Momentum in patient demand must not be wasted

Momentum in patient demand must not be wasted Slow diffusion of offers down to the level of the health care professionals providing treatment The most important points in brief Swiss ehealth Barometer : Key players in health care Study on behalf of InfoSocietyDays, March Project team Lukas Golder Political and media scientist Cloé Jans Political scientist Stephan Tschöpe Political scientist Alexander Frind Political scientist Noah Herzog Secretary's office and administration

Study initiator: Study partners: Bern,. February Copyright by gfs.bern Blocking period: 9 March, 12 noon Publication: on the occasion of InfoSocietyDays 2

2011 2012 2013 2011 2012 2013 The most important points in brief Status of ehealth among health care professionals The introduction of the electronic patient record stands at the heart of the efforts to establish ehealth across Switzerland. In the summer of, the Federal Act on the Electronic Patient Record (EPRA) was passed by the National Council and the Council of States. The cantons were called on to review their respective legal systems as regards compatibility with EPRA and, where necessary, to initiate the required changes. The objective here is to ensure a gradual implementation of the act that takes account of the specific circumstances at a cantonal and regional level. This should take place in close cooperation with those responsible for the provision of treatment and on the basis of common standards.1 Especially when it comes to these common ehealth standards, the majority of the surveyed health care professionals believe that only minor progress has been made. Over time, the share of health care professionals who are closely assessing the situation has also tended to increase. It almost appears that it will only really be possible to determine how much progress still actually has to be made upon subjecting the issue to greater scrutiny. Figure 1 Trend in comparison of progress in the area of ehealth standards "Very generally speaking: How do you assess the status of the work in connection with standards for ehealth? Is this work already very advanced, fairly advanced, not really very advanced or not very advanced at all?" As a % of surveyed IT at hospitals, cantons, IT at Curaviva 1 4 3 4 6 4 11 1 20 1 22 16 18 38 33 0 31 32 43 36 38 43 44 32 47 9 4 4 4 9 4 14 8 39 2 12 42 48 1 36 48 33 40 33 3 1 1 16 17 1 11 9 4 2 2 1 2 20 3 27 13 2 37 31 31 7 2 2 IT-hospitals Cantons IT-Curaviva gfs.bern, Swiss ehealth Barometer, December February 6 8 1 4 8 1 There are no standards Not very advanced at all Not really very advanced Don t know/no answer Fairly advanced Very advanced Trend in comparison of progress in the area of ehealth standards "Very generally speaking: How do you assess the status of the work in connection with standards for ehealth? Is this work already very advanced, fairly advanced, not really very advanced or not very advanced at all?" As a % of surveyed pharmacists, old people s homes, NPO Spitex 6 6 44 22 16 18 48 48 22 18 11 9 9 9 7 16 20 16 20 2 38 28 33 3 13 6 9 7 9 9 1 1 1 1 1 27 38 23 2 1 18 42 37 Pharmacists Old people's NPO-Spitex gfs.bern, Swiss ehealth Barometer, December February 27 There are no standards Not very advanced at all Not really very advanced Don t know/no answer Fairly advanced Very advanced The efforts being made to implement ehealth are becoming ever more institutionalised. Institutionalisation can occur, for example, when specific ehealth strategies are developed within the organisations and these organisations are also the base for an increasing number of those individuals with designated responsibility for ehealth. While the main impetus for participation in specific implementation projects is clearly coming from IT specialists, interest is also being signalled by the remaining health care professionals (apart from the medical profession). A focus is also currently being placed on inter-cantonal implementation. 3

