Lessons learned implementing a regional health information exchange in Geneva as a pilot for the Swiss national eHealth strategy.

It took more than ten years from the initial mandate to the first implementation of e-toile, the Geneva health information exchange. Although most actors quickly agreed on the goals and potential benefits of such a system, obstacles were many, and mostly non-technical. The transparency resulting from a streamlined exchange of information may improve the continuity, quality and efficiency of care, while, at the same time, reveal and challenge habits and practices of care professionals and of citizens. This tension must be understood, and trust must be fostered amongst stakeholders. In our experience, key enablers were the collaborative elaboration and negotiation of an eHealth law, the definition of an eHealth strategy, as well as the involuntary increased financial pressure on all healthcare stakeholders. Nevertheless, and even though it is often cited as a successful model, the Swiss health system, being highly fragmented and based on a complex interplay of private and public stakeholders, is not as conducive to the deployment of eHealth systems as most other developed countries.