Information

Activities since 2008

Swiss eHealth Strategy 1.0 until adoption of the EPRA

In 2006, health and the healthcare system were added to the Federal Council’s strategy for an information society in Switzerland, dating back to 1998. This resulted in the preparation of the Swiss eHealth Strategy for 2007–2015, which was adopted by the Federal Council in June 2007. This strategy comprised three action areas – Electronic Patient Record, Online Services and Strategy Implementation – and set out a number of objectives. The most important one was the implementation by 2015 of a national Electronic Patient Record (EPR) managed primarily by patients themselves and from which, if required, key medical information can be accessed in electronic format anywhere and at any time. The primary objectives at healthcare system level were improved efficiency and safety, and optimised treatment quality for patients.

External link: Swiss eHealth Strategy 2007 (in German) (730 KB, 10/04/23)

As one of the first operational measures under the eHealth Strategy, the Confederation and Cantons signed a framework agreement, under which eHealth Suisse was created as a national coordination centre on 1 January 2008. From that time, eHealth Suisse was responsible for implementation of the eHealth Strategy. Accordingly, eHealth Suisse’s broad-based project organisation started work during 2008 with representation from all relevant stakeholders (Swiss Medical Association and doctors, hospitals, Cantons, professional associations, industry and patient and consumer organisations). Responsibility at strategic level lay with eHealth Suisse’s steering committee, which was chaired by the Head of the Federal Department of Home Affairs (FDHA), while operational responsibility was assumed by the project management committee.

The project organisation was divided into six workstreams:

  • Online services and empowerment
  • Education and research
  • Pilot trials and public-private partnership (subsequently: Development and networking)
  • Standards and architecture
  • Legal aspects
  • Financing and incentive systems

One working group made up of stakeholders in the topic was deployed for each workstream. Between 2009 and 2014, these working groups developed recommendations, each of which went through a broad consultation process beforehand. The recommendations covered those topics that would have to be considered for the future interoperability of the national EPR in the broadest sense: not only technical considerations, but also political, legal, semantic and organisational matters.

The online services and empowerment workstream drew up recommendations on empowering patients to manage medical information (health literacy) and use the new IT tools (digital literacy). The workstream also produced a report describing several options for a public health portal. In January 2012, the Confederation and Cantons decided to forego the portal on resource grounds.

The aim of the education and research workstream was to examine the measures and modifications that would be necessary in educational offerings for healthcare professionals to accommodate modern-day information and communication technology requirements. The workstream also examined the integration of this content into the relevant teaching and study programmes.

The pilot trials and PPP (public-private partnership) workstream formulated recommendations for eHealth pilot trials and the conditions that have to be fulfilled for them to succeed. Pilot trialling was intended to generate insights for the future national Electronic Patient Record (EPR). A scheme developed by the workstream gave pilot projects the option of being evaluated by eHealth Suisse and of obtaining a label if found to be suitable.

The standards and architecture workstream examined and recommended standards in the broad sense (technical, content-related and semantic) that are required to set up a national architecture for the EPR. This workstream laid the foundations for fundamental decisions that still underpin the EPR today – its distributed architecture, adoption of non-proprietary standards at technical level (IHE profiles) and high-granularity patient management of the EPR that promotes informational autonomy.

The legal aspects and financing and incentive systems workstreams identified a legal framework within which eHealth could established despite competencies being split between the Confederation and Cantons. Thought was also given to the measures and incentives that could be used to fund and drive forward the EPR. The preliminary work done by the legal aspects workstream was used by the eHealth expert group deployed by the Federal Department of Home Affairs (FDHA) in December 2009. Its task was to establish which areas of eHealth the Confederation would be able to regulate under the existing constitutional provisions and which would become the responsibility of the Cantons. A preliminary draft of the Federal Act on the Electronic Patient Record (EPRA) was put out to consultation in 2011. In April 2012, the Federal Council commissioned the FDHA to produce a dispatch and draft act on the EPR. This dispatch and draft act were submitted to Parliament in May 2015. Parliament adopted EPRA in June 2015.

External link: Federal Council business

External link: EPRA bill 2010–2017

While this work was in progress, eHealth Suisse began to lay the technical foundations for the EPR in 2014/15 in the form of specifications, which it drew up in partnership with the Federal Office of Public Health (FOPH). These specifications provided the foundations for the Ordinance on EPRA, which was heard during the first half of 2016. The Ordinance took effect on 15 April 2017. At its heart is the certification process for communities and core communities as amalgamated service providers with an obligation to provide
EPRs.

In terms of semantics, SNOMED CT was adopted as the national reference terminology in 2016. Since then, eHealth Suisse has been operating the associated Release Center.

External link: SNOMED CT

From February 2009 to the end of 2018, eHealth Suisse was also actively involved in the European efforts to establish Europe-wide infrastructure intended to ensure secure exchange of patients’ medical data across national boundaries. A National Contact Point was set up and operated at Geneva University Hospital for this purpose as part of involvement in various EU projects. At the end of 2018, the European Commission (EC) dispensed with Switzerland’s contributions for political reasons.

Swiss eHealth Strategy 2.0

The Federal Act on the Electronic Patient Record (EPRA) and the two ordinances on the EPR entered into force on 15 April 2017. In 2018, the cantons and the Confederation approved the Swiss eHealth Strategy 2.0, which replaced the first version from 2007. In so doing, they sought to promote digitalisation within the Swiss healthcare system. The strategy’s initial four-year term was extended by two years until the end of 2024.

