Digital Health : Foresight for French-speaking Switzerland

"Everywhere, technologies are changing the way things are done. Activitiesrelated to health and care are no exception to this trend. Their scope of action is expanding; new players are appearing while others are being disrupted by technical change. The supply and demand for care are also changing under the pressure of technologies that are upsetting the established order. Initially known for being hierarchical, knowledgeable, organized and respected, the professional community that has long driven health care no longer has a clear view of its future. It sometimes doubts that its practice still meets the Hippocratic oath that defines its duties: duty to its masters, to the patient and to the society in which it operates. The public's behavior is also changing, because the Web provides a wealth of free information on illnesses, well-being and health care to everyone: platforms compare services, list hospitals, doctors – both general practitioners and specialists – and pharmacists. This multiplies the number of people listening to services that are dedicated to public information, prevention (tobacco, alcohol, drugs) and that share many other data on diseases, therapeutics or techniques, whether these are restorative, diagnostic or comforting. The digital boom therefore concerns both patients (which, potentially, all of us are) and health professionals. The patient's record, in electronic form, has become accessible or exchangeable between practitioners, between insurers and with patients; as is the vaccination record; consultations, diagnoses, prescriptions and even certain operations can be carried out remotely and mobilize very effective, but often expensive, means of communication and intervention. How and through what socioprofessional process can a public health system adapt to the "digital era"? Using a prospective method, for demonstrative and pedagogical purposes, an experiment was set up in Geneva to get students from the Haute école de gestion (Geneva School of Business Administration) to think about the future of the Swiss health system in French-speaking Switzerland by 2024. This chapter summarizes this experience, its lessons and the prospective scenarios that emerged. This approach attempts to rehabilitate prospective thinking by applying it to the vast field of care and health, in which enormous resources are invested, both public and private. A growing part of research and technical development involves services that em ploy a growing proportion of the active population in modern countries. The digital disruption that is transforming these activities is also changing certain practices, renewing part of the knowledge, expertise and professional practices. There is thus an almost unlimited field of action for prospective reflection."