New electronic health record: ok from the National Council (cross-border guide)

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.

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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.

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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.

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