• Measure A6.2 - The legal basis for the EHR is regularly updated on the basis of the preliminary conceptual and technical work of Swiss eHealth (measures A6.1 and A9.1). Guidelines for reference communities and communities regarding data protection and security are also regularly adapted to current requirements
• Objective A7: eHealth Switzerland to develop recommendations for nation-wide interoperability of EHP-related applications (e.g., for targeted communication between healthcare professionals as part of the treatment process)
• Measure A7.1: Possible ways to ensure the technical and semantic interoperability of complementary services are determined in a national recommendation by Swiss eHealth

Scope A3: Promotion of mobile health (mHealth)

Objective A8: Swiss eHealth to ensure that the implementation of the "mHealth Recommendations I" progresses and issues additional recommendations as needed (see also the “Legal opinion on mobile health” from January 2018 and “Swiss eHealth guides and checklists for the development of safe health applications” from  March 2018)

• Measure A8.1: The "mHealth Recommendations I" will be gradually implemented, as part of Strategy 2.0, and it will be verified what actions still need to be taken and what has been achieved
• Measure A8.2: Current developments at home and abroad are regularly analyzed and, if necessary, integrated into own activities

Objective A9: Together with the communities, Swiss eHealth to encourage the integration of relevant health data from mHealth applications into the EHP. In doing so, it must ensure that there are no risks related to the protection and security of data

• Measure A9.1: Technical and semantic standards for the exchange of information between mobile health applications (mHealth) and EHP are developed. In this context, priority is placed on internationally established standards

Scope A4: Promotion of adequate and safe primary systems

Objective A10: Swiss eHealth to work with stakeholders to establish common minimum standards for primary systems for EHP, implementation of data protection and data security guidelines, and adequacy for use as part of the treatment process

• Measure A10.1: Common minimum standards are formulated with the relevant stakeholders for the attachment of primary systems to the EHP, the implementation of data protection and security guidelines and the adequacy for use in the context of the process of treatment

Objective A11: With its existing instruments for promoting innovation (e.g., Innosuisse), the Confederation to support the improvement of primary systems

• Measure A11.1: The confederation must check what are the possible encouragement measures when the message concerning the encouragement of training, research and innovation 2021-2024 is developed

Scope A5: Promoting cybersecurity and data security in the health system

Objective A12: With the help of specialists and stakeholders, the Confederation and the cantons to develop solid measures to strengthen cybersecurity and data security within the health system

• Measure A12.1: To promote awareness-raising measures to care institutions and health professionals (short-term) as well as the population (medium-term)
• Measure A12.2: Models of good practice for the protection of systems and infrastructures that process or transmit health data are documented and published. The mandatory establishment of minimum requirements is subject to verification
• Measure A12.3: New technological approaches to ensure sustainable data exchange in the health field, and their use to be encouraged. This is primarily to propose a continuous use of cryptographic processes ensuring the protection of confidentiality and integrity during the recording and transmission of particularly sensitive data
• Measure A12.4: Models of good practice to ensure the availability of IT infrastructure within healthcare institutions are documented and operationalized by the healthcare institutions (resilience)
• Measure A12.5: Professional exchange platforms are used and consolidated for the promotion and establishment of the exchange of information as well as for the spontaneous declaration of cyber incidents

Scope A6: Promotion of a European cross-border network

Objective A13: Swiss eHealth to play an active part, as part of European coordination, in the development of a network beyond national borders.

• Measure A13.1: Swiss eHealth participates in the activities of European and international committees

Objective A14: The FOPH sets up a national contact point, as the EHP law states, to guarantee the international consultation of health data from the EHP

• Measure A14.1: The legal and organizational conditions necessary for the operation of the national contact point according to Art. 14 EHP laws are created

Scope B: Coordination of digitization

General objective: Digitization within the health system is done in a coordinated way and allows multiple uses of data and infrastructure

Scope B1: Multiple uses of data and infrastructures

Objective B1: The Confederation and the cantons to create, within the scope of their respective competencies, the conditions so that the data of all the domains of the health system are seized so as to be able to be used for various actions. In this context, the administrative, the social insurance processes, as well as the needs of research, statistics and the quality assurance, must be taken into account. Coordination with the action plan of the "Digital Switzerland" strategy must be ensured

• Measure B1.1: The federal authorities concerned, in particular, the Federal Office for Public Health (FOPH), the Federal Social Insurance Office (FSIO) and the Federal Statistics Office (FSO), draw up current overviews of the digitization-related projects of the Confederation and coordinate their activities if necessary. Conflicts of objectives or potential interests between protection, security, and use of data must be identified and addressed proactively
• Measure B1.2: The potential and risks of coordinated digitization are being discussed in existing committees. An overall vision is necessary in order to identify the synergies with e-government processes

