Similar to other areas of human endeavour, healthcare is bound to undergo the inevitable process of digital transformation. In the last two years the Czech Republic has taken its first steps towards digitizing its healthcare system by introducing mandatory electronic prescriptions and electronic sick notes and is about to introduce an electronic medications record. Unfortunately, there has been little progress on other fronts. Moreover, the Ministry of Health has yet to complete its draft law setting common standards and rules for eHealth, and it is unlikely to meet its current goal of having the law go into effect in 2021.
Although legally anchored much earlier, electronic “e-Prescriptions” (in Czech “eRecept”), were not widely employed until January 1, 2018, when they became mandatory. Despite initial objections and resistance, mainly by independent general practitioners, today several million e-Prescriptions are issued every month.
Each e-Prescription carries information about drugs prescribed to the patient and ensures an electronic exchange of this information between the doctor, patient, pharmacy, and healthcare insurer. When a doctor issues an e-Prescription, it is stored in the central repository of electronic prescriptions, and accessible to the relevant pharmacy dispensing the drug. The patient is free to choose how he/she will receive the e-Prescription identifier. Paper note identifiers are still the most common, but electronic means such as SMSs, emails, and smartphone apps are becoming increasingly popular.
The central repository allows for the creation of patient-specific medication records, i.e., a registry of all e-Prescriptions issued and drugs dispensed to the patient. Effective from June 2020, any doctor treating a patient will be able to view the patient’s medication record, as will any pharmacist dispensing a drug to the patient. This will prevent duplicate prescriptions and unwanted drug interactions. Patient consent to authorized access to their medication record is presumed but can be revoked (i.e., an opt-out system).
On January 1, 2020, an electronic system went into use for processing decisions on temporary incapacity to work. The system for these “e-Sick Notes” (in Czech “eNeschopenka”) was inspired by the e-Prescriptions system. It ensures an exchange of information among doctors, employers and the relevant social security office. Doctors no longer issue sick notes in hard copy. Employees inform their employer that they are sick via phone or email without the need for paper forms. Employers verify the e-Sick Note via the Social Security Administration’s web portal. There, they can also opt to receive sickness notifications for their employees via an electronic databox and notification alerts to their email.
Once the sick employee has surpassed 14 days of sickness he/she is entitled to sickness insurance benefits. Under the new system employees no longer have to inform their social security office; it is done automatically. The benefit is deposited directly in the employee’s bank account, which is provided by the employer.
Carrying out systematic digitization of the national healthcare system would not be possible without an appropriate legal framework. The Ministry of Health is currently drafting a law that will set out a comprehensive systematic solution. The Act on Electronic Healthcare (the “e-Health Act”) is expected to set common technical standards for digitization and sharing of health records among healthcare providers and patients. Considering the sensitive nature of this data and the potential related risks, it is envisaged that health records will not be centrally collected; as a general rule, they should be indexed instead. Only an “emergency data record” containing basic information about the patient relevant for emergency services (e.g., allergies), will be kept in a central register. The e-Health Act should also establish registers of patients, healthcare providers, and healthcare workers and set out the rules for access to this information.
While the e-Health Act was expected to go into effect this year, there have been significant delays. Currently, the Ministry of Health intends to have the draft law prepared by mid-2020 and is hoping to put the law in effect in 2021. At this point, these goals seem unrealistic, considering the paucity of information available about the draft law and the fact that it will likely face significant debate with all relevant stakeholders (state authorities, healthcare providers, payers, patients, etc.), not just on the technical standards and practical issues of implementation, but also on personal data protection aspects of healthcare digitization.
By Monika Maskova, Partner, and Michal Rehorek, Associate, PRK Partners Prague