Telematik-Rahmenarchitektur
Titel1
April 4th 2003, ZTG, Krefeld
The Missing eHealth
Strategy in Switzerland:
From Deregulation to
Innovation?
Martin D. Denz, Head eHealthcare
Swiss Medical Association FMH
ZTG, 030404
© Martin D. Denz, FMH
Overview
Titel1
1. Swiss Healthcare System
2. Key Players and Stakeholders
3. Electronic Health Card
4. Electronic Health Record
ZTG, 030404
© Martin D. Denz, FMH
Federal Government's
Strategy
Titel1
1998 "Strategy Infosociety"
• Abstention from any Key Role
• No Mentioning of Healthcare
• Innovation left to Private Initiative
• Government's responsibility for
social development of infosociety
ZTG, 030404
© Martin D. Denz, FMH
1 Country, 26 Healthcare
Systems
Titel1
Source: P. Berchtold, College-M
ZTG, 030404
© Martin D. Denz, FMH
Players in Swiss
Titel1 Healthcare
Cantons
Federal Government
Insurances
Taxpayers
Patients
Caregivers
e.g. Physicians, Hospitals
Source: P. Berchtold, College-M
ZTG, 030404
© Martin D. Denz, FMH
Legal Framework
Titel1 (KVG 1994)
• Obligatory health insurance, same service for all
• Optional features: HMO/PPO-models, Franchise
• Free choice of insurer (competition!)
• Federal Government defines complete services catalogue
(for in- and outpatients)
• Private insurances (Hotel services, free choice of
physician and hospital) are not part of the regulated social
insurance (solidarity excluded)
Source: P. Berchtold, College-M
ZTG, 030404
© Martin D. Denz, FMH
Legal Framework
Titel1 (KVG 1994)
• Cantons (States) organize provision of medical care:
Hospitals (planning, hospital lists, contribution),
emergency services
• Physicians paid by insurances: Compulsory contract
• Reimbursement by scales ("Tarife") negotiated between
caregivers and insurances (authorities)
Outpatients: TarMed, individual fees for private facilities
Inpatients (KVG): lump sums ("Pauschalen")
Source: P. Berchtold, College-M
ZTG, 030404
© Martin D. Denz, FMH
Need forTitel1
Coordination
Caregiving without coordination
6‘000 general practitioners
8‘000 specialists
2‘000 hospitals
Redundancy
Discontinuous processes
ZTG, 030404
© Martin D. Denz, FMH
Potential of Health
Titel1 Telematics
Swiss healthcare system costs
CHF 45 Mia / year
Theoretical potential of
optimization 10-20%
≥ CHF 8 Mia / year
ZTG, 030404
© Martin D. Denz, FMH
Overview
Titel1
1. Swiss Healthcare System
2. Key Players and Stakeholders
3. Electronic Health Card
4. Electronic Health Record
ZTG, 030404
© Martin D. Denz, FMH
Swiss Federal Social
Titel1 Insurance Office
Innovation in Healthcare Delivery
Useful Complement?
Ä Test Practical Value
Ä Deliver Quality
Ä Gather Experience
Let's do it!
Source: F. Britt, Vice-Director BSV
ZTG, 030404
© Martin D. Denz, FMH
Fostering Networks
Titel1& Managed Care
Use of legal liberties
More market orientation
Data & Transparency: Choice
Networks
Care Management
Info & Comm Technology
Source: F. Britt, Vice-Director BSV
Office for Education
Titel1 & Technology
Zur Anzeige wird der QuickTime™ Dekompressor „TIFF (Unkomprimiert)“ benötigt.
ZTG, 030404
© Martin D. Denz, FMH
Health
Info Net
Titel1
Zur Anzeige wird der QuickTime™ Dekompressor „TIFF (Unkomprimiert)“ benötigt.
