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The unseen code: Unlock Switzerland’s female tech potential

This white paper aims to present solutions for solving the talent shortage in the technology sector by attracting a greater share of women to technology professions. By equipping stakeholders with actionable recommendations, it addresses missed opportunities arising from the gender imbalance.

Women are still significantly underrepresented in tech-related professions. On the occasion of International Women’s Day, McKinsey & Company, the Competence Centre for Diversity & Inclusion at the University of St. Gallen and digitalswitzerland are releasing the white paper “The unseen code: Unlock Switzerland’s female tech potential”. It serves as strategic guidance for the executives, policymakers, and professionals in the technology industry who are navigating the challenges posed by this shortage, with a specific focus on Switzerland.

Featuring expert insights from leaders in the Swiss technology industry, The white paper highlights the need to address the talent shortage and to enhance Switzerland’s competitiveness by empowering female talents to enter or transition to tech professions: Creating a corporate culture that supports women is crucial, as is retaining talent, promoting career changers, and enabling women to enter the industry in the first place. Additionally, it is important to take measures across company boundaries to address structural factors and make the tech industry more attractive to women.

Find the full white paper here.

In our latest whitepaper, “Charting the Future: Switzerland’s Path to Generative AI Leadership in 2024 and Beyond”, we dissect the transformative impact of Artificial Intelligence (AI) and generative AI (GenAI) in Switzerland as of 2024. Backed by a survey of 279 Swiss professionals and insights from expert-led Digital Xchange workshops, the findings paint a vivid picture of the GenAI landscape.

The Current Landscape: The survey reveals a robust 62% adoption of AI, with a significant 30.6% implementation across five or more business functions. However, a closer look uncovers a landscape in flux, with 50% of respondents anticipating a major shift in jobs within the next three to five years.

Challenges and Concerns: While enthusiasm for GenAI is palpable, concerns remain. Privacy, data breaches, and over-reliance on technology emerge as key worries. Furthermore, a staggering 52% of organisations lack clear policies on AI in the workplace, indicating a critical need for guidelines.

Urgent Issues: Two pressing issues demand immediate attention. First, the survey signals an outright explosion in demand for skills training as GenAI reshapes the workplace. Second, there is a concerning lack of awareness among Swiss professionals regarding official GenAI policies, with only a third advocating for more government regulation.

Actionable Recommendations: Our whitepaper concludes with strategic recommendations for policymakers, business leaders, and education providers. Urgent actions include the establishment of a robust educational and political framework, investment in transforming continuing education, and a focus on the judicious use of GenAI to maximise opportunities while minimising risks.

Join the Conversation: As Switzerland stands at the crossroads of GenAI innovation, we invite you to study the full whitepaper, to gain a comprehensive understanding of the challenges and opportunities that lie ahead. Read the full report here.

This whitepaper was jointly created and published by digitalswitzerland, IMD and EPFL.

Executive Summary

Switzerland is one of the most innovative countries in the world, but when it comes to digitalisation of its healthcare system, the process of implementation is very slow. Nevertheless, the Federal Council is currently supporting the transformation with its Health2030 Strategy and its digital health promotion programme Digisanté. A central pillar of this digitalisation process is the electronic patient record (EPR) which has faced many hurdles to be implemented and adopted successfully due to the fragmented Swiss healthcare system. 

Switzerland has three main regions, which are home to digital health innovations: canton of Zurich, the Arc lémanique region and the Great Basel Area. These locations place Switzerland as a great digital health market where companies and startups choose to settle. 357 digital health startups were identified in Switzerland by the Swiss Healthcare Startup’s directory guide spanning through the entire patient journey (from prevention to diagnosis, treatment and monitoring). This correlates with the constant increase in investment in such ventures. However, these organisations face many hurdles, especially with reimbursement of their solutions, as the mechanism is complex and reimbursement for digital health solutions is not transparent.

According to our population survey, conducted in 2022, 68% of the population want to be owners of their personal health data. It is therefore key to empower patients more to better understand and use their health data through training, education and awareness-raising measures. Swiss Health Data Space, is a new initiative going in this direction, as it recruits pioneers who want to test and explore the digital healthcare infrastructure in Switzerland while keeping full control and ownership of their health data.

Digital health ecosystems are slowly emerging, for example networks of different organisations and solutions across the healthcare sector that share a digital infrastructure to ensure a seamless experience for patients. These networks increase transparency and efficiency in communication between the different actors. One such example is the Swiss Patient Journey Ecosystem Map.

Already now, numerous Swiss solutions support the overall patient empowerment, such as the four scaleups that were part of the Digital Health Academy’s 2023 cohort: Decentriq, heyPatient, Soignez-moi, and TOM Medications.

Eventually, the future of healthcare should be human-centric, fostering education and empowerment of the population to better understand their health data and navigate their digital health journey. Citizens should collaborate more with healthcare professionals, as this will strengthen their relationship and trust, as well as ensuring the continuum of care. Additionally, innovators and investors need to build symbiotic relationships as strategic investors provide valuable resources to innovators who are navigating the complex healthcare landscape; this will ensure long-term impact. Last but not least, public authorities need to set national standards and a clear framework for digital health in Switzerland, ensuring that solutions to our current problems are based on the same standards.

Chapter 1: Introduction to digital health

1.1 Background 

Switzerland is recognised as one of the most innovative countries in the world, highly ranked for many years in the IMD World Digital Competitiveness (WDC): it was ranked 5th in 2022 and in 2023 it can hold its position once again (IMD World Competitiveness Center, 2022). Similarly, Switzerland ranks 1st in the Global Innovation Index (Dutta et al., 2023), with the Index highlighting the significant R&D investment of Swiss global corporates, led by life science giants Roche and Novartis.

The Swiss healthcare system is one of the sectors in which Switzerland still lags behind in terms of digitalisation, as underlined by the “Bertelsmann Stiftung’s Digitalisation Index” (Bertelsmann Stiftung, 2019), where it was only ranked 14th. 

Digital health refers to the use of information and communications technologies in medicine and other health professions to manage illnesses and health risks and to promote wellness (Ronquillo et al., 2023). It has a broad scope, spanning through the entire patient journey (from prevention to diagnosis, treatment and monitoring) and includes mobile health apps, electronic health records, wearable devices with sensors, telemedicine and personalised medicine. Digital health has various benefits such as accessibility, accuracy, time saving and cost reduction.

The COVID-pandemic played a massive role in digital health’s growth worldwide, as new solutions were developed to support the healthcare of the population through the crisis, and a necessity to switch to at-home or minimal contact care models. Certain countries have been able to implement the necessary infrastructure and regulations required to digitalise their healthcare systems such as Estonia, Canada, Spain, Israel and Denmark. Their governments have made clear commitments to supporting the development of the sector. 

Switzerland is also trying to win back lost times by developing the digital health sector positively through various innovative solutions.

The Federal Council is currently supporting the digital transformation of healthcare in Switzerland through different ways. In the Health2030 Strategy, it defined the new health policy priorities, setting digital transformation as one of the main objectives (Federal Office of Public Health, 2019). In addition, the Federal Office of Public Health (FOPH) and the Federal Statistical Office (FSO) are jointly developing on behalf of the Federal Council, the digital health promotion programme Digisanté (Federal Office of Public Health – Digisanté, 2023).

Switzerland is facing complexities in the introduction of digital solutions such as the electronic patient record (EPR) (Patientrecord.ch). Due to its fragmented healthcare system and cantonal policies, its law has recently been placed in consultation to identify the optimal changes required for it to finally be adopted successfully by the population. As the governmental solution is taking a lot of time to be installed, healthcare players identified opportunities to launch joint consortiums to provide a digital health platform. The two biggest consortiums are Compassanna (Bluespace Ventures AG, 2023) and Well (Well Gesundheit AG, 2023). 

In recent population studies, it was clearly identified that the Swiss population is willing to share their health data digitally (Pletscher & Lerch, 2022) and onboard a digital health journey (Sternberg, 2022) given it has clear added value.

1.2 State of the digital health landscape

Switzerland’s digital health landscape has expanded in various areas over the years: telemedicine, wearables, patient records, healthy ageing, mental health, femtech, value-based healthcare and personalised medicine. 

Three principal regions are home to digital health innovations: Canton of Zurich, the Arc lémanique region and the Great Basel Area.

Zurich is the home to major technology companies, key universities in Switzerland (ETH, UZH, ZHAW) as well as many hospitals. In recent years, Zurich has grown its digital health footprint through the development of digital health hubs and incubators such as Digital Health centre in Bülach, Bluelion, and HealthTechPark in Schlieren.

L’Arc lémanique has also expanded massively, especially around Lausanne and Geneva due to the presence of  EPFL, university hospitals (CHUV and HUG) and campus of Biotech Innovation Park and Biopôle. 

Last but not least, the Great Basel area is a flourishing region, where pharmaceutical companies and medtech are closely located to the university hospital. DayOne from Basel Area has also recently grown massively and is leading a four-year Innosuisse Innobooster around digital health, the Digital Health Nation Innobooster.

These ideal locations position Switzerland as a great digital health market where companies choose to settle, and startups choose to be founded.

The digital health startup scene is also growing massively in Switzerland with 357 digital health related startups and scaleups identified in Swiss Healthcare Startups’ digital directory in October 2023 (Cortex – Swiss Healthcare Startup, 2023). Many incubators and acceleration programmes support the emergence of startups such as the Digital Health Nation Innobooster (Basel Area Business & Innovation, 2023). 

Investment into Swiss digital health startups has been steadily increasing until this year, reaching 30 investment rounds in 2022 (8% of all rounds) totalling close to 200M CHF (5% of all capital invested to Swiss startups in 2023). Just over 50% of these funds were invested into digital health startups in canton Vaud (Swiss Venture Capital Report, 2023).

One major hurdle which the startups in digital health are continuously facing is their business model, as reimbursement of digital health solutions in Switzerland is still not a transparent process. In comparison, Germany’s DiGa legislation is in place since the end of 2019 (BfArM, 2023), Belgium’s mHealth app reimbursement since 2021 (Agoria and beMedTech, 2023), and France’s PECAN legislation was approved earlier this year (2023) (Farah et al., 2023). Health applications in Switzerland that follow specific rules can be reimbursed by the basic insurance as stated in the Information Sheet provided by the Federal Office of Public Health (Federal Office of Public Health, 2022).

1.3 Citizen’s empowerment to own and understand their health data and health journey

According to digitalswitzerland’s 2022 study, which is based on the results of a population survey on the needs and fears towards the digitalisation of the Swiss healthcare system, citizens are willing to share their data digitally, given it has clear added value such as better usability (Sternberg, 2022).

It must also offer enhanced prevention, improved diagnosis and treatments and lower healthcare costs. One major finding from the study is the correlation between the level of education and the level of digital literacy and health literacy in Switzerland. 

Careum Foundation, combined both terms into a new term, digital health literacy, which is defined as the degree to which individuals are able to obtain, understand and judge health information from digital sources and use it to make decisions about their health. Careum Foundation worked on a two-year study project on health literacy (2019-2021) where they found that 72% of the Swiss population has difficulties in dealing with digital information and services and accordingly has very low levels of digital health literacy (De Gani et al., 2021).

Giving equal access to digital health competences in Switzerland should be a key focus to enable the population to feel empowered over their health data. More awareness-raising measures should be developed to support this. 

68% of the population want to be the owners of their personal health data (Sternberg, 2022). Citizens want to be in control of their health data, know who has access to it and give consent to how it can be used for research (swissethics, 2021). The electronic patient record (EPR) is going in this direction as each individual has control over who can access their health information. The Federal Act on the electronic patient record, which states the framework conditions for the EPR has recently been put in revision to be adapted and ensure a successful adoption and use within Switzerland (Federal Office of Public Health – EPRA, 2023). 

Furthermore, a new initiative was launched at the end of 2022 with Swiss Health Data Space, which recruits pioneers who want to test and explore the health data landscape in Switzerland while keeping full control and ownership of their health data (Verein Gesundheitsdatenraum Schweiz, 2022).

The future of healthcare should be human-centric with a key focus set on educating and empowering the citizens to better understand their health data and navigate their digital health journey. This enables the patient to stay in better control of his health, their wellbeing, and therefore stay healthier longer.

Chapter 2: Best-practices and topical clusters

2.1 Ecosystem approach

Digital ecosystems have disrupted many industries such as mobility, retail or media over the last years. In recent years, they have also started to appear in the digital health sector as networks of diverse organisations and solutions across the healthcare sector. They are connected by a shared digital infrastructure which ensures a seamless patient journey combining in medical data and patient generated data. These ecosystems enable disparate siloed solutions to be connected to ensure the patient has access to the best prevention, diagnostic, treatment and monitoring possible.

A digital health ecosystem ensures clear added value for the different actors (Deetjen et al., 2020):

Crucial for such digital ecosystems is the need to identify and articulate positive network effects across different user platform view, and to grow the critical mass that each one has an immediate benefit from participating in such platforms (Zhu & Iansiti, 2019).

Additionally, digital ecosystems increase transparency and efficiency in communicating between the different players to improve the overall value for the system. 

digitalswitzerland has therefore created a Swiss Patient Journey Ecosystem Map to illustrate the different digital solutions focussing on enhancing the digital patient journey and digitalisation of the healthcare system in Switzerland. This representation enables the different players to remove the gaps, identify synergies between themselves and enhance collaboration. 

The Q4 2023 map illustrates more than 80 different players distributed along the five different categories: data interoperability, health monitoring, healthcare interactions, medical data history, prevention/ awareness.

Figure 1 – The Swiss Patient Journey Ecosystem Map – Q4 2023

This map illustrates all the different solutions supporting the patient journey in Switzerland based on five categories: Health interactions, Medical Data History, Health Monitoring, Data Interoperability and Prevention/Awareness. The list is not exhaustive and is updated every quarter. 
2.2 Deep dives on best-practices

Switzerland has a great number of digital health solutions which support the overall empowerment of patients to better understand their health data and navigate their health journey. We will introduce the four key scaleups of the year: Decentriq, heyPatient, Soignez-moi and TOM Medications.

Decentriq

The challenge
To address the most pressing challenges in healthcare today, organisations require access to data beyond their borders. Between clinical notes, lab tests, medical images, sensor readings, genomics, electronic health records and the Internet of Medical Things (IoMT), copious amounts of real-world data (RWD) are generated daily, hiding a wealth of potential insights that could lead to better treatment and diagnosis — if they would be connected. Switzerland is at the forefront of healthcare innovation, possessing a wide ecosystem composed of pharmaceutical companies, leading hospitals and startups. However, the data is often siloed due to privacy concerns and poor data interoperability, making it hard for organisations to access and utilise it. This poses a dilemma for data custodians, like hospitals, who must balance patient privacy with the potential life-saving benefits of collaborative data use.

Solution
Decentriq combines confidential computing technology with a data clean room (DCR) framework to create a comprehensive platform for secure data collaborations at scale. This platform addresses the healthcare industry’s challenges by assuring both data privacy and data usability. It allows for rapid setup of data clean rooms that merge data from various sources without ever exposing any raw data and without any special equipment needed on-site.

Confidential computing technology provides hard proof that data is always under the data custodian’s control and never accessible by anyone else — not by other organisations participating in the collaboration, nor Decentriq, nor the cloud provider. Finally, advanced privacy filters ensure that retrieved results won’t unintentionally reveal private information.

Impact on the patient
The use of RWD greatly accelerates research and development, as well as legislative decision-making processes, resulting in quicker access to more effective treatments in the market. When treatments become more targeted and administered more promptly, patients experience improved outcomes. Hospitalisations are minimised, and care providers can potentially intervene even before they become necessary thanks to improved diagnostics models. This means patients benefit from more efficient and proactive healthcare solutions.

Testimonies

“Decentriq’s unique solution gives us the ability to bring diverse datasets together for research while strictly preserving patient privacy. By facilitating secure analysis, their innovative approach holds the promise of improved patient outcomes and a more collaborative healthcare ecosystem.”

— Prof. Dr. med. Dirk Müller-Wieland, Director of Center for Cardiological Studies, University Clinic RWTH Aachen

Team
Decentriq was founded by Maximilian Groth and Stefan Deml in 2019 in Zurich. They lead a team of 35 people from the company’s headquarters in Zurich and are distributed across more than 10 European countries. The company’s mission is to foster data collaboration, even with the world’s most sensitive data.

Collaboration & Partnerships
Data clean rooms powered by confidential computing have enabled the following use cases:

Development of tools to enable earlier treatment of rare diseases
Using Decentriq, data custodians from hospitals make rare disease datasets available — offering a comprehensive perspective of the patient journey without revealing patient row-level information or risking patient reidentification.