Objective B2: The Confederation and the cantons to support, within the framework of their respective competencies, the multiple uses of existing higher infrastructures (in particular the means of identification, the professional registers and the electronic Health Government platform (eHGP)). Coordination with the action plan of the "Digital Switzerland" strategy is necessary for this purpose

• Measure B2.1: The competent departments of the Confederation and the cantons to take into consideration the possibilities of multiple uses of architectures and (higher) infrastructures when developing new professional applications for the execution processes and during new legislative projects
• Measure B2.2: In the service mandates, the cantons check whether the multiple uses of infrastructure plays a role in the allocation. In order for the technical interoperability to be taken into account during the allocation, a list of criteria is defined as an aid (as for SAGA.ch)

Scope B2: Technical and semantic interoperability

Objective B3: Swiss eHealth to develop, taking into account all the actors involved, an interoperability strategy for the multiple uses of data from a technical and semantic point of view

• Measure B3.1: An interoperability strategy for authorities and private actors is developed to serve as a basis for coordinated digital networking (e.g., multiple uses of data and infrastructure). The process is coordinated with other relevant actors

Objective B4: The Confederation to appoint a body responsible for coordinating the maintenance and development of semantic standards and defines its method of financing

• Measure B4.1: As part of the implementation of the interoperability strategy, the Confederation controls how care and the development of semantic standards can be guaranteed

Scope B3: Use of international standards and good practices

Objective B5: The Confederation and the cantons shall, within the framework of their respective responsibilities, ensure that established technical and semantic standards (e.g., FHIR, IHE, HL7, LOINC, SNOMED CT) are defined as binding

• Measure B5.1: As part of the implementation of the FOPH's strategic IT planning 2019-2022, to ensure that established technical and semantic standards are used as early as possible for the development of new professional applications, but also for the development new legislative projects
• Measure B5.2: Thematize the directives concerning the use of inter-cantonal technical and semantic standards in existing committees and ensure the early integration of the corresponding directives into cantonal projects

Objective B6: Swiss eHealth to reinforce the sensitivity of all important stakeholders to the fact that existing international standards and best practices should be used as much as possible and is available as a contact to answer any questions on this subject

• Measure B6.1: Measures developed under objective B3 are implemented

Scope C: Enable digitalization

General objective: People in Switzerland are digitally educated and capable of handling patients' digital data responsibly, being aware of the risks

Scope C1: Information and education of the Swiss population

Objective C1: The cantons, the reference communities, and Swiss eHealth to inform the Swiss population about the EHR

• Measure C1.1: The communication plan for the introduction of the EHR is regularly updated. The planned measures and products are implemented progressively, in agreement with the (reference) communities and the cantons
• Measure C1.2: The cantons participate in regional information campaigns to the population about the introduction of the EHR
• Measure C1.3: The Confederation and the cantons find a way to support the dissemination of the EHR using health policy strategies (e.g., National Dementia Strategy or Palliative Care Platform) as well as corresponding activities of other policy areas

Objective C2: The cantons and Swiss eHealth are helping to encourage people in Switzerland to use EHR by supporting relevant stakeholders such as patient organizations and health leagues as well as healthcare professionals and institutions. In this context, the concerns of people with special needs are taken into consideration

• Measure C2.1: For the measures mentioned in objective C1, the issue of encouragement of people with special needs is taken into account from the beginning
• Measure C2.2: The stakeholders mentioned in the objective C2 are the subject of support in the context of the internal training of the collaborators (elaboration of documents, accompaniment during the training, list of contacts, etc.)
• Measure C2.3: Models of good practices for the promotion of eHealth skills are developed for (reference) communities
• Measure C2.4: The stakeholders mentioned in the objective C2 are integrated to work on the EHR or to work on eHealth strategies in areas of care delivery

Scope C2: Capacitation of health professionals

Objective C3: Swiss eHealth to develop, with healthcare institutions and professional associations, a foundation for using existing or new practice-based tools to help healthcare professionals use digitalization effectively and safely in their daily work

• Measure C3.1: The adequacy of the products and measures mentioned in objective C1 for health professionals is regularly checked and, if necessary, supplemented
• Measure C3.2: For training within organizations, aids are developed where necessary in common with healthcare institutions and professional associations and made available (e.g., training guides, eLearning)

Objective C4: The Confederation and the cantons shall ensure, within their respective areas of competence and in agreement with the responsible training organizations, that eHealth is included in the training curriculum of all health professionals and addressed in the context of continued and postgraduate training

• Measure C4.1: The training coordination group continuously monitors which nationally coordinated activities are required

Objective C5: The Confederation and the cantons to, within the framework of their respective competencies, educate the specialists for the implementation of the EHR

• Measure C5.1: A corresponding recommendation is provided to the universities

See the full report in German here, and in French here.

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