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As with many other aspects of the modern world, in healthcare, the explosion of data and resources opens new opportunities for the development of added-value services. Still, a number of specific conditions on this domain greatly hinders these developments, including ethical and legal issues, fragmentation of the relevant data in different locations, and a level of (meta)data complexity that requires great expertise across technical, clinical, and biological domains. We propose the Patient Dossier paradigm as a way to organize new innovative healthcare services that sorts the current limitations. The Patient Dossier conceptual framework identifies the different issues and suggests how they can be tackled in a safe, efficient, and responsible way while opening options for independent development for different players in the healthcare sector. An initial implementation of the Patient Dossier concepts in the Rbbt framework is available as open-source at https://github.com/mikisvaz and https://github.com/Rbbt-Workflows. ; This work has received funding from the Elixir-Excelerate project, from the European Union's Horizon 2020 Research and Innovation Programme, under grant agreement N. 676559, and from Plataforma de Recursos Biomoleculares y Bioinformáticos PT13/0001/0030. Additional support came from the Lenovo - BSC Master Collaboration Agreement (2015) and from the IBM-BSC Deep Learning Centre (2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ; Peer Reviewed ; Postprint (published version)

As part of its health policy strategy, the Swiss Confederation is setting up a nationwide electronic patient file. The aim of this file is to facilitate both the transmission of medical information to the various health professionals and the management of access to this data for the patient. In order to illustrate the various issues related to this implementation, we present two projects: mondossiermedical.ch (Canton of Geneva) and Mon Dossier Santé (Canton of Neuchâtel). The first is a precursor, since it was set up in the 2000s, well before the Confederation's requirements. The second was launched under the impetus of the federal law on the electronic patient file and corresponds to the State of Neuchâtel's desire to develop an e-health strategy. Several issues revolve around e-health: the security of sensitive health data, the question of their conservation and finally the problem of interoperability. ; Dans le cadre de sa stratégie pour une politique de santé, la Confédération suisse met en place à l'échelle nationale un dossier électronique du patient. L'objectif de ce dossier est de faciliter à la fois la transmission des informations médicales aux différents professionnels de la santé et à la fois la gestion des accès à ses données pour le patient. Afin d'illustrer les différents enjeux liés à cette mise en place, nous présentons deux projets: mondossiermedical.ch (Canton de Genève) et Mon Dossier Santé (Canton de Neuchâtel). Le premier est précurseur, puisqu'il s'est mis en place au cours des années 2000, bien avant les exigences de la Confédération. Le second a été lancé sous l'impulsion de la loi fédérale sur le dossier électronique du patient et correspond à une volonté de l'État de Neuchâtel de développer une stratégie de cybersanté. Plusieurs enjeux gravitent autour de la cybersanté: la sécurité de ces données sensibles que sont les données de la santé, la question de leur conservation et enfin la problématique de l'interopérabilité.

The authors investigated the relationships between patients' reactions to health care attributes and their overall satisfaction with primary care. The study found the following: (1) patients' overall satisfaction levels are disproportionately influenced by low levels of their reactions (less satisfied) to the primary care attribute, rather than simply aver-aged out among attribute reactions. This is a noncompensatory relationship. (2) The marginal impact of primary care attributes on overall satisfaction decreases at higher levels of patients' reactions (more satisfied) to primary care attributes, indicating a nonlinear relationship. Patients combine their reactions to the health care attributes by means of noncompensatory and nonlinear models to form their overall satisfaction. Decision makers should selectively concentrate training resources on those areas of attributes showing high dissatisfaction rather than attempt to improve an attribute that showed the largest parameter estimate. This approach would not only save resources but result in better out-comes of patient satisfaction.

The dynamics of healthcare are shifting the patient paradigm in dramatic ways. The former patient is now both a consumer and a customer. The mantra of this new consumer is "convenient, fast, simple, and high value." Their expectations for healthcare are similar to what they experience in other industries such as transportation, banking, short-stay rental housing, retail shopping online, same-day deliveries, and more. Smart mobile devices enable the customer to conduct transactions at any place and at any time, and without waiting in line. Healthcare providers need to offer customer service experiences similar to Apple, Amazon, Nordstrom, and other benchmark companies in order to stay competitive. The mindset of the new patient-turned-consumer has fundamentally shifted and there is no looking back. Anyone connected to healthcare needs to learn the profiles of the new consumer, better understand their behaviors, and comprehend their expectations as customers who have a choice. The patient paradigm shifts tells you everything a successful business needs to know about the powerful new healthcare consumer.

Section 1 - Between the doctor and the patient -- 1. Between the doctor and the patient: the history of the relationship -- 2. Between the doctor and the patient: the ancient conceptions of philosophy as medicine -- 3. Between the doctor and the patient: origins of an intermediate world -- 4. A systemic approach to health and disease: the interaction of individuals, medicines, cultures and environments -- 5. The ward as a scene -- 6. Between the doctor and the patient: the role of the unconscious in the relationship -- 7. Between the doctor and the patient: Bioethics -- 8. Between the doctor and the patient: consent and trust -- 9. Between the doctor and the patient: big data and precision medicine -- 10. Rehabilitation after a disease: what is "normality" after an invalidating disease? -- Section 2 - The patient as a person and the disease -- 11. Toward patient care: integrative and complementary approaches -- 12. Human complexity: a symphony of vital rhythms -- 13. Spirituality in medicine: a new dimension in the light of a millennial tradition -- 14. The body of Descartes and humanism in medicine -- 15. The history of narrative medicine. A way to know the patient dimension between Apollonian and Dionysian -- 16. To care for a patient as a person: emotional architecture of the environment -- 17. Beauty Saves. Culture Cures -- 18. An integrated and systemic approach to the patient: beyond Evidence Based Medicine -- 19. Medicine: a science in-between -- 20. A dialogue between the philosopher and the doctor.