Linking clinical trial data with RWD 
With Decentriq’s DCR technology, pharmaceutical companies can combine patient data, match it to clinical trial data, and analyse the data to create more targeted treatments — all while preserving patient privacy.

Enabling transformative healthcare networks
Decentriq is providing core infrastructure enabling iCARE4CVD consortium partners to bring together data on over one million cardiovascular disease patients while ensuring patient privacy.

Research of this magnitude has the potential to transform care for the 60 million Europeans, and many more around the world, impacted by cardiovascular diseases.

Future vision of healthcare
Decentriq’s vision for the future of healthcare is one where more organisations can collaborate on health data while resting assured that this data will remain private. We look forward to seeing how these collaborations can result in pioneering research and advances in diagnostics, treatment, and patient care.

heyPatient

The challenge
Doctors use 80% of their time for administration, while patient-faced processes are mostly still paper-based. Healthcare costs explode and puts healthcare  service provision at stake. A joint study from McKinsey and ETH concluded that Switzerland can reach annual savings of CHF 8.2 billion per year through the use of patient-centred digital health solutions (Hämmerli et al., 2021). The potential health impact and medical utility are substantial.

Solution
heyPatient streamlines processes, relieves staff members, thus improves healthcare outcomes and reduces costs.

Impact on the patient
heyPatient’s impact on patients is significant, as it digitally accompanies patients along their journey across various healthcare providers, simplifies interaction, thus improves healthcare outcomes.

Patients’ Testimonies
Here are two quotes that capture this impact:

“With heyPatient, I no longer have to spend hours managing my healthcare appointments and paperwork. It has made my healthcare experience much more convenient.”

“heyPatient is like having a personal healthcare assistant in my pocket, it helps me manage my health by making everything from appointments to communication with healthcare staff much easier.”

Team
heyPatient’s dedicated team consists of 12 individuals with a diverse range of expertise, who have achieved remarkable success in building a strong offering and establishing an awarded, market-proven healthcare SaaS-solution (Swiss made software) with highest customer value.

The co-founders Matthias and Regula Spuehler, both serial founders, lead in the role of CEO and COO with a strong commitment, owning over 75% of heyPatient AG.

Every team member is an expert in their field, allowing heyPatient to quickly develop and deploy value-focused services and solutions for their customers.

Collaboration & Partnerships
heyPatient is dedicated to collaboration and has achieved significant success:

Future vision of healthcare
heyPatient’s future vision for healthcare centres on the simplification of interactions with increased patient-centricity, efficiency, and digitalisation. This encompasses:

Soignez-moi

The challenge
It happens often that one is sick and cannot reach their General Practitioner (GP) or they do not have an available appointment for treatment. What can be even worse, is to wait countless hours in an emergency department (ED). Soignez-moi.ch has a solution to help patients in such situations.

Solution
Reaching out to a doctor has never been that easy. Soignez-moi provides a simple solution to treat everyday symptoms that drag patients down. Soignez-moi’s medical questionnaire is free of charge and its triage indicates if someone can be treated remotely or a physical consultation is required. By design, Soignez-moi is a patient-centric and fully digital company where the patient decides his journey and is in charge of their data. They are the only provider in Switzerland that can send prescriptions directly to patients, thus allowing them to choose freely where they want to get their medicine. Their triage module is also extremely customisable and allows hospitals to improve patients’ flow in the emergency department. By better defining the level of emergency ahead and thanks to their modular approach, a hospital can better plan certain cases (pre-defined symptom or group of symptoms), or refer patients to various care centres, depending on infrastructure and available personnel.

How it works
Soignez-moi provides a simple and intuitive solution:

  1. Patients simply go to soignez-moi.ch and answer a medical questionnaire to find out if they can be treated remotely.
  2. A doctor then calls the patient within the hour, and if needed, they receive an electronic prescription to go to the pharmacy of their choice.
  3. The patient might even perform some exam/test in one of 180 partner pharmacies to identify the best treatment.
  4. A consultation report is sent to the patient’s GP and Soignez-moi follow up on the case 48h later to check on the progress of the treatment.

Business Model
For a flat fee of CHF 59 reimbursed by the mandatory health insurance (if any, the exam/test are also covered by mandatory health insurance).

Impact on the patient
The impact on patients is huge since they have direct access to a doctor within a couple of minutes and thus can be treated and relieved. The best way to ensure that a solution has a real impact on people is to perform a survey. Soignez-moi therefore send a satisfaction survey one week after the consultation of a patient ended. 40% of their patients filled in this questionnaire and more than 95% rate their experience with 4 stars . 

Patients’ Testimonies

“Fast, proactive and efficient. I would use the service again without hesitation given the difficulty of obtaining a physical appointment with a general practitioner.”

“It was really fast and I really appreciated the doctor I had on the phone, very understanding and attentive!”

Team
Soignez-moi has a very seasoned team that supports their vision. Just within the founders, they have more than 50 years of healthcare experience. The team includes a dedicated team of developers all coming from Lausanne. Their medical protocols have been validated scientifically by the Notfall Zentrum of Inselspital, thus giving credibility to the work performed by their doctors.

Collaboration & Partnerships
Soignez-moi have treated more than 23,000 patients over the last three years and have been able to conclude renowned partnerships in the Swiss French part. They are the telemedicine provider for Réseau Delta (>950 registered GPs), Medbase Romandie, Hôpital la Tour, Hôpital de Réseau Neuchâtelois, Hôpital Jules Gonin, etc.

Future vision of healthcare
The future of healthcare for Soignez-moi.ch is a dynamic landscape where advanced technologies, personalised medicine and patient engagement converge to redefine the delivery of services. From AI-driven diagnostics to genomics-based treatments, this future promises a holistic and interconnected approach focused on prevention and individual well-being.

TOM Medications

The challenge
Only 10% of patient’s disease therapy is monitored today by doctors, hospitals or insurances. 90% lies in the darkness of the patient’s privacy. Uncontrolled. Unobserved. What is seen as a crucial problem in advancing the future of medicine is not access to accurate real-life data. All patient information is captured in specific time-boxes, and we have no idea how patients behave and what happens in their everyday lives outside of the surveillance of doctors and pharmacists. Currently, there is a black box of information about patients, which is needed in order to truly deliver personalised medicine.

Solution
TOM Medications wants to advance personalised medicine, by building a real-world evidence platform, the «TOM insights» platform. At the core of their technology lies high-quality real-world data, sourced from the TOM app. These patient-generated data undergo rigorous analysis to yield intuitive insights into various aspects of healthcare, including disease progression, patient experiences, medication adherence, disease burden, treatment pathways, treatment effectiveness, and the cost of care.

Recognising the need to capture previously untapped information, they designed the TOM app with a focus on engagement, drawing from feedback from over 20,000 patients. This approach has resulted in a highly engaged patient community, with an app stickiness of up to 71% surpassing even social media giants like Twitter (41%), and comparable to Facebook (66%), and WhatsApp (84%).  Patients use TOM as their companion throughout their disease management, resulting in an enormous pool of patient health data over a long period of time.

Through this commitment to gathering and analysing authentic patient experiences, TOM Medications drive healthcare advancements firmly rooted in real patient journeys. This approach paves the way for a personalised approach to healthcare, ultimately reshaping the way care is delivered and experienced.

Impact on the patient
Patients are already benefiting from being able to use the TOM app 100% free of charge and 100% anonymously to manage their disease, leading to more positive treatment outcomes for patients and a higher quality of life. The insights generated from the TOM Insights platform will add to the benefits since it aims to advance developments of more personalised medicine for patients. Thus, patients will get treatment tailored to their needs and improve their health.

Patients’ Testimonies

“Since I’ve been using TOM, I’ve been taking my medication more consciously and consistently! The fact that the app informs me when the medication is almost used up is awesome! I would definitely recommend it!”

“I had recently lost track of when I needed to take which medication and whether I had already taken it. Before I tried TOM, I had tried other medication apps, but I find that TOM has been much more thoughtfully created. It really has thought of everything and it helps me a lot in my everyday life.”

Team
The team of TOM Medications currently counts 12 people, composed of pharmacists, data engineers, software developers, UX designers and business developments. Having such an interdisciplinary team is necessary to bring their vision to life. Apart from their team, they are excited to have their advisory and management board consisting of experts from the healthcare industry and science, successful entrepreneurs, as well important stakeholders, such as Galenica and Sanitas, which are their go-to partners in building a product that really fulfils a current need in the market.

Collaboration & Partnerships
TOM Medications collaborate with a two-digit number of partners from the healthcare sector, be it pharma, insurance, or research institutions. And all these collaborations have the patients’ health improvement in its centre. For instance, they collaborated with Sanitas to create an adherence programme, worked with Galenica and Mediservice to digitalise pharmacy services in the TOM app, and with the Diabetes Center Berne they collaborated in Real-World-Data.

Future vision of healthcare
Their company’s vision is clear: personalised medicine is the future of healthcare, enabling healthcare providers to shift the emphasis in medicine from reaction to prevention. But personalised medicine needs data to do so. And especially (hard to get) patient-generated data to create unique real-world insights. These insights can lead to breakthroughs in treatment strategies, the identification of previously undetected adverse effects, and the development of novel therapies tailored to individual patients’ needs. With more than 200 million patient-generated data already at the heart of the TOM evidence model, they are at the forefront of the transformation of the Swiss healthcare system.

Chapter 3: Outlook

3.1 Society: How can the Swiss population engage with digital health initiatives?

Human-centred and patient-centric design principles strive to put people at the centre of their solutions, particularly with respect to being aligned with their needs in the context of the local healthcare system(s). A majority of the population will not have been involved in the initial design phases of new digital health solutions, yet have an important role to play in refining these solutions – either through direct feedback or simply by letting the companies behind them leverage their user data to improve.

To engage with new solutions, there are often some fundamental prerequisites that enable an integrated user experience. One such enabler is the electronic patient record (EPR), which will become the gateway to many future digital health solutions. The sooner people begin to use their EPR, the sooner we reach a critical mass of people able to access digital services.

Fostering digital health literacy is therefore pivotal. Ensuring the Swiss population, especially the elderly, feels safe, and comfortable navigating these digital technologies is essential. Widespread education in the form of workshops, training programmes, and user-friendly interfaces are imperative to bridge the digital divide, as well as encouraging dialogue between those who have had initial experiences with these solutions and those who are still learning about the benefits and convenience of digital healthcare delivery.

Moreover, collaboration with healthcare professionals is also key. Building trust between patients and digital health providers can be achieved by involving local doctors and nurses in telehealth initiatives. This collaborative approach ensures that patients receive a continuum of care (including all providers from pharmacy to at home nursing by the intermediary of the hospitals) combining the advantages of both digital and traditional healthcare services.

Such collaboration can be initiated by the patients themselves too; this will encourage providers to start or continue their digital transformation initiatives. By engaging with digital health tools, the Swiss population can open the dialogue as to the pros and cons of these technologies, and together address the key questions of data privacy, data ownership and usability.

Adopting new digital health tools when in good health is a good way to become familiar with solutions before they are needed in a care setting. Once onboarded, patients can comfortably benefit from the services they offer such as online information resources, telemedical consultations or opportunities to plan and track diagnostic and therapeutic information in support of care pathways.

3.2 Business: What is needed from innovators and investors to increase impact in Swiss digital health innovation?

Digital health innovation is rarely a short-term journey. While initial (angel) investors and grant funding can help initiatives to get started, the road ahead to patient impact and profitability will be long and complicated due to decisions on which market segments and solutions to prioritise. 

Therefore, dilutive and non-dilutive investors must seek long-term impact rather than short-term gains.  Correspondingly, innovators must be prepared and equipped to articulate this impact in terms of savings and improvements to different healthcare stakeholders. 

The Swiss economy is investing heavily in hardware and software, especially in digital technologies as stated in ETH’s survey (Wörter, 2022). This is particularly the case in the digital health area with an important growth in funding of digital health companies and therefore an increasing number of venture funds entering the sector.  In startupticker VC report’s survey, it was identified that more than half of the investors invest in digitalisation topics in the healthcare sector (Swiss Venture Capital Report, 2023). 

While this year, 2023, has clearly been challenging in the Venture Capital sector, particularly for those seeking first-time investment, an increasing number of active Corporate Venture Capital (CVC) funds have begun seeking earlier stage investments. CVCs are often in the strategic position of aligning their portfolio companies with their respective corporate strategies, and therefore have an opportunity to seek close integration of innovative solutions through collaboration; both in terms of teams, customers, and data interoperability. 

To increase the impact of digital health innovation in Switzerland, a symbiotic relationship between innovators and investors of any kind is crucial. Investors can provide mentorship and resources beyond monetary support, aiding innovators in navigating the complex healthcare stakeholder landscape.

Open interfaces enable other solutions to connect and securely share data via international standards such as HL7 FHIR. Such solutions enable greater scalability as new collaborations can be integrated via these standards. This also results in an imperative for established companies to explore how to enable such data interoperability and move away from siloed data models. Cuore from Swiss Post is just one example of a platform that enables data interoperability (Swiss Post Ltd, 2023).  

In this way, innovators have the opportunity to leverage the ecosystem mindset and encourage regional and national initiatives that increase skills and enable technology which is required in key areas such as connectivity of devices within care settings. Identifying solutions that deliver mutual benefits in the realm of digital transformation can provide industry-wide benefits as a positive externality from the implementation of one specific innovation. 

In this spirit, there is an imperative to be inquisitive about what is holding back the integration of digital health solutions and ensure even with limited resources that innovators are addressing environmental, social, and governance topics in addition to their technical solutions.

3.3 (Non-)Political: How should/will the Swiss regulatory framework around digital health evolve in the next few years?

In the coming years, the Swiss regulatory framework around digital health is poised for significant evolution. Public authorities need to set national standards and a clear framework for digital health in Switzerland together with international regulatory bodies and industry stakeholders. 

Moreover, beyond setting standards, public authorities also have a role to ensure that different players collaborate within the ecosystem to avoid Swiss citizens being obliged to use multiple disconnected applications and services. The human-centred design principles of the innovators should be considered by policymakers.

Data security and data privacy should be at the forefront of the discussions as it is important to ensure that all solutions follow strict regulations and ensure that the citizens’ data are handled appropriately. The FOPH has launched a group of experts focusing on Data management and standardisation in Switzerland (Federal Office of Public Health – Digisanté, 2023). It is key that all the different digital health solutions, which are developed, are based on the same standards and follow the international FAIR norms. The Swiss Personalised Healthcare Network has made considerable progress on making health data FAIR for secondary usage (SPHN, 2023). 

The different health solutions need to use structured interoperable data for the different systems to be able to communicate with one another efficiently. This is the only way possible to ensure that we move away from siloed solutions into ecosystems and networks of solutions that interlink with one another. Like this, each actor will be able to focus on its key added value and bring their own expertise to the healthcare ecosystem.  

Furthermore, there should be a concerted collaborative effort to establish clear guidelines and standards for digital health solutions such as telemedicine practices, home monitoring devices, and digital therapeutics. This clarity is essential for both, providers and patients, ensuring that services are safe, reliable, and accessible across the country.

Conclusion

The Swiss healthcare system is ready for digital transformation. Due to its great location and presence of diverse key healthcare partners, Switzerland has all the required tools to grow steadily in the digital health sector. However, this will only be possible if all the different healthcare players – patients, providers and public authorities – collaborate. 

Startups and scaleups are a very important part of the innovation process of healthcare in Switzerland, and they will continue to play an even greater role in the upcoming future as thought leaders of our evolving digital health ecosystem. 

Empowering Swiss citizens to better understand and own their health data as well as better navigate their health journey are critical to ensure equal access to digital health knowledge and positive patient outcomes for the population. Digital health solutions, such as the ones who took part in digitalswitzerland and Swiss Healthcare Startups’ Digital Health Academy 2023, are the innovators of today and tomorrow; they are the new digital health players who will enable us to achieve the next steps of digitalising the healthcare system in Switzerland by working together with the patients and other healthcare actors.

In the future, citizens should become an even stronger partner in designing and testing digital health solutions to ensure their needs are met. Innovators and investors will need to partner up to ensure that long-term impactful and interoperable solutions thrive in the healthcare ecosystem.

About the authors

This is a collaborative publication between the different scaleups from the Digital Health academy and digitalswitzerland’s team.