Figure 2 Comparison of participation in implementation projects "Do you participate in a regional or cantonal ehealth implementation project?" As a % of surveyed doctors, IT at hospitals, old people s homes, cantons, IT at Curaviva, NPO Spitex 2 8 4 18 18 19 16 22 77 4 14 16 16 24 42 Don t know/no answer No, this does not interest me No, but I would be interested 4 62 43 47 36 Yes, in a pilot project 1 16 2 2 2 1 2 2 31 16 12 14 4 3 11 IT-Curaviva IT-hospitals Cantons NPO-Spitex Pharmacists Old people's homes and nursing homes gfs.bern, Swiss ehealth Barometer, December February Doctors Yes, planned in the next 12 months Yes, cantonal Yes, regional A majority within all groups of health care professionals express an interest in ehealth. Nevertheless, health care professionals are today not tapping into the potential for improving their own professional environment any more than they were a few years ago, when progress was at a much less advanced stage. While hospitals are acting as spearheads and driving ehealth efforts in many respects, members of the medical profession working at practices tend to have their foot on the brake. This is also the group of health care professionals who see the least potential in ehealth. It is members of the medical profession, both at hospitals and practices, who will be essential for the success of ehealth in Switzerland. They will play a central role when it comes to diffusing information on the various options down to the level of patients and clients. A key factor here may be the provision of specific training on this topic, which is still clearly desired by the individual health care professionals. Electronic documentation and networking Electronic systems for the saving and management of patient data can now be found nationwide and within all groups. The transition towards a fully electronic organisational structure can be well traced for all health care professionals over the last approximately four years. Digitisation still tends to meet with most resistance from doctors working at practices. A majority are satisfied with the respective care documentation at the medical practices and this level of satisfaction is even greater than that among members of the medical profession working at hospitals, who otherwise tend to be more impressible. Dissatisfaction is primarily triggered by a lack of functionality, excessive complexity and, in some cases, the slowness of the systems. 4

General practitioners Specialists Pharmacies Acute-care hospitals Old people s homes Rehabilitation clinics Spitex Therapeutic groups General practitioners Specialists Pharmacies Acute-care hospitals Old people s homes and nursing homes Rehabilitation clinics Midwives Spitex Therapeutic groups Figure 3 Filter of the comparison of the assessment of electronic documentation "How do you assess your electronic medical history (ekg) / the electronic documentation of your hospital (KIS) / your electronic care documentation / your electronic inhabitant record / your software system today? Are you very satisfied, quite satisfied, not very satisfied or not at all satisfied with this?" As a % of surveyed doctors with their own medical practice, hospital doctors, NPO Spitex, old people s homes, pharmacists with an electronic system 6 3 4 2 18 14 Not at all satisfied 12 18 1 24 26 14 20 Not very satisfied 43 7 8 1 63 Don t know/no answer 43 Quite satisfied Figure 4 1 6 7 Doctors with own medical practice Hospital doctors NPO-Spitex Old people's and nursing homes Pharmacists gfs.bern, Swiss ehealth Barometer, December February (n doctors with their own medical practice = 32, n hospital doctors = 127, n NPO Spitex = 171, old people s homes and nursing homes = 43, n pharmacists = 411) Very satisfied The objective of the electronic storing and processing of patient, client and resident data is, in particular, also to improve the interfaces between the individual health care professionals. This is clearly a slow and time-intensive process and over the years only minor progress has been observed. Compared to the beginning of the series of surveys, however, an improvement can be seen for each individual interface. While the changes are taking place in small steps, they have until now been clearly evident. Trend filter of the assessment of interfaces with key players pharmacists "How do you personally assess the interfaces between you and the following key players:" As a % of surveyed pharmacists with an electronic system, share of "very good/quite good" 84 6 9 4 0 3 41 79 70 41 43 3 4 8 46 29 3 23 60 63 0 20 2 27 29 18 19 Trend filter of the assessment of interfaces with key players Old people's homes "How do you personally assess the interfaces between you and the following key players:" As a % of surveyed old people s homes with an electronic system, percentage of very good/quite good 74 71 64 4 49 46 78 77 69 61 60 1 7 72 67 9 6 47 69 60 2 0 43 gfs.bern, Swiss ehealth Barometer, December February (n pharmacists = approx. 380 in each case) gfs.bern, Swiss ehealth Barometer, December February (n old people's = approx. 400 in each case) The groups of health care professionals that see the greatest potential for improvement when it comes to interfaces with other key players vary. Nevertheless, some groups clearly stand out. Specialists, acute-care hospitals and general practitioners appear in the top three of the groups with the greatest potential for improvement in almost all cases. The electronic patient record is assigned great potential by majorities in all groups of health care professionals when it comes to integrated care.

