Electronic health record (Austria)

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The electronic health record ( ELGA ) is a system for standardizing electronic communication between health service providers based on HL7 and for networking health data and information based on the Clinical Document Architecture .

History and Development

From 2006 to 2010, ARGE ELGA worked on behalf of the Ministry of Health with the Main Association of Social Insurance Institutions , the Federal Health Agency and the federal states on the development of ELGA. ELGA expects an "increase in quality, effectiveness and efficiency of health care" through "uniform specifications for uniform documentation and coding of information". ARGE ELGA was financed by providing 2.4 million euros from the Federal Health Agency .

Basic studies were carried out up to 2007, and detailed planning began in 2008. With the ELGA Act, which came into force on January 1, 2013, Parliament created the legal basis for the implementation of the nationwide ELGA after extensive negotiations. This includes the establishment of the technical components (ELGA portal for citizens, the central patient index, index of health service providers, authorization and logging system, local ELGA areas) and the step-by-step provision of health data (initially hospital discharge letters, laboratory and radiology results) for use by various health organizations and professional groups in the health sector defined by law.

The law provides for a gradual roll-out until 2022. The first ELGA applications are e-diagnosis and e-medication . The e-medication has been rolled out across the board in the private practice area (pharmacies and cash registers) since autumn 2019. The connection to the public hospitals started at the end of 2015 and has now taken place across the board.

With regard to participation in ELGA, an objection option has been created where patients who want to partially or completely unsubscribe from ELGA can submit a written objection. By the end of 2019, 390,000 people had deregistered from ELGA, which corresponds to 3.4% of citizens. Regardless of a possible contradiction, health data (e.g. laboratory and radiology findings, x-rays) must continue to be stored in the inpatient health facilities such as hospitals for 30 years as they have been up to now. In the private sector, this storage obligation is 10 years. ELGA itself does not save any data, but merely networks the documents made available for ELGA. An ELGA objection concerns the possibility of access by the insured himself to his own data and documents as well as access by health service providers.

ELGA GmbH

ELGA
legal form Limited Liability Company (non-profit)
founding 2009
Seat 1200 Vienna , Treustraße 35–43
management Günter Rauchegger, Franz Leisch
Number of employees 30th
Branch e-health
Website www.elga.gv.at

ELGA GmbH was founded in 2009 as the successor organization to ARGE ELGA .

The core tasks of ELGA GmbH include the further development of the IT architecture of the electronic health record, the further development of the standards used including international coordination, the overarching program control of all necessary projects, the management and implementation of the necessary integration tests, public relations, and overarching coordination of the operation as well as the further development and control of information security in ELGA.

Enterprise purpose ELGA GmbH is "the non-profit provision of public interest services in the field of general interest in the field of e-health for the introduction and implementation of the electronic health record." Owners are federal , states and social security .

Around 200 people from the specialist staff of social insurance carriers (including regional health insurance funds ), hospital operators (e.g. from KAV Vienna and Upper Austrian Health Holding GmbH), the medical association , software manufacturer and diagnostic provider Telekom Austria , from the Austrian standardization institute and the University of Applied Sciences Technikum Wien also develop document samples with regard to interface management and the interoperability of IT systems. For this purpose, CDA implementation guidelines were created for a laboratory report, radiology report and discharge letters from a doctor and from nursing. These have been published for comment.

access

According to the Austrian Medical Law, hospitals, pharmacies and their employees should have access to ELGA documents or references to these documents via e-card . Company doctors and public medical officers as well as doctors, hospitals and pharmacies abroad, authorities and insurance companies should not be able to access the references to ELGA documents. In principle, the references are stored for a limited period of time for ten years. This does not affect the statutory retention requirements for medical histories.

Patients have a general or a graduated opt-out, i.e. the right to completely or partially prevent references to their documents from the various institutions. There are extended information requirements on the right to opt-out for HIV disease, termination of pregnancy , mental illness and genetic analyzes.

Data protection guarantees

Art 8 (4) of the Data Protection Directive 95/46 / EC and Section 1 (2) DSG 2000 require appropriate guarantees when using sensitive data. The Health Telematics Act 2012 (GTelG 2012) provides the following appropriate guarantees:

criticism

The medical association warns of a "transparent patient", sees no reasonable relationship between costs and benefits and ultimately takes the position that " only a doctor should decide which data may be passed on in the interests of the patient ".