Authors:

Romain Boichat, Co-founder and COO, Soignez-moi
Redona Hafizi, Co-founder and Head of Pharma, TOM Medications
Maria Scoz, Healthcare and Life Sciences Business Developer, Decentriq
Phil Norris, Senior Manager Scaleup Enablement, digitalswitzerland
Regula Spuehler, Co-founder and COO, heyPatient
Jade Sternberg, Senior Project Lead Digital Health, digitalswitzerland

Supported by:

Diana Hardie, CEO of Swiss Healthcare Startups
Susanne Gedamke, Managing Director, Swiss Patient Organisation
Milan Vopalka, Head Healthcare, Public Sector Switzerland , Amazon Web Services (AWS)
Theodor Wilhelm, Head of Strategy and Business Development and Member of the Executive Board, Post Sanela Health AG

About the Digital Health Academy:

In collaboration with Swiss Healthcare Startups, digitalswitzerland launched the first edition of the Digital Health Academy, a 6-month cohort based programme for scaleups working to empower the patients to own and understand their health data better. Decentriq, heyPatient, Soignez-moi and TOM Medications were part of the 2023 cohort and, through this academy, were positioned as thought leaders in the digital health space. As part of the programme, they were mentored by experts, benefited from in-depth workshops, a matchmaking bootcamp with corporates and the chance to join ecosystem events such as Digital Health Day (Zurich) and AI for Life (Geneva).

About digitalswitzerland:

digitalswitzerland is a nationwide, cross-sector initiative that aims to transform Switzerland into a leading digital nation. Under the umbrella of digitalswitzerland more than 200 organisations, consisting of association members and politically neutral foundation partners, are working together to achieve this goal. digitalswitzerland is the point of contact for all questions relating to digitalisation and is committed to solving a wide range of challenges. Learn more about digitalswitzerland

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Impressum

The Swiss healthcare system: entering a new digital era. 

A visualisation of the pioneering solutions that inspire a digital health ecosystem” is published! 

Zurich, 13 December 2023

Although great care has been taken in the preparation of this publication, the author and contributors involved are not responsible for the accuracy of the data, information and advice provided, nor for any printing errors.

All rights reserved, including translation into other languages. No part of this publication may be reproduced, transcribed and/or translated into any computer language, including any information processing language, in any form without the prior written permission of the authors.

The rights to the trademarks mentioned remain with their respective owners.

Coordination of the publication: Melanie Holenweger and Jade Sternberg (digitalswitzerland)

Graphic design: Nina Holenstein (www.niniparati.com

Study on the cybersecurity of Swiss internet users in 2023

A representative survey of over 1,200 people in Switzerland between August and September provided important insights into attitudes and behaviour towards cyber risks. The study shows that hacking and cyberattacks are becoming increasingly clever and frequent. The average household already has seven devices connected online that are potential targets, and this number is expected to rise. Employers play an important role in raising awareness, but this measure does not reach the most affected age group (65+) sufficiently. This group tends to rely on traditional media and their personal environment. Although 86% of respondents feel safe online and 68% rate their skills as good, 31% use the same password for almost all online services. The most common consequences of cyberattacks are financial losses, data loss and violations of personal rights.

The survey was carried out on behalf of the Swiss Mobiliar Insurance Company Ltd, digitalswitzerland, Allianz Digitale Sicherheit Schweiz, the University of Applied Sciences Northwestern Switzerland FHNW – Digital Transformation Competence Centre, the Swiss Academy of Engineering Sciences SATW and Swiss Internet Security Alliance (SISA).

Read the study in German.

Read the press release in German, French and Italian.

Read the press conference presentation in German.

To download the infographics of the study, please navigate to internet-sicherheit.ch.

In partnership with BILANZ Wirtschaftsmagazin, HANDELSZEITUNG and PME, and supported by Innosuisse, digitalswitzerland is once again celebrating the 100 people changing the face of the Swiss digital landscape. Read the full interviews with all 100 Digital Shapers in the dedicated Bilanz issue

Shaping the digital landscape in Switzerland

We are pleased to introduce Digital Shapers 2023, a group of dedicated innovators who are committed to shaping a digital future that empowers us all. Their tireless efforts and passion serve as a driving force, inspiring their peers to redefine the limits of what is possible. We are delighted to support this annual campaign. We seized the opportunity to learn what drives these visionaries and are pleased to present some of the deserving winners!

The Nature Techies: People who use digital transformation in order to protect and preserve nature.

Auréline Grange

Auréline and her team at Open Forest Protocol have developed scalable, open and transparent monitoring and financing tools to massively scale the restoration of nature and forests especially. These tools are, for instance, now being used by organisations and landowners in the Global South. Some of these landowners used to have no other choice than to deforest their land to get revenue. With Open Forest Protocol, they now have access to an alternative revenue stream based on reforestation and forest protection. 

Q: What are you most excited about for digital innovation in 2023 and beyond?

A: “I’m genuinely excited about the potential of digital innovations such as remote sensing, AI, and blockchain in addressing climate change. These technologies offer game-changing transparency and can ensure that funds are directed efficiently to essential nature-based climate initiatives. By meticulously tracking progress and validating results, we are able to ensure utmost accountability and effectiveness. As our planet faces critical challenges, it’s really imperative that we leverage these innovations to scale our efforts, steering us towards a much needed, more sustainable and resilient world.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: “I think in the next 10 years, we’ll see a lot of pressure on humans to use digital innovation and tools to always become more efficient. Hopefully, we’ll be able to remember the irreplaceable value of physical interactions between us and how creative and skilled at problem-solving we are when we work together. I truly believe that balancing the efficiency of digital innovations with the nuances of human interaction will be key to creating a holistic, productive, and fulfilling work environment for us all.”

The Spin-off Founders: Entrepreneurs who carve out their idea from a big organisation into a startup.

Péter Fankhauser

Péter completed his PhD in robotics in 2017, alongside co-founding ANYbotics. Through various roles, including now leading at the front as CEO, Peter is driving impact on a global scale at ANYbotics.

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “Switzerland’s unique strength lies in blending its history of precision engineering with a strong push in software & AI, backed by our leading universities. This combination creates an ideal environment to transform AI into tangible products, like robotics, addressing pressing global challenges such as workforce shortages and sustainable production.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: “In the next 10 years, the most significant change will be how seamlessly we can interact with and use machines, all thanks to AI. It will be a huge shift, similar to the transition from typewriters to computers.”

The Internationalisers: Founders and advisors who help their startups to establish a foothold in foreign markets.

Emilia Pasquier

As the CEO of Swissnex in San Francisco, Emilia Pasquier supports Swiss innovators, startups, artists, and academia in exploring or entering the US market by connecting them to key players in the San Francisco Bay Area. With a team of over ten Swiss and American professionals, her overarching goal is to connect Switzerland and the world in education, research, and innovation. Pasquier’s focus is to strengthen Switzerland’s position as a world-leading hotspot of innovation.

Q: If you could give your 16-year-old self one piece of advice (career or life), what would it be?

A: “If I could advise my 16-year-old self, I’d say: be wild, rebellious, and audacious. Embrace the uncharted paths, and don’t fear failure. The unconventional roads often lead to the most extraordinary destinations. Challenge the norms, strive for innovation, and don’t be afraid to step outside your comfort zone, as pushing the boundaries very seldom happens from within them. In both life and career, it’s these qualities that inspire change and drive success.”

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “Switzerland has the potential to make a profound impact on the digital innovation stage, particularly in the area of health, where we have established considerable knowledge through small and big corporates and are amongst the global leaders. Moreover, Switzerland can impact the space by becoming an international platform for crucial discussions around the ethical use of AI. Building upon the legacy of international Geneva, we can lead dialogues that shape responsible AI governance, thereby ensuring that technology evolves in harmony with human values and global standards.”

The Spin-off Founders: Entrepreneurs who carve out their idea from a big organisation into a startup.

Silvio Bonaccio

Silvio Bonaccio is one of Switzerland’s most influential people in generating spin-offs. He has led the ETH technology transfer for nearly two decades – spinning off countless companies and encouraging a generation of entrepreneurs.

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “In Switzerland in general and at ETH Zurich in particular, one finds world leading centres and institutes in many areas, such as information security and privacy, robotics/autonomous systems, AI, visual computing, quantum computing, etc. to name just a few. We are very well positioned in terms of technology. What we need to provide are efficient platforms and support structures to allow for a fast development and a short time-to-market. Then our country will continue to have an impact on the digital innovation stage in various fields.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?A: “The future of augmented reality (AR) changes the way we interact with the digital world and merges the virtual elements with our physical surroundings. This innovation will permeate all areas of life. Already today, our researchers at ETH Zurich are developing products like context-aware AR support for complex operator tasks, hand action prediction or visualisation strategies.”

The Decentralisers: They distribute data around the world leveraging technologies like Web 3.0, distributed ledger, blockchain, cloud & Co.

Carla Bünger

Pushing technological boundaries is in Carla’s blood. Together with her team at KORE Technologies AG, she operates ISO certified blockchain solutions at scale for large corporates like Richemont Group on a global scale. Her company certainly finds solutions for tough problems. Moreover, Carla is an inspirational speaker and motivates people to move into entrepreneurship and tech.

Q: What are you most excited about for digital innovation in 2023 and beyond?

A: “AI and machine learning will revolutionise industries by automating tasks, uncovering insights from vast data amounts that we can not analyse yet and by enabling personalised experiences. This will accelerate innovation in a massive way. This technology holds immense potential to optimise processes, enhance decision-making, and address complex challenges across various domains, transforming the way we work, live, and interact. It’s not just the next buzzword but a deeply impactful development in humanity.”

Q: If you could give your 16-year old self one piece of advice (career or life), what would it be?

A: “Embrace continuous learning in IT. The digital landscape evolves rapidly; stay curious and adaptable. I’d stress the importance of learning coding and computational thinking as well as cybersecurity basics and data analytics. However, what will be important in addition is everything that technology can’t provide: soft skills. The most important being a critical mind to analyse the validity of sources, the ability to take decisions and focus, creative and networked thinking, the skill to express yourself as well as relate, interact and negotiate with one’s environment.”

The Mobilisers: People who transport mobility into the digital age.

Judith Häberli

Judith is a mobility expert. She sits on the Advisory Board at the Institute for Mobility at the University of St.Gallen and is Co-Founder of Urban Connect. First as CEO and now as COO, she is finding digital solutions for physical problems.

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “I think an area that is often overlooked is mobility. And I think Switzerland is uniquely qualified to serve as a laboratory to systematically test new mobility concepts by virtue of its small size, diverse landscape, efficient public transport system, its dense network of roads and railways, its advanced level of digitalisation, and its progressive and pragmatic regulatory approach. So, in short, I think concepts can be tested here before being rolled out systemically in bigger countries with a big impact.”

Q: If you could give your 16-year-old self one piece of advice (career or life), what would it be?

A: “I would tell her to stop trying to fit in and instead approach life with a sense of curiosity, wonder and gratitude. I would tell her that failure is part of progress and no one’s opinion about her should ever matter more than her own. I would tell her that the brain works like a muscle and that she should take on challenges, seek out new experiences and hang out with people that talk about ideas and not about people.”

The eMedics: People who use digital transformation to improve various aspects of wellbeing, health and medicine.

Matthias Spühler

Matthias has a long history in healthcare digitalisation, including at KS Winterthur and recently at Inselspital Bern. Today, he is driving patient centric collaboration with heyPatient together with his Co-Founder, Regula Spühler.

Q: What are you most excited about for digital innovation in 2023 and beyond?

A: “We’re excited about elevating quality of life with the help of digitally enhanced healthcare systems, transitioning from a sickcare model to a true healthcare paradigm.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: “Digital augmentation will enable a worldwide enhancement to unfold: We will experience healthier environments, better living, and increased equality. In healthcare, new technologies like the digital twin or AI catalyse transformative progress. We will become much more aware of our own health, what we need for our well-being and have information at hand to take an informed decision when it comes to lifestyle changes or starting a medical treatment.”

The AI Generators: Masterminds of putting Artificial Intelligence to use.

Vanessa Foser

Vanessa Foser is a founder, entrepreneur and board member with a special focus on Artificial Intelligence (AI) and data in combination with innovation, impact and leadership. She supports leading Swiss companies, as well as public institutions, to empower their people on how to make practical use of AI in their daily jobs. Vanessa is also engaged in supporting less privileged people in various countries in getting access to first-class AI education for free, with a special focus on inclusion and diversity.

Q: What are you most excited about for digital innovation in 2023 and beyond?

A: “As an AI-enthusiast/ -pioneer, I am most excited that 2023 stands as the pivotal year when AI’s potential is fully harnessed, driving unprecedented digital progress and revolutionising how we work, communicate, and experience the world. (Generative) AI and digital innovation have converged to define a transformative era. Rapid advancements in machine learning, automation, and data analytics are reshaping industries and everyday life. AI-powered solutions enhance efficiency, personalisation, and problem-solving across all sectors and functions.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: “The next decade will witness a paradigm-shift in the digital world and the way we work. Generative AI-technologies will play a pivotal role in automating even creative and sophisticated tasks, freeing professionals for innovation. The real change lies in our evolving relationship with AI, demanding a culture of digital literacy, encouraging individuals to critically assess the outputs of AI-systems and to intervene when necessary. This synergy ensures AI enhances human capacity, leading to a harmonious coexistence where collective progress thrives.”

The eMedics: People who use digital transformation to improve various aspects of wellbeing, health and medicine.

Sven Beichler

Sven is the Co-Founder and CEO of TOM Medications and has managed to build the fastest growing active community of patients with chronic diseases in Europe in a very short time. 

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “The future of personalised medicine needs data. Switzerland, with its excellence in pharmacy and medical research, is poised to redefine digital innovation in personalised medicine. By integrating data from different health areas and individual health histories, we can gain unparalleled insights. It is critical to disaggregate and share this data, while always respecting regulatory standards, to advance research and care together. This collaborative approach will not only put Switzerland at the forefront of innovation, but also ensure outcomes that benefit individuals.”

The eTeachers: Helping to educate the world using digital tools is their mission.

Öykü Işık

Öykü Işık leads IMD’s Cybersecurity for Managers programme and is an expert on digital resilience and the ways in which disruptive technologies challenge our society and organisations. She helps businesses to tackle cybersecurity, data privacy, and digital ethics challenges, and enables CEOs and other executives to understand these issues, which she believes are too important to be left to technical specialists alone.

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “I did my PhD in the US because I wanted an international experience, and American universities have that inviting culture that says ‘research’, ‘innovation’ and ‘international collaboration’. But these three years in Switzerland have made me think: ‘why didn’t I come here instead?’ This country is home to a vibrant academic community and, more importantly, a culture of hands-on innovation. It’s clear why it’s a fertile ground for AI and cybersecurity startups.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: I think we’ll have amazing innovations enabled by machine learning and we’re likely to see productivity gains from AI, but I don’t think these necessarily will have a positive impact on our quality of life; I am afraid it won’t make us less overworked. The other aspect is surveillance economy, with social media and data collection: I’m hopeful that the increasing awareness of each new generation, coupled with global regulations, will make the challenge of data privacy better.

The Incubators: People who help digital startups to grow – with money, advice and connections.

Katka Letzing

Katka has been involved in innovation projects connected to acceleration and startup development in the USA, Asia and Europe. She was one member of the founding team of Kickstart and since then has helped hundreds of entrepreneurs to grow and startups to scale up within the Kickstart programmes. 

Q: Where do you think Switzerland can make the most impact on the digital innovation stage?

A: “I believe that the impact will be driven by topics of deep tech and circular economy as well as artificial intelligence, digital personalised health, robotics, advanced manufacturing, and blockchain – all mentioned technologies are coming out in Switzerland and will influence the productivity and competitiveness of the country.”

Q: What will be the biggest change in the world of digital and the way you work in the next 10 years?

A: “I believe that as we see a shift of co-existing in a hybrid environment, we will see even more data-driven and highly personalised digital experiences that enhance the way how we can see things and make decisions about customer journeys for better engagement and lifetime. That said, solutions that will continue to break silos and support collaboration will still make a big impact.”

Find out more about the jury behind selecting our deserving winners here.

Annual Report 2022

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Outlook for 2023

A collaborative community is key

With the strategy 2025 defined at the beginning of 2022, we laid the ground for a major transformation – aiming at impact in society in clearly defined areas of action. At the same time, the team is focusing on creating visibility for the digitalswitzerland ecosystem and improving interactions with our community of 200+ Association members and non-political Foundation partners. The new strategy also created new and additional member benefits that reinforce the relevance of digitalswitzerland as a horizontal movement. Our plans include regional community events, a new hub concept for WEF 2024, an exclusive virtual platform for members for coordination and inspiration, and events dedicated to female leaders to engage and champion more women in management positions. In 2023, we are renewing our focus on our Western Switzerland (Romandie) chapter with the addition of a dedicated Lead based in the region. We are also excited to intensify our efforts in internationalisation. Together with the Swiss Digital Initiative (SDI), digitalswitzerland has entered into a Memorandum of Understanding (MoU) with SGTech in Singapore. This partnership is proof of our shared commitment to driving digital transformation forward across borders and using synergies between nations.

