Navigating the Challenge: Interoperable Health Data Exchange in Switzerland
30.05.24 | Oliver Egger
Mr Egger, you founded a company that specializes in standardizing the exchange of information in the healthcare sector.
Where do we stand today with the exchange of health information in Switzerland? Where does this commitment come from?
Switzerland is only just beginning to exchange health information across organizations and is lagging well behind other countries, as the Bertelsmann study has shown. A lot has happened internationally in recent years, hence our commitment. We want Switzerland to make progress in interoperable exchange as well.
How do you classify the EPR in this landscape? Where do you currently see its strengths and weaknesses?
The electronic patient record (EPR) is the first infrastructure in Switzerland that allows documents and data to be made available to everyone throughout Switzerland. This structure is a good foundation. We can see this in Austria, for example, where new applications were quickly made possible on the basis of ELGA (the Austrian equivalent of the EPR).
One challenge is the adoption of the Swiss EPR. On one hand, many service providers are not yet connected to the infrastructure, and on the other, there are still only a few people who have opened an EPR for themselves. I hope that the upcoming legislative revisions will contribute to a greater adoption of the EPR.
You have been working as a consultant for eHealth Suisse and the EPR for many years. Why do we not yet have more exchange formats that enable interoperable, structured data exchange?
Exchange formats, such as a structured medication plan or a laboratory report, contain a lot of information. The parties involved must agree on the meaning and relevance of terms so that information can be exchanged in a standardized way. This process is lengthy, as many stakeholders are involved and need to be integrated in order to achieve an optimal result for everyone. New exchange formats are being tested for their practicality: for example, as part of the EPR Projectathon. The first exchange formats have been created in the area of medication and vaccinations.
The development of exchange formats is increasingly taking place at European and at international level. Eight mandatory exchange formats are planned in the EU as part of the European Health Data Space. One of these, the laboratory report, is also being used as a basis in Switzerland. This is a good example of how international interoperability work functions.
Even if the exchange formats are defined, there is still a long way to go before they can be used in practice, as they first have to be integrated into the various software systems and processes. In addition, there is no regulation or incentive to use such exchange formats in Switzerland. The only exceptions so far are the two legally mandated eVaccination and eMedication exchange formats, the implementation of which is legally prescribed in Annex 4 of the Ordinance to the Federal Act on the EPR.
Various players in the healthcare sector demand structured data. Only then will the EPR be useful for them. What would you say to these people in response to their demands?
Medication lists and vaccinations can already be stored in the EPR in a structured way today. But there is a lack of commitment to implementation. Incentives or regulations should therefore be created to ensure that data is increasingly structured at source so that it is useful for recipients and service providers. In the US, for example, there is such a regulation, which requires every provider to supply patients with a core data set, via an interface, in a structured manner.
We are also seeing an increasing number of pilot projects in which AI is used to support the conversion of unstructured data into structured data. The much-cited PDF graveyard, which is criticized in the EPR, could be transformed into a container for structured data storage in the future.
What can eHealth Suisse do to promote structured data exchange even more? What can other players, such as the manufacturers of hospital information systems or primary systems, do to ensure that structured data exchange becomes the norm?
eHealth Suisse has played a pioneering role in the development of interoperable data exchange in Switzerland. In order to promote structured exchange, I believe it will be important for eHealth Suisse to define a core data set with a corresponding interface.
In the meantime, it is helpful when service providers request the corresponding interoperable approaches in their tenders and integrate them into their organization accordingly. There are innovative software companies who incorporate standardization directly into their products and actively participate in standardization activities. Ultimately, however, software companies will do what the market demands.
eHealth Suisse relies on the FHIR standard for the development of its exchange formats. Why is this the standard of the moment and who sets these standards?
FHIR is the latest generation of standards from HL7, an international standardization organization. On the one hand, FHIR makes it possible to structure healthcare data, on the other hand, this standard offers an interface (API) for the interoperable exchange of data. It is an open standard that is being further developed on a consensus basis, is widely accepted in the IT industry and has a large community. The fact that eHealth Suisse relies on FHIR for the development of exchange formats and for the further development of the EPR is therefore forward-looking.
What happens when different service providers work with different standards? Can the information be “translated” or does this make data exchange impossible?
Of course, FHIR is not the only standard. We have various standards that cover healthcare exchange at both national and international level. Standards can be mapped, but this involves additional work. For this reason, there are international initiatives such as the Joint Initiative Council to harmonize standards. In Switzerland, we are also in the process of coordinating the exchange of standardization organizations in the healthcare sector so that we can better harmonize the various standards and make them interoperable in the future.
Translation by Sarah Carrington.