PEOPLE waiting for electronic services in health care will have to wait another year. The Health Ministry halted the competition over the system to secure, among other things, connections between hospitals and general practitioners’ clinics, and postponed the implementation of its e-Health project to 2017 over concerns that it might have to return some EU funds.

In the wake of the delay, the health insurers now say they doubt the ministry will pass any important reforms to the system by the end of its tenure. They are also asking whether it would be possible to refund the money they have already invested in the project.

“Time is short and we could not implement this project effectively,” said Viliam Čislák, state secretary of the Health Ministry, as quoted by the SITA newswire, adding that “so after the agreement with the Finance Ministry we decided not to use the money, so it can be used for projects the Finance Ministry can implement by the end of 2013 programming period.”

The Health Ministry launched a competition over software components for the National Health Information System (NZIS) worth €40.25 million last summer. The winner was to start preparing the system in December 2013 and finish it by September 2015, the TASR newswire wrote.

The ministry planned to use EU money from the Operational Programme Digitalisation of Society allocated for the 2007-13 period. Thanks to an exception from the European Parliament, Slovakia is able to use the money by the end of 2014 or 2015.

However, because of a complaint submitted by an unsuccessful bidder in the competition, which is currently under scrutiny by the Public Procurement Office, the ministry cannot sign an agreement with the winner. This means that the competition will not end in time and the ministry will not be able to use the EU money earmarked for the project in time, Health Ministry spokeswoman Martina Šoltésová told The Slovak Spectator.

The ministry now plans to use the money allocated for the years 2014-20, Šoltésová added.

Health insurers concerned

The Association of Health Insurance Companies (ZZP) however says that the delays in the e-Health project will slow down reforms in the health-care system again. Since the ministry has already postponed another big project, the launch of DRG (Diagnoses Related Groups) classification system that should set the payment scheme for hospitals, it is not sure it will implement any crucial reforms by the end of its tenure, Katarína Kafková, chair of the ZZP, said in a statement provided to The Slovak Spectator.

She also asked how the ministry wants to deal with the poor state of the health-care system.
“We know that the debts of hospitals are rising uncontrollably, and e-Health was to contribute to better management,” Kafková said in a statement.

According to Ivan Uhliarik, MP for the Christian Democratic Movement and former health minister, the fully operational e-Health system may save about €100 million a year, as reported by SITA.

Kafková also expressed doubts about the new deadline for e-Health implementation. Not only will a new government need to implement it, but there is also a risk that the price for the project will increase, she said.

The ZZP also asked what will happen to the money the health insurers already invested in e-Health. For 2013 and 2014 they contributed altogether €13.3 million to the budget of the National Health Information Center (NCZI), a state-run institution responsible for the electronification of the health-care system, and planned to send another €9.4 million this year.

“It is the money from public health insurance, meaning the money allocated for the treatment of patients,” Kafková said. She also asked whether, if the project was postponed, it would not be better to return the funds so they can be used for their original purposes.

No threat to other e-Health projects

This is not the first time the Health Ministry postponed the e-Health project. It started preparing it in 2008, with its implementation planned for 2013. The plan was meant to limit duplicate examinations and tests, and also to secure communication between doctors, hospitals and pharmacies, so patients would not receive the same medication or medication with contradictory effects, the Sme daily wrote.

The Health Ministry, however, stresses that its decision to postpone the implementation of the NZIS will not affect the first support piece of the project, the Electronic Services of the Health Care project, which includes electronic medical records, electronic prescriptions and a national health portal.

“E-Health remains the priority of the ministry and the work on it continues,” Šoltésová said.

Along with halting the public competition over NZIS, the Health Ministry introduced several changes to the e-Health project. One of them is that the NCZI, not health insurers, will be responsible for issuing health cards with electronic chips. The issuing of these cards will be postponed, from this July to September 2015, Sme wrote.

AZZ welcomes these changes and consider it right to postpone the wrongly prepared project, Kafková said. She, however, was surprised that the Health Ministry did not discuss the problems with others active in the health-care sector.

“The health insurers who have experience with their own electronification have offered help with preparing the project several times,” Kafková said. She stressed that the last meeting of the Council for Informatisation and Electronification of Health Care, which ZZP regularly attended, took place in April 2013.