Review of 2022

Education, Professionals and Diversity

The importance of education and the need for continuous learning increases in the digital age. In 2022 the team nurtured collaborations with other educational organisations to support Switzerland’s education transformation for the digital future. The close cooperation with ICT Berufsbildung Schweiz is being increased through joint activities in the fields of lifelong learning. Another such successful collaboration is the one with Pro Juventute for the Future Skills Campaign. The awareness building campaign was finalised with the release of 12 videos featuring role models and young adults from different STEM (Science, Technology, Engineering, Mathematics) fields. The overall campaign achieved an impressive 200,000 interactions.

Learning knows no age

Our goal is to address and raise awareness for education at all stages in life. This was illustrated by the continuation and completion of the Lifelong Learning Documentary Series – a campaign featuring digitalswitzerland members talking about their experiences and activities in respect to lifelong learning. 

People Upskilled
1 +

With the continuation of the successful Boost Programme, the team showcased how simple and unbureaucratic lifelong learning can be. By the end of 2022, already more than 300 people were supported with a financial contribution to an upskilling course to navigate and thrive in the digital economy. The programme was generously supported by UBS.

Recognising the value of experienced professionals in the ICT sector, digitalswitzerland joined the Initiative focus50Plus to actively work on solutions for the 50+ workforce in light of the skills shortage. These professionals are a valuable source for the sector and can help fill the current skills gap.

Planet MINT

To support STEM Initiatives in Switzerland, we launched the Planet MINT network (Science, Technology, Engineering, Mathematics) in September 2022. The network gatherings have already shown impact, as they resulted in the initiation of a whitepaper on gender sensitive STEM that was published in January 2023.

People, Culture and Mindset

Swiss Digital Days 2022 spread their wings

To ensure that the Swiss population keeps up with the developments of the digital present and future, engaging and including everyone is vital. The Swiss Digital Days fulfilled this purpose. For this edition, the event was extended into a nation-wide campaign. Swiss Digital Days 2022 offered the Swiss population the opportunity for exchange, discussion, and access to more than 350 events on the topic of digitalisation. During seven weeks, digitalswitzerland in collaboration with its partners successfully organised a series of local events in seven regions of Switzerland. The Swiss population joined our team in the physical bubbles, attended online events, and experienced the digital future. Within the swissp[AI]nt project, visitors of Swiss Digital Days created thousands of digital artworks about Switzerland and digitalisation with the help of advanced artificial intelligence. Selected artworks will be turned into crypto stamps as part of the Swiss Crypto Stamp 3.0 editions, released in 2023 by the Swiss Post.

Viboo wins the GreenTech Startup Battle

Talented Startups across Switzerland participated and competed in the GreenTech Startup Battle. A competition showcasing startups from across Switzerland with innovative and sustainable technologies and solutions. These entrepreneurs show a deep commitment to change and are working to create solutions that enable us to live, work and innovate more sustainably. The winner of the pitch duel at the Swiss Digital Days closing event was Viboo, an Empa spin-off that creates cloud software solutions to reduce the energy consumption of buildings.

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#herHACK – the female-led hackathon

We have made it a priority to foster female talents in the ICT field. With #herHACK – the largest female led-hackathon in Switzerland – 250 women with different backgrounds across all Swiss regions came together. Their task: Solving pressing challenges and developing solutions in line with the Sustainable Development Goals (SDGs) of the UN Agenda 2030. With #herHACK, we create an environment to inspire women and non-binary people to work in the technology industry and allow them to create a network of like-minded professionals. 

The future belongs to the youth

Involving the youth is crucial for the digital Switzerland waiting for us. NextGen Future Skills Labs, one of the main format events during Swiss Digital Days 2022, has done exactly that. 186 children aged 10 to 15 from across Switzerland participated in the NextGen Future Skills Labs. In specially designed workshops, the children were able to learn about digital technologies and innovative methods and thus discover and develop their future skills. Skills that are not only crucial in business, but also in a personal digital future.

Digital Health

The Digital Health initiative was boosted in 2022 after a WEF panel discussion on the digitalisation of healthcare and multiple exchanges with experts in the field (private and public). With this initiative, we pursue the ambitious goal of creating the support needed for digitalising the entire healthcare system in Switzerland and making it patient-centric. Digital health has the potential to revolutionise healthcare for patients by improving access, efficiency and outcomes while reducing costs and improving the patient experience. 

As a driving orchestrator, digitalswitzerland brings together key players representing all aspects of the healthcare ecosystem: the patients, hospitals, insurance companies, the pharma industry, medtech, the government and more. We need the inclusiveness for success. United with a common goal, they collaborated and supported the team to kick off and shape the Digital Health initiative, reaching two key milestones in 2022: A population survey to better understand the needs and fears of the digitalisation of the healthcare system and a Swiss patient ecosystem map to illustrate all the existing digital solutions which enable an enhanced patient journey. Based on the results of the survey and with the involvement of multiple members who are experts in the field, the study “A Swiss digital healthcare system: What the population thinks” was published. Furthermore, the Swiss Patient Ecosystem Map represents the different existing solutions and initiatives in Switzerland to provide the ecosystem with more clarity and help to identify synergies and gaps.

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Infrastructure & Cybersecurity

Remaining perseverant in pursuit of an E-ID solution

2022 has surely been a year of new beginnings for Infrastructure & Cybersecurity. After the “no” vote to the proposed E-ID law in 2021, the team worked to support the government with its new approach, considering the feedback from Swiss citizens and developing a more pragmatic approach with the goal to create more acceptance; we were therefore leveraging our broad network of expertise and members to propose solutions and initiatives. 10 members actively contributed to the keystone whitepaper to propose a new E-ID solution based on an ecosystem of verifiable credentials and self sovereign identity principles.

Leveraging national and international connections

On the cybersecurity front, in 2022 our involvement has led to the launch of the CyberSeal managed by the “Allianz Digitale Schweiz”. digitalswitzerland was also present at the Swiss Cyber Security Days as well as supported the growth of the SME cyber check by Cybero. Last but certainly not least, digitalswitzerland orchestrated discussions with the goal to enable the required framework and conditions for a Swiss Data Space Ecosystem to develop. For this purpose, digitalswitzerland has also been upkeeping international coordination efforts with the industry-led, transnational data ecosystem initiative Gaia-X.

eSustainability

At digitalswitzerland, we build on digital solutions paving the way for a sustainable future and as a driver for accelerating sustainable innovation. This is why we create new digital and sustainable lighthouses and support initiatives that lead the way.

Simplicity brings clarity

The kick-off for the carbon data project WISER happened in a large consortium of both academic and implementation partners. The idea of WISER is to simplify the implementation, reliability and comparison of greenhouse gas assessments with a sophisticated digital ecosystem. The idea is supported as one of the few flagship projects from Innosuisse. Development of the backend of WISER began in 2022 and the team started preparing to position the tool as a valuable contributor for businesses climate strategies.

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4T-DLT

Strengthening the Distributed Ledger Technology community

The team kicked off 2022 with a large-scale event co-organised with the Capital Market Technology Association to strengthen the relationship between Western and Eastern Switzerland in the DLT space. This event brought together 70 C-levels and experts in Zurich. To make Switzerland a leading DLT-hub, accessibility is key. Thus, we created a dedicated 4T-DLT website where the community can access all blueprints in one location and is able to actively share its own contributions. The site serves perfectly as a collaborative platform (add your own events, blueprints, definitions and join the forum to exchange). A LinkedIn group to enable easy access to content for experts and stakeholders interested in DLT complements the community-focused offer.

Scaleup Enablement

The Startups and International programme was renamed to Scaleup Enablement in 2022 to reflect the initiatives and endeavours of the programme more accurately. 2022 was a vibrant year for Switzerland’s startup ecosystem, demonstrating resilience in all areas. Notably strong growth could be observed in sustainability startups, and capital invested into ICT companies up by over 70%. 

Our flagship event in Bern, Startup Days, was once again a celebration of Swiss innovation and engaged many members and partners, not least through the General Assembly that runs concurrently with the event.

Finding the perfect match

Scaleup Bootcamps ran throughout the year together with VentureLab and the Gerbert Rüf Stiftung, providing thematic matchmaking between corporates and startups. Industries included Foodtech, Smart Manufacturing, Fintech & Insurtech, Enterprise Tech & Cybersecurity, Life Science, Digital Health, Cleantech & Circular Economy, and Smart City & Mobility.

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Swiss innovation, worldwide

Under the SwissTech umbrella, the team took 17 spin-offs, startups and scaleups to GITEX Global in Dubai, accompanied by a delegation of members and Women In Tech Switzerland. As a gateway to the Middle East, Asia, and Africa, this was important to showcase the strength of the Swiss ICT sector and an opportunity to gain inspiration from their local crypto valley.

Scaleup Slopes

The team was pleased to support Swisspreneur in the Scaleup Slopes, bringing together various players across startups, scaleups, corporates, and investors. We also supported the Swiss Startup Radar and Swiss Venture Capital Report, two important reports for highlighting the strength of our startup ecosystem.

Switzerland is home to many entrepreneurs

In partnership with Bilanz, Handelszeitung and PME, digitialswitzerland was once again celebrating the 100 people changing the face of the Swiss digital landscape – Digital Shapers 2022. Their continued efforts and commitment inspires and brings those around them on a journey to challenge what’s possible.

Politico-Economic Environment

At the beginning of 2022, the team welcomed Dominique Reber as the new Head of B2G (Business to government). In 2022, the newly formed Public Affairs team hosted three events with parliamentarians, including an event co-hosted with ePower on Cybersecurity vs Independence. The other two events were centred around Swiss Digital Days and the topic of Energy and Digitalisation.  

Policy Milestone

In December 2022, digitalswitzerland submitted a list of 17 lighthouse projects for potential funding under EMBAG’s article 17 (Federal Act on the Use of Electronic Means for the Performance of Official Duties), which foresees federal funding via private-public partnerships for digital transformation projects.

Agenda for Digital Transformation

In a very open and constructive process, we contributed to the development of the Digital Strategy of Switzerland and supported the Federal Chancellery in creating visibility for this important guidance for our country. We are fully supportive of this strategy of Switzerland and it is very much in line with the priorities that are guiding digitalswitzerland.

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Regions

We renewed our commitment to the regions beyond Central Switzerland and Ticino. This is why in July 2022, we agreed on a strategic collaboration with the Economic Chamber of Biel-Seeland to increase our presence in this region. Further, Anthony Corbaz has been appointed to lead and expand activities in Western Switzerland, starting in 2023.

Central Switzerland

The commitment of diverse actors within Central Switzerland for a joint regional initiative, with digitalswitzerland acting as the orchestrating organisation, was further strengthened. In particular, the Canton of Lucerne has been won as an active supporter who provides significant seed funding for local, impact-oriented activities. Following its launch in 2021, the “DigitalTag Zentralschweiz 2022”, which took place in the Swiss Museum of Transport, was further established as the flagship event for digitalisation in Central Switzerland. The “DigitalTag Zentralschweiz 2022” further served as a starting point for initial talks between the Swiss Museum of Transport and digitalswitzerland for a joint collaboration regarding the development of a “House of Digital Switzerland.”

Ticino

In 2022, digitalswitzerland held the “AI Round Table” in cooperation with the Locarno Film Festival and hosted Swiss Digital Days in Bellinzona and Lugano. The event in Lugano was very successful in particular and the team was able to welcome many interested people as well as a public figure with Christa Rigozzi. 

To widen the network and to attract new members, the team collaborated with the Lifestyle Tech Competence Centre in Lugano on networking events. The Lifestyle Innovation Day in April 2022 was one such occasion, which brought over 1000 visitors to Lugano to talk about innovation in fashion, food and life in general.

The digitalswitzerland Foundation

digitalswitzerland consists of 200+ Association members and non-political Foundation partners. The Association and Foundation continued to collaborate closely in pursuit of strengthening digitalisation in Switzerland. 

Digital Xchange

2022 marks the first operational year of the digitalswitzerland Foundation. The creation and implementation of the Digital Xchange format to foster bottom-up dialogue with the population and discuss the impact of digitalisation on society stands out in the efforts of 2022. Within this format, the team interviewed a wide spectrum of experts and keyholders, organised four public focus groups with more than a hundred participants of all ages and backgrounds. Further, the 1st edition of the Digital Xchange Forum in September 2022 convening over 50 leaders and representatives of very diverse stakeholders to address digital inclusion in Switzerland was held.

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Our whitepaper “Empfehlungen für gendersensible MINT-Angebote” (Recommendations for gender-sensitive STEM programmes) is live! Together with Prof. Dr. Bernadette Spieler from the University of Education Zurich, we have the pleasure of publishing this important contribution to the MINT topic. The whitepaper helps organisations and individuals dealing with STEM (science, engineering, technology, and mathematics) to recognise the potential of STEM disciplines.

The global pandemic has continued to drive rapid digitalisation, while also revealing digital inequalities resulting from differences among people in their digital skills, competences and usage. The digitalswitzerland Foundation addressed this topic through its Digital Xchange, a series of interactions on “digital divides and digital inclusion”. From expert interviews, Swiss-wide public focus groups and a high-level forum, diverse stakeholders from the private and public sectors, academia, NGOs and civil society organisations came together to discuss and identify ideas and opportunities to tackle the issue.

Learn more about the stakeholder’s different perspectives on digital divides and what can be done to be more digitally inclusive in the synthesis written by the digitalswitzerland Foundation team.

Executive Summary

Switzerland is recognised as one of the most innovative countries in the world. In the IMD World Digital Competitiveness (WDC) ranking 2022, Switzerland ranks fifth (2021: sixth place) (IMD World Competitiveness Center, 2022). Digitalisation has picked up speed in Switzerland’s industries, such as the banking sector, which is now almost fully digitalised. One sector is still lagging far behind: healthcare. This topic has been the focus of multiple actors from the public and private sector for many years. Until now, the digital transformation has not been successful. We are still years behind European countries such as Denmark or Estonia, which have fully digital healthcare systems. 

The different actors of the healthcare ecosystem have spent a lot of time and effort in establishing the best technology to support this change. Many solutions and initiatives around this topic are present today. The electronic patient record (EPR) was developed. New digital health platforms were created recently through collaborative consortiums. 

To be effective, digital tools are developed and tested with end users to ensure that tools are performing as effectively as possible. If they do not meet the needs of end users, they will not be adopted. Therefore, the digital healthcare platform/solution should be developed with its end users, the citizens of Switzerland. 

With this publication, we wanted to give the Swiss population the opportunity to express their desires and concerns regarding the digitalisation of the healthcare system. This was achieved through a survey, conducted at the end of summer 2022. 

With this survey, the citizens’ perspective on the topic can be grasped more accurately. We can clearly see the willingness of the Swiss population to use a digital healthcare system, provided it offers clear added value such as better usability, improved diagnosis and treatments and lower healthcare costs.

The survey reveals that many Swiss citizens rate their health literacy (76%) and digital literacy (72%) as high to very high. Health literacy increases with age, whereas digital literacy decreases. The level of education also plays a key role, as people with a higher level of education have higher health and digital literacy.

Another key finding is around the trust in different organisations handling health data. 70% of respondents have a high to very high level of trust in health providers (including hospitals) followed by the government (47%), while the private sector (22%) enjoys the lowest level of trust. Trust in hospitals and general practitioners also justifies their high status as being the most important source of health information (54%). Medical staff have been a central element of the health system for centuries, but there are signs of a shift towards a system that is less focused on medical professionals and more on patients.

Simultaneously, the role of the patient is also evolving as they are taking a more active role and more personal responsibility than in the past. Thus, 31% of the population no longer refer exclusively to people in need of treatment as patients. Everyone is a patient, whether healthy, ill or injured. This is also reflected in the increasing diversity of prevention services offered by health insurance companies. Tomorrow’s health system should be patient-centric and enable patients to inform themselves about their health and to engage more with preventive measures. This is with the aim of promoting a more active and healthier society.

This goes well with patients’ desire to have more control over their own health data. 68% of the population want to be the rightful owners of their personal health data. The electronic health record is a step in this direction, as patients themselves have control over who can access their data.

Digitalisation has many advantages, but it also arouses fears among citizens. 46% of the respondents fear that their data will be misused or stolen. Data protection has recently become more of a focus, but must play an even more central role in the digitalisation of healthcare in the future to ensure that appropriate systems and solutions are used to store and exchange data as well as to avoid data misuse, incorrect storage or data theft.

Only with a collaborative approach from all the healthcare players (including patients) will it be possible to advance the healthcare system into the digital space and bring about a change in awareness among the population.  