Table 1 Potential for improvement to interfaces (% yes, of course/yes, possibly in brackets) Rank Doctors IT at hospitals Pharmacies 1 Specialists (82) Acute-care hospitals (96) 2 Acute-care hospitals (82) 3 General practitioners (81) Specialists (9) General practitioners (94) Old people s homes NPO Spitex Specialists (94) Hausärzte (88) Acute-care hospitals (9) Acute-care hospitals (93) General practitioners (92) Acute-care hospitals (88) Specialists (86) Specialists (9) Rehabilitation clinics (9) 4 Pharmacies (77) Pharmacies (90) Pharmacies (92) Spitex (8) General practitioners (94) Spitex (72) Rehabilitation clinics (89) 6 Rehabilitation clinics (71) 7 Old people s homes (67) 8 Therapeutic groups (64) Alters- und Pflegeheime (84) Spitex (84) Therapeutic groups (83) Spitex (91) Old people s homes (89) Rehabilitation clinics (87) 9 Midwives (43) Midwives (49) Therapeutic groups (74) gfs.bern, Swiss ehealth Barometer, December February Rehabilitation clinics (83) Pharmacies (82) Spitex (87) Old people s homes (82) Old people s homes (91) Pharmacies (86) Midwives (7) Therapeutic groups (70) Therapeutic groups (71) Midwives (18) Midwives (39) Figure Internal networking index Significant differences remain when it comes to the status of networking within an organisation and networking with external organisations. The type of clinical data that is generated electronically and made available to the respective patients and also exchanged within the individual institutions has remained relatively constant within the individual groups of key players and is based on the specific needs of the working environment of each health care professional. With the exception of pharmacies, which to perform their task also simply require access to fewer different data sources than care homes, for example, the degree of internal networking is advancing slowly but surely. External networking index 0 0 90 Doctors 90 Doctors 80 70 60 0 40 30 6 46 36 3 66 69 2 42 40 3 4 42 41 71 6 48 44 43 IT-hospitals Pharmacists Old people's homes NPO-Spitex 80 70 60 0 40 IT-hospitals Pharmacists Old people's homes NPO-Spitex 20 0 1 14 14 14 gfs.bern, Swiss ehealth Barometer, December February Total 30 24 2 19 19 22 20 19 19 17 12 12 12 14 1 1 8 12 14 4 6 0 gfs.bern, Swiss ehealth Barometer, December February Total 6

The receiving of data from sources outside an institution, i.e. external networking, is far less advanced, however. Nevertheless, certain progress has been observed over time in this area, with hospitals once again at the forefront of these developments. Introduction of electronic patient record The majority of all health care professionals and the eligible voters support the introduction of an electronic patient record. Here, the level of approval among the eligible voters is exactly the same as that of members of the medical profession. Relatively speaking, these are the two most critical groups. Between and, a reduction was observed in the level of approval for the electronic patient record. There has been a change to this development in, however. Figure 6 Trend in comparison of the assessment of the introduction of the electronic patient record "Do you basically support the introduction of an electronic patient record? Are you..." As a % of surveyed doctors, IT at hospitals, pharmacists, cantons, old people s homes, IT at Curaviva, NPO Spitex, eligible voters, percentage of those who are definitely/to some extent for 0 93 69 0 0 9 9 90 83 83 82 80 80 78 79 78 71 7 77 74 72 76 68 71 6 71 68 63 64 63 61 9 6 6 4 3 Doctors IT-hospitals Pharmacists Cantons Old people's homes IT-Curaviva NPO-Spitex Eligible voters 2012 2013 gfs.bern, Swiss ehealth Barometer, December February In line with the findings on the status of ehealth with the health care professionals, an emphasis is placed on the definition of common standards and training measures when it comes to the desired measures for the introduction of the electronic patient dossier. Here, the cantons primarily see their role in the areas of coordination and, where necessary, regulation. At this time, only minorities of all the surveyed key players would like to offer an electronic patient record, even to their own patients or clients. With regard to the introduction and offering of electronic patient records, hospital doctors and pharmacies are most likely to be among the leaders in this regard. At the NPO Spitex, a considerable leap in the degree of willingness to offer an electronic patient record can be observed relative to. 7

