In 2008, after receiving government approval, the Slovak Ministry of Health began its preparations for, and the strategic development of, the National portal of electronic health ("eHealth"). eHealth will be operating under the National Health Information Center ("NCZI"), while the legal framework is set forth in Act 153/2013 Coll. on the National Health Information System, as later amended. The purpose of this Act is to increase the efficiency and quality of healthcare through informatisation (i.e. through the application and role of information technology). Although the Act has only been in force since 1 July 2013, it has already been amended several times. The changes relate to the fact that full implementation of eHealth in Slovakia has been repeatedly postponed for several reasons, including a lack of preparation by the State and associated stakeholders for its full operation.
In general, eHealth in Slovakia will have similar intended benefits to those in other EU countries, such as medical, social and economic benefits. The priorities of eHealth will be focused particularly on the elimination of duplicated outputs and prescriptions, a decrease in the administrative workload of physicians, improved patient information access, decreased adverse drug interactions and a general increase in healthcare quality.
The system has received public scrutiny due to delayed implementation and escalating costs. The complexity of the system and some implementation issues with the system’s developers are creating challenges for the State. Patients are also concerned about privacy protection, fearing that digitisation and centralisation of their personal and sensitive medical data will lead to it becoming increasingly accessible and leave it more vulnerable to unintended exposure. This creates a conflict between the interests of physicians who want greater accessibility and individual patients who are concerned about the confidentiality of their personal data.
Despite the above, eHealth in Slovakia is being implemented through a series of projects, with the primary one, known as “eSO1”, developed and officially completed on 21 December 2015. This project included the launch of eHealth along with primary functions such as Citizen Health eBook, ePrescription, eMedication and eAllocation.
The second project, referred to as “The National eHealth Extension of Functionality and Services”, included the consolidation of the medicine and knowledge databases, advanced administration, expansion of the functionality and range of electronic health services and data protection. This phase was also officially completed on 21 December 2015.
The pilot version of eHealth was launched with several healthcare providers and laboratories and has been operating since March 2016. As can be expected with the implementation of a large scale system, various operational challenges have arisen that will need to be resolved by the Ministry of Health. At this time, certain components of the project such as Citizen Health eBook and ePrescription are being finalised, while secondary functions, such as the Vaccination reminder, are expected to be fully operational later on.
Although the deadline for full national implementation has been extended in the past, under the current law, eHealth will become mandatory as of 1 January 2018. All healthcare providers, health insurance companies, laboratories, pharmacies and other related entities are also obligated to participate and be fully operational by 1 January 2018. They are required to have information systems along with the requisite certifications in place by this deadline. Nevertheless, the Ministry of Health is encouraging all parties concerned not to wait until the final deadline in order to avoid a system overload.
Many healthcare providers already have their own internal electronic systems, which should be adequately adapted to the unified and interconnected eHealth system by 2018.
According to the Act, all healthcare professionals (including physicians, dentists, nurses etc.) are required to apply for an eID number by 31 October 2017 to obtain authorisation to access the eHealth system. The eIDs and card readers, through which patients will identify themselves, shall be provided by the State. Patients will join the eHealth system through their regular ID card or their insurance ID card.
Many health professionals don’t currently possess the necessary technical equipment to integrate into the system. The Ministry of Health is aware of this and is planning on providing some financial assistance through the existing health insurance.
To conclude, many challenges lie ahead for eHealth in Slovakia. However, despite this, things are moving ahead, even if at a slow pace. In light of the repeated delays regarding the operation of the system, many stakeholders are reluctant to believe that eHealth will finally be in place and fully operational by 2018. We hope that additional delays will be avoided and the system will be implemented successfully.