Digital health: How Switzerland is losing touch

Digitalization has the potential to fundamentally change our healthcare system. It improves efficiency, reduces costs and increases the quality of patient care. While countries such as Denmark and Finland are considered pioneers in e-health and already introduced digital healthcare platforms in the noughties, Switzerland is still struggling with the implementation and acceptance of the electronic patient record (EPR). The usage figures in the population show this difference in a striking way: While around 90 percent of adults in Denmark1 and as many as 65 percent in Finland2 have an electronic patient record, the figure in Switzerland is just 0.9 percent3.

The Nordic countries – a beacon of digitalization 

Denmark has established itself as a pioneer in healthcare digitalization in recent years4. A key element of this success is the national patient portal “Sundhed.dk.” Through this platform, citizens have access to their health data at any time, can book appointments, renew prescriptions, redeem them at pharmacies, document vaccinations and medications, and communicate with their doctors. The portal is widely used by the population – a clear sign of trust in digital health solutions and their seamless integration into daily life. Cancer patients, for example, can even manage their chemotherapy from home – an option known as “outpatient chemo.” This reduces the strain on the healthcare system, and those affected can return to their everyday lives more quickly.The use of electronic patient records is mandatory for all medical institutions and healthcare personnel in Denmark. All health data is centrally recorded, updated, and accessible to medical professionals at any time. A GP in Copenhagen, for instance, can immediately see what treatments a patient received in Aarhus. X-rays, test results, prescriptions, allergies – everything is transparent, standardized, and easily accessible. To enable this, Denmark has heavily invested in the modernization and digitalization of its hospitals. Under the “SuperHospital” strategy, hospitals have been built or renovated to include digital interfaces everywhere, streamlining administrative processes and integrating data seamlessly. Data is collected according to international medical standards.

Health data such as weight, height, heart rate, blood pressure, or blood sugar can also be stored in the patient record – either manually or automatically via medical devices that can connect to the record. It is ensured that patients can withdraw their consent to share their data with medical staff or researchers at any time.

Finland5 also set the course for comprehensive healthcare digitalization early on. Through the national health information system “Kanta,”6 citizens can view their complete medical history and share it with healthcare providers. Healthcare professionals are required to use this system. Its widespread adoption has led to a high level of acceptance. Additionally, Finland relies on telemedicine and mobile health applications to ensure medical care in remote regions. For instance, a patient from Lapland can attend a doctor’s appointment via video without needing to undertake a long journey. This saves time and costs, and promotes disease prevention and early treatment.

Switzerland: digitalization in its infancy

Switzerland is still far from achieving simple, standardized, and digital recording of health data. Unlike in Denmark and Finland, the use of electronic patient records by medical professionals is often voluntary here. Many doctors’ practices and hospitals are reluctant to adopt new tools and processes due to the financial and administrative burden involved.

As a result, doctors spend a significant portion of their working time filling out forms, making diagnoses, and coding treatments – often multiple times, as data must be updated across several systems. A Swiss surgeon now working in Denmark mentioned in an interview with Tages-Anzeiger that in Switzerland, he spent several hours each day on administrative tasks that are largely automated in Denmark. A discharge report in Denmark can be generated within minutes because all relevant information is already available digitally. In Switzerland, however, much of the data still has to be entered manually, and documentation practices vary from hospital to hospital. While the Federal Office of Public Health (BAG) recommends that data be recorded according to international standards, this is not mandatory in Switzerland. Moreover, the legal framework for the anonymized use of health data in research is so complex that many projects have been relocated to Nordic countries in recent years, which has harmed Switzerland’s position as a research hub.

On the patient side, things aren’t much better: many Swiss citizens have never heard of the electronic patient record (EPR) or are unaware of its benefits7. Another reason why so few people use the EPR is the cumbersome registration process. To open an EPR, one must register via one of several different “core communities.” These communities have varying technical standards and requirements, making it difficult to get started. This highlights a key issue: federalism and digitalization do not mix well. The digitalization of healthcare can only succeed if all stakeholders are involved and with an organizational approach in which the federal government takes a leading role.

In addition, many features that an electronic patient record could offer are not (yet) available in Switzerland. For instance, while prescriptions can be stored in the patient record, pharmacies are not allowed to retrieve them. Hospitals do store treatment information electronically, but only as PDFs, which cannot easily be processed by machines. Since there are often no standardized platforms for data management in medical institutions, X-rays are still sent by email and prescriptions faxed. Doctor’s appointments are arranged by phone. While telemedicine exists, it is still underutilized. This is about more than just reducing paperwork and duplication: it’s about the health of the population, disease prevention, and extending life expectancy. Integrated, individualized, and interactive digital solutions can help patients make healthier decisions, detect diseases early, and monitor the treatment of chronically ill patients remotely – from monitoring drug interactions via AI systems that know the patient’s profile and diagnosis, to personalizing treatment methods. Digitalization is not an end in itself – ultimately, it’s about benefiting patients while simultaneously lowering costs.

New directions by the Federal Council: a step in the right direction

With the Federal Council’s decision on 27 September 2024, several important steps were established for the digitalization of Switzerland’s healthcare system. The federal government will now provide the central technical infrastructure for the electronic patient record (EPR), significantly improving interoperability and data exchange. Additionally, the introduction of the EPR will be simplified: all residents of Switzerland will automatically receive an EPR, unless they opt out (opt-out system). Furthermore, the use of the EPR will be mandatory for all healthcare providers – such as hospitals and also outpatient facilities such as doctors’ practices and pharmacies. This direction set by the Federal Council is crucial for fully realizing the potential of the EPR and advancing healthcare digitalization. These measures will now be included in the message for the EPR Act revision.

Recommendations for Switzerland

To ensure sustainable success, the following steps are also essential:

• Comprehensive information campaigns are needed to build trust in digital health solutions, focusing on the benefits of digitalization and security aspects.

• Clear standards should be established for data collection and exchange between different systems to improve efficiency and guarantee the highest security standards.

• A clear legal framework permitting the use of anonymized data for research could strengthen innovation, make Switzerland more attractive as a research hub, and advance medical development.

• It must be ensured that the centralized technical platform of the EPR is in place, and the IT systems of healthcare providers are modernized to enable seamless integration.

Switzerland can learn from the experiences and best practices of the Nordic countries and close its gap in healthcare digitalization. However, this requires a clear strategy, bold political decisions, and a willingness to invest in the future to ensure the quality of healthcare and maintain its attractiveness as a research hub.