|E-health in Poland|
|Implemented in this survey?|
The Polish MoH presented the second package of the systemic health laws (the first one was vetoed in 2008) including the Law on E-health project. It has been submitted to the social cosultations on 23rd of August and the deadline for sending feedback was 30th of August. The project aims at the improvement of the whole health care system, and the MoH declared that the new law will change its efficiency and responsiveness to patients´ needs significantly.
Main goals of the legislation
The Ministry of Health (MoH) listed the main goals of the projected legislation entitled "the information system within the health care system ". The following issues have been included there:
1) Elaboration of informative conditions (criteria) in order to enable the process of taking optimum health policy decisions - the MoH underlined in this respect that the new conditions should not depend on the organizational model of health care in Poland and on the financing rules (transferability of the solution, easy adaptation);
2) Creation of a stable information system in health care with the following features: a) elasticity of the approach to the systemic resources organization including the model of health care services financing (National Health Fund (NHF) contracts, budgetary financed services and others) and b) strong "resistance" towards disturbances concerning the collection and storage of health care system data and records;
3) Elimination (or at least decrease) of the information gap in the health care sector postponing the establishment of the optimum health care model;
4) Systematization of the existing model of collection, processing and use of information in health care based on the following rules:
The other goals expected by the MoH as a result of the new legislation are:
5) The improvement of health care functioning in Poland due to the complexity, timeliness, compatibility of norms, processes, systems and information resources in the health care sector that influence the information order coherence with special regards to population needs concerning information;
6) Optimal implementation of the solution for the financial inputs regarding the process of "informatization" of the health care sector, and the information society development in respect of health care effects;
7) Restoration of proper relations between data producers, data collecting information systems gestors and bodies using and analyzing the data originated in the information systems.
Origin and development of the policy
The idea to promote the implementation of e-health was originally generated a few years ago by researchers familiar with the problems in the health care sector and then undertaken by the government, and other medical professionals. The main purpose stipulated in the government documents was to support cross-border mobility of citizens and provision of the ongoing work on e-health interoperability in this respect. The tools foreseen at that time for the policy achievement were legal measures (laws and executive regulations) and strategic governmental political documents establishing goals and describing methods. Still, direct financial measures have not been provided for the realization of this health policy.
As it has been described in theHPM report on e-health in Poland (10) 2007, the MoH issued an internal document called "Poland - E-health Strategy for 2004-2006" in 2004. In the subsequent year it prepared the "Strategy of information infrastructure development in health care and introduction of the European Health Insurance Card". All issues concerning the subject of e-health introduction to the health care system were included in the National Program of Development (2005). At that time the most important questions focused on data protection, telecommunication, digital signature and health-IT product liability. Since then, the need for adequate legislation and executive regulation has been stressed quite often. The main priorities in the field of e-health were pointed out, such as the assurance of easier access for citizens to health care information, improvement of the effectiveness of the health care sector with regards to electronic exchange of documentation and the creation of a Medical Information System. The expected outcomes were pointed out as well. These are the improvement of the process of information exchange, establishment of centers of health information with specialized references, improvement of the availability of standards, the creation of medical portals and the establishment of the electronic health insurance card (EHIC), and electronic health care (EHC).
Within the period 2004 - 2007 the main goals indicated with respect to the e-health issue focused on the problem of the elaboration of proper legal frameworks, concerning different levels, taking into account the development of internal (national) regulation adequate to the standards provided by European documents concerning e-health. The need for the National E-health Implementation Plan has also been underlined with a focus on system management rationalization. The main goals were the following: optimum management of the health system, interoperability of the health information system, interoperability of electronic health records, mobility of patients and health professionals, and - last but not least - financial savings.
The political and economic background has to be connected to the grounds of binding legislation on different levels with special concern for the need to comply with international and EU regulations and political documents, and with WHO regulation initiatives and documents. Consequently the new proposals and changes in Polish legislation have to take into account the documents issued by different EU and WHO bodies: plans, communications, strategies and decisions - see the report (10)2007. Moreover, there are also several important Polish documents with regard to the issue of e-health and its implementation - mostly the e-health strategies constituting the integral parts of the National E-health Implementation Plan (the subsequent strategies for years: 2001-2006 and 2004-2006). The Center for Strategic Information on Health Care´s (CSIOZ) key role should be also stressed in this respect.
