Switzerland is limping behind in e-health – although individual institutions spend sums that the e-health pioneers can only dream of, even at national level. Now this should change – through professional stakeholder management. This topic was the focus of the Swiss eHealth Forum 2023. The big questions: How do we deal with stakeholders? How do we inform them, because there is a great lack of knowledge about eHealth? And: How do we overcome their resistance, which has so far had a largely blocking effect?

Roland Blättler, head of IT at the Obwalden Cantonal Hospital, is obviously in a double role: as a designer in his own perimeter, he wants to take others along with him, and as a participant in the larger setting of the course, he himself is taken along. He reported anecdotal but representative examples of rejection of new digital solutions within his area. He emphasised that the digital transformation was only just beginning. He also drew parallels to the Californian gold rush, where the tool manufacturers did the big business, not the prospectors. That means, even if it was not said in such a way, the IT industry and possibly the consulting service providers will make a killing, but the benefits for the organisations will remain manageable for a long time. He also sees large hospitals and central standardisation as the winners – nota bene at the expense of the small ones and federalism.

Liechtenstein as a role model?

Christian Wolf, co-project leader of the electronic health dossier (eGD) in Liechtenstein, reported how Liechtenstein was able to set up the eGD in a second attempt and with intensive advice – mainly from Austria, but also from Switzerland – in a very short time and with very few resources. From 1 July, its use will be compulsory, for which three large training events were organised in advance. Wolf assumes that the eGD will indeed be used by all those who are obliged to do so from mid-July. The Liechtenstein secrets of success are learning from good practices, a comparatively very short law (and a short ordinance), and opt-out for patients instead of double voluntariness. The next goal, even if in Wolf’s view the legislative process has not created optimal conditions, is to bring data from neighbouring countries into the dossiers through direct cooperation.

The speed and conciseness of the legislation in Liechtenstein’s second attempt are particularly impressive! As far as the availability of the solution is concerned, the eGD is already a success project. Whether this will also be the case in practical use, only time will tell. Smaller circles are currently trying to overturn the opt-out principle and thus stop the eGD’s successful run.

20.000 already have an EPD

Gian-Reto Grond, Head of the Digital Health Section at the Federal Office of Public Health (FOPH), reported on the relaunch of the “electronic patient dossier (EPD)” project in the Swiss health system. One has to know the history of this: 15 years ago, when this project got off the ground, it was primarily about completing a government mandate. The perspectives of the stakeholders were not central. (However, eHealth Switzerland participated in the large scale pilots EPSOS as well as STORK 2.0 and cultivated international exchange). In parliament, the bill was then pushed back and forth between the two councils and in the end passed with the principle of double voluntariness as a fundamentally distributed solution without a shared infrastructure throughout Switzerland. As a result, implementation experienced delays and knowledge about the project accumulated in a few minds while it vaporised in the rest of the health system. Although the goals are documented online in an exemplary manner, unlike the Austrian theatre poet Raimund, “Nobody knows anything even before the end” applies, as a student research project showed here two years ago.

Grond emphasised that there are already 20,000 EPD holders and that he finds it very easy to open. Our research prior to the event showed that it takes perseverance to get an appointment to open an EPD in Bern. Unlike the passport system in Berlin, however, one is successful in Bern. Grond’s statement that only those with an EPD are allowed to have a say in the opening of the EPD is, however, unintentionally funny: with this logic, the eGovernment critics in Berlin could be completely silenced. Nevertheless, the reorientation towards stakeholder participation, which was undertaken by Grond and his colleagues, is a big step towards the actual implementation of the electronic patient dossier! It will not only lead to more user-friendly and useful solutions, but will also increase acceptance in the health ecosystem and, moreover, increase knowledge about the EPD among health professionals. With this quadruple booster, a success of the EPD also seems possible in Switzerland. For the time being, however, this does not change the fact that Switzerland is lagging far behind the Scandinavian countries and Austria. But if the increase in the gap is stopped thanks to professional stakeholder management, much more will have been achieved than seemed possible so far.

Interoperability yes, but different from the EU

The next steps were presented by Martine Bourqui-Pittet. She presented the DigiSanté programme and addressed the issue of interoperability in particular. This is another topic that has had a hard time in Switzerland so far. The realisation of the eMove took so long because the European concepts were rejected and instead large European service providers were relied on. But now they have internalised the concepts of the European Interoperability Framework (EIF) and want to work out the corresponding standards for Switzerland together with the stakeholder representatives. This is good news and worthy of a big round of applause! The fact that this elaboration is taking place in committee work, among other things, will probably provoke various detractors who consider the Swiss committee practice to be a particularly bad lack of culture in the country. But apart from the fact that the Swiss committee system is a truly wide-ranging country – from ego-shooter clubs to rounds of sympathetic and idealistic chaotics to extremely constructive committees in which curiosity and factual orientation shape the rituals – in the case of the digital transformation of the health system, it is hardly possible without institutionalised stakeholder participation, i.e. only with committees of elected members. For light versions of participation, agile and situational, there is too much politics involved: solutions must not only be factually correct, but their design must also be legitimised.

The presentation by Ulrike Burkhard showed that professional stakeholder management is not a speciality of public administration, but is also possible in health organisations. She reported on the successful implementation of a digital ward board in psychiatry, which involved the users very intensively.