E-health advances in Austria
Report: Michael Krassnitzer
Like many others, Austria is in the process of introducing electronic patients’ records (EPRs) for use in and by all healthcare facilities. After a drawn out preparation phase, a company was founded to implement the project and ELGA (Elektronische Gesundheitsakte) is underway. ‘E-health will come, step by step, but inexorably’, said Austrian Health Minister Alois Stöger.
With the launch of the public health portal www.gesundheit.gv.at, the first ELGA milestone has now been reached.
ELGA is a searchable database that contains all health data about a patient, no matter when and where they were collected – i.e. in healthcare institution. The data can be accessed anytime by everybody who has the necessary access privileges. ‘A reliable system of strict access privileges is a crucial issue,’ said Dr Susanne Herbek, managing director of ELGA-GmbH. ‘Privacy and patient autonomy have to be guarded under all circumstances.’
Citizens can opt out, i.e. deny ELGA access to either their complete set of health data or to selected information, for example sensitive data on in-patient treatment in psychiatric institutions. They can also call up the logs where every access - when, where, by whom – is recorded. These logs in particular are designed to prevent abuse, and, as Dr Clemens Martin Auer, senior official in charge of ELGA at the Ministry of Health, assured, any abuse of the data in the EPRs will be subject to criminal prosecution.
‘In its final form, the health portal will be every Austrian’s door to his or her personal EPR’, Susanne Herbek added. For the time being, the online portal focuses on the provision of quality-assured and independent health information, such as a medical encyclopaedia, or information on patient rights and laboratory procedures.
The first ELGA application to be implemented is eMedikation, i.e. electronic prescriptions. Data on prescribed and dispensed medication will be stored and can be accessed from hospitals and doctor’s offices. eMedikation will cover both prescription and over-the-counter drugs if they contain active ingredients that might interact with other pharmaceuticals. Automatic checks of prescriptions and fillings in the pharmacies are designed to detect and prevent interactions and multiple prescriptions. However, there is no time frame yet for the introduction of eMedikation and nobody knows when the negotiations between all stake holders will be concluded. In Austria, the professional associations of physicians and pharmacists are traditionally not on particularly friendly terms.
Much easier was the definition of harmonised technical standards – a precondition for any ELGA application. All information systems have to be IHE-compatible, which means they must comply with the interoperability guidelines of the Integrating the Healthcare Enterprise (IHE) initiative. CDA (Clinical Document Architecture) was selected as the document standard.
While some Austrian hospitals and hospital associations still struggle with the introduction of ELGA, others are well prepared. The federal state of Tyrol, for example, is a trail blazer in terms of e-health. ‘Gesundheitsnetz Tirol’, a ‘mini-ELGA’ in Tyrol, has been established over the past few years. Seven hospitals run by different operators can access physicians’, labs’ and radiology departments’ data in a database that began to be filled in 2001. Since the operators of the ‘Gesundheitsnetz Tirol’ recognised the importance of IHE and CDA years ago, the network can easily be integrated into the country-wide ELGA system.
In Austria’s capital, Vienna, the situation is more problematic. The Wiener Krankenanstaltenverbund (KAV), a network of twelve hospitals and eleven geriatric institutions, is one of Europe’s largest hospital associations. Long before ELGA, KAV developed its own EPR system – which, however, is incompatible with ELGA’s technical standards. Consequently, KAV has to introduce CDA as an additional format, build an IHE-based archive and replace proprietary interfaces with IHE interfaces. All in all, quite a daunting task.
A project such as ELGA is not universally loved. Privacy is a major concern and consumer-protection organisations and office-based physicians have voiced their protests clearly. They fear repercussions for patients on the labour market when prospective employers can access a candidate’s ELGA data, or for patients whose record shows poor compliance. ‘As soon as such data are available, there are immediately many parties who want to access them – for whatever reason. In view of a whole slew of scandals involving the unauthorised use of data and privacy infringements throughout Europe, we strongly advise against such data pools’, Dr Christian Euler, president of the Austrian association of GPs, has warned. Moreover, general practitioners fear that the wealth of data cannot be analysed in a timely manner and that they will be held responsible if they overlook a piece of information hidden somewhere in the depth of the data pool.
‘We do take the fears and concerns seriously and try to find a solution,’ Susanne Herbek emphasised. ‘But personally I consider the concern that ELGA will be turned into a system of control entirely unfounded.’
14.05.2010
