Tour of Medical Informatics

Interview with Pierre Alain Schnegg, Health Director of the Canton of Bern

Interview: 14. July 2020 (Etappe 2), over phone

What are your duties and responsibilities at work?

In my directorate I am responsible for health, especially for care planning, for the hospital lists, but also for all approvals of institutions, the professional licenses. We are also responsible for all the social matters in the Canton of Berne, social services, social institutions and all integration. For example, the integration of people from the social services, but also the integration of refugees and temporarily admitted persons.

Medical Informatics is still a young field of study. What importance do you already attach to this course of study today?

IT and digitalisation will be one of the most important pillars in the coming years. Especially in medicine. There is still much to be done in this area. I am also thinking especially of the whole data acquisition process. At the moment, this is still being done very poorly and incorrectly. All the interfaces between the various systems. I am also thinking of the Electronic Patient Dossier (EPD), which is not necessarily progressing quickly at the moment. The demand will be insanely high in the future, I believe that with more data and with better data quality, we will be able to provide a better quality of service. It will also have an impact on containing cost growth.

What chances for the development of the health care system do you see in connection with medical informatics?

I believe that a much more personalized medicine can be provided in the future. With all the IT and all the data that could be collected and made available, and also cross-analysed, it would help us to provide a personalized medicine. And not a medicine where we have to use clinical tests to try to determine whether a drug has an effect on a person or not. I see that we already have some information available, but it is not yet needed enough and sometimes not in the quality that one might expect.

Are there also risks regarding personalized medicine? If so, which ones?

There are certainly also risks. Firstly, there is the whole issue of data protection, which must be solved. How far do we have to go in data protection, how far with the improvement of the general public. These are very important questions, ethical questions. Depending on how we treat this, it could also be that we would refuse certain treatments to certain people, and that certainly cannot be the case. That would not be an improvement. And there will be risks, who controls which part of the medicine.

Corona has shown that Switzerland’s healthcare system is still too little digital. The electronic patient record is to be implemented for several years. Why is this taking so long?

I have the impression that we want to provide a Rolls Royce immediately, instead of starting with a smaller car that would run and could be improved. And it is often the case that if we now take the Windows operating system, for example: It did not start with the functionalities we have available today. And in the EPD we try to cover everything down to the last detail. On top of that, there is also strong regulation, which in principle will bring about nothing. It will cost us millions and millions. I am afraid that the attention will go away because the project will take so long and because most of those who have to participate will not use the EPD in the end. That is perhaps the Swiss consensus that patients and doctors should now be given the opportunity to participate or not. But that doesn’t achieve much. If we really want to implement an EPD successfully, it must be mandatory for everyone. Each resident should then be given a number with a dossier in which his or her data is stored. This would enable us to avoid a lot of testing and samples because many doctors do not know that the previous doctor has done it.
It would also help us in emergency situations when the patient is no longer responsive and perhaps none of the relatives are present. And it would certainly have a good impact on cost containment, but it would require more courage to implement the EPD in Switzerland.

I also doubt the solutions that have been taken where several tribal communities are built up. By this I mean that in Switzerland a single home community would have been absolutely sufficient. But an open market must be provided around the home community, where people can develop additional applications and functionalities that are needed depending on the region, profession or institution.

As a future medical computer scientist, how can I provide support here so that some of these stumbling blocks can be eliminated?

I believe that at the moment there is a big gap between the decision makers and the people who will have to implement it afterwards. And I think it will be very important that people communicate more about the possibilities they have and the methods you can use. So that decisions are not just made based on the interest of certain service providers.

Is medical informatics a profession of the future? If so, why?

Yes, because we will have a big development in the future, I am thinking in this respect also of the care of the elderly population. We will have more and more people over the age of eighty and we need new methods. We have a shortage of skilled workers in certain areas, which we could very well bridge with better digitalisation. Think, for example, of the entire radiology department, where we could certainly bring a great deal of relief with artificial intelligence. But also, for example, for monitoring chronic diseases. Instead of the person having to go to the doctor every month, he could be monitored remotely, perhaps once a month at an MPA (Medical Practice Assistant) and then perhaps only go to the doctor once or twice a year. This would allow us to make the whole system more efficient. But to do this, we need specialists who know something about digitalisation and IT, but also about medicine.

Then we are already at the end of my questions. Is there anything else you would like to add?

Yes, I wish you a great trip around Switzerland and much success in your studies. I am pleased that you have chosen this course of study and are committed to the BFH, that is certainly a good thing.

Thank you very much for the time you have taken for the interview. I wish you a nice day and enjoy your summer vacations!

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