Survey Method

The survey was conducted in a representative random sample (n= 1110) of the Swiss population. The population was contacted via an online panel between 1st and 14th September 2022. An independent research organisation (gfs-zürich) was commissioned to conduct the survey. The participation was anonymous and voluntary. The demographic composition of the interviewed participants from the population was specifically constructed to be representative of the 18+-year-old French-, German- and Italian-speaking population of Switzerland, according to the quota features gender, age and language region. Ticino was slightly over-proportionally surveyed to allow for individual assessments. To obtain the overall results the sample was weighted according to language regions. 

Percentages are always rounded to a whole number, averages to a decimal. Percentages <1 per cent are partly visible in the graphs through colours, but are not labelled. 

Chapter 1: Health Status

1.1 Health state information

In the 2018 report from the Euro Health Consumer Index (EHCI), Switzerland was ranked as having the best healthcare system in the world (Björnberg & Phang, 2019). The quality of care is very high in Switzerland due to the high density of healthcare professionals (World Health Organisation, 2022) and high ranking universities. Additionally, every citizen living in Switzerland needs compulsory health insurance which allows access to good health services. (Health Insurance, BAG). 

In the survey, we asked the population if they felt sufficiently informed about their health. 78% of the respondents felt well to very well informed about their health. The youngest generation (18-39 yrs, 74%) is slightly behind the two older generations (80% and 81%) (Graph 1). This could be due to the fact that the younger generation is “healthier” and therefore less interested in health related topics and their health status.

Interestingly, people who rate themselves as having good to very good digital skills are also more likely to say they are well or very well informed about their health state (82% versus 64%). Digital technology enables people to quickly search and collect all types of information. They can easily access data related to their different health conditions. 

No influence could be found between the evaluation of the health information level and the fact whether one suffers from a chronic disease or not. 

Digital solutions open up a whole new level of access to information for the citizens. In the future, the population would therefore easily find information regarding their own health and feel even more in control of their wellbeing.

Graph 1 – Information level on health state

(Information level on health state (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training), high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from low to high)).

The untapped potential of prevention in the Swiss healthcare systemPhilomena Colatrella, CSS

“We all hope to be spared a serious illness. But how can we maintain our health? And who’s in charge of that? Traditionally, healthcare systems focus on healing people. It therefore comes as no surprise that we’re not exploiting the full potential of prevention. Especially when it comes to widely spread non-communicable diseases such as diabetes or cardiovascular problems.

Studies have shown that behaviour has a much greater impact than factors such as genetics, the environment or even access to healthcare. And there are so many ways to support a healthier lifestyle. Smart watches, fitness trackers and other wearables have reached all segments of our society and can be of great use: by tracking our steps and motivating us to move more.

By supporting us in making better choices when it comes to our nutrition. Prevention can come in very different forms. As a health insurer, we offer financial incentives for those who commit to behaving in a healthier manner – a strictly voluntary proposition which is very well accepted. It is by integrating new forms that we can make prevention more effective. It is time to pursue this goal by all available means.”

1.2 Sources of health information in Switzerland

Today’s healthcare system is focused mainly on diagnosing and treating ill and injured patients. As the population is ageing, this makes Switzerland’s healthcare costs extremely high, leading to a total of CHF 83.3 billion per year in 2020 (Swiss Confederation – BFS, 2022). The system is slowly shifting towards a system focused more on prevention and keeping “patients” healthy for a longer period. This will help to decrease the costs and enhance the quality of life.

Switzerland has many different actors playing different roles in the healthcare system. We were curious to better understand who the population would turn to for additional information regarding prevention activities. 

Graph 2a shows that medical staff remain the main source of information for the Swiss population as a whole, regardless of the sex of the respondents (54%). Insurance companies come in second position, with a significantly higher proportion of males wanting to be informed by providers (43% versus 35%). Males also look more to the government to provide information (29% versus 18% for females).  

Graph 2b shows the difference in distribution according to the generation of respondents. The older generation is more inclined to seek additional information from medical staff (60%) and less from insurance providers (32%) versus 18-39 yrs: 44% and 40-64 yrs: 39%. The youngest generation turns more to the government (26%) and strongly believes in the importance of education for the dissemination of information on health prevention (43% versus 15% and 5% for the older generations). 

Medical staff have been at the centre of the healthcare system for centuries and therefore identified as the main source of information relating to healthcare data. Today’s healthcare system is slowly shifting towards a system less evolving around the medical professions and more around the patient. 

Medical professionals still have the most important role to play in healthcare in the eyes of patients, especially the older generation. The healthcare system is currently shifting towards a network model, where each actor plays a specific role to enable a successful outcome (medical staff, insurances, government etc.).

People who self-assess their health state as rather poor or patients suffering from chronic diseases are more likely to seek information on health activities from general practitioners (both 65%). They may not feel empowered about their health and seek guidance from their closest ally: their doctor.

Health insurers play an important role in the preventive activities in the Swiss healthcare system as stated in Article 19 and Article 26 of the Federal law on health insurance (KVG/LAMal, 1994). It is therefore in their duty to promote preventive health activities to keep citizens healthier and premiums as low as possible. Many health insurance companies in Switzerland have developed digital tools to help customers follow a healthy lifestyle and be more self aware. For example, CSS has developed active365, an application which rewards users with valuable points when making positive decisions regarding their nutrition, exercise mindfulness or mental health. Helsana has also developed a similar application, the Helsana+ app, which rewards preventive health measures and interaction with the insurance company. 

The younger generation sees high potential for the education system to play a more active role in promoting health prevention activities. Education is mandatory and free for all children in Switzerland for a total of eleven years. (Compulsory Schooling – SWI Swissinfo.ch, 2022). As habits are more easily formed during childhood, it would be a great environment to raise awareness for health prevention measures and activities to ensure that all citizens have access to the same initial level of information and can live equally healthy lifestyles. 

Promotion of preventive health activities leading to healthier lifestyles will be the baseline of the healthcare system of tomorrow. Only if each actor of the healthcare network plays a role in the system will this be feasible. Digital tools such as apps or wearables can help citizens track their habits and make positive choices for a healthier life. 

Graph 2 – Actors who should share additional information regarding health prevention activities in Switzerland

A. Distribution based on sex

B. Distribution based on age

Actors who should share additional information regarding health prevention activities in Switzerland (n = 1110, data in percentage, multiple option possible).
1.3 Swiss population health status self-assessment

The combination of multiple factors affect the health of individuals. Social, economic and physical environment, as well as individual characteristics and behaviours influence an individual’s health state(World Health Organization, 2017). 

In the survey, we asked the interviewees to personally reflect on their current health state. It is important to keep in mind that the time of day and state of mind of the respondent has a direct influence on their self-assessment of personal health. 

Almost three quarters of the interviewees rate their own health as good or excellent (74%). The younger generation feels best (79%) and the middle-aged generation feels worst (71%), which is still a high level. 

When comparing the purchasing power of the respondents, it is interesting to see a correlation between the level of wealth and the person’s health state. The wealthy group has the highest self-assessed health state (86%), whereas the group  with the lowest purchasing power reports the lowest health state (61%).  

Interviewees who rank their health and digital capabilities highly feel in better shape than people who don’t (78% versus 60%).

Switzerland is a very wealthy country, ranking 3rd in the United Nations Index (UNECE, 2020) and offering a great standard of living. This explains partially the high rate of personal health evaluation from the respondents. The level of wealth is directly linked to the health status, as it impacts the conditions under which one can afford to live. 

Digitalisation enables easy access to health related information and has a direct impact on an individual’s health state as they feel they have more control (Ward, 2013). They have access to a pool of knowledge at their fingertips.

Graph 3 – Swiss population’s health status self-assessment

Swiss population’s health status self-assessment (n = 1110, data in percentage, scale from 1: poor to 5: excellent, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, purchasing power: low income, lower average, higher average and wealthy)).

Chapter 2: The Patient

2.1 Who are “patients”

The term patient comes from the Latin “pati-” to suffer, to endure, to bear (Neuberger, 1999). Throughout time and amongst differences in cultures, its definition has evolved and been adapted multiple times, giving the patient a passive role of enduring pain quietly and awaiting medical care. Nowadays people use the word patient to define many different personas, which we could often replace with synonyms such as “client”, “consumer”, “user” and “customer” of the healthcare system (Deber, 2005). The relationship between the patient and the healthcare provider has also evolved. The patient is not seen as a passive player any longer. They take a more active role and are equal to their professional adviser who gives them medical guidance (Neuberger, 1999). Patients have more recently been defined as individuals who interact with a clinician, either for an actual or perceived illness or for health promotion and disease prevention, therefore the patient no longer needs to be ill or injured (Institute of Medicine, 1994). 

In the survey, we asked the population who they considered to be a patient. 68% of the overall population still define a patient as a person who needs medical consultation, diagnosis or treatment, whereas only 31% of people refer to everyone as a patient, whether healthy, ill or injured. 

In Graph 4 (see page 7) we identify a significant difference in perception of patients within the different age groups. The younger the interviewee, the more likely they are to understand the term “patient” as meaning any individual. This might indicate that younger (and often still healthy) generations see themselves as both healthy and being a “patient” in the sense of a healthcare consumer taking action for their wellbeing and health status. 

We are all affected by our health on a daily basis and are therefore all “patients”. The healthcare system of tomorrow should be patient-centric, empowering the patient to be informed about their health, focusing more on prevention activities in order for citizens to take more action and stay healthy longer. This will decrease the costs and increase the citizens’ wellbeing.

Graph 4 – Population’s perception of the term “patient” based on age group

Population’s perception of the term “patient” based on age group (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+)).

Graph 5 – Occurrence of chronic disease in the Swiss population

Occurrence of chronic disease in the Swiss population (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, purchasing power: low income, lower average, higher average and wealthy).
Being a “patient” in Switzerland and their future desired roleSusanne Gedamke, Swiss Patient Organisation

“The whole health care system talks about patient-centeredness. But how patient-centered is our healthcare system really? One thing is clear: We don’t even know. Because patients are not asked. All parameters in the healthcare system are based on professional criteria. But shouldn’t a healthcare system be primarily oriented toward the users of the system, the patients, the people?

It is time that the needs of patients are determined reliably and differentiated and that resources of patients are included in the decision-making process. After all, in a high-quality health care system, it is not only the professional perspective that counts, but also the perspective of those affected.”

2.2 Chronic diseases

Chronic diseases, also known as non-communicable diseases (NCDs), are a result of a combination of genetic, physiological, environmental and behavioural factors and last for a year or more (About Chronic Diseases, 2022). The main types of chronic diseases are cardiovascular diseases, chronic respiratory diseases, cancer and diabetes, but there are other, less common NCDs. 

One third of the interviewed citizens (33%) state that they are currently suffering from a chronic disease (see Graph 5, page 7). The older the interviewees are, the more likely they are to suffer from a chronic disease. One in two citizens above the age of 65 is affected by a NCD ( 49%). This is due to the fact that through the ageing process, multiple molecular and cellular event malfunctions occur, ultimately leading to various chronic ailments and diseases, including neurologic disorders, cardiovascular diseases, macular degeneration and diabetes. These chronic diseases usually occur in the middle/later age after a long exposure to specific features and an unhealthy lifestyle (lack of physical activity, high-fat diet, stress, alcohol and tobacco intake) (Prasad et al., 2012).

We also observe that people with a low purchasing power are more likely to state that they are suffering from a chronic disease (43%). This could be due to the fact that due to their lower income, they are not able to afford the best health services and nutrition sources (Kim et al., 2016), which leads to unhealthy lifestyle choices, and thus to chronic diseases. 

Fortunately, chronic diseases are well treated in Switzerland today and “patients” can monitor their symptoms and lead a healthy life. This is seen in the survey as interviewees suffering from NCDs do not assess their health status to be lower than other interviewees.

In the future healthcare system of Switzerland, we should do more prevention promotion in order for citizens to follow healthy lifestyles and decrease their chances of developing a chronic disease. Tracking health data can support positive habits and enable citizens to live healthier lives. 

Chapter 3: Health & Digital Literacy in Switzerland

3.1 Health literacy

Personal health literacy is the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others (HRSA, 2022). This was the selected definition which was used in our survey. 

Three quarters of respondents evaluate themselves as having high to very high health literacy levels (76%). 

As identified on Graph 6, there is a significant correlation between the age of the interviewees and their level of health knowledge. The older generation has the highest health literacy (82% versus 71% for the younger generation). This can be explained by the fact that the older you become, the more interested you are in your health and in topics related to it, as your health is slowly decreasing. 

There is also a correlation between the level of education and the level of health knowledge. The higher a person’s level of education, the more likely they are to have  high levels of health literacy (79% versus 62% for low level of education). It is therefore important to include health topics in the school curriculum as education is compulsory for everyone up to eleven years (from the age of 4 until the age of 15) . 

The French-speaking region of Switzerland is less health literate as the German- and Italian-speaking regions (W-CH: 61% versus D-CH: 77% and I-CH: 73% ranked 4-5 to the question). These differences between the regions might be explained by differences at the cantonal level. This emphasises the importance to focus on improving health literacy, not only at a national level but also at a regional or cantonal level. Especially in a country as decentralised as Switzerland (Guggiari et al., 2021).

Careum Foundation, working towards promoting healthcare education, worked on a two-year study project (2019-2021) to compare the health literacy of 17 different European countries. It was identified that Switzerland performed below average in comparison to other countries (De Gani et al., 2021). This shows that even if health literacy levels are high in Switzerland, there is still much improvement required at a cantonal, regional and national level for Switzerland to reach the level of other European countries such as Denmark. 

Importance of health literacy in Switzerland – Alexandros Giannakis, Accenture

“Switzerland is a country where increasing health literacy can be more effective than normal in terms of impact:

🔹 People have access to information, and to communication channels across the country, and more than an average country

🔹 People have the necessary means to access health advice, be it in the form of better nutrition, or in the form of accessing and using fitness and/or wellbeing services, etc.

🔹 Switzerland, especially in rural areas, is made up of small, tightly-knit communities. When reaching a certain scale of health literacy within a given community, then the impact and effect can scale across the whole, or bigger parts of the community, meaning the ROI of health literacy can be even more effective than normal

In view of these positive factors, health literacy should be strengthened throughout the country and especially in rural areas, where certain aspects of health and a healthy lifestyle (e.g. nutrition), can be significantly improved. Tobacco consumption, on the other hand, is statistically higher in Switzerland than in other high-income countries, as the statistics of recent decades show.

With health insurers having the means to push for health literacy campaigns and initiatives, this is providing a very sound setup for a country where health literacy can be pursued and improved drastically.”

Graph 6 – Health literacy in Switzerland

Health literacy in Switzerland (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, digital literacy level (from none to high)).

Graph 7 – Digital literacy in Switzerland

Digital literacy in Switzerland (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), concern in digitalisation (very unconcerned to very concerned)).
3.2 Digital literacy

Digital literacy refers to the ability to use information and communication technologies to find, evaluate, create, and communicate information, requiring both cognitive and technical skills (ALA, 2011). This was the selected definition which was used in our survey. 

Almost three quarters of the respondents estimate that their digital competences are high to very high (72%). 

There is a significant correlation between the age and the education level of respondents and their perceived digital skills. The younger the interviewees are, the more digital savvy they assess themselves to be (61% for the 65+ yrs, 74% for the 40-64 yrs and 78% for the 18-39 yrs). 

Digitalisation essentially started in the 1950s with the advent of computers but only made its disruptive arrival in the 1990s with the advent of the Web (Press, 2015). Therefore older generations did not grow up with digitalisation and had to upskill at a later stage, whereas younger generations were born with the internet and grew up using digital tools. The pandemic had a very positive impact on digital technologies as the older generation needed to use them to communicate with their families and friends and therefore 74% of the older generation used the internet (Rubín et al., 2020). The more educated the interviewees are, the more digital literate they are (low: 53%, middle: 70% , high: 85%). 

This can be explained as the further you study, the more you are confronted with the digital word and digital tools. Switzerland has one of the highest-ranked educational systems in the world which includes excellent work opportunities and is starting to incorporate digital knowledge and computer science into the school curriculum (Robert).

One in two respondents corresponding to the wealthy purchasing power category rate their digital skills as very good (scale 5: 55%). 

The majority of the stakeholders of the wealthy purchasing power group rate have corporate professions, which require the daily use of computers and other technologies. 

People who are mostly unconcerned about digitalisation more often indicate high digital literacy (82% versus 70% for very concerned respondents). This could be explained by the fact that stakeholders who are more concerned by digitalisation tend to be more cautious of using digital tools and therefore less digital literate.

Digital literacy in Switzerland has increased extensively over the past years and has taken a step towards a sustainable development (Swiss Confederation – BFS, 2021). But it still requires a fast upgrade to keep up with the change rate and avoid a digital divide, leaving out a part of the population in the digital transformation. 

