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EHTEL, 021128 © Martin D. Denz, FMH

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The Implementation of The Implementation of eHealth in SwitzerlandeHealth in Switzerland

ororHow to Cook with WaterHow to Cook with Water

Martin D. Denz, Head eHealthcareSwiss Medical Association FMH

33rdrd Annual EHTEL Meeting, Bruges Annual EHTEL Meeting, Bruges

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

Titel1Titel11 Country, 26 Healthcare Systems1 Country, 26 Healthcare Systems

Source: P. Berchtold, College-M

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EHTEL, 021128 © Martin D. Denz, FMH

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Insurances

Caregiverse.g. Physicians, Hospitals

Taxpayers Patients

Federal Government Cantons

Players in Swiss HealthcarePlayers in Swiss Healthcare

Source: P. Berchtold, College-M

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EHTEL, 021128 © Martin D. Denz, FMH

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• 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)

Legal framework (KVG 1994)Legal framework (KVG 1994)

Source: P. Berchtold, College-M

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EHTEL, 021128 © Martin D. Denz, FMH

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• 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")

Legal framework (KVG 1994)Legal framework (KVG 1994)

Source: P. Berchtold, College-M

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EHTEL, 021128 © Martin D. Denz, FMH

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Caregiving without coordination

6‘000 general practitioners

8‘000 specialists

2‘000 hospitals

Redundancy

Discontinuous processes

Need for coordinationNeed for coordination

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EHTEL, 021128 © Martin D. Denz, FMH

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Swiss healthcare system costs

CHF 45 Mia / year

Theoretical potential of optimization 10-20%

≥ CHF 8 Mia / year

Potential of Health TelematicsPotential of Health Telematics

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

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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

Federal Government's StrategyFederal Government's Strategy

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EHTEL, 021128 © Martin D. Denz, FMH

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Useful Complement?

Test Practical Value

Deliver Quality

Gather Experience

Let's do it!

        

    

    

     

    

Swiss Federal Social Insurance OfficeSwiss Federal Social Insurance Office

Innovation in Healthcare Delivery

Source: F. Britt, Vice-Director BSV

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EHTEL, 021128 © Martin D. Denz, FMH

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President Brunner promotes:

• Interconnected Electronic Health Information Structures in Switzerland• Transmission Standards, Health Info Net• Information on eHealth: Best practice, demonstration of real world solutions• Quality assessment and improving• Ethical code: Internet HealthcareCoalition• Conference eHealthCare.ch, EHTEL

Swiss Medical Association FMHSwiss Medical Association FMH

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EHTEL, 021128 © Martin D. Denz, FMH

Titel1Titel1Cultural Change: Critical IncidentsCultural Change: Critical Incidents

Source: M. Kaufmann

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

Titel1Titel1Introducing Electronic Health CardIntroducing Electronic Health Card

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EHTEL, 021128 © Martin D. Denz, FMH

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• Practitionners– 40 General Practitionners– 40 GPs' Assistants

• Hospitals– 50 Physicians– 100 Nurses– 30 Administrative Staff

Region chosen: Town of Lugano and Surroundings

• Pharmacies– 50 Pharmacists– 100 Pharmacists' Assistants

• Ambulances– 2 Emergency

Physicians– 20 Ambulances

3’000 Patients

Tessin: Rete Sanitaria - Trial PhaseTessin: Rete Sanitaria - Trial PhaseSource: I. Cassis & M. Della Santa

www.retesan.net

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

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Industry Wholesalers Pharmacies Physicians Insurances

Patients

TrusteesClearing

Org.

HospitalsExisting Systems

?

? ?

?

DatenbasesUniversitiesLaboratoriesHealth Professionals'

Associations

? ? ? ?

GPs' Roundtable: Information GPs' Roundtable: Information Systems and IntersectionsSystems and Intersections

Source: triamun® - managing healthcare

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EHTEL, 021128 © Martin D. Denz, FMH

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Today's Functions of

GPs' and Pharmacies'

Software

Today's ClientServer-Solutions

ASP-Solutions

Time

Performance

e-prescription (incl. Feedback)

e-databases (e.g.Galdat)

e-patient admin data mgmt (z.B. Triadat)

e-finance & e-trustee

e-delivery / e-procurement

e-radiology assignment (incl. Feedb)

e-Laboratory assignment (incl. Feedb)

e-patient record

e-decision support & expert systems

e-learning / CME

e-health record

e-hospital referral

e-physician referral

e-hospital dismission

Seeking for Process-IntegrationSeeking for Process-Integration

Source: triamun® - managing healthcare

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

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2000 2001 2002

0

200

400

600

800

1000

1200

1400

41 45 49 53 4 8 12 16 20 24 28 32 36 40 44 48 52 4 8 12 16 20 24 28 32 36 40 44

Sanitas Intras

innova KPT

HMO Beobachter

Other Rega

Growing Demand for Call-Centers Growing Demand for Call-Centers

Source: Medgate

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EHTEL, 021128 © Martin D. Denz, FMH

Titel1Titel1Compass

answer each question overall

contents

Digital collection and processing of the whole knowledge in insurance

and health business

Digitalized processes for

customers (B2C) and partners (B2B)

Management of complex damages

and claims E-Learning by using the entire

knowledge base and services

Customer relations by personalized

services and information

Medical care and information

online and 7x24 hours

Legal support and information by

mouse click only

Insurers as Service ProvidersInsurers as Service Providers

Source: e4life / KPT

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EHTEL, 021128 © Martin D. Denz, FMH

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1. Swiss Healthcare System

2. Key Players Inducing Change

3. Cantons: Electronic Health Card

4. GP-Information Systems and ASP

5. Insurers: Innovative Care Concepts

6. Telemedicine and Contact Centers

Selective OverviewSelective Overview

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EHTEL, 021128 © Martin D. Denz, FMH

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Zürich liveZürich live

TV-UniTV-Uni USZ USZ

200-300 Participants200-300 Participants8 x / Year8 x / Year

BaselBasel

ZürichZürich

20022002multipointmultipoint

BrigBrig 1 ISDN-Leitung

1 ISDN-Leitung128 kbit/s128 kbit/s

3 ISD

N-Leitungen

3 ISD

N-Leitungen

384 kbit/s

384 kbit/s

Switch

BellinzonaBellinzona

St. GallenSt. Gallen

AarauAarau

MeranMeran

in house: IPin house: IP

ThunThun

3 ISDN-Leitungen

3 ISDN-Leitungen

384 kbit/s

384 kbit/s

Need for Reimbursement StructuresNeed for Reimbursement Structures

Source: University Hospital Zürich

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EHTEL, 021128 © Martin D. Denz, FMH

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Physician within 3 d

30%

Emergency15%

Self-Care41%

Ambulance1%

Physician within 3-7 d

13%

Contact Centers: New Experiences Contact Centers: New Experiences

Source:

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EHTEL, 021128 © Martin D. Denz, FMH

Titel1Titel1See you in Switzerland ;-)See you in Switzerland ;-)