www.hin.ch
• Spin-off of the Swiss Medical Association
FMH, founded 1996
• Security Provider, Internet-provider and
Community (CUG) of the FMH
• VPN-like client-based security solution
• Free for all members of the FMH
ZTG, 030404
© Martin D. Denz, FMH
Doctors' own
TrustCenters
Titel1
ZTG, 030404
© Martin D. Denz, FMH
Cultural Change:
Critical Incidents
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Source: M. Kaufmann
ZTG, 030404
© Martin D. Denz, FMH
Growing Demand
for Call-Centers
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1400
1200
1000
Sanitas
innova
HMO
Other
Intras
KPT
Beobachter
Rega
Source: Medgate
800
600
400
200
0
41 45 49 53 4
2000
8 12 16 20 24 28 32 36 40 44 48 52 4
2001
ZTG, 030404
8 12 16 20 24 28 32 36 40 44
2002
© Martin D. Denz, FMH
Insurers as Service
Titel1 Providers
Compass
answer each
question overall
contents
Legal support and
information by
mouse click only
Digital collection and
processing of the whole
knowledge in insurance
and health business
Medical care and
information
online and 7x24
hours
Digitalized
processes for
customers (B2C)
and partners (B2B)
Source: e4life / KPT
Customer relations
by personalized
services and
information
Management of
complex damages
and claims
ZTG, 030404
E-Learning by using
the entire
knowledge base
and services
© Martin D. Denz, FMH
Overview
Titel1
1. Swiss Healthcare System
2. Key Players and Stakeholders
3. Electronic Health Card
4. Electronic Health Record
ZTG, 030404
© Martin D. Denz, FMH
Patients: Real
Data Ownership
Titel1
Electronic Patient Record
Spital
Pflege
Patient
Vertrauensarzt
(Versicherer)
Arzt
Erteilen der Zugriffsberechtigung mit Kombination von
health Professional Card
und Patientenidentifikation
Apotheke
ZTG, 030404
Identifikation des Patienten
und Autorisierung der
Health Professionals durch
den Patienten
© Martin D. Denz, FMH
Electronic
Health Card
Titel1
Before Fall 2002:
• Patient Card & Health Professional Card
• Access Card, no medical information
• No link with Social Security ID
Since Fall 2002:
• Health Insurance Card
• Parlament rejects revision of KVG
• Still waiting for a national card solution…
ZTG, 030404
© Martin D. Denz, FMH
Introducing Electronic
Titel1 Health Card
ZTG, 030404
© Martin D. Denz, FMH
Tessin: Rete Sanitaria
Titel1 - Trial Phase
Source: I. Cassis & M. Della Santa
Region chosen: Town of Lugano and Surroundings
• Pharmacies
– 50 Pharmacists
– 100 Pharmacists' Assistants
• Ambulances
– 2 Emergency
Physicians
– 20 Ambulances
3’000 Patients
• Practitionners
– 40 General Practitionners
– 40 GPs' Assistants
• Hospitals
www.retesan.net
ZTG, 030404
– 50 Physicians
– 100 Nurses
– 30 Administrative Staff
© Martin D. Denz, FMH
Overview
Titel1
1. Swiss Healthcare System
2. Key Players and Stakeholders
3. Electronic Health Card
4. Electronic Health Record
ZTG, 030404
© Martin D. Denz, FMH
University Hospitals:
Titel1 Project UNIT
Results 1999-2002
• There are technical
solutions available
• priority to communicability of
information
• needs for shared standards
• needs for a clear communication
framework
ZTG, 030404
© Martin D. Denz, FMH
Seeking for Process
Titel1 -Integration
Performance
Today's Client
Server-Solutions
ASP-Solutions
e-hospital dismission
e-physician referral
e-hospital referral
e-health record
e-learning / CME
e-decision support & expert systems
Today's
Functions of GPs'
and Pharmacies'
Software
e-patient record
e-radiology assignment (incl. Feedb)
e-Laboratory assignment (incl. Feedb)
e-delivery / e-procurement
e-finance & e-trustee
e-patient admin data mgmt (z.B. Triadat)
e-databases (e.g.Galdat)
e-prescription (incl. Feedback)
Time
Source: triamun® - managing healthcare
ZTG, 030404
© Martin D. Denz, FMH
Bottom-up Titel1
Activity: compIS
Association for Compatible Medical
Practice Information Systems:
• Standardization and process optimization
• Interoperability between stakeholders
• Primary point of care as the starting
point of patients' clinical process
• Role of GP as the process-coordinator
• Evaluation: needs and certification of
information systems in ambulatory care
ZTG, 030404
© Martin D. Denz, FMH
Paradigm
Titel1 Shift
HUB
HUB
HUB
HUB
HUB
HUB
My
Database
ZTG, 030404
HUB
© Martin D. Denz, FMH
From Virtual Patient
Titel1 Record to…
Laboratory
Results
Optic Card
Dispensed
Medication
Personal Health
Record
Physician
Medical Record
Integrated Electronic
Medical Record
Dental Card
Clinical Medical
Records
Specialised Medical
Records
Implant Profile
ZTG, 030404
© Martin D. Denz, FMH
…to Patient-centric
Titel1 Meta Database
Specialised Medical
Records
Laboratory
Results
Input
Output
Optic Card
Physician
Medical Record
Dental Card
Clinical Medical
Records
Dispensed
Medication
Input
Meta
Database
IEM R
ZTG, 030404
Output
Health Profile
Implant Register
© Martin D. Denz, FMH
Thank you for Titel1
sharing knowledge!
ZTG, 030404
© Martin D. Denz, FMH
Building a Transnational
Hub
Titel1
Zürich, October 16-17th 2003
• Problem analysis
• Solution concepts
• Practical solutions
ZTG, 030404
© Martin D. Denz, FMH
Creating a Societal
Titel1 Discourse
December 10-12th 2003
• eSociety
• eEducation
• eHealth
http://www.itu.int/wsis/
ZTG, 030404
© Martin D. Denz, FMH