3.3 Interconnection between health and digital literacy

Health and digital literacy levels in Switzerland are highly ranked overall. There is a strong correlation between both. People that highly rate their health literacy have a higher tendency to have high digital literacy levels as well (83%) and vice-versa (79%). Respondents who self-assess their health state highly are more likely to have high digital competencies (79%) in comparison with the ones who rated it low (55%). Nowadays information is mostly accessible through the internet and therefore it is logical that people with higher digital literacy are most likely to have better access to health information and have a better literacy in that domain. This leads to better health conditions. 

These two competences are now also summarised under the new term digital health literacy. It is defined by Careum Foundation as the degree to which individuals are able to obtain, understand and judge health information from digital sources and use it to make decisions about their health (De Gani et al., 2021). If these levels are low, it will lead to negative consequences such as increased health inequities in a world where healthcare is being digitised. Patients who are not capable of using digital tools or don’t see their importance or cannot access them will not have access to their benefit and give them a clear disadvantage for their health improvement and engagement (Heath, 2022). 

We need to act quickly to ensure no one is left behind. We need to prepare the users for a healthcare system which continuously integrates new ways to engage the patient with technologies and therefore find new strategies to improve the level of digital literacy in Switzerland.

Chapter 4: Digital Habits

4.1 Time spent on digital tools

At the beginning of 2022, the Swiss population counted 8.74 million (Worldometer), with 8.57 million internet users representing 98% of the population (Kemp, 2022). Digitalisation is therefore more present than ever in this central European country.

In the survey, we wanted to better understand the average time spent on digital devices, including their time at work. The findings were well distributed with nearly a third (29%) indicating a duration of use of up to 3 hours, another third between 3 and 6 hours (32%) and 36% using it daily more than 6 hours. 

The younger respondents are the ones who spend more time on digital tools (18-39 yrs: 55%, 39-64 yrs: 41% and 65+yrs: 10% spent above 6h). This can be partially explained by the fact that during your employment age, you are often using computers daily for your professional occupation. The older population who are more commonly retired, do not need to use digital tools as often as they do not need them for their professions. In Switzerland, the retirement age is 64 for women and 65 for men, but people can also retire earlier if they have the financial possibility (Swiss Confederation). On the other hand, the young generation spends more of their free time on devices than the older population (average of 4 hours) versus 2.5 hours for the middle aged population (Swissinfo, 2019). 

The higher the purchasing power category, the longer time spent per day on digital devices (48% of the wealthy purchasing power category  spend more than 6 hours on their digital tools). People with more financial means are more inclined to have professions requiring more screen time and technologies, and this in addition to their free time digital leisure would add up and increase their overall average time spent on their computers, tablets or smartphones.

As seen above, the Swiss population is accustomed to using digital tools for work and leisure on a daily basis and could therefore easily become comfortable using it as well to track their health data and wellbeing. 

Graph 8 – Time spent on digital tools

Time spent on digital tools (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), purchasing power: low income, lower average, higher average and wealthy, digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).

Graph 9 – Health data tracked on digital tools

Health data tracked on digital tools (n = 1110, data in percentage).
4.2 Health data tracked on digital tools

92% of the Swiss population uses a smartphone in 2022 (O’Dea, 2020). Smartphones contain internal or external applications which often track health data continuously. While some data is collected without the knowledge of individuals (e.g. steps) other data is collected on a voluntary basis through connected watches, mobile phones and applications. 

In the survey, we asked the Swiss population what types of data they monitored with digital tools (Graph 9, page 14). More than half of the Swiss population captures their daily steps (51%) with an even higher proportion in the younger generation (60%). 

While certain citizens cautiously track their steps per day with precise gadgets, most of the population still is not aware that their mobile phone tracks such information in the background. As it is often recommended to walk a certain amount per day, these tools help to see progress and how much you need to walk to stay healthy.

Sport activities (32%) and pandemic containment applications come in second place (32% of the population monitors this data) followed by data linked to insurance (29%). 

On the contrary, sport related, pandemic data and insurance related data are all tracked on a voluntary basis and therefore often need to be downloaded or connected to additional applications or gadgets to track continuously. The COVID-19 pandemic brought many limitations to the Swiss population which removed certain rights if they did not have the possibility to present certain health data. This increased the uptake of such applications as the citizens wanted to move freely in their towns and continue to live their lives. 

After monitoring these health data linked to special needs/rights, citizens track the most specific health-related features such as menstrual cycle by the female population (27%), heart rate (20%) and sleep cycle (20%). These data give you a better understanding of your state of health and help you monitor your health and wellbeing. 

Even if a majority of the population tracks at least one type of health data, 21% do not receive/manage any data digitally. This is mostly represented by the older generation which did not grow up with these different tools and which is less inclined to take on new habits of tracking their different health features. They are still used to getting their health values captured only one time a year at their doctor’s visit.

Overall on average, the older the interviewee, the less types of data they manage digitally (18-39 yrs: 3.1, 40-64 yrs: 2.6 and 65+ yrs: 1.7).

In the future of healthcare, monitoring one’s health values at home continuously would enable better health outcomes as the doctor would be able to better understand the evolution of the data through time and ensure the best treatment possible for the patient.

4.3 Frequency of use of digital tools for health tracking

In 2021, 80 million smartwatches were sold, compared to barely 16 million conventional Swiss watches (Müller, 2022). Smartwatches offer additional features as they can directly be synchronised to other devices. Among many functionalities, these devices help to monitor sleep patterns, nutrition, exercise, monitor vital signs or keep track of chronic disease (Schoonbee, 2021). In the survey, we questioned Swiss citizens how often they use such digital tools for health monitoring. More than a quarter (28%) record their health data on a daily basis, while 43% never use such gadgets to monitor their health. This means that a vast majority of the population tracks their health activities on a gadget or application on their smartphone nowadays (Swissinfo, 2018). 

As one could expect, the younger the respondents, the more they use apps or gadgets to record their health status (33% of the younger generation record it daily and 19% multiple times a week). This is explained by the fact that millennials and Gen Z are the most receptive to new technologies and new gadgets (Koch, 2018) and are more targeted by such products through social media platforms (sproutsocial). On the contrary, the older generation has a higher tendency to not monitor their health with devices (65% never track any data). 

An interesting finding is that people who often use digital tools to monitor their health do not feel more health literate, only more digital literate. This could be due to the fact that many people just want to capture their health data and do not take the time to understand what this data really represents and how they could use them to better understand their health state.

People who are less concerned about digitalisation tend to use such tools on a more regular basis (47% use it on a weekly basis). This is well explained by the fact that stakeholders which are concerned about the implication of digitalisation tend to avoid using digital devices to store/share their health data. They are concerned as they feel they have no control over how their data is being handled.

Smartwatches and smartphones are great digital tools to monitor health data. They should be more used in Switzerland as they allow citizens to capture real time data and have a better understanding of their health. It is a great product in the medical field to enable easy information overview between healthcare professionals and patients (Elnagar et al., 2022). To enable smooth adoption, technology providers should tailor their products to all age groups and clearly explain how health data is being processed and tracked. 

Home monitoring for enhanced health data tracking Dr. med. Conrad E. Müller FMH, MBA, Pro UKBB Foundation

Patient home monitoring avoids hospitalisation 
During the COVID-19 pandemic, the health care system was under heavy strain. Up to 30% of the hospital capacity was needed for the COVID patients. This resulted in long waiting times for elective treatments and delayed diagnosis and therapy for other conditions with correspondingly negative outcomes. 

What is Home Monitoring? 
When patients are cared for at home, their vital signs are usually only measured once or twice per day. For many diseases, such as respiratory diseases for instance, it would be useful to record the trend of the disease progression using continuous monitoring of the vital signs to enable prompt action should the condition deteriorate. The required monitoring equipment works with a small sensor on the fingertip, for example the Masimo SafetyNet. It continuously measures SO2¹, respiration and heart rate and sends the measurements via smartphone to the clinical portal. 

Patients are thus not exposed to the risk of infections, they do not lose muscle mass and they do not develop mental disorientation. A next step could be the full virtual hospital at home, where the hospital ward of the patient is the  home. “Stay safe at home” will soon be a reality like the home office today.

Graph 10 – Frequency of use of digital tools for health tracking

Frequency of use of digital tools for health tracking (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).
* ¹SO2: Sulphur dioxide



Chapter 5: Digital Health System

5.1 Platform provider

The Swiss healthcare system is highly decentralised and follows a federal structure where the federal government, cantons and local municipalities take on different roles. The system is funded through premiums, taxes, insurance contributions and out-of-pocket payments (Sturny, 2020). The government is responsible for defining the rates of the deductibles and accepts or rejects changes to premiums. Cantons specify which hospitals provide which benefits and specify the working hours and wages of nurses and doctors. The private and public sector must work together. Private health insurance companies provide basic and complementary insurance but they need to follow the regulatory requirements of the Federal Office of Public Health and Financial Market Supervisory Authority (Sanitas). Basic insurance is compulsory for anyone living in Switzerland.  

Digitalisation is key to more transparency and easier access to various data. Digital transformation has taken over many industries in Switzerland, making this country very innovative. In the healthcare system, the acceleration of digitalisation would bring various benefits to all the stakeholders, including patients as it would improve health outcomes, treatment quality, patient experience and reduce administrative burden (Hämmerli et al., 2021).

In the survey, we therefore asked Swiss citizens who they believed is the best provider of a Swiss digital healthcare system, defined as a system which enables all health data to be available in an easy-to-use, secure digital way. 

More than a quarter of the respondents believe the government (29%) and/or health insurance (27%) should be the provider of a digital healthcare system platform. Hospitals come in third place (20%). NPOs, private organisations² and private-public partnerships³ are only mentioned by a very small percentage (NPOs: 7%, private organisations: 4% and private-public partnerships: 4%).

A high number of interviewees (9%) preferred not to answer this question due to lack of information or lack of opinion.

Swiss citizens strongly believe that the state should play a central role in providing the overall digital solution and believe in the important role of health insurers. In fact, as every citizen has an obligatory insurance, they already have a strong relationship with their insurance provider. Respondents believe that hospitals also have an important role to play but should not be in the driving seat. Private organisations, NPOs and partnerships should only have an indirect role in the system.

It is interesting to see the differences between age groups and the level of education of interviewees. The older or less educated you are, the more you see the hospital as the best provider (65+ yrs: 32%, lower education: 30%). The younger or the more educated you are, the more you believe the government should take responsibility (18-39 yrs: 32%, higher education: 36%). 

We can see significant differences between respondents who are very concerned about digitalisation and the ones who are not. The people who are unconcerned believe that the government should be responsible for the platform (35%), whereas the concerned group gives a higher percentage to hospitals (26%). This can be explained by the fact that people who fear digitalisation might want the system to remain as it is and therefore under the control of hospitals.

For now, the government and the health insurance companies have taken up key roles in the digitalisation of the healthcare system. A lot of progress has already been made, but much more needs to be done. Further information on these solutions can be found below.

²Private organisations such as pharmaceutical companies, technological companies etc.
³Private-public partnerships are a cooperation between public authorities and the private sector which provides public sector facilities and services using private resources and expertise (The World Bank, 2022 and Müller-Tschumi & Wyss Ltd, 2012).


Digitalisation of the healthcare system in Switzerland – Background

In 2007, the Federal Government launched the “eHealth Strategy Switzerland” to help patients access and share their health data with selected health providers. The Federal Law on the electronic patient record regulates the secure requirement for handling of health data in the electronic patient record (De Pietro & Francetic, 2018). Since then the adoption has made some progress but it is still rather limited. A revision of the law and consultation in summer 2023 (FOPH, 2022) is planned to ensure its success with changes affecting the voluntary participation and the opt-in model (Hämmerli et al., 2021). Private organisations have developed solutions which comply with the Federal Act on the Electronic Patient Record. In 2022, Swiss Post became the main provider of EPR after acquiring the majority of the shares of Axsana, which was working with the Swisscom solution before successfully migrating to the Swiss Post platform at the beginning of October 2022 (Swiss Post, 2022). 

As the government was taking time to implement digital solutions for the healthcare system and the EPR was having a slow start, insurance companies saw the opportunity to launch joint consortiums with other ecosystem players to provide a digital health platform. Two different consortiums have come to life in recent years: Well Gesundheit and Compassana.

Well Gesundheit is a joint venture between CSS, Medi24, Visana, Zur Rose with recent arrival of Galancia, Swiss Medical Network and Allianz Care. It is an open and independent platform connecting what is important in healthcare, treating data securely and confidentially.

Compassana was founded by Medbase, Hirslanden, Groupe Mutuel, Helsana and SWICA to develop a digital healthcare ecosystem. Their goal is to improve treatment quality and process efficiency with the development of a simple, user-friendly portal (Kaufmann, 2022). Even though such solutions are coming into place, one important problem remains, digital technologies cannot currently be reimbursed in Switzerland (Sander et al., 2022). 

Digitalisation of the Swiss healthcare system is high on the agenda for many people today. Every player wants to contribute, placing their own piece of the puzzle to enable the full system to be digitalised. The only way to achieve this would be for the public authorities to set the national framework and standards and for all other players to collaborate with one another. The FOPH has recently launched a new expert group focusing on Data management and standardisation (FOPH expert group, 2022).

Graph 11 – Switzerland’s preference for digital healthcare system platform provider

Switzerland’s preference for digital healthcare system platform provider (n = 1110, data in percentage) – Government (Federal, cantons etc.), Hospitals (doctors, nurses etc.), Non-profit organisations (as for example: WHO, Swiss Red Cross, Doctors Without Borders etc.), Private organisations (pharmaceutical companies, technological companies etc.).

Graph 12 – Swiss citizens desired benefits from digital healthcare system platform 

Swiss citizens desired benefits from digital healthcare system platform (n = 1110, data in percentage).
The electronic patient record as a driver of digitisation in the healthcare sectorMatthias Glück, Swiss Post

“Swiss Post firmly believes in the value of the electronic patient record (EPR) as a cornerstone of digital healthcare. The introduction of the EPR means citizens have the key to their health information in their hands. They always have access to their own medical data and can decide for themselves who else also has access to their EPR.

Swiss Post is taking a leading role as an integrated provider in the introduction and development of the EPR in Switzerland. Access will also be simplified to ensure that as many people as possible benefit from the EPR. Swiss Post is providing support to interested parties today. They can already seek advice about the EPR in selected Swiss Post branches and open an EPR in person. The goal of all parties involved with the EPR is and will remain that the general public can verify their identity online and open an EPR quickly, simply and electronically in a single step.

Service providers such as hospitals and clinics also benefit from the EPR. Patients can grant healthcare professionals easy access to their treatment-related documents. This allows the diagnostic process to be supported digitally. Thus, reducing examination risks, increasing the quality of treatment, and helping control costs in the Swiss healthcare system.”

5.2 Desired benefits from the platform

Digital tools have a higher adoption rate when they are user-friendly and offer added value which one would not benefit from without the tool. In most industries nowadays, users play an important role to develop, test and seek feedback on a new tool or device and its key values.

For example, why are people so dependent on their iphones? These devices are easy to use, with clear added value compared to regular phones. Additionally, Apple makes sure to include user feedback in the development of the next generation of smartphones (Vigroux, 2020). This ensures a high retention rate. 

Why should this be any different when it comes to the healthcare industry? For now most digital healthcare solutions were developed without asking the main users, the patients, what key benefits they expect the solution to offer. 

In this survey we asked the Swiss citizens to choose which three benefits the digital healthcare system should offer? 

The most important requirement for the system is the reduction of health costs (cited by 37%). In fact, the healthcare system in Switzerland has extremely high costs (Swiss Confederation – BFS, 2022), which leads to increases in the premiums (Keystone-SDA/dos, 2022). As mentioned in the report from McKinsey & Company, the costs of the Swiss healthcare system could be reduced by CHF 8.2 billion due to digitalisation (Hämmerli et al., 2021). 

Swiss citizens highly value having access to their health data from anywhere (31%), at any time (27%) as this would enable them to better monitor their health and play a more active role in their health journey.  

Reduction of redundant tasks is also identified as a key benefit (28%). With the analogue healthcare system, it is common for patients to fill out the same information multiple times and to contact different healthcare providers. Having a digital solution which contains all the important health data would be a great time gain as one could easily share the required data with the different health providers. Facilitated communication with the various healthcare providers was also identified as a key value of the system (28%). The respondents would also appreciate having access to additional information about their illnesses and treatment (22%) as this would empower them and raise their health competencies and therefore health literacy. 

Swiss citizens see personal ownership of data (13%) and data storage in Switzerland (10%) as less important requirements even though they believe that they should be owning their health data (see section 5.2 – Data ownership).

