Stakeholder participation in e-Health. A case study from Switzerland

Swiss politics is known for a strong involvement of society in its legislative process. In addition to the elected legislative and executive authorities, it is also possible for parties, associations and unions of citizens to... [ view full abstract ]

Swiss politics is known for a strong involvement of society in its legislative process. In addition to the elected legislative and executive authorities, it is also possible for parties, associations and unions of citizens to share their thoughts and concerns about concrete laws and regulations. These comments find their way into the final laws and regulations to a varying extent.

The implementation of eHealth services in Europe is set by basic democratic rules. Their introduction involves complex project management, including several public and nonpublic stakeholders.

In German speaking countries the introduction of the “elektronische Gesundheitskarte” (Germany), “e-card” (Austria) and “elektronisches Patientendossier” (Switzerland) shows strong stakeholder involvement. This study discusses the influence of stakeholders on the legislative process through the example of the Swiss electronic health record, and analyzes the influence of stakeholder groups by means of a quantitative and qualitative analysis. Precisely 139 comments about the central decree on the introduction of electronic health records were studied during the political hearing procedure in 2016.

The relevance of the paper regarding the panel “Digitalization and its implication in the creation of public value within a co-production framework” shows stakeholder options to influence the legislative process. The case study sets the following objectives:

• Introduction of the participation process of stakeholders in the development, legislation and implementation of eHealth services in Switzerland (co-production, co-design),
• Presentation of central adaptations (user rights, digital data storage) of the decree, based on stakeholder comments
• Description of various stakeholder roles during the implementation of eHealth,
• Comparison and quantification of the different stakeholder influences regarding diverse topics in eHealth legislation (logistic regression, group comparison),

The research question of this study is as follows: Which stakeholders have the most influence on eHealth legislation in Switzerland?

The Advocacy Coalition Framework (Sabatier 1987, 1993, 2007) provides the theoretical framework for this case study. The hypotheses are deduced based on this approach (group differences, influence). First results show, that public stakeholders on the federal level and health associations tend to have more influence on the development of eHealth legislation than other groups (industry, society). General practitioners have the ability to decline a legal decree. As “veto players”, they might not implement a lawful requirement in their daily practice. The federal states (cantons) have tested the functions of the electronic health records in advance and are able to give well-founded inputs. This explains their rather significant influence.