The policy´s driving forces
At the beginning the important driving forces behind this idea were private sector companies (providers of computer programs, projecting and managing the databases, managing the electronic systems, and other connected issues. These companies offered the external projects, programs and also the services concerning the systems management and functioning monitoring. Since the previous report the role of the MoH in respect to the sectoral policy in this field increased, and the direct result is a new law project prepared and presented to the external consultancies by the MoH. Surely, the government is interested in the improvement of data access and in the process of progressive "optimization" of the monitoring of the health care service delivery process. Still, the introduction of e-health is expected to save money in the system (see the example of the electronic cards and register of health services in Silesia Voivodeship, given in the previous report). However, the currently proposed project, included into the whole package of health care reforming laws, may not bring the expected changes. It seems obvious that the MoH special activity concerning the legislation changes affected in the proposals that are far from perfection, and the critical voices are now being heard from different areas: academics and researchers, public health experts, computer business companies, and - from the political opponents. The approach of the idea has to be described as renewed. The idea originated some years ago but the current aproach of the MoH is quite new due to the complexity of the proposed legislation.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The health policy concerning the issue of creating a new, complete and modern, responsive, well functioning and adequate to the Polish health care system medical information system, should be created on a basis of existing laws regarding protection, processing and collection of personal data. Also, they should be created in cooperation with competent, skilled professionals and businesses, researchers and institutions. The elaboration of the package of the 12 projects was designed as a spectacular proof for the governmental activity in the sphere of complete "revolutionary" reform of the whole health care system, however, failing the particular intended legislative goals. The development of a medical information system in Poland should be treated as a serious issue engaging multilevel and multidimensional change: adequate public institutions, medical environment, businesses, researchers, lawyers and politicians. It emerges for the solutions that will work and bring a change to the health care system - expected from all parties engaged for quite a long time and not solved so far. The systemic impact as well as transferability of the MoH policy formulated in this project have to be described as neutral due to the probability of abandonment of the project (in case of the opposite situation - rather difficult to assess due to the indicated weakness of the proposed legislation).
|Implemented in this survey?|
Position of the National Health Fund
The external consultancies resulted in 27 commentaries sent back by different bodies, among them the NHF, the National Chamber for Nurses and Midwifes, and the General Inspector for Personal Data Protection. The critical voices from the NHF side as one of the most important institutions in this area focus on the following issues:
The important arguments in the document sent by the NHF put the fundamental goal of the project in question: the creation of the system INDEPENDENTLY of the organizational model of health care. The NHF strongly opposes this idea arguing that the Polish health insurance system calls for an adequate solution - based on the assumption that the specifics of the insurance model need data and information solutions corresponding to the insurance rules (which is not a surprise concerning the role of the NHF within the health insurance).
The other arguments are:
The NHF´s position has to be described as extremely opposed: the closing remark of the project underlines that it is impossible to formulate particular opinions concerning the particular provisions, and that a completely new one should be prepared in this sphere. It may be understood as a declared rejection of the MoH proposal.
Position of other bodies
The other critical voices raised by different bodies focus on the following:
At this stage, taking into account the social consultancies effects and the other critical opinions from different sides, the only one conclusion to be made for the future of a complex regulation on e-heatlh in Poland is the completely new elaboration of the project - engaging different interested parties. The MoH should take into account the institutions offering the knowledge and professional skills in the sphere of information systems design.
As it was described in the previous report the idea to promote the implementation of e-health was originally generated a few years ago by researchers familiar with the problems in the health care sector and then undertaken by the government and other medical professionals. The main purpose stipulated in the governmental documents was to support the cross border mobility of citizens and provision of the ongoing work on e-health interoperability in this respect. The tools foreseen at that time for the policy achievement were legal measures (laws and executive regulations) and strategic governmental political documents establishing goals and describing methods. Still, direct financial measures have not been provided for the realization of this health policy. The new project was announced by the MoH as a revolutionary change - at the moment, however, the probablity of the abandonment of this complex legislation seems to be quite high.
Impossible, due to the reasons indicated above.
The results expected by the MoH are described above - these are the general objectives focusing on the reasoning for the need to build the medical information system. The results in practice however - taking into account the critical opinions from different interested parties - are nearly impossible to achieve.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The impact of this project will not be satisfactory in any case. Probably the project in the proposed version will not be presented to Parliment, however, facing the opposite situation - the future of it is difficult to forsee at the moment.
|E-health in Poland|
Process Stages: Idea
Anna Mokrzycka, Iwona Kowalska
Lecturers and researchers at the Health Policy and Management Department, Institute of Public Health, Jagiellonian University. Research on social protection system, health insurance.