Every month, we meet with players in the Valais healthcare ecosystem. Today, we interviewed Cédric Michelet, head of eHealth at the Public Health Service (SSP) of the canton of Valais, to take stock of the availability of the electronic patient record (EPR) in Valais and the health digitization projects that are occupying the SSP.
The electronic patient record has been at the heart of the news in recent months. Indeed, many questions remain about its adoption in Switzerland. The data contained in this file is extremely sensitive, so how can we trust digital solutions? Cédric Michelet sheds light on the situation in Valais and reveals the different projects of digitalization of health that occupy the Public Health Service.
Could you briefly introduce yourself and describe your role within the Public Health Department?
After nine years at the Hôpital du Valais, where I set up various projects, both within the institution and at the cantonal level, particularly in relation to the exchange of medical information between healthcare professionals, I have been in charge of e-health at the Public Health Department for two and a half years.
Although eHealth encompasses a wide range of technologies and domains, my primary role is the implementation of the EPR in our canton and the coordination of these actions within the intercantonal association CARA that we founded with 5 cantons (Fribourg, Geneva, Jura, Vaud and Valais) in 2018.
My function covers the intercantonal coordination, that of the various local actors concerned by the EPR (hospital, clinics, pharmacies, EMS, CMS, patients…) and the concrete implementation and technical follow-up of the solutions.
The deployment of the EPR in French-speaking Switzerland experienced some technical problems at the beginning, especially in the access to the platform by the users. Could you tell us a little about this?
The EPR was initially planned for April 2020 in Switzerland. The Swiss government underestimated the complexity and duration of the audits needed to meet the legal requirements, so all projects were postponed. The CARA community, in which Valais participates, was certified in April 2021 (3rd community in Switzerland out of a dozen to have been certified, and the largest to date). Then, the platform was opened to the public at the beginning of June 2021. As the intercantonal platform is finally technically available, each canton can complete the integration with its local partners at its own pace.
It should be noted that in order to access an EPR a user (professional or patient) must have an electronic means of identification (EMI) that is also certified according to the law. These certifications have taken a long time, and have slowed down the implementation of the EPR; the referendum on the federal eID in March 2021 has also led to uncertainty in this sector. This is why, while waiting for the potential arrival of the federal eID in a few years’ time, the canton of Valais has decided to offer its citizens a SwissID from the company SwissSign, in order to access e-health services first, and then certainly e-government services. This implementation is an additional task for the canton and is also one of the factors delaying the initial schedule.
In addition, beyond the technical concerns of the project’s youth, it should be noted that the legislator, when he conceived the law and the ordinances surrounding the implementation of the EPR in Switzerland, put two principles at the heart of his considerations: security and the patient at the center. Requiring a very high level of security is obviously inevitable given the sensitive content of medical information. However, it is important to be aware that requiring a higher level of security than that of the banks implies, on the one hand, significant costs to be borne by the cantons and, on the other hand, an increase in the level of complexity of the system and its access by the end users. In addition, giving patients full control over both the management of their EPR and access to it implies that they have an active role, with the risk that their EPR will remain unusable or inaccessible if it is poorly configured or badly managed.
It is therefore vital to have the best possible support for each user in order to make the experience as simple and ergonomic as possible; but it will still take some time for everything to fall into place correctly.
What about the adoption of the EPR in Valais?
As previously mentioned, the canton of Valais has decided to make SwissIDs available to its population free of charge to access their EPR. To this end, 4 physical counters will be deployed throughout the canton, initially at the hospital sites of Martigny, Sion and Brig/Viège (alternating).
These counters will allow the verification process to be carried out in order to obtain a certified SwissID (level accepted for the EPR), but will also offer the possibility of opening a EPR.
These counters will normally be operational from the end of January 2022.
It is also possible to open an EPR via the CARA website. However, a certified SwissID is still required. This is why the canton of Valais has remained discreet for the time being in terms of communication about the EPR, until it has a complete system to welcome its citizens.
Discover the second part of the interview next week. Stay tuned!