|Implemented in this survey?|
The Federal Ministry of Health worked out the health telematics law for securing the transmission of sensitive patient data. The law elaborates security measures already stiputlated in the Data Protection law 2000. The government coordinated public administrations and the involvement of regional and local authorities in the development of the strategy. The social security sector participated and the private sector ensured the strategy implementation on the business level.
This legislation was motivated by acknowledging that expanding medical knowledge and new and improved treatment resulting from this expansion will only lead to improvements in the level of
efficiency if the health sector makes use of information and communication technology (ICT). Furthermore, the EC-eHealth initiative triggered the process and provisions of this
law following broadly EU stipulations.
The main objectives of the law are:
The law consists of 20 clauses covering definitions of terms, roles, identities, confidentiality, integrity, documentation and the eHealth directory. The further development of the electronical patient record (ELGA) is conditional on the provisions in the health telematic law. Regulations of ELGA will be closely linked to provisions in eGovernment and in eHealth both initiatives on the EU level.
The law does not specify particular incentives but it estimates outlays necessary to achieve the objectives and of administrating the eHealth directory. It expects no imediate savings but improvements in the quality of service delivery.
The main objectives of the law are:
No incentives are specified explicitly but the law provides for opportunities for providers to invest in ICT and to participate in improving ICT standards.
health care providers, health insurance, government agencies, Business
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Even though claimed to be delayed this legislation is rather innovative and has the potential to increase transparency and accountability in the Austrian health care sector; in line with
eGovernment provisions it is also a systematically developed step to make provider performance subject to "third party" evaluations.
This potential however may lead to a certain degree of controversy as health care providers in Austria are not accustomed to monitoring. It is furthermore not really specified who will have access to all the information gathered;
The establishment of the Information Society as a significant policy field in Austria begun at the 'Alpbach Technology Forum 1994', where both Chancellor Vranitzky and Minister Klima stated the
need for political actions in their speeches, referring to Al Gore's talks about the Information Highway and the 'Bangemann Paper' by EU Commissioner Bangemann.
In November 1994, the government programme the area "Information Society" was taken up again. Working groups were established, some only with a duration of some months others with the duration of half a year. The working groups included 300 to 400 persons from the most important stakeholder groups. The results were published in a final report in December 1996.
The intensive phase of conceptual work was followed by a phase in which activities and dedication to the mission clearly declined. In March 1997 the second and final meeting of the government working group took place and the final report was accepted. The constitutional phase of Information Society policy herewith came to a temporal end.
Nevertheless, the Information Society initiative caused a spark of new activities (Ohler 2004):
EU policy for Austrian information society policy became increasingly important. The European Commission's "E-Europe" initiative was an important factor in motivating the Austrian "E-Austria
in Europe" initiative in the year 2000. The area Information Society became another boost by a change of government in 2000. The center-right government prioritized this topic which was enforced
by a reorganisations of government responsibilities.
A Chief Information Office was established and improved the quality of eGovernment and administration (Ohler 2004).
Austrian Data Protection Act
Negotiations of unified nationwide IT standards based on the 2000 and 2003 government policy paper
|Implemented in this survey?|
In December 1995 a String-Commission was established as an advisory board for the Minister of Health - at the time of the systematic introduction of ICT into the health sector. The
commission acted as an interface between institutions of the health sector. Its members are representatives of the university, health professional groups and data protection. It meets about
three times per year.
In June 2000 the String-Commission issued a recommendation for an Austrian health data network, the MAGDA-LENA directives (Version 2.0)The MAGDA-LENA directives (Medizinisch-administrativer Gesundheitsdatenaustausch-Logisches und Elektronisches Netzwerk Austria) were taken into consideration in a draft for a health telematics law in June 2002. MAGDA-LENA directives were however only non-binding recommendations.
The MAGDA-LENA directives are guidelines for the transmission of sensitive patient data between parties of the Austrian health care system. These guidelines stipulate
The aim of the MAGDA-LENA directives was to guarantee a compatible, digital and safe communication between different members of the network, ensuring data security at any time. Health care
providers need access to reliable information about the health status, patient history of every patient anytime everywhere. (STRING-Kommission 2002).
The MAGDA-LENA directives were taken into consideration in a draft health telematics law in June 2002. The law passed in 2004 and became effective on the January 1, 2005.
