A new electronic health card aimed at improving the efficiency of the Swiss health system is causing concerns over data protection and privacy.

The e-health card will resemble a credit card and store personal details about the holder as well as his or her medical history.

Such a card is a long way off from being introduced in Switzerland, but a pilot project in the region of Lugano is being drafted to test the efficiency and acceptability of the proposed system.

The project is part of wider efforts to establish a computerised medical information network across Switzerland.

"From 2005, around 4,000 patients and 3-4,000 medical officials such as doctors, pharmacists and emergency services will use the card," Marzio Della Santa, head of the project, told swissinfo.

If successful, the scheme could be introduced nationwide, probably some time after 2008.

Cultural resistance

Della Santa said the long lead time will give the authorities the chance to grapple with "cultural" resistance to the idea of having one's personal details stored on a piece of plastic.

The data will include routine information such as a person's name, contact details and insurance company, but also far more sensitive information such as their allergies, vaccination history, drug prescriptions and major medical events in their lives.

Before the card could be introduced there are also fundamental legal questions to be resolved, according to Michele Albertini from the Data Protection office in canton Ticino. Currently, there is no law regulating an electronic medical card.

"Regulations must be created and introduced into the cantonal health laws to deal with the e-card based on the experiences of the pilot project," Albertini told swissinfo.

Privacy

A top priority will be to ensure card-holders' privacy.

"Security and privacy must be assured when the information is handled... and not everybody should have access to this information. This is something all health institutions must clarify - who can have access to the information," Albertini said.

Della Santa says restricted access to certain categories of information has been built into the card, during preparations for the pilot phase.

"Medical personnel will have access to one part of the card, while another part containing more sensitive information will have greater security measures, including a pin code which the patient will have to enter before access can be granted," Della Santa told swissinfo.

Patient empowerment

Della Santa is keen that the card be seen as "empowering patients" given that the patient will hold the e-card, and decide who gets to use it.

"Until now, medical personnel have always controlled patients' information. Now the patient has some rights thanks to this card."

The impetus for the card comes largely from the European Union, which is putting Switzerland under pressure to follow its lead, Della Santa said.

EU-member states, notably France, Germany and Italy have introduced an e-health card as well as an insurance card. This system is serving as a model for Della Santa's project in Lugano.

Impelled

In March 2002, the EU introduced a compulsory insurance card and "by virtue of the bilateral agreements with the EU, Switzerland feels impelled to do the same by fostering the introduction of a similar card," project organisers in Lugano said.

Della Santa says the intention is also to follow suit with the insurance card, which will "contain administrative as well as personal health information".

Albertini insists that if the card system is introduced, there must be two cards - one for the health and one for insurance.

"Insurance and health cards must be kept separate ... Insurance information is more administrative and [insurance officials] could have access to certain other types of information but not directly to medical information."

Banal?

Described as "banal-looking" by Della Santa, the e-health card is central to Switzerland's efforts to modernise its health care services.

Computerising the network would improve the exchange of information among medical personnel and help cooperation in the country's fragmented health system.

Health policy is a matter for the cantons, and the card - a dual insurance and health card - might encounter stiff resistance at cantonal level.

The card would also contain a "eurocompatible chip" to enable Switzerland to exchange personal and medical information with other countries in Europe in future.

Like a cash or visa card, holders will have to keep it in a very safe place.

swissinfo, Samantha Tonkin

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