The digital stethoscope: Why Switzerland's Electronic Health Record requires citizen testing

Area of Science:

• Health Informatics
• Digital Health Systems
• Public Policy

Background:

• Switzerland's Electronic Patient Record (EPR) system suffers from critically low adoption rates (<2%) despite significant investment.
• Understanding citizen perspectives is crucial for addressing the EPR adoption crisis and improving digital health infrastructure.

Purpose of the Study:

• To conduct the first citizen-led, real-world assessment of Switzerland's digital health infrastructure, focusing on the Electronic Patient Record (EPR).
• To identify key barriers and opportunities for improving the EPR system from the user's perspective.

Main Methods:

• A citizen-led "expedition" involving 120 volunteers ("salutonauts") systematically tested the EPR system.
• Participants opened EPRs, requested health data, and documented their experiences with the digital health infrastructure.

Main Results:

• Citizens value the concept of secure, personally controlled health records.
• Current EPR implementation is economically unviable, with estimated costs exceeding billions for nationwide opening, data uploading, and insurance claims retrieval.
• 95% of participants desired structured data from comprehensive checkups, indicating a demand for beneficial digital health records.

Conclusions:

• The current EPR system is impractical and economically unsustainable, necessitating an evidence-based redesign.
• The proposed Electronic Health Dossier Law (E-GD) revision presents a critical opportunity to create a patient- and physician-centric EPR system.
• Recommendations for successful implementation include default EPR opening at birth, AI-driven data automation, streamlined interfaces, and utilizing EPR for billing.