New electronic health record: ok from the National Council

Context

In brief

• The National Council has approved a new health law
• The electronic health record (EHR) is born
• It will replace the previous computerized patient record
• Introduction planned by 2030 by the Federal Council

Key facts

• Votes in favour: 134
• Votes against: 53
• Abstentions: 10
• Restructuring deadline: by 2030
• Management and financing: Cantons

Following the disappointing results of the computerized patient record, defined by many as a genuine fiasco due to a complex structure and a burdensome opening process that held back its use well below expectations, the National Council has decided to give a new impetus to the digitalization of the Swiss healthcare sector. Meeting to debate the future of medical data in the Confederation, the plenum approved a new law aimed at introducing the electronic health record. The dossier now moves to the Council of States for the subsequent legislative stages provided for by the federal legal system.

Objectives and structure of the digital reform

The bill presented by the government last autumn aims to put the individual at the centre of their clinical history, offering an overview of relevant medical data without any barriers linked to domicile, place of treatment, or specific service provider. Information currently fragmented, including consultation reports, discharge summaries, vaccinations, medications taken, and laboratory values, will be stored and made digitally available in a single place, always accessible. The intent pursued by the Federal Council, as highlighted in the parliamentary debate, is to proceed with a radical restructuring by 2030, replacing the previous infrastructure to globally improve the quality of care, increase patient safety, eliminate duplications, and concretely contribute to containing overall healthcare costs. Many parliamentarians insisted on the need to make up for lost ground, avoiding the design errors that characterized the past.

Operational details

Coinvolgimento dei professionisti e modello automatico

A differenza del precedente sistema, la nuova normativa stabilisce che tutti i professionisti della salute dovranno obbligatoriamente partecipare al sistema della cartella sanitaria elettronica. L'obbligo non riguarderà più soltanto gli ospedali e gli istituti di cura, già tenuti a collegarsi, ma verrà esteso a medici, farmacisti, fisioterapisti e a tutti gli altri fornitori di prestazioni ambulatoriali che emettono fatture a carico dell'assicurazione obbligatoria delle cure medico-sanitarie. Questo ampliamento della platea mira a sfruttare appieno il potenziale tecnologico dello strumento digitale raccogliendo un volume di dati clinici completo e omogeneo su tutto il territorio nazionale svizzero.

Un altro aspetto centrale della riforma riguarda le modalità di adesione per la popolazione residente. La cartella elettronica non dovrà essere richiesta attivamente dai singoli cittadini: ogni persona domiciliata in Svizzera la riceverà in modo automatico e totalmente gratuito. Ciononostante, il principio della volontarietà d'uso rimarrà pienamente garantito. Chiunque non desideri disporre della cartella sanitaria elettronica potrà infatti opporsi alla sua apertura iniziale o richiederne la completa eliminazione in qualsiasi momento, avvalendosi della clausola di esclusione volontaria. In questo modo, i pazienti manterranno la piena e incondizionata sovranità sui propri dati personali e clinici, conservando il potere decisionale assoluto su chi potrà accedere alle informazioni e su quali sezioni specifiche consultare.

Organizzazione centralizzata e competenze cantonali

Sul piano infrastrutturale e organizzativo, la nuova cartella si differenzierà nettamente dalla sua antenata grazie all'adozione di un'architettura centralizzata. Su proposta della commissione preparatoria, è prevista la creazione di un'unica comunità nazionale di riferimento che agirà da interlocutore ufficiale per i titolari della cartella, per i professionisti della salute e per le strutture sanitarie coinvolte. Questa entità centrale sarà gestita e finanziata direttamente dai Cantoni, una soluzione che nel corso della votazione in aula ha superato la proposta alternativa che affidava la medesima responsabilità alla Confederazione. Tale ripartizione di compiti istituzionali sottolinea il ruolo chiave che le autorità cantonali continueranno a svolgere nella governance della sanità pubblica svizzera, coordinando le risorse e l'implementazione pratica del progetto sul proprio territorio.

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Key points

Security debate and political skepticism

Despite the large majority vote in the National Council, the project was not free from criticism and concerns raised by a parliamentary minority, particularly among the ranks of the Swiss People's Party (SVP). Representatives of this faction, while agreeing on the underlying goals of health improvement, raised strong doubts regarding the clarity of the actual costs of the operation and the security of the model based on automatic exclusion. According to the critical arguments presented in parliament, the approach providing for automatic enrollment unless explicitly opposed amounts to a mechanism where silence is taken as consent on extremely sensitive data, for which it would instead be appropriate to require a prior and explicit expression of intent from the individual.

Also targeted by critics was the choice to focus on a large-scale centralized infrastructure, considered a complex and potentially risky federal IT project. The danger of vulnerabilities to cyberattacks by hackers was highlighted, alongside the possibility of human errors in managing such an extensive system. Health Minister Elisabeth Baume-Schneider responded to these concerns, assuring that data security represents an absolute and unquestionable priority for the executive. The Federal Councillor reiterated the institutional commitment to delivering a technological tool that is fully worthy of citizens' trust, balancing the efficiency of digitization with the rigorous protection of privacy.

Next institutional steps and further details

The regulatory process for the electronic patient dossier now continues as the dossier moves to the Council of States, where senators will discuss the technical and financial details approved by the National Council. A transition phase thus begins for residents and Swiss healthcare operators toward the 2030 target set by the Federal Council for the completion of the digital reorganization. Those wishing to monitor the evolution of health regulations, assess the impact of fixed costs related to the healthcare system, or learn more about aspects related to LAMal benefits and related coverages can consult the information tools available online, including insights dedicated to the cost of living and fixed expenses in Switzerland. For a comprehensive analysis of monthly expenses and to calculate the impact of mandatory costs on your budget, consult the cost of living comparator.

Source: swissinfo.ch