The approach of the idea is described as:
The division of accountability in health policy between the Ministry of Health and Women (MoH) and the Ministry of Social Affairs and Generations requires efforts to coordinate ICT developments in
health care; furthermore, the MoH is not employing all its formal power even though her authority for ICT is quite high (Ohler 2004). Even though currently there are no intensions to have the
e-card carrying sensitive patient data, provisions in the e-card legislation (see survey (4)2004) seem not explicitly synchronized with the Health Telematic law.
As for allmost all Austrian health policy fields the fragmentation in financing and in delivering care is the major challenge for the development of a coherent ICT policy. The role of social health insurance does not seem to be clearly specified. However, the influence of SHI is rather strong as it serves as a model in implemenation of data secutrity is. If providers are forced to set up infra-structure to adopt provisions of the law social health insurance might be confronted with higher than average fee claims. This may in addition cause delays in investments.
|Ministry of Health||very supportive||strongly opposed|
|Health Insurance||very supportive||strongly opposed|
|Providers||very supportive||strongly opposed|
Legislation was finally smooth and part of the "Gesundheitsreform-Gesetz 2005" (see survey (4)2004).
|Ministry of Health||very strong||none|
|Health Insurance||very strong||none|
Experts claim that the delay of the Health Telematics Law reflects the low priority given to this aerea. Resources are needed and the government willingness to deal with frictions and risks involved in carrying out a certification procedure (Ohler 2004). The Austrian Medical Association decided not to wait but instead to issue its own directives and to carry out certifications for compliant health telematics firms.
Monitoring will be crucial if this legislation should achieve its objectives; The objective to harmonize diverse activities in this aera and to assure compliance
with the Austrian Data Protection Law will therefore be the biggest challenge.
Currently there is few data and information available about the current IT infrastructure on the various levels of health care provision. Furthermore, few information is available about the scope of electronic data transmission within providers and among health care settings.
As the EU requires transparency and reporting on electronic data transmission activities and as the government acknowledges the need of this information for policy making the legislations foresees monitoring carried out by the MoH:
Apart from requirements from the EU, the goal for this monitoring is to inform strategic policy making and planning and to improve general health reporting activities.
Morever, to gather knowledge about the digital divide, the economic impact and the impact on health care service utilization the law stipulates sound evaluation of the application of ICT in health care.
This law is important for achieving higher transparency in the Austrian health care sector. To achieve its objectives, a strong commitment of policy makers to improve the
information base is necessary. Moreover, this law forms the basis for developing electronic transmission of highly sensitive data as intended by the electronic health record (ELGA). And the
implementation is largerly bounded by the Austrian Data Protection Law.
Public attention is relatively small. Thus, further delays may occur if policy makers do not push for initiating and guiding a broad forum to discuss implementation hurdels and to provide (monetary) incentives for providers to invest in infrastructure.
The fragemented structure of the Austrian health care system may also be a hurdle for smooth implementation as lines of responsibilities and accountability are basically ambigous in particular in inpatient care.
The OECD evaluted the health-telematics initiative positively stating that there was a commitment of the government, of social security and the buisness sector to develop common strategies and to implement key technologies in order to increase the value added. Benefits were expected through better regulation, interactive communication, electronic billing and a large scale use of infrastructure. (OECD 2004).
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
If the all the activities are carried out as specified in the law and if health policy shows leadership and committment in this area the impact on the quality of service provision will be high;
moreover and in connection with the health quality law (see survey (4)2004) it will increase transparency with respect to intrinsic and geographical differences in service provision which itself
is likely to help lifting quality care.
The level of equity will likely remain unchanged unless evaluations are carried out which explicitly target the digital divide and its causual association with the socio-economic status and the health status of a population at risks. Basically the law foresees these evaluations.
In the short run the level of efficiency is likely to remain unchanged; once the utility of investments in ICT has (over-)compensated outlays for setting up and coordinating the activities a positive impact on cost efficiency in the longer run is highly likely. Due to the quality enhancing nature of this legislation, higher levels of cost efficiency may well go hand in hand with increasing effectiveness of care which will also positivley influence the level of cost effectiveness. But this will certainly take a while.
Maria M. Hofmarcher, proof reading: Engelbert Prenner, BMGF, Abteilung IV/6 ? Gesundheitstelematik