About the need for a Swiss digital health ‘Sistine Chapel’ – lessons from 25 years of health policy

Abstract Background The Swiss government’s ‘DigiSanté’ program 2025-2034 aims to address Switzerland’s delay in digitising its healthcare system. Public and professionals’ trust is central for the implementation of digital health initiatives and partially based on past experiences with the digital health system. To inform DigiSanté, it is crucial to analyse the evolution of the socio-political discourse surrounding health data sharing in Switzerland in the past 25 years to identify the main obstacles encountered and lessons learned during this period. Methods We designed a multi-method study comprising a policy analysis of 65 Swiss policies on health data sharing from 1998 to 2023; scoping review of 250 editorials; sentiment analysis of 400 news articles from six major Swiss newspapers; and thematic analysis of transcripts from 11 online interviews with key stakeholders. Results We identified 32 key policy milestones in Swiss health data sharing, with the COVID-19 pandemic emerging as a trigger for present policymakers’ awareness of health data’s potential and the need for healthcare system digitization. The troubled implementation of the Electronic Patient Dossier (EPD) and its negative narrative are identified as more central in eroding long-term public trust than scandals. Primary obstacles to implementation of the EPD include misaligned stakeholders’ interests, slow policy processes, lack of professional support, low public awareness, and technical interoperability issues. Future strategies involve increasing actors’ involvement to establish a common vision and strategy and improving public communication. Conclusions The present socio-political discourse on health data sharing in Switzerland is shaped by past negative experiences with the EPD, compounded by additional scandals. To cultivate public trust, stakeholders should collaborate to align interests and ensure all parties work cooperatively toward common goals. Key messages • National and international scandals marginally affect public trust compared to the impact of the negative narrative surrounding the slow EPD implementation. • Misalignment of stakeholder interests is the main barrier to implementing health data sharing initiatives, causing delays and trust erosion.