Engaging with the patient organisations in designing the future improvements of the solution (Hämmerli et al., 2021) of the digital healthcare system and EPR and its roll out will help to include patients’ needs and requirements for digital platforms. This is the only way the whole population will adopt the solution and change their ways of handling their health. 

Added value of universal access to health data (independent of time and space)Dr. Susanne Weissbäcker, Josselin Meylan, EY-Parthenon

“As individuals, our health is based on multiple parameters:

🔹Who we are (our genotype, phenotype…)
🔹How we live (what we eat, how much we move, our environment…)
🔹And how the above expresses itself (our general health status, examination results…)

Most of this can be called health data, which is likely to be stored in very different places or systems: Our doctors’ offices, the hospitals we visited, our devices, the claims we file with insurance companies…or even in the results of controlled clinical trials. Combined, these data sets will paint a picture of us what will allow drastic progress in the way we’re treated: 

🔹Our conditions can be diagnosed earlier, based on very early signs
🔹For the less fortunate, the right treatment can be identified with less trial and error
🔹Relevant trials can be identified quickly

Overall, combining data sets can lead us towards true personalized medicine, with better outcomes at a low marginal cost to society – without even mentioning the cost savings of not duplicating exams because the data hasn’t followed us to our next healthcare provider. To unlock this value, systems designed for privacy and patient consent providing timely access to health data will be key drivers… and only a strong collaboration among all the healthcare system stakeholders will allow this.”

Usability and value of an electronic patient recordThomas Gross, BINT and ofac

“The value of the Electronic Patient Record (EPR) is undeniably enormous and indispensable today: We can all store our sensitive health data in a highly secure, federally certified place in Switzerland (and not in a cloud with Google or Apple).Thanks to an equally secure network, we can provide those who are supposed to treat us with access to our data as needed. Our dialogue with them alters fundamentally: We are changing from a rather passive role to an actor on an equal footing. Data from treatment, patient measured data and prevention data join together as a whole. The quality of treatment improves and costs decrease.

This EPR is now available, and it basically works. But the usability is not satisfying yet. The onboarding, the identification process, the filling, the integration of structured data from different sources or the networking options with other apps urgently need to be simplified. The FOPH has a particular duty to pave the way for such simplifications. It must not incapacitate users again with exaggerated data protection thinking. If this is heeded, we will be amazed at how much innovation and practical value will be added over time to what is already a remarkable starting point!”

5.3 Data ownership

From a legal perspective, ownership is defined as the state of having exclusive rights and control over property (Law, 2022). Property is often thought of as a relation between an individual and an object (Liddell et al., 2021). Personal information was suggested by Alan Westin to be recognised as an object of property rights in the 1960s (Westin, 2015). In this sense, personal health data should be legally owned by patients themselves. Unfortunately, it is not as simple as it seems.

Institutions which collect health data often believe they own the data but in reality they are only “data custodians” and the data is property of the patient. This means that the patient needs to provide consent for the data to be used outside of the clinical institution (Hulsen et al., 2019). 

When conducting the survey, we wondered how the Swiss population felt regarding this critical question of data ownership. As expected, more than two thirds of respondents (68%) want to be the legal owners of their personal health information. The electronic patient record (EPR) goes in this direction as the patients themselves have the control over who can access or not their health data in the electronic health record (Swiss Confederation, 2017). Almost one fourth (22%) would like their general practitioner to be the legal owner. The older people are, the more likely they are to want their doctor to have the rights and control their data (65+ yrs: 36%). This could be explained by the fact that the older population trusts their doctor more than themselves to keep track of their health. 

The more educated or the more wealthy people are, the more they would like to own their data (high education: 78%, wealthy: 70%). They have access to more information and therefore understand in more depth what it signifies for them to be able to control their own data. 

Significant differences can be seen between the different regions of Switzerland. The German-speaking region of Switzerland has a stronger willingness to legally own their health data (71% versus W-CH: 57% and I-CH: 60%), this could be due to the fact that Swiss Germans have a higher trust in individual responsibility which they believe leads to collective responsibility (Bradely, 2020). 

Respondents with high digital literacy and health literacy have a stronger desire to personally own their data themselves (very digital literate : 71%, very health literate: 69%). They have higher competencies in both topics and therefore a better understanding of what it entails to own your personal health data.

In the future, patients should be the legal owners of all their health data and therefore have control over their data (able to delete data at any time). Patients should also have control over which data can be taken for secondary use of health data (research) through the patient consent form (swissethics, 2021).

Graph 13 – Perception of Swiss citizens on personal health data legal ownership 

Graph 13 – Perception of Swiss citizens on personal health data legal ownership (n = 1110, data in percentage) – my close ones (family and friends), digital wearables (FitBit, Apple watch, etc.)
Role of the government in the digital transformation of the health systemMathias Becher, FOPH

“Health care is a collective issue with the citizen as the main stakeholder. The cooperation of all involved players is key to a citizen-centric approach towards a successful digital transformation of the health care system. Given the Swiss federalistic organisation of health care with a number of different participants and parties with varied competencies, the Swiss government’s role is manifold: It guarantees the essential regulatory framework that promotes digitisation and sets the adequate premise for establishing a digital-driven ecosystem in health care, promotes the development of a common architecture and of joint standards, orchestrates the collaboration of all stakeholders within the data ecosystem and provides for the right incentives. Also, the government is to implement its own digital procedures as a part of the common digitised ecosystem, based on the collectively developed architecture.”

Role of hospitals in the digital transformation of the health systemSebastiano Caprara, Balgrist University Hospital 

“Healthcare systems are currently facing multiple challenges including an ageing population, workforce shortage, and the pressure to perform at highest levels while reducing costs[1]. As a paradigm shift towards electronic health records is rapidly gaining momentum, it is clear that digitalisation has the potential to address these challenges. Data-driven technologies, such as remote patient monitoring devices, risk factors’ prediction, and radiological analysis are developing in mature methods that can support clinical workflow and also potentially the reduction of costs[2]. For a successful clinical translation of these methods, digitalisation is essential but, in addition, it requires effective interlinking of patient records and their interoperability.

To optimise the interface between novel technologies and the healthcare system, hospitals should strategically remodel the way digital tools can be integrated into traditional clinical services. A complete integration will be highly effective in terms of improving the patient journey, thus improving population’s trust on digital medical technologies. As trust from the patient is central to successfully developing personalised medicine, and as the majority of patients report the strongest trust in their physicians and medical institutions[3], hospitals must have a central role in the continuous development of digital health solutions. Only in this way will we be able to successfully integrate data-driven technologies in healthcare.”

References
[1] Bajwa J, Munir U, Nori A, Williams B. Artificial intelligence in healthcare: transforming the practice of medicine. Future Healthcare Journal 2021 Vol 8, No 2: e188–94
[2] Rajkomar A, Oren E, Chen K, Dai A.M. et al. Scalable and accurate deep learning with electronic health records. NPJ Digital Medicine (2018) 1:18[3] Brall C, Berlin C, Zwahlen M, et al. Public preferences towards data management and governance in Swiss biobanks: results from a nationwide survey. BMJ Open 2022; 12: e060844

Role of insurance companies in the digital transformation of the health systemPius Zängerle, curafutura

“Switzerland’s population is proud to have a well established and renowned health system. At the same time, it is a common perception that the grade of digitalisation is average in Switzerland, instead of ranking high as in other sectors of the Swiss economy where Switzerland is world leading.

Insurance companies could play the role of a catalyst in the challenge to bring forward the digitalisation, as they have regular contacts to all inhabitants in the country, both patients and insured persons. They are therefore in a dominant role to provide apps and data connected to health and insurance. If insurers successfully bring function to the patients, they can be door openers to digitalisation. From an economic perspective and regarding the relatively small population, it is key that Swiss insurers are supporting solutions where different players – providers and insurers – find ways to establish common platforms (or ecosystems or portals) to achieve minimal size for economic success of digitalisation.”

Role of pharmaceutical companies in the digital transformation of the health systemMarie-Jeanne Semnar, Interpharma

“In order for an open health data ecosystem to deliver all its potential benefits – for the healthcare system as a whole, as well as for patients and research – all actors involved have their contributions to make. This also applies to the pharmaceutical industry, of course. Pharmaceutical companies are aware of their responsibility: The members of Interpharma are already making valuable contributions that promote the development and setting up of a health data ecosystem.

They provide expertise, resources and their international network, invest in the development and maintenance of sub-ecosystems and participate in a variety of collaborations, for example with universities or the government (e.g. private-public partnership).

In addition, they train professionals and apprentices in data literacy and share structured data with other researchers and interested parties. In dealing with data, pharmaceutical companies are committed to ethical standards and ask for a clear regulation of secondary use of health data for. To this end, pharmaceutical companies are actively engaged in the societal dialogue about the value of the health data ecosystem.”

Chapter 6: Trust in Swiss Institutions

Trust is essential. Nowadays, trust is hard to gain but easily lost. To maintain the trust of its population, Switzerland needs to demonstrate that strict standards are met in regards to the security of data infrastructure. It is an obligation to handle people’s data carefully and communicate transparently with citizens, engaging in a dialogue with the public (Bergamin, 2018). In recent years, Switzerland has observed a massive loss of trust, especially in the middle generation (40 to 64 years old) with a 40% decrease in willingness to store electronic health data between 2018 and 2020 (Golder & Jans, 2020). In the survey, we asked citizens how much they trusted different Swiss institutions (hospitals, public authorities, private organisations and non-for profit organisations) on a scale of 1 to 5 (1= no trust to 5= high trust). In the next sections, you will find a deep dive in the different organisations.

6.1 Trust in health providers (including hospitals)

As shown on Graph 14, 70% of the respondents have a high trust in health providers (scale values 4-5), with the highest value for the older generation stakeholder group (80%). General practitioners are identified as trustworthy partners for data handling (Golder & Jans, 2020). A relationship of trust between healthcare professionals and patients leads to better results in medical treatment. Trust needs to come from both sides with each party knowing their rights and obligations (Swiss Confederation – FOPH, 2022). Older people tend to trust people and institutions more (Knecht & Manz, 2022). 

People with high health literacy and high digital literacy have higher trust in hospitals than people without (high health literacy: 74%; high digital literacy: 73%). This is due to the fact that they have more knowledge and understanding and therefore higher expectations in the hospitals which leads to higher trust (Bertram et al., 2021).  

6.2 Trust in Public authorities

Despite the COVID-19 pandemic, Switzerland has maintained high faith in the government (Swissinfo, 2021). Almost half of the survey’s respondents (47%) have a high trust in public authocrities (scale values 4-5) (see Graph 15). 

More males have a higher trust level in the government than females (54% versus 40%). This is also the case in most OECD⁴ countries as outlined in the Trust Survey 2021 (OECD, 2022).

The younger and more educated respondents are, the higher trust they have in the government (18-39 yrs: 51%; high education: 54%). The young population highly values transparent communication around health topics, which happened for example during the pandemic. This leads to higher trust levels (Gonzálvez-Gallego & Nieto-Torrejón, 2021). Stakeholders who consider their health and digital skills to be high and who are less concerned about digitalisation also have a higher trust in the public authorities (high health competencies: 51%, high digital competencies: 54%, unconcerned about digitalisation: 58%). People with high education, strong digital and/or health skills have a more in depth understanding of the way the public authorities will deal with their health data and this leads to a higher trust than within less educated people. Stakeholders which are less concerned about digitalisation have a higher chance to have faith in how the state will treat their own data.

⁴OECD countries: Organisation for Economic Co-operation and Development is an intergovernmental organisation with 38 countries founded in 1961 to stimulate economic progress and world trade ( https://www.oecd.org).


6.3 Trust in Private sector

The private sector of healthcare combines insurances, pharmaceutical companies, MedTech and BioTech. It encompasses all companies which are not owned or governed by the state but provide health services. Within the survey, they were the sector which Swiss citizens trusted the least. Only one fifth of the respondents have a rather high trust in them (22%). People fear that private companies are working in the healthcare sector solely for their own benefit and not for the benefit of society and that therefore their data will be used only for their personal profit (Gille et al., 2021).

The young generation, as well as the wealthy and upper purchasing power category have the highest trust in the private sector (18-39 yrs: 27%, higher average & wealthy purchasing power: 26%).

6.4 Trust in Non-profit organisation

Non-profit organisations in the healthcare sector include organisations such as WHO⁵, Swiss Red Cross⁶, Doctors Without Borders⁷ and many more. Two fifths of the respondents (40%) have (rather) high confidence in NPOs (scale values 4/5). This correlates with the Edelman Trust Barometer 2022, which shows a raise in trust in multinational institutions such as the WHO (Edelman, 2022).

The young generation has slightly higher trust than older generations once more (18-39 yrs: 45% versus 40-64 yrs: 38% and 65+yrs: 40%). We observe the young generation in Switzerland tends to trust the different health organisations more than the other generations.

Additionally, stakeholders who rate their health and digital skills as high also have greater trust in NPOs than those who consider their skills to be low (high health competencies: 44%, high digital competencies: 45%). People with higher skills have a better understanding of what non-profit organisations are actually pursuing and therefore higher trust in what they would be able to do with their health data.

6.5 Comparison

Health providers (including hospitals) are the most trusted organisation in Switzerland regarding health data handling followed by the government, whereas the private sector is the least trustable sector. Building up trust in different organisations will be key to digitalise the full healthcare system.  Health professionals and the government will play a key role in the digitalisation of the healthcare system in Switzerland. Communication will be an important part of the transformation, making sure the population fully understands how their data will be handled and what the added value of such a transformation is.

⁵WHO: United Nations agency which promotes health and keeps the world safe, serving the vulnerable
https://www.who.int/)
⁶Swiss Red Cross’ main goal is to maintain, promote and restore good health for everyone (https://www.redcross.ch/en)
⁷Doctors Without Borders brings medical assistance to victims of epidemics, natural disasters, conflict or healthcare exclusion (https://www.msf.org/switzerland)

Graph 14 – Trust in health providers (including hospitals)

Trust in health providers (incl. hospitals) (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).

Graph 15 – Trust in public authorities

Trust in public authorities (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).

Graph 16 – Trust in private sector

Trust in private sector (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training), high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).

Graph 17 – Trust in non-profit organisation

Trust in non-profit organisation (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training), high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, health literacy level (from not informed to very well informed), digital literacy level (from none to high), concern in digitalisation (very unconcerned to very concerned)).

Chapter 7: Drivers and Barriers to Health Data Sharing

7.1 Actions taken prior to data sharing

In today’s society people share various types of data with others on different platforms. They often do not check anything prior to sharing and therefore they do not know where their data is stored or processed. It is critical to find a way to let people regain sovereignty over their data and maintain the right of decisions on their data (Fontanet, 2022). This is complex as once the data is shared, it can easily be copied and people can lose control over it. It is therefore important to be attentive to certain criteria before sharing personal data, especially personal health data.

We asked the Swiss population what actions they usually take prior to handling their health data (collecting, storing, editing or sharing). The results can be seen in Graph 18.

Two fifths of respondents (40%) say they want to check who will have access to the data. About a third want to know what the data will be used for (32%) or how it will be protected (31%). Only a few respondents take no action while knowing the consequences (7%).

Another third (31%) do not indicate any clear action, either because they have no experience in this area (15%), because they would never collect, store, process or share health data (14%), or because they did not give a reason for not answering the question (2%). 

The older generation has a higher tendency for finding out what will happen to their health data (if they collect/store/edit or share their health data) than the younger generation. This could be explained by the fact that as the respondents are above 65 years, they are more cautious about digitalisation. They are also more attentive to how their data is being processed when they decide to store or share it. 

In the future of healthcare, digitalisation will play a key role. It is therefore important to upskill citizens on the value of data and therefore on how to be attentive to the handling of their data. Defining comprehensive guidelines for such data handling would be needed (Hoffmann, 2018). Collecting, storing and sharing data will be regular activities, which need to be taken by everyone but in a smarter way to ensure full control and ownership of the data by its owner. 

Graph 18 – Actions taken prior to sharing data

Actions taken prior to sharing data (n = 1110, data in percentage) – select as many answers as applicable

Graph 19 – Conditions to share personal health data

Conditions to share personal health data(n = 1110, data in percentage) – select only the three most important conditions
Added value of health data sharingAnne Kuruvilla, SwissRe

“When sharing or disclosing personal health information, we can feel vulnerable. This stems from a fear of not knowing what is happening with this data and how it is being used. To respond to such legitimate concerns, trust-building measures are needed to explain that stakeholders/providers are pursuing equitable, safe and comprehensive care.

The holistic approach is that sharing this data can have many benefits for patients, physicians, hospitals, insurers, etc.

For patients, the transparency and deeper insights that data sharing allows means that an emerging condition can be viewed holistically, allowing for better prevention. Doctors and hospitals, on the other hand, have information at their disposal that helps them to take comprehensive and sustainable healing measures. Insurers have the opportunity to make more individual offers or use non-personal data to optimise their risk profiles.

