What Switzerland can learn from Estonia’s Electronic Health Records


On April 15, 2017, the law on electronic patient records (German: Gesetzgebung Elektronisches Patientendossier, short: EPDG) came into force. The law regulates the implementation of electronic patient records (German: Elektronische Patientendossiers, short: EPD) in Switzerland. It is aimed to build trust in the system, secure interoperability and security, and thus encourage the wide-spread use of the records. However, there still are numerous critics that question the actual as well as potential acceptance of the system among the Swiss population and healthcare providers.

Other countries have introduced similar systems before, so a look abroad might be useful to assess the points of criticism that have been put forward. In 2008, Estonia was the first country to implement a nationwide electronic health records system (EHR). Until today, the system serves as a model because of the high acceptance among Estonian patients and healthcare providers. So what made the Estonian system the most successful system there is today?

Estonian patients are free to decide whether they want their data to be centrally stored, and they can set restrictions of access to their health data. They have full access to their medical history and, what is more important, a comprehensive overview of how their medical records are used by medical institutions, by the state, and by other EHR participants. The same is true for the Swiss system. Although medical personnel are allowed to save documents in the record system without having access rights, they need access rights, which are assigned by the patients, in order to retrieve documents. All retrievals are documented, so the patient has a complete overview on who is accessing which information. This is all regulated by the EPDG and cannot be overruled by cantonal regulations.

Many have criticized, however, that the EPD does not simplify or support current processes for medical personnel but ultimately changes the way they work which will limit acceptance. The Estonian system has an especially high acceptance among healthcare providers. Estonian officials recommend involving healthcare providers in the development process from the beginning to minimize the rejection by medical personnel. Above that, they argue that the solution needs to be fast and simple, and that it should have a balance between security and usability. For both patients and healthcare providers, incentives and motivations are necessary from the start to achieve a digital documentation that is as complete as possible.

The EPD seems to be on a good track but needs some more effort to ensure a widespread use of the system. Providing patients access to their data and the right to decide on how to use it surely has huge potential. Still, only if the system is used by the majority of participants, it will be possible to capture its full potential and consequently increase efficiency of the Swiss healthcare system.