Figure 7 Trend in comparison of future offering of an electronic patient record "Do you yourself want to offer your patients/clients an electronic patient record in the future?" As a % of surveyed doctors, pharmacists, NPO Spitex 36 33 14 12 No 49 46 2 43 48 9 1 Don't know/no answer 19 40 36 46 20 28 Yes Figure 8 Doctors with own medical practice Hospital doctors Pharmacists NPO-Spitex gfs.bern, Swiss ehealth Barometer, December February Nevertheless, in cases in which a desire was expressed to do so, an emphasis was primarily placed on the improvement of work processes. Transparency (especially for the NPO Spitex) and data accessibility (especially for pharmacies) also play a role, however. Arguments against the offering of an electronic patient record include the issue of data protection (members of the medical profession, pharmacies) and the continuing uncertainty as regards the benefits of the record (especially at the NPO Spitex). Filter comparison of reason for the offering of an electronic patient record "Why do you want to offer your patients/clients an electronic patient record?" As a % of surveyed doctors, pharmacists, NPO-Spitex wanting to offer electronic patient records in future Improvement of work processes Transparency Availability of data General Other Don t know/no answer 1 1 16 20 16 31 40 40 gfs.bern, Swiss ehealth Barometer, December February (n doctors = 128, n pharmacists = 188, n NPO Spitex = 49) 39 4 8 77 78 Doctors Pharmacists NPO-Spitex Filter comparison of reason for not offering an electronic patient record "Why do you not want to offer your patients/clients an electronic patient record?" As a % of surveyed doctors, pharmacists, NPO Spitex not wanting to offer electronic patient records in future Data protection Dubious benefits General Cost reasons Other Don t know/no answer 4 6 8 11 13 22 26 19 23 3 33 31 32 33 gfs.bern, Swiss ehealth Barometer, December February (n Doctors = 142, n Pharmacists = 19, n NPO-Spitex = 36) 42 Ärztinnen/ärzte Apotheker Spitex In the different cantons and regions, associations of health care professionals are currently being formed as a prerequisite for the introduction of electronic patient records. As before, there is a clear preference among all key players to join an association in which various representatives of their own or very closely related professional groups are members. The desire for a cantonal-based association, which is already also reflected in the expressed participation in implementation projects, is also frequently communicated. 8

It is difficult to assess the value and benefits of a good that you yourself have no or almost no experience with. Nevertheless, there does indeed appear to be a certain willingness to pay for access to an association of this kind. Figure 9 Comparison of amount that key players are willing to pay to join associations of health care professionals "How much would you or your organisation in principle be willing to pay to join such an association of health care professionals?" As a % of surveyed doctors, doctors with their own medical practice, pharmacists, old people s homes and nursing home, NPO Spitex Don t know/no answer 8 6 61 66 78 More than 00 CHF 01 to 00 CHF 2 1 2 1 11 12 4 4 24 2 2 7 8 12 6 6 3 3 3 2 12 12 9 Doctors Doctors with own medical practice Pharmacists Old people's and nursing homes NPO-Spitex gfs.bern, Swiss ehealth Barometer, December February 1 to 00 CHF 1 to 0 CHF Nothing Data protection Data protection remains a key factor for the success of ehealth in Switzerland and especially also for the successful introduction of the electronic patient record. The idea that patients and clients will in future even be able to access their own data directly is generating mixed feelings among health care professionals. Among members of the medical profession, in particular, only a minority believe that this option offers a benefit. Nevertheless, the level of approval in this regard has increased over recent years. While the eligible voters welcome the access to their own data that is opening up to them, it is still unclear to what extent they will actually make use of this access. The surveyed health care professionals are today confronted with requests from their patients to view their medical histories. Nevertheless, such requests remain rare. 9

