The EPR in short
What is the EPR?
The electronic patient record (EPR) is a collection of personal documents containing information relating to the health of your patients. The patient determines who can see which documents and when. Via a secure internet connection, the information stored in the EPR is accessible to your patients and, if approved, to you as a healthcare professional at any time. This new way of exchanging information between patients and you as a treating healthcare professional is and the foundation for the future of a safe, high-quality and efficient Swiss healthcare system.
The aim of the EPR is set out in the Federal Act on the Electronic Patient Record (EPRA): “The aim of the electronic patient record is to strengthen the quality of medical treatment, improve treatment processes, increase patient safety, enhance the efficiency of the healthcare system, and promote the health literacy of patients.”
What is the EPR not?
The EPR does not contain all the electronically recorded health information concerning your patients, but only that which is relevant for other health professionals and for subsequent treatment.
Alongside the EPR, you will continue to maintain your patients’ complete medical records. These records contain far more information than the EPR – for example, your personal notes.
Authorities or health insurers cannot store documents in – or access – the EPR.
Who is the EPR designed for?
Everyone in Switzerland can open an EPR. As a rule, this is voluntary and free of charge, and the EPR can be closed again at any time by the owner. And even though it’s called a “patient record”, people don’t need to be ill to have an EPR – people who are healthy can open one too.
Both patients and their healthcare professionals are involved: patients as owners of their EPR and health professionals as participants.
More information on "Who can access the EPD? Healthcare professionals according to the EPRA":
Who is the EPR not designed for?
Persons and organisations not involved in patient care cannot access the EPR. Consequently, authorities or health insurers cannot store documents in the EPR.
Thus the EPR cannot be accessed by employers, authorities, health insurers, supplementary insurance providers or life insurers either. Nor can EPR documents be examined by a health insurer’s independent medical adviser.
Under the Federal Act on the Electronic Patient Record (EPRA), acute care hospitals, psychiatric clinics, rehabilitation centres, nursing homes, birthing centres and, from 2022, newly licensed medical practices are required to adopt the EPR. These healthcare professionals are also required to store important health information in the EPR as soon as their patients have opened their EPR.
Who has to connect to the EPR?
For all other healthcare professionals, participation in the EPR system is voluntary. This applies to, for example, independent physicians licensed before 2022, pharmacists, Spitex providers or physiotherapists.
The EPR makes it easier for you to access treatment-relevant information. Being able to exchange information directly facilitates coordination and cooperation among healthcare professionals.
The EPR can be useful in the fields of health promotion and prevention. Information on individual prevention can be stored and made accessible in the EPR, for example results from a preventive checkup or blood pressure readings. The EPR also strengthens patients’ rights and health literacy: it gives them access to their key documents without having to expressly request them from their healthcare professional. That means they can participate more actively and autonomously in the treatment process.
Today, interprofessional cooperation is a reality for most healthcare professionals. More and more parties from a range of specialised groups are involved in treatment. Even for more minor health problems, a treatment process could involve, among others, a physician, a pharmacist and a therapist. The more healthcare professionals are involved, the more a coordinated and efficient working relationship is required.
As an integrative data exchange platform, the EPR obviates the need for telephone queries or for requesting documents from other healthcare professionals, and thus reduces transmission errors. The data standardisation brought about by the EPR, including the structured exchange formats, allows the various healthcare organisations to share and read these structured data without having to deal with potential software incompatibilities. The more healthcare professionals and patients participate in the EPR system, the better and more efficiently the information will flow during a treatment.
Copies of documents deemed to be “treatment-relevant” are stored in the EPR. This means information which is important for the continuing treatment of the patients by other healthcare professionals, in an emergency or for isolated treatments by another healthcare professional. As a healthcare professional, you can, for example, upload a patient’s medication list, a nursing report or a hospital discharge report to the EPR. For their part, patients can also store documents in the EPR, for example an advance directive, organ donor card or previous medical findings.
Examples of documents stored by healthcare professionals:
- Current medication list
- Hospital discharge report after an operation
- Spitex home care report
- Updated vaccination card
- Information on known allergies
- X-ray findings
When you as a healthcare professional update existing documents, earlier versions remain available in the EPR.
The EPR contains only the patient health information which is relevant for other healthcare professionals and for subsequent treatment.
Alongside the EPR, healthcare professionals continue to maintain their patients’ complete medical records. These records contain far more information than the EPR – for example, the treating professional’s personal notes or the invoices for the health insurer.
As the attending healthcare professional, you decide which information is important for subsequent treatment by other healthcare professionals. However, patients can also request that specific documents not be included in their EPR.
For example, the hospital nurse will store the patient’s discharge report in their EPR to let Spitex employees know what to watch out for when providing care.
To gain access to an EPR, you will need to be registered with a certified EPR provider and have a secure electronic identity.
The most important thing, however, is the right of access. The patient grants this to you directly or indirectly, by authorising either you personally or the group of healthcare professionals of which you are a member. The right of access is always temporary.
Patients can change both the access settings and the confidentiality level of individual documents at any time.
The Federal Act on the Electronic Patient Record (EPRA) alters nothing in terms of the demarcation of responsibilities and the question of liability.
The EPR represents a new source of information that is now available to you. It alters nothing in terms of the existing duty of care. As before, it’s you who decides in any given situation what information you obtain where and what you take account of in your work. The EPR isn’t designed as a depository for all the documents and information about patients. It’s only intended for documents that are necessary for ongoing treatment. This means you should make sure you only use it to store information relevant to treatment. Patients don’t have to be asked for their consent each time. If your patient has an EPR, you can assume that they agree to having documents stored in it. In individual cases, a patient may ask you not to store documents on their current treatment in their EPR.
The usual rules on liability apply
Matters of liability are regulated in Articles 41 and 97ff of the Swiss Code of Obligations and in the relevant special statutory legislation. The EPR does not create any situation not covered by the present rules. The Federal Act on the Electronic Patient Record (EPRA) alters nothing in terms of the demarcation of responsibilities and the question of liability. The matter of whether a violation of duties of care has occurred in the event of an error must always be decided on the basis of the specific circumstances in the concrete case at hand. The decisive question is whether, in the situation at that time, a healthcare professional made a justifiable decision on the basis of the available information and diagnostic or therapeutic options. It is already the case that anyone who maintains patient documentation has to assume that third parties will trust in the information contained in them. They may become liable vis-à-vis patients if they suffer harm in the course of treatment by third parties owing to incomplete or incorrect information in the documentation.
The EPR will be gradually refined and improved. Initially documents will mainly be shared as PDFs. But it won’t be long before interactive formats can also be integrated on the EPR platform. This will enable you as doctors and pharmacists, for example, to adjust your patients’ current medication list directly in the EPR. The more people open an EPR and the more healthcare providers are prepared to store key documents in the record, the greater the benefit of the EPR will be. The goal should be that all the healthcare professionals involved in a patient’s care have access to the same information at all times. This will make the flow of information relating to a treatment better and more efficient.
Opening an EPR
How do healthcare professionals connect?
To take part in the EPR system you must select an EPR provider and go through their registration process.