Q&A: A year down the road – What has the EPR accomplished in Switzerland?

By April 2020 all Swiss hospitals should join a “stammgemeinschaft”, a regional community to offer a national EHR, the so-called EPR (electronic patient record) throughout Switzerland, according to the Federal Electronic Patient Dossier Act (EPDG).

One year later, Healthcare IT News asks Stefan Hunziker (pictured below), CIO at the Lucerne Cantonal Hospital (LUKS), how the EPR has developed in Switzerland and how the hospital plans to implement it. 

HITN: The LUKS is considered a pioneer in the Swiss healthcare system – and the EPR is part of the Swiss digitisation strategy. How is the nationwide implementation of the EPR going?

Hunziker: To cut a long story short: The EPR is not yet up and running in Switzerland and we therefore have no experience with it at LUKS. The partly controversial discussion and the pandemic have clearly shown deficits and are giving the digital transformation in the healthcare system a strong push. As things stand, we assume that we will really be able to use the EPR from autumn 2021.

However, via our hospital information system (HIS), which we have been using at the Lucerne Cantonal Hospital for 1.5 years, we have already been exchanging data with the outpatient sector for some time and have also been serving the patient side since June 2020.

HITN: What does this HIS-based data exchange with the outpatient sector look like in this dual strategy?

Hunziker: On the one hand, we are currently using the referral portal from our HIS to communicate with GPs and referring physicians, and thus include the GP in the treatment team. With the patient’s consent, the co-treating outpatient doctor receives a comprehensive insight into the patient’s medical history and the opportunity to interact with the inpatient colleagues.

On the other hand, for point-to-point communication, we have been using an encrypted mail communication platform for health professionals called HIN (Health Info Net) for decades. The degree of use varies greatly here, depending on the preference of the outpatient providers.

HITN: How does the HIS-based data exchange with patients work?

Hunziker: We communicate with patients via the integrated patient portal, which is available as a separate smartphone app or web solution. With the pandemic, demand has increased massively. Both options provide the patient with lab data, discharge reports and coronavirus test results. That is an enormous relief for us in the current situation.

HITN: What challenges still need to be overcome in order to make the EPR usable for Swiss hospitals in practice?

Hunziker: The regional community, which LUKS has joined, has not yet been certified. Accordingly, the EPDG is not yet in operation. The start has been postponed several times by the legislator and has not yet been determined for our region. Our connection work has been completed as far as possible. The release of the LUKS connector to the EPR is still pending as part of the certification process.

HITN: Healthcare IT News recently reported on the status quo of the ePA in Germany. There, too, the national patient record is not yet fully operational. What would your advice be based on your experiences?

Hunziker: The aim should be to focus on use cases that bring benefits. The processes should really be digitised and not transferred 1:1 from the analogue world. Digital transformation is a major investment and will not work without financial incentives from the public sector.

HITN: What advantages does Epic’s HIS still offer inpatient care after the roll-out has now been completed?

Hunziker: The platform is stable and especially during the pandemic some advantages have became apparent. Thanks to the standardisation in the nursing service, we were able to quickly deploy nursing staff across departments. We have a detailed overview of COVID-19 cases at all times and pandemic-related software developments were available to us from Epic in a timely manner.

We use the patient portal for the transmission of results of the coronavirus tests and for vaccination planning for patients and staff. We currently have over 50,000 active portal users. We also use the platform for home monitoring, e.g. for monitoring oxygen saturation in coronavirus-positive elderly patients or for nutritional control of obese patients. Of course, there is still a lot of optimisation work to be done in the aftermath of the launch. We also strive for further standardisation and also structured data exchange.

HITN: Are there any other experiences with the Epic HIS solution that you’d like to share?

Hunziker: We use an integrated platform centred on the patient. We focus on interdisciplinary and interprofessional cooperation in individual patient care. In addition, we have real-time information at system level for planning, monitoring and resource management as well as data to support quality management.

At LUKS, we carry out two upgrades a year with innovations and also have interoperability tools at hand in the Epic toolset. For example, we are independently able to provide the COVID-19 vaccination data required by the regulator to national registries.

HITN: What do you hope for from the EPR in the future?

Hunziker: At the moment, we do deliver the data to the EPR. However, the end-user only notices this to a limited extent. The key question is: What is relevant to treatment? What should we deliver and what from the EPR is relevant for us as a hospital? This is a big debate in Switzerland, especially since the data is currently still delivered unstructured in documents. At LUKS, we are striving for a structured data exchange and will focus primarily on the vaccination dossier and medication as the first use cases.

Healthcare IT News is a HIMSS Media publication.

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