The ÖGAM refers to the term evidence-based medicine , which must first be filled with life. ELGA could hardly contribute to the extent of the quality of primary care.

The data protection commission suggests a principle opt-in requirement for the exchange of all health data and points out that basically everyone can make a claim to health data . This indicates a possible use of the references for calculating insurance risks and marketing drugs.

In October 2014 ELGA received the Big Brother Award (negative price).

Criticism of criticism

The accusation of the transparent patient at ELGA go in view of the strict, legal prohibition of use and a. for authorities, courts, insurance companies, employers ( § 14 Abs 3 GTelG 2012) in the void. In addition, under current law, health data can currently be used much further, for example by courts, federal organs or WADA .

Experience from the European epSOS project also shows that opt-in systems are practically not used in the health care sector.

The Art 29 Data Protection Working Party asserts, for example, that Article 8 (3) of the Data Protection Directive 95/46 / EC does not constitute a legal basis, but does not justify it.

See also

Individual evidence

  1. ↑ Agreement ARGE ELGA, 2006, PDF , p. 4 f. Retrieved November 18, 2011.
  2. ↑ ELGA: ELGA at a glance. Retrieved April 23, 2020 .
  3. ↑ Declaration of intent regarding the ELGA participation status , requested on January 2, 2014
  4. ↑ ELGA: Numbers-Data-Facts. Retrieved April 23, 2020 .
  5. ↑ ELGA - Frequently Asked Questions . Retrieved March 3, 2014.
  6. ↑ Topic: ELGA - Electronic Health Record - One Topic - Two Opinions ( Memento of the original from March 3, 2014 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Retrieved March 3, 2013  @1@ 2Template: Webachiv / IABot / www.selbsthilfe-oesterreich.at
  7. ↑ ELGA: Company and management. Retrieved April 23, 2020 .
  8. ↑ Harmonization work for medical documents on elga.gv.at, accessed on November 23, 2011.
  9. ↑ Federal Law Gazette I No. 111/2012 : Electronic Health Record Act - ELGA-G.
  10. ↑ Auer / Milisits / Reimer , ELGA manual - The electronic health record, margin no.132
  11. ^ The points of conflict at ELGA on orf.at, accessed on June 7, 2012 as well as ELGA and the fear of the loss of medical power in: Der Standard from November 17, 2011, accessed on June 7, 2012.
  12. ↑ ÖGAM News 15 + 16, PDF , accessed on June 7, 2012.
  13. ↑ Opinion of the Data Protection Commission of March 17, 2011 ( memento of the original of March 7, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , accessed November 20, 2011.  @1@ 2Template: Webachiv / IABot / www.dsk.gv.at
  14. ^ The points of conflict at ELGA on orf.at, accessed on June 7, 2012.
  15. ↑ derStandard.at - "Big Brother Awards" for Heinisch-Hosek, Facebook and LG . Article dated October 25, 2014, accessed October 26, 2014.
  16. ↑ Auer / Milisits / Reimer , ELGA manual - The electronic health record , margin nos. 28 to 31 and 132
  17. ↑ Auer / Milisits / Reimer , ELGA manual - The electronic health record, margin no.152
  18. ^ Reimer , Current and future Austrian legal situation with regard to electronic patient files, EJBI 2012; 8 (2): de16
  19. ↑ Art-29 data protection group , working paper - processing of patient data in electronic patient files (EPA), WP 131, 12
  20. ^ Reimer , Current and future Austrian legal situation with regard to electronic patient files, EJBI 2012; 8 (2): de4

literature

  • Auer / Milisits / Reimer : "ELGA manual - The electronic health record ", Manz Vienna 2013.
  • Jutta Frohner : "Data protection in health care" in Bauer / Reimer (ed.) Handbook on data protection law, wuv-facultas Vienna 2009.
  • Thomas Riesz : "Medical confidentiality - with special consideration of hospital and data protection law", dissertation JKU Linz 2013.
  • Reimer , Current and future Austrian legal situation with regard to electronic patient files , EJBI 2012; 8 (2): de2 – de21 - full text

Web links


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