2013 2013 2013 2013 2013 2013 Figure Trend in comparison of assessment of direct access to the patient record (1/2) "In future, it is planned that patients will be granted direct access to all data in their patient record via a portal and will be able to decide themselves on access to this data. As regards the medical care provided to patients, is this..." As a % of eligible voters, doctors, doctors with their own practice, hospital doctors, IT at hospitals 7 14 9 4 2 Eligible voters 16 14 14 9 8 18 1 17 9 1 13 9 7 4 4 3 7 14 16 16 24 14 33 32 37 36 39 18 22 2 22 2 22 22 22 31 28 3 7 Doctors 2 33 36 31 39 3 36 33 41 42 1 14 23 26 17 24 29 17 19 27 26 24 27 27 20 20 19 46 38 3 3 3 3 8 6 4 7 Doctors with own medical practice Hospital doctors 17 19 gfs.bern, Swiss ehealth Barometer, December February 19 38 49 31 48 2 13 22 16 17 IT-hospitals A major disadvantage Fairly disadvantageous Don t know/no answer Fairly advantageous A major advantage Trend in comparison of assessment of direct access to the patient record (2/2) "In future, it is planned that patients will be granted direct access to all data in their patient record via a portal and will be able to decide themselves on access to this data. As regards the medical care provided to patients, is this..." As a % of surveyed eligible voters, pharmacists, old people s homes, cantons, IT at Curaviva, NPO Spitex 7 3 2 2 3 1 1 12 6 6 1 14 13 13 1 13 14 2 13 19 19 18 9 7 37 13 9 14 17 18 40 42 16 20 8 32 12 29 29 41 67 39 49 43 43 4 0 48 47 4 0 40 38 6 69 39 43 2 1 28 1 0 3 48 41 24 20 27 27 33 3 4 4 20 2 13 13 1 Eligible voters Pharmacists Cantons Old people's homes IT-Curaviva gfs.bern, Swiss ehealth Barometer, December February NPO-Spitex A major disadvantage Fairly disadvantageo us Don t know/no answer Fairly advantageous A major advantage At present, however, there is no continuation in the negative trend observed in as regards the trust placed in data protection by the bodies responsible for providing treatment. However, there are still concerns in this regard, especially among members of the medical profession working at practices. In contrast to the eligible voters, health care professionals are also of the opinion that their patients and clients are rather poorly qualified when it comes to making decisions on access to their own data. Grafik 11 Trend in comparison of trust in compliance with data protection "How much trust do you have that the authorities that work with patient data / resident data / client data also comply with data protection requirements in connection with the electronic patient record?" As a % of surveyed doctors, IT at hospitals, pharmacists, old people's homes, cantons, IT at Curaviva, NPO Spitex, share of those who trust them entirely / trust them to some extent 9 9 73 71 71 69 67 66 4 0 0 90 81 77 73 7 71 72 73 69 67 71 71 68 66 62 7 62 Doctors IT-hospitals Pharmacists Cantons 40 42 Old people's homes IT-Curaviva NPO-Spitex 2013 gfs.bern, Swiss ehealth Barometer, December February Data base For the seventh Swiss ehealth Barometer carried out on behalf of InfoSociety- Days, 37 doctors, 83 people responsible for IT at hospitals, 411 pharmacists, 43 people responsible at old people s homes, people

