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CARA: at full speed towards the digitalisation of the Swiss healthcare system

Interview with Patrice Hof, General Secretary at Association CARA

What is CARA?

CARA is an association founded in spring 2018 by five Cantons of west Switzerland (Geneva, Valais, Vaud, Fribourg, Jura). It aims at implementing the Electronic Health Record (Dossier Electronique du Patient, DEP) as required by the federal law (LDEP) and more broadly at developing digital health in the different Cantons members of the association.

Behind this, the real objective is to leverage the potential of such a powerful technological tool to contribute to the achievement of public health objectives.

Why such a big effort to achieve this objective?

An improved healthcare system has to place the patient at the centre of care, as owner of his own health data and has to provide an adequate continuum of care, a more efficient coordination, communication and information transfer among the different healthcare professionals. It is a radical change that requires a huge effort. In such a system the patient will finally have the chance to play an active role in managing his health; the long-term objective is a deeper awareness of the healthcare pathway and an increased compliance to the therapeutic process. The priority ambition of the project is to open the e-health platform by the deadline set by the law on the 15th April 2020.

Do you think the need for such a change is perceived broadly enough?

I think we still don’t hear enough about digital health. The interest of healthcare professionals is there, they know it will help to increase the quality of healthcare but at the same time it implies a true paradigm shift: the doctor won’t own patient data anymore, the patient will. Right now, I think it is still difficult to determine the impact this will have on the healthcare system. On the patient side, pilot experiments showed that especially chronic patients under multiple treatments understand the great potential of the DEP. This may sound a bit paradoxical since the elderly (often the sicker patients) are much less familiar with the technology compared with the younger generations who do not necessarily realize the benefits of the DEP at this stage. However, the engagement of the whole community is crucial and will require a significant effort.

Which are the most difficult barriers you are currently facing?

Right now the simultaneous development of all the different components of the project by the deadline with a too little team capacity is the biggest challenge: data safety, communication, health literacy, cultural change, technical development… Multiple interactions between these several aspects must be established as soon as possible. Furthermore, we should not forget that five Cantons with different sizes, healthcare contexts and landscapes are being aligned. We need to take into consideration everything and a customized implementation and deployment strategy is needed.

Which are the main advantages patients will have by adhering to the DEP?

Patients will have access to their data anytime and from anywhere. How many times do we wonder: when did I have that? Which antibiotic did I take? What happened that time? This won’t happen anymore because they will have the entire information and will be able to easily communicate all their data to a new doctor or specialist.

Why is digital health the future?

I think the digitalisation in general is the future, and the healthcare goes with it. It’s a groundswell movement that we observe in all domains of society and the healthcare is necessarily part of it. In the digitalisation of healthcare process, Switzerland is late compared to other countries and we now have the chance to catch up!


Interview date: February 2019 (Beatrice Volpe, Vivactis Switzerland)