How service providers are integrated into the electronic patient dossier
The complexity of connecting a service provider to the electronic patient dossier varies depending on the level of integration. An overview of the relevant IHE profiles can help in the decision-making process The electronic patient dossier (EPD) will come, this was reaffirmed in the eHealth Strategy 2.0. For hospitals, this means that by 2020 they must be able to read treatment-relevant documents from the EPD and file them in the EPD. 1] Due to the complexity of the EPD and the short time until the planned start of operations, service providers must deal with the integration of the EPD. There are various options as to how deeply the EPD should be integrated into the existing systems. The choice of integration depth has a direct impact on how automatically the data exchange between the service provider and the EPD takes place. 2] The deeper the EPD is to be integrated, the more complex the introduction will be, but the more efficient its use will be due to automation and thus the more cost-effective it will be in the long run. This is the result of a calculation by a special working group of the private hospitals in Basel. 2] For a minimum implementation of the EPD in conformity with the law, it is sufficient to connect to a master community and register a health professional for access to the EPD.  In such a case, the electronic patient files would be managed manually via the portals of the (home) community. Accordingly, the personnel effort for the administration of the EPD increases with the increasing number of patients with an electronic patient dossier. The Health Commission of the National Council decided in August 2018 that doctors with practices must also participate in the EPD so that they can continue to bill the health insurance funds for basic care. If this is enshrined in the law, the likelihood increases that many patients will open an EPD in the medium term. This is also the goal of the legislation. Accordingly, the initial effort to integrate the EPD can be worthwhile for hospitals.
Integration is complex
Integrating the EPD into the existing system landscape is extremely complex and differs according to the requirements of a hospital. Depending on the degree of automation that is to be achieved, different IHE profiles are required and must be supported. The IHE (Integrating the Healthcare Enterprise) is an initiative of users and manufacturers with the aim of standardising and harmonising the exchange of information between IT systems in the healthcare sector. IHE profiles are technical guidelines based on existing standards that are intended to ensure interoperability between IT systems. 4] For the EPD, various IHE profiles have undergone national changes or completely new IHE profiles have been developed. This means that even the manufacturers of hospital information systems (HIS), which already support many IHE profiles, have to make changes to the interfaces for the EPD in order to be able to integrate the EPD. 
Figure 1: Possible integration architecture with relevant IHE actors and transactions
Figure 1 shows a possible integration architecture in which the actuators and transactions of the IHE profiles are shown that are used in the EPD and are relevant for the service providers. By using a communication server, it can be taken into account that the health professionals and their groupings are not managed in the primary system and that their management tool does not support IHE profiles. Depending on the selected integration depth and technical possibilities, this representation will of course change. The file registration of the PACS is also missing from this overview. Image data in the EPD do not have to be copied in the repository, but may remain as originals in the PACS, but are registered and linked in the document registry. 6] Accordingly, the presentation is an example situation without any claim to completeness. The integration of the EPD is not only a technical project, but has an influence on various processes within a hospital. The on-boarding of patients into the EPD, the downloading and publishing of treatment-relevant documents, as well as the management of healthcare professionals in groups and their synchronisation with the EPD are some of the processes that must be redefined, changed and implemented with the introduction of the EPD.
Decentralised structure is questionable
Regarding the EPD, it can basically be said that the technologies used are established technologies that are also used in other, similar projects (PEPA in Heidelberg, REPO in Austria). Apart from the IHE profiles with national adaptations, IHE profiles are used that should be standardised worldwide.  The decentralised structure of the EPD does not generate any significant added value for the service providers, since due to the legal obligation to introduce the EPD, the hospitals are not in competition with each other and the number of different master community platforms is small. For this reason, a merger of parent communities within the language regions of Switzerland would certainly be worthwhile from a cost point of view, as this would mean that the identical know-how would not have to be built up in several locations. 7] Regardless of the depth of integration chosen, integration of the EPD and its processes is an obligation for all inpatient service providers and also an opportunity to get to grips with eHealth.
- Legislation Electronic Patient Dossier (EPDG)
- Basel Private Hospitals Association, “Basler Privatspitäler-Vereinigung 20.4.2018 – Schwerpunt EPD”
- J. Lindenmann, M. G. GmbH, P. Heierli, and M. G. GmbH, “”Georgis”: offering a community as a service”, p. 28.
- B. Bergh et al, “[The role of Integrating the Healthcare Enterprise (IHE) in telemedicine]”, Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, vol. 58, no. 10, pp. 1086-1093, Oct. 2015.
- BAG, “Integrationsprofile Erläuterung”, 22 March 2016.
- eHealth Suisse, “Implementation Guide Primary Systems”. 18. September 2017.
- A. Ott, “Authentication of health professionals into the EPD”, 13.07.2018, p. 101.