The Electronic Patient Record (EPR) was a central pillar of the strategy. In addition, the strategy set out ambitious objectives concerning the digitalisation of federal and cantonal administrative processes in healthcare, the empowerment of healthcare professionals and patients to use eHealth services, and regulation in the area of mobile applications (mHealth) and primary systems.  

The final report presents the measures implemented by the Confederation, cantons and eHealth Suisse to meet the objectives of the strategy. It also assesses the degree to which these objectives were achieved. The Swiss eHealth Strategy 2.0 was not renewed.

The DigiSanté programme of the Federal Department of Home Affairs (FDHA) was launched in 2025 to promote digital transformation in the healthcare sector. DigiSanté aims to establish seamless health data flows and standards, and to coordinate all stakeholders in an integrated manner. The EPR is not part of the DigiSanté programme, but is part of the Swiss Health Data Space and will be pursued and developed in parallel.  

External link: Swiss eHealth Strategy 2.0 (2018) (in German) (2.7 MB, 10/04/23)

External link: Final report on the Swiss eHealth Strategy 2.0 (in German) (375 KB, 07/17/25)

Interoperability report (2021)

The report focuses on patient treatment pathways and describes the necessary requirements for standardised data exchange in treatment processes. The experts involved in the work consider the action area ‘transfer between healthcare institutions’ as a priority.

External link: Interoperability report (in German)  (7.2 MB, 10/04/23)

Responsibilities of eHealth Suisse

The Federal Department of Home Affairs (FDHA) and the Swiss Conference of Cantonal Ministers of Public Health (CMPH) signed a framework agreement in 2007 to implement the Swiss eHealth Strategy. Following the introduction of the Federal Act on the Electronic Patient Record (EPRA) on 15 April 2017 and the extension of the Swiss eHealth Strategy (2017–24), the tasks of eHealth Suisse have evolved to support the rollout of the EPR. The FDHA and the CMPH therefore signed a new framework agreement in the spring of 2017, which is valid until the end of 2024.

From 2025, a new framework agreement defines the tasks and responsibilities of eHealth Suisse to take account of the launch of the DigiSanté programme and the revision of the Federal Act on the Electronic Patient Record (EPRA).

Internal link: Tasks of eHealth Suisse

External link: eHealth Suisse framework agreement 2017 (in German) (2.9 MB, 07/30/25)

External link: Explanatory notes on the eHealth agreement CMPH -FDHA 2017 (in German)  (291 KB, 07/30/25)

(Core) community development

Nine core communities and one community were set up following the introduction of the EPRA. Seven core communities (Mon Dossier Santé, CARA, Abilis, XAD/Sanela, eHealth Ticino, eSANITA and eHealth Aargau) and one community (AD Swiss) completed certification between December 2020 and November 2022.

In autumn 2022, SwissPost acquired a majority holding in the operating company axsana AG. The infrastructure of the xsana platform was transferred from Swisscom’s technical solution to that operated by SwissPost. Since then, Swisscom has not provided any technical infrastructure for the EPR.

In spring 2023, axsana AG was renamed Post Sanela Health AG and the xsana brand was discontinued. The core community name – XAD – remains the same. On 1 January 2025, the eHealth core community in Ticino also ceased its operations in the canton of Ticino, which have been taken over by Post Sanela Health AG.

Certification process

The certification procedure is performed by KPMG AG, a company accredited by the Swiss Accreditation Service SAS to certify EPR communities, core communities and EPR identification tools. The certification process is time-intensive and complex, particularly because of the extremely high data protection requirements and the need to ensure data security given the nationwide networking of the EPR. Certification of the communities and core communities had to be performed carefully in the interests of patient protection and took longer than planned.

The eight (core) communities – eHealth Aargau, CARA, eSANITA, Mon Dossier Santé, Post Sanela (formerly XAD), Abilis, eHealth Ticino and AD Swiss – finalised their certification in accordance with the EPRA between the end of 2020 and the end of 2022. They are also responsible for ensuring the interoperability of their respective platforms. Consequently, the interoperability tests started in January 2023. In this process, the task of eHealth Suisse was to coordinate the interoperability tests and to issue technical recommendations. Due to the delay in certification, the evolution of the platforms, and the merging of communities, complete interoperability between all EPR providers was only finalised in February 2025. 

To enable the technical EPR providers to prepare for certification under EPRA, eHealth Suisse organised the first EPR Projectathon in September 2017. This has been repeated every year since then to permit technical testing of new EPR functions. The EPR Projectathlon was renamed Digital Health Projectathlon in 2025 to reflect the tests also carried out for other projects supported by the Confederation and cantons.

Internal link: Practical interoperability test

External link: Chronology of the EPR rollout (in German)  (302 KB, 10/09/23)

Progressive connection of healthcare institutions

Under the Federal Act on the Electronic Patient Record (EPRA), which has been in force since 15 April 2017, acute care hospitals, rehabilitation centres and in-patient psychiatric clinics had to join a certified core community within three years. The implementation deadline, which was defined as 15 April 2020, could not be met due to the complexity of the certification process.  Birthing centres and nursing homes were required by law to join a core community by 15 April 2022.

On 19 June 2020, parliament adoptedExternal link: a revision of the HIA to authorise care providers. It entered into force on 1 January 2022. Since then, doctors and facilities that provide outpatient care by doctors have had to prove to the cantonal authorities that they are members of an EPR community when they apply for authorisation to provide services charged to compulsory health insurance (External link: Art. 37, para. 3, HIA ).

The cantons are responsible for reviewing applications and decide what records have to be submitted.

All other healthcare institutions and healthcare professionals in outpatient settings are free to choose whether or not they join an EPR community.