Significant improvements in the quality and efficiency of healthcare as well as better access to it: that’s what we expect from electronic health records (EHRs). However, their developers have recently suffered a number of setbacks. In the Czech Republic the development of the Elektronická zdravotni knižka (IZIP) was abandoned in May this year. In the previous year, the British National Health Service stopped the NHS ‘Connecting for Health’ project and, in 2009, during its first test runs, Germany’s Federal Government announced an EHR moratorium.
However, in Austria work on the development of a national EHR system – the ELGA – continues undeterred. ‘There is a significant difference in the quality of treatment if a doctor knows which drugs a patient has previously been prescribed and if a hospital knows how a patient has previously been treated,’ Austrian Health Minister Alois Stöger, points out, listing two advantages of such systems. If things go this Minister’s way, the Austrian Parliament will pass a law before the end of 2012 that will form the legal basis for the ELGA. The Austrian government adopted a relevant resolution shortly before this publication‘s press date.
The ELGA is to store discharge letters, laboratory reports, radiological images, diagnoses as well as the current medication of each citizen, and the record is to be available to doctors as well as patients. The existting social security card (E-Card}, given to every Austrian shortly after birth, is used as a key. When inserted into a reader the doctor is given four weeks of access to the results of that patient. Every Austrian who does not explicitly object is automatically included but can decide at any time that his data are not to be accessible to anybody. However, hospitals, general practitioners and pharmacies are obliged to participate in the ELGA. Particularly sensitive data, such as psychiatric reports and genetic analyses, are excluded from storage.
Constitutional experts and data protection campaigners have many objections against ELGA in the form it is currently envisaged. Traditionally in German-speaking countries the sensitivity to a potential misuse of data has been particularly high. Those critics are especially disturbed by the fact that every citizen’s data are automatically stored unless they specifically object. They are calling for an opt-in solution, with healthcare data only being stored if a citizen actively agrees.
The Austrian Medical Council is criticising a completely different issue. Doctors’ representatives are complaining about the lack of the system’s usability. As there is no cross-document search function it will not be possible to find quickly and precisely the information that doctors need in an actual treatment situation, the Medical Council President Dr Artur Wechselberger MSc MBA argues. This requires modern document architecture, usually referred to as ‘CDA level 3’, but which is not provided with ELGA. CDA (Clinical Document Architecture) is a standard for the electronic processing of medical documents. It is inconceivable for us to work with an electronic data processing system the structure of which is so outdated that it will complicate and slow down entire processes for patient treatment in surgeries and especially in hospitals,’ he stresses.
In any case, the pilot project for one of the first ELGA applications, i.e. electronic drug prescriptions (e-Medikation} did not go well. Al-though the official evaluation report recommends the continuation of the project, it also states that this should only be done after a comprehensive redesign. According to the report, participation in the pilot project required a significant amount of time from the participating doctors – an average of three to four minutes per prescription. Furthermore, the software used was described as ‘lacking in practical relevance’ and being ‘poorly conceived’. Nonetheless, Alois Stöger is still determined to start the project in the middle of next year. Medical Council President Wechselberger, however, is convinced that ‘if a system does not take into account the workflow of doctors in hospitals and surgeries it is likely to collapse’.
Alois Stöger has been the Austrian Health Minister since 2008. The career of this trained machine fitter started at the Austrian Federation of Trade Unions. Along with his function as a trade union official he took courses at the Social Academy of the Vienna Chamber of Labour and the European Social Academy and, through distance learning, he passed the Diplôme des Hautes Etudes des Pratiques Sociales at the Marc Bloch University Strasbourg (France). A Social Democrat, from 1997 to 2009 he was a local councillor in Gallneukirchen (Upper Austria), and from 2005 to 2008 acted as chairman of the Upper Austrian regional medical insurance company, the statutory medical insurer of this Austrian state.
Artur Wechselberger MD, President of the Austrian Medical Council since June 2012, has been an Innsbruck GP since 1989, President of the Tyrolean Medical Council from 1990 and Vice-president of the Austrian Medical Council between 2007-2012. He gained a Masters in Health Management (MSc) and Master of Business Administration (MBA) at Donau University Krems (Lower Austria) and is a trained EOQ Quality Systems Manager.