TCM therapists and their possibility to participate in the Electronic Patient Record

Electronic Patient Record, E-Health

The age of digitalization has revolutionized the Swiss healthcare sector. The integration of information and communication technologies (ICT) through IT applications or mobile devices enables the design, support and networking of all processes and participants. Now TCM therapists and their patients should also be able to benefit from it. With the introduction of the Electronic Patient Record (EPR), it is no longer only technically possible, but also legally permissible, to make certain health data available digitally to a larger circle of healthcare professionals. This article introduces the content and concept of the EPR and refers to practical aspects for TCM therapists.

What's the EPR?

The EPR is, simplifying described, a digital patient record. It is a virtual and dynamic collection point of links from which decentralized medical data and documents (e.g. reports, laboratory data, prescriptions or vaccination cards) of patients can be accessed. The EPR is recreated with each query for a specific treatment case and links the treatment-relevant information, which is made accessible in various data storage systems.

The EPR therefore does not create a uniform patient record (e.g. as a chip card with all health data of a specific patient) or a new, additional data collection (in the sense of a national data pool with all health data of the entire population), but rather an artificial unit of health-relevant information on a specific person as well as various data storage systems and a multitude of technical applications.

The EPR has its legal basis in the Federal Act on the Electronic Patient Record (EPRA) and the associated ordinances, all of which have been in force since 15 April 2017. The EPR will be introduced gradually and should be available throughout Switzerland in spring 2020. As a result, participation in the EPR is not yet possible.

What are the advantages of the EPR?

The advantages of the EPR can be summarised as follows:

  • easier coordination between different healthcare professionals;
  • access to all health data by patients at all times;
  • fast access to important information in emergencies;
  • simplified processing through standardised data by all healthcare professionals.

Can I participate in the EPR as a TCM therapist?

The law stipulates that both patients and healthcare professionals can store and access health data in the EPR. The term "healthcare professionals" is to be understood broadly. This includes all occupational groups in the healthcare system with federally or cantonally recognised training such as doctors, psychologists, pharmacists or nurses.

Whether a person has the professional qualification for a healthcare professional can usually be checked in a federal or cantonal professional register. The national register of healthcare professions "NAREG" lists in particular healthcare professions with FH or HF qualifications. This register lists professions recognised under cantonal law and is the responsibility of the Conference of Health Directors CHD. Also listed are naturopathic practitioners with a federal diploma who carry out TCM therapies. Consequently, it is also open to TCM therapists to participate in the EPR. In specific individual cases, the respective (master) communities are responsible for checking professional qualifications.

What do I do if I want to participate in the EPR?

In order to be able to use the EPR, approved TCM therapists must join a so-called community or master community. For independently practicing TCM therapists, joining is voluntary. However, hospitals and rehabilitation clinics as well as birth centres and nursing homes are obliged to introduce the EPR from 2020 and 2022 respectively. If TCM therapists are connected to and work for institutions such as hospitals, clinics and practices of all kinds that participate in the EPR, they are indirectly integrated into the EPR system through these institutions. In addition, TCM therapists have the opportunity to be registered with more than one (master) community. This is the case, for example, if the TCM therapist works at two different institutions which are not affiliated to the same (master) community.

The federal government's website on the EPR (www.e-health-suisse.ch) contains various (master) communities, so-called providers, which TCM therapists can join. If the TCM therapist works in a health institution, it is likely that the institution will decide whether or not to join a (master) community.

Once the TCM therapist has selected the (master) community, he goes through a clearly defined admission process. Connection to the (master) community is in principle made via the health facility. If an independent TCM therapist would like to join, the connection is therefore not made through him as an individual, but through his individual practice. If the TCM therapist is logged in, he is entered in the EPR subscriber directory. This enables patients to find their TCM therapist quickly and easily and to grant access rights to specific data and documents as required. The technical connection of the TCM therapist is made either via an access portal or via treatment software.

Does participation in the EPR cost me anything?

The (master) communities are free to charge fees to their affiliated healthcare professionals, especially as they have to find sustainable funding for the EPR. However, it can be assumed that the EPR will be free of charge at least for the population or patients.

What do I have to consider regarding liability in connection with the EPR?

Since the keeping of medical records is one of the duties of the healthcare professional, the question arises as to what possible situations the healthcare professional is responsible for when using the EPR. Liability may arise, for example, if the healthcare professional has made incorrect entries in the EPR or omitted to make necessary entries. Cases of treatment errors against patients resulting from the erroneous creation or deletion of the EPR or from incorrect or incomplete entries in the EPR are likely to be of particular practical relevance. The eligible loss items are the costs of physical or mental impairments and loss of assets due to costly post-treatment.

To determine the basis of liability, a distinction must be made between whether the TCM therapist works in a private or public hospital or even independently in his own private practice. The diagnosis and therapy in a private practice or a private hospital are based on a contractual relationship under private law. This treatment contract is a mandate within the meaning of the Swiss Code of Obligations. The therapist, the hospital, the clinic, etc. are therefore liable under contract law. The patient must prove that the contractual relationship was poorly fulfilled and that he suffered damage as a result. Proving a breach of contract regularly proves difficult, as it has to be proven that the care expected from an average TCM therapist in this situation has not been applied. If the proof can be furnished, pure financial losses are also covered by the liability. The TCM therapist or the hospital can only be released from liability by proving that the TCM therapist cannot be accused of fault.

If a patient is treated in a public hospital, the contractual relationship between the parties must be qualified as a hospital or hospital admission contract, which is generally subject to public law. As a rule, liability is based on cantonal regulations.

If there is no direct contractual relationship between the patient and the TCM therapist (e.g. because the contract was concluded with the private clinic), the patient can only claim compensation for the damage caused by the TCM therapist directly from the TCM therapist in a non-contractual manner. The patient then has to prove the sharper basis of a claim for non-contractual liability. However, the patient is free to assert contractual liability against his contractual partner.

What can be said in summary

The Electronic Patient Record can make the everyday life of TCM therapists and patients much easier. Participation in EPR by TCM therapists is highly recommended due to the easier coordination between different healthcare professionals or the simplified processing through standardized data. In order to use the EPR, however, TCM therapists must join a (master) community, unless they are working for an institution that is itself involved in such a community.

November 2018 | Authors: Juana Vasella, Andrea Voëlin, Nadine Küng

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