Promoting trust among patients is essential. It is important to inform all stakeholders how transparency, security, ownership, and ethical responsibility are defined and guaranteed. A collaborative partnership between data providers, processors and consumers, is therefore mandatory.
Such an ecosystem must serve the wellbeing of people and create visible added value for doctors, hospitals, insurers and also for Switzerland. With such advances in digitalisation, the Swiss healthcare system could take an important step forward not only in treatment, but also in efficiency.”

7.2 Conditions to share personal health data

Data sharing in Switzerland begins with the permission/consent of the data owner. It is therefore very important to better understand the drivers and barriers influencing the willingness to share personal health data (Pletscher et al., 2022).

As shown on Graph 19, improved quality of diagnosis/treatment (52%) is the main driver to share data. It is followed in second place by the use of data once anonymised for research purposes (41%). About a third would expect positive effects on health insurance (34%) or other financial benefits (34%). About one in ten respondents (12%) do not find any of these conditions good enough to share their personal health data.

Altruist motivators are the most cited, this is in line with the current healthcare system where the goal of the healthcare system is to heal patients in an optimised way. Secondary use of clinical data for research is very important as it enables us to test new drugs and solutions with real data. Nowadays in Switzerland whenever you visit a hospital or care centre, you are automatically asked for your consent if the centre wants to pursue research or projects using your clinical data. They will ask you if you authorise them to anonymise your data (removing the identifiers⁸) and use it for research (swissethics, 2021). During the COVID-19 pandemic, patients were more willing to share their clinical data to improve research and develop a vaccination in the quickest time possible (Tosoni, 2022). This was the first time in history that researchers had access to so much real time data and collaborated worldwide. This made it possible to develop the first vaccination (Pfizer) in only one year (Solis & Guildford, 2021).

Even if less highly ranked, citizens do also see financial benefits of sharing data. They have a higher incentive to adopt new digital tools when rewarded with financial benefits.

The older generation is willing to share their data mostly to obtain better treatment and diagnostics (62%) and less for any money incentives (21%). This can be explained as they are getting older and this directly impacts their health. They are therefore more sensitive to their wellbeing than to any monetary incentive.

The more educated respondents see higher value for improved treatment (57%) and for research purposes (50%) than others. This was already found in a large-scale survey published in 2021 (Brall et al., 2021). This could be explained by the fact that they have access to more information and knowledge and therefore understand the added value of primary and secondary use of data.

Educational efforts need to be increased in Switzerland to understand and raise awareness of data sharing and the benefits within the population to ensure the patient fully knows how their data is being processed and by whom (O’Connor et al., 2017). If the added value is clearly communicated and understood by the citizens then the adoption of digital tools and mindshift shift to a digital healthcare system should be eased. 

⁸Identifier: any feature which clearly identifies an individual and can permit another person to “assume” that individual’s identity.

7.3 Concerns on health data sharing

Digitalisation has picked up speed in recent years, especially following the COVID-19 pandemic which also means greater cyber-risks in the healthcare sector. To tackle this, the Swiss Conference of Cantonal Ministers of Public Health developed recommendations on data protection and information security which are based on the National Cyber Security Center recommendations on cybersecurity in healthcare. Cybersecurity is a key factor to ensure resilience and availability of critical health services (Swiss Confederation – NCSC, 2022). To ensure full positive effects of digitalisation in healthcare, it needs to be well protected and maintained. 

We wanted to better understand how the Swiss population feels regarding the digitalisation of their personal health information and if they were concerned or not regarding this topic.

A slightly higher percentage of the population is not worried about digitalisation (36% selected scale value 1-2) than very worried about it (31% chose scale value 4-5). This leads to an overall average of 2.9 on a scale of 5 of general concern level (approximately the middle of the scale). The subgroups do not differ significantly from each other.  

In the future system, to reduce concerns, we should ensure that digitalisation is well explained to the whole population to avoid inequalities in access to information, and also prioritise data protection to prevent data breaches or cyber attacks.  The next section will help us understand in more depth the different fears of the population regarding this digital transformation.

Graph 20 – Concerns related to health data sharing

Concerns related to health data sharing  (n = 1110, data in percentage, age groups: young (18-39 yrs), middle aged (40-64 yrs) and elderly (65+), sex distribution (male, female), linguistic regions: D-CH for German-speaking region of Switzerland, W-CH for French-speaking region of Switzerland and I-CH for Italian-speaking region of Switzerland, education level: low (mandatory school), middle (final secondary school examination, higher vocational training) , high (university or university of applied sciences), purchasing power: low income, lower average, higher average and wealthy, Health literacy level (from not informed to very well informed), Digital literacy level (from none to high)).
How to ensure the security of the digital health system to avoid data breaching?Garif Yalak, Cisco

“Over the past years, healthcare became the #1 target for cybercriminals. Even before the COVID-19 pandemic, 76% of healthcare providers reported they experienced a significant security threat. In its annual trends report, Cisco⁹ found that healthcare was the most targeted industry vertical for the vast majority of the year 2021. 

Healthcare organisations are particularly susceptible to threats when it comes to IoT. Outside of physical facilities, considerations for healthcare IT and security professionals include medical devices, wearables, telemetry equipment, and a new breed of health apps. Connected medical devices, third-party equipment and systems, and the environment should also be considered. 

When healthcare organisations define their strategy to strengthen their security posture, our advice is that they structure the thinking around 3 key pillars: people, technology, and processes. 

From a technology perspective, the most complete and sensible approach is to view security as a whole, treating security as an end-to-end system rather than a distinct set of individual components. 

Next to technology, the education of employees has the utmost importance. 95% of attacks are successful because of human errors. Industry players such as Cisco offer free education courses in cybersecurity through programs such as the non-profit Cisco Networking Academy.”

⁹Cisco Talos Incident Response Team

7.4 Fears regarding digitalisation of health data

“Everyone has the right to be protected against the misuse of their personal data”, this is a robust privacy right written in the Swiss Constitution (Federal Constitution of the Swiss Confederation, 1999). 

Therefore, for the collection and use of sensitive data, such as personal health data, either a legal basis is required, a public interest must be demonstrated, there must be  informed consent or the data must be anonymised (DPA, 2011). 

In the past years, the media has often drawn attention to the different health data violations, tracing and punishing the data thefts and ensuring to protect the data as best as possible. In 2019, sensitive medical data including 200,000 patient images ended up on unsecured servers. This was due to the fact that this health data was initially stored on servers with poor security (Keystone-SDA/AFP/ts, 2019). It is very important to store health data on servers which are protected and well maintained. One other important data breach took place in early 2021 when Myvaccines foundation was suspected of violating data protection. The free platform allowed people to create an electronic version of their paper vaccination record to ensure regular updates on their vaccination status. It was supported by the Swiss Government. The platform was accused of making 450,000 vaccination data information of 240,000 people openly accessible and vulnerable to manipulation. This led to the Federal Data Protection Act opening a procedure against Myvaccins in accordance with the Federal Data Protection and Information Commissioner (FDPIC) and National Cyber Security Centre (NCSC) (Keystone-SDA/ac, 2021). 

These extreme examples, even if rather rare, tend to scare the Swiss citizens regarding digitalisation of their health data as they are afraid that their health data will be mishandled or misstored.

In the survey, we wanted to get a better sense of what the Swiss citizens fear about the digitalisation of their health information. 

As illustrated in Graph 21, almost half of the respondents fear misuse or theft of their data (46%). The second most important reason (38%), is the fear of data misuse due to incorrect or improper storage. In third position, the population is frightened by the fact that a third party will make money with their health data (29%). This is closely followed by the fear of being controlled (26%). 

A fifth of the respondents are afraid of their health data negatively impacting their insurance (22%), losing control over their data (21%) or fearing to lose access to medical data (17%). 

One in ten do not have any fears regarding digitalisation (9%). 

As expected, the stakeholders who are very concerned about digitalisation are more afraid of the fact of being controlled (36%). 

Data protection needs to be at the centre of the future digitalisation of the healthcare system, ensuring appropriate systems and servers are used to store and share data and avoid any data mishandling, misstoring or data theft. Additionally, it should be ensured that patients are fully responsible for and in full control of their own health data and that third parties not have access to the data without the patient’s consent.  


Graph 21 – Fears regarding digitalisation of health data

Fears regarding digitalisation of health data (n = 1110, data in percentage) – select only the three most important conditions.

Conclusion

The survey reveals that the Swiss population is willing to use a digital healthcare system if it offers clear added value for the citizens, such as better usability, improved diagnosis and treatments, as well as reduced healthcare costs.

Swiss citizens have high levels of literacy in digitalisation and health but more can be done in order to ensure that no one is left behind. A stronger focus should be set on empowering citizens to better navigate their health and engage with the digital world. Digitalisation opens up a whole new source of knowledge where  patients can search for information and become agents of their own health and have more control over their health. 

It is also very important to upskill the population to better understand how their data is being processed as well as to show them the direct societal benefits of data sharing. Today, the Swiss population is primarily concerned about data mishandling, data theft and third parties making money from their data. To reassure citizens, data protection should be at the heart of the digital solution to ensure that appropriate systems and servers are used to store health data.

Swiss citizens already use digital devices on a daily basis for work and leisure. Additionally, applications and wearables are already regularly used in Switzerland to track health data.

Citizens could therefore easily  learn how to use these tools to monitor their health and wellbeing. This information would help them make positive decisions regarding their life, take on healthier habits and prevent them from many illnesses. This real-time data would also be a key asset for health professionals to better diagnose and treat patients.

These devices need to be tailored to be used by all,whatever their age, education, or gender. We are all “patients” at the end of the day as we are all daily affected by our health. We, as patients, should be invited to co-design the future of the digital healthcare system and EPR. This would ensure a higher adoption rate as the solution would be patient-centric and answer the needs of citizens: reducing health costs, easier access to health data independent of time and space and time reduction spent on admin tasks.

Citizens should be the legal owners of their health data as outlined by most survey respondents. They want to have full control over their health information and how it is being used. We are moving from a system where hospitals are at the centre towards a system where the patient is at the centre.

The question of trust is also crucial. Hospitals, followed by the government are considered the most trusted organisations in Switzerland when it comes to handling health data. Building trust in the different health organisations will be important for this digital transformation, as all players contribute to this transformation to enable the system to be digitalised from end to end. This will only be feasible if public authorities set a national framework with key standards and for all actors to collaborate. Increased adoption of the digital system and a change in the public’s mindset are only possible if all efforts are directed towards clearly communicating how the system will work, how health data will be  digitally processed and what key benefits citizens will have in their daily lives.

We hope that with our Digital Health initiative we can contribute to the overarching goal of digitalising the entire healthcare system and making it patient centric by aligning all healthcare stakeholders and empowering citizens.

About the Authors

This document was written between mid-October and mid-November 2022 based on the results from the Swiss population’s survey: “Needs and fears of the citizens towards the digitalisation of the healthcare system in Switzerland”. The survey was conducted in partnership with gfs-zurich.

Main author:

Jade Sternberg, Senior Project Lead Digital Health, digitalswitzerland

Support from the Digital Health Steering Committee from digitalswitzerland:

Mathias Becher, Head of Digital Transformation department (CDO), Federal Office of Public Health (FOPH)

Dr. Sebastiano Caprara, Health Data Repository Project Lead, Balgrist Hospital

Philomena Colatrella, CEO, CSS

Susanne Gedamke, Director, Swiss Patient Organisation (SPO)

Alexandros Giannakis, Managing Director – Global Lead Life Sciences Digital Health Accenture

Matthias Glück, Head of Platform Ecosystems, Swiss Post Digital Health

Thomas Gross, Strategic advisor, BINT and ofac group

Anna Kuruvilla, Head of Tech Steering & Innovation Management, SwissRe

Toni La Rosa Group Chief Sales Officer, ELCA

Dr. med Conrad Eric Müller, President Pro UKBB Foundation, Paediatric surgeon

Marie-Jeanne Semnar, Public Policy Manager, Interpharma

Chantal Stäuble, Head Business Development Digital Entreprise, Netcetera

Dr. Susanne Weissbäcker, Partner at EY-Parthenon Life Sciences Strategy

Dr. Garif Yalak, Head of Digital Transformation Healthcare, Education & Governance, Country, Digital Acceleration, Cisco Switzerland

Pius Zängerle, Director, curafutura

About digitalswitzerland

digitalswitzerland is a nationwide, cross-sector initiative that aims to strengthen Switzerland’s position as a leading digital nation. Under the umbrella of digitalswitzerland more than 240 organisations, consisting of association members and politically neutral foundation partners, are working together to achieve this goal. digitalswitzerland is the point of contact for all questions relating to digitalisation and is committed to solving a wide range of challenges. Learn more about digitalswitzerland

We would like to thank Karin Mändli Lerch and her team at gfs-zürich for their support in conducting the survey.

About Digital Health initiative and its Steering Committee

In 2022, digitalswitzerland launched a new initiative in Digital Health which aims to digitalise the entire healthcare system in Switzerland and make it patient-centric. This will help increase transparency, accessibility and understanding of health information for the entire Swiss population. All healthcare actors need to collaborate to achieve this ambitious goal.

digitalswitzerland built up a Steering Committee composed of experts from different sectors of the Swiss healthcare sector who help drive and shape the future of Digital Health in Switzerland. 

We would like to thank all of the Digital Health Steering Committee members for their engagement, their support in the study and expert contribution text.

Question glossary

Chapter 1: Health status

1.1 Do you feel sufficiently informed about your state of health?

1.2 From which actors would you like to obtain additional information regarding general health prevention activities in Switzerland?

1.3 How would you personally report your current health status?

Chapter 2: The Patient

2.1 Who do you consider to be a “patient”?

2.2 Are you currently suffering from a chronic disease?
(e.g. arthritis, asthma, cancer, chronic heart disease, chronic kidney disease, Crohn’s disease, diabetes, epilepsy, high/low blood pressure, Lyme disease, obesity,  etc. )

Chapter 3: Health and Digital Literacy in Switzerland

3.1 How health literate are you?

3.2 How digitally literate are you?

Chapter 4: Digital Habits

4.1 How many hours a day do you spend on a digital device (including time spent at work) ? Devices such as tablets, computers, smartphones etc.

4.2 What personal health data do you receive and/or manage digitally via apps, on websites or in portals?

4.3 Do you use apps or gadgets (such as FitBit, Apple Watch or cycle tracking apps) to monitor your health?

Chapter 5: Digital Health system

5.1 In your perspective, who should provide the digital healthcare system platform/solution? 

5.2 What benefits would you like the digital healthcare system to offer?

5.3 In a digital healthcare system, who should legally own your personal health information?

Chapter 6: Trust in Swiss institutions

How much do you trust the following organisations to handle your personal health data?

Chapter 7: Drivers and barriers to health data sharing

7.1 Before collecting, storing, editing or sharing your health data with others on the internet, what do you do? 

7.2 Under what conditions/circumstances are you willing to share your personal health data?

7.3 In general, how concerned are you about the digitalisation of your personal health information?

7.4 What frightens you the most about the digitalisation of your health data?

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Impressum

The Swiss population’s perspective on the digitalisation of the healthcare system in Switzerland 

Zurich, 14 December 2022

Although great care has been taken in the preparation of this publication, the author and contributors involved are not responsible for the accuracy of the data, information and advice provided, nor for any printing errors.

All rights reserved, including translation into other languages. No part of this publication may be reproduced, transcribed and/or translated into any computer language, including any information processing language, in any form without the prior written permission of the authors.

The rights to the trademarks mentioned remain with their respective owners.

Coordination of the publication: Emily Livingston, Eliane Panek and Jade Sternberg (digitalswitzerland)

Graphic design: Lina Alice Machts (Ads and Ventures)

In this text, we refer to health data as any information related to the physical or mental health of an individual or the provision of health services to the individual. It refers to any type of data related to health status, personal choice of treatment, health security or policy number, all types of treatment reports, causes of death, socio-economic parameters regarding health and wellbeing, historical health data such as diseases in past years and this kind of information (IGI Global – 2019).

digitalswitzerland is a Swiss-wide, cross-industry initiative that aims to strengthen and anchor Switzerland as a global leader in digital innovation. Under the umbrella of digitalswitzerland, Association members and politically neutral Foundation partners work together transversally to achieve this goal. The appointment of new Managing Director Stefan Metzger in January 2022 highlights a transition to a stronger focus on impact, with 6 priority activities to make Switzerland one of the leading digital nations in the world.

Are you interested in a membership or partnership? We are happy to have a conversation with you about our offerings, answer any questions you might have and to discuss the next steps. Please contact us at info@digitalswitzerland.com.

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