responsible for IT at the level of the cantons, 13 people responsible at the cantonal associations of Curaviva and 173 members of NPO Spitex grassroots organisations were surveyed in an online study. The survey was carried out between 1 December and 31 January. For members of the medical profession, there was also the possibility during this period to complete the survey on paper and return it by post. Conclusion of the study The following working hypotheses are provided as reading aids and to provide guidance for the classification of the key findings presented here. They should also sharpen the readers view as regards the further development of ehealth in Switzerland. Working hypothesis 1: Address increasing demand Movement can currently be observed in the level of patient demand for technologies and offers in the area of ehealth (e.g. apps). The opportunities created by this momentum should not be wasted by health care professionals and should instead be addressed with appropriate offers. Working hypothesis 2: Implementation of common standards ehealth is an issue that is now very much established among health care professionals. Nevertheless, there is still great potential for providing further clarification on the issue. When it comes to the implementation of common standards for all involved key players, in particular, there are still specific areas of uncertainty. The more that health care professionals are confronted with the implementation, the clearer it becomes to them just how much work still needs to be done. ehealth is currently being subjected to a reality check of sorts. Working hypothesis 3: IT and providers as drivers of progress The care professionals with direct patient contact (members of the medical profession, care home, NPO Spitex, pharmacies) are pivotal in ensuring the successful implementation and introduction of the electronic patient record. The providers and IT departments are proving to be effective drivers of progress here. Working hypothesis 4: as the turning point? The passing of EPRA in summer left a considerable mark on health care professionals. The issue appears to be a more topical item on the agenda. From the survey conducted in, the level of interest and ehealth itself have been addressed more systematically within the organisations. The modestly expressed enthusiasm must be addressed with a nationwide further-training effort. Working hypothesis : Focus at cantonal level The implementation of the Federal Act on the Electronic Patient Record requires the formation of associations of specialists. These are now becoming established, although efforts are still primarily being focussed at a cantonal level. For this reason too, an important active role in guiding these efforts is assigned to the cantonal authorities in their position as coordinators and regulators. 11

Working hypothesis 6: Diffusion required The specific application of ehealth, be this the electronic patient record, electronic vaccination record or the improvement of interfaces, is currently primarily being observed among specialists who are tasked with its implementation. This means in IT departments and at cantonal authorities. From now on, this momentum must be passed on to health care professionals, as ultimately they are responsible for the establishment of ehealth in the health care system. Working hypothesis 7: Implementation of electronic patients record which strategy promises success? In, a majority of the population can, for the first time, imagine opening an electronic patient record. At least some of them, however, would only do so on the recommendation of a health care professional as a rule their general practitioner. Compared to members of the medical profession with their own practice, the level of openness towards the electronic patient record is greater at hospitals and pharmacies. Also taking account of the regulation relating to double voluntary action, a strategy for the introduction of the electronic patient record that focuses on hospitals and pharmacies as well as care homes and NPO Spitex organisations could thus prove promising. 12

Annex gfs.bern Team LUKAS GOLDER Co-head, political and media scientist, Master of Advanced Studies in Communication Management Areas of focus: integrated communication and campaign analyses, image and reputation analyses, media analyses/media impact analyses, youth research and social change, votes, elections, modernisation of the state, health policy reforms. Publications in omnibus volumes, specialist magazines, daily press and on the internet CLOÉ JANS Junior project manager, political scientist Areas of focus: votes and elections, society research, campaigns, analysis of political themes and issues, media content analyses, teaching STEPHAN TSCHÖPE Head of analysis and services, political scientist Areas of focus: coordination of services, complex statistical data analytics, EDP and survey programming, projections, party and structural analyses with aggregate data, integrated communication analyses, visualisation ALEXANDER FRIND Data analyst, political scientist Areas of focus: data analysis, programming, qualitative methods, research, media analyses, visualisations 13

NOAH HERZOG Secretary s office and administration, Swiss Federal Certificate of Competence as a business specialist Areas of focus: desktop publishing, visualisations, project administration, presentation administration 14

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