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Health Telematics Law (GTelG)

Country: 
Austria
Partner Institute: 
Institute for Advanced Studies (IHS), Vienna
Survey no: 
(6)2005
Author(s): 
Maria M. Hofmarcher, proof reading: Engelbert Prenner, BMGF, Abteilung IV/6 ? Gesundheitstelematik
Health Policy Issues: 
Public Health, System Organisation/ Integration
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no
Featured in half-yearly report: Health Policy Developments Issue 6

Abstract

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.

Purpose of health policy or idea

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:

  • Prevent malpractice and assure confidentiality of sensitive individual data travelling through networks
  • Harmonize data safety measures Austrian-wide and raise the standards of those measures
  • Provide braod baseline information for descision makers



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.

Main points

Main objectives

The main objectives of the law are:

  • Prevent malpractice and assure confidentiality of sensitive individual data travelling through networks
  • Harmonize data safety measures Austrian-wide and raise the standards of those measures
  • Provide broad baseline information for descision makers.

Type of incentives

No incentives are specified explicitly but the law provides for opportunities for providers to invest in ICT and to participate in improving ICT standards.

Groups affected

health care providers, health insurance, government agencies, Business

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent neutral system-neutral

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;

Political and economic background

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):

  • Mobilisation of the most important actors in the country.
  • Public appearance of regional Internet-initiatives in the years 1994-95 (e.g. the Austrian Platform for Telematics Applications, APTA)
  • Start of the ITF-Program 'Technologies for the Information Society'
  • Extensive developments in the digitalisation of the public administration (especially, back-office).
  • Suggestion and plan to create an e-card replacing the paper voucher for entitelments to health care services. 

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).

Change of government

Complies with

EU regulations

eGovernment, eHealth

Other

Austrian Data Protection Act

Change based on an overall national health policy statement

Negotiations of unified nationwide IT standards based on the 2000 and 2003 government policy paper

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Origins of health policy idea

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

  •  that for the electronic exchange of patient data an exact agreement of the data content is needed
  • that all participating persons and organizations (e.g. patients, physicians) as well as all submitted data (e.g. patient history) have to be clearly identifiable

and comprise

  • requirements to ensure data security and data safety
  • implementation of guidelines for providers before becoming member of the Austrian heath data network
  • aims of the network, such as a more efficient patient treatment, access for all health care provider to treatment relevant patient information, and reducing unnecessary collection of identical information. (STRING-Kommission 2002).

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.

Initiators of idea/main actors

  • Government

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

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.

Actors and positions

Description of actors and their positions
Government
Ministry of Healthvery supportivesupportive strongly opposed
Health Insurancevery supportivesupportive strongly opposed
Providersvery supportiveopposed strongly opposed

Influences in policy making and legislation

Legislation was finally smooth and part of the "Gesundheitsreform-Gesetz 2005" (see survey (4)2004).

Legislative outcome

success

Actors and influence

Description of actors and their influence

Government
Ministry of Healthvery strongstrong none
Health Insurancevery strongvery strong none
Providersvery strongvery strong none
Ministry of HealthHealth InsuranceProviders

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

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 and evaluation

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:  

  • Market observation and analysis
  • Standardized reporting including the data contained in the eHealth directory  (the law does not specify a time frame for the reporting)

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.

Expected outcome

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).

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high 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.

References

Sources of Information

  • Bundesministerium für Gesundheit und Frauen; Gesundheitsreform; Gesundheitsversorgung auf hohem Niveau gesichert; Europäisches Forum Alpbach 24.2.2005;
  • Bundesministerium für Gesundheit und Frauen: Erlaeuterungen zum Gesundheitstelematikgesetz http://bmgf.cms.apa.at/cms/site/detail.htm?thema=CH0015&doc=CMS1038912447892:  Oct 12, 2005
  • Embacher Gerhard; Aktuelle Entwicklungen im Bereich der Diagnosen- und Leistungsdokumentation in Österreich; 4. Drei-Länder-Treffen Deutschland-Schweiz-Österreich am 1. Oktober 2004 in Innsbruck; Foliensatz; Bundesministerium für Gesundheit und Frauen 2004.
  • European Commission; high level committee on health; health telematics working group of the high level committee on health: final report; 2003.
  • OECD; Information Technology Policy Survey 2004 Austria; 2004.
  • Ohler Fritz, Polt Wolfgang, Rammer Alexandra, Schindler Julia; Governance in Austrian Information Society Policy; Final Report; Joanneum Research, 2004.
  • STRING-Kommission beim Bundesministerium für soziale Schicherheit und Generationen; MAGDA-LENA 2.0; 2002; www.bmgf.gv.at/cms/site/search.htm?query=MAGDA-LENA
  • 711 der Beilagen zu den Stenographischen Protokollen des Nationalrates XXII.GP; Bericht des Gesundheitsausschusses; Wien; 2004.

Author/s and/or contributors to this survey

Maria M. Hofmarcher, proof reading: Engelbert Prenner, BMGF, Abteilung IV/6 ? Gesundheitstelematik

Suggested citation for this online article

Maria M. Hofmarcher, proof reading: Engelbert Prenner, BMGF, Abteilung IV/6 ? Gesundheitstelematik. "Health Telematics Law (GTelG)". Health Policy Monitor, October 12, 2005. Available at http://www.hpm.org/survey/at/b6/1