E-health in Poland

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In 2004, the MoH issued an internal document called ?Poland ? eHealth Strategy for 2004-2006?. In March 2005 the ?Strategy of information infrastructure development in health care and introduction of the European Health Insurance Card? was prepared. The issue of e-health was also included in the National Program of Development (2005). Polish legislation addresses the issue of data protection, telecommunication, digital signature and Health?IT product liability trough relevant acts, regulation.

Purpose of health policy or idea

The main priorities in the field of e-health are the following:

• assurance of easier access of citizens to health care information
• improvement of the effectiveness of the health care sector with regard to electronic exchange of documentation
• creation of a Medical Information System

The outcomes that are expected are as follows:

• 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
• the establishment of the electronic health insurance card (EHIC), electronic health care (EHC)

Main points

Main objectives

The main objective is the implementation of information programs by the health care units with the use of information technology: internet at every health facility, application of uniform standards of IT in health care units, introduction of IT solutions in health care units.

The strategic objectives that have been defined as critical strategic aims focus on the encouragement and promotion of an environment for detailed specification testing, achievement of interoperability based on standards through evaluation or certification; creation of data bases and electronic health records; Medical Information System; the creation of an E-prescribing system with decision support, electronic transferability of prescriptions and the establishment of electronic health/patient records. 

Type of incentives

The foreseen incentives for the implementation process of E-health in Poland are legal frames:

1. internal (national) regulation: the law on the introduction of IT in entities that perform public functions (e-Government Act)
2. European documents concerning E-health (see section "Political and economic background")
3. the national e-health implementation plan (see section "Political and economic background")

The other incentive for implementing E-health in Poland concern the issue of system management rationalisation. Particular objectives that are expected to be achieved are the 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.

Groups affected

Patients, health care providers, payers and private sector (companies dealing with information systems, electronic data bases etc.)

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The policy introduces a new innovative approach. The objectives of the policy do not cause controversies, however health professionals may oppose the proper implementation process due to the so far existing possibilities to make financial gains because of the of non-functional data bases. The impact on the systemic structure is fundamental (see expected results described above). The discussion on the issue concerns mostly experts, the scientific society, professionals, managers and governmental institutions. The media did not report it widely so public access to the information is quite low.

Political and economic background

The political situation concerning the introduction of e-health in Poland at the first place focuses on the need to comply with international and EU regulations. In this respect the most important documents are as follows (in chronological order):

1. eEurope 2005: An  Information Society for All - An Action Plan, EU Commission COM (2002) 263 final, 28.5.2002;
2. Cohesion Policy in Support of Growth and Jobs: Community Strategic Guidelines, 2007- 2013 (COM(2005)299 final; SEC (2005) 904;
3. Ministerial Declaration Brussels, 22nd of  May 2003 final;
4. E-health - making healthcare better for European Citizens: An Action Plan for a European e-health, EU Commission Communication, COM (2004) 356;
5. Followup to the high level reflection process on patient mobility and healthcare developments 
6. European Parliament and Council decision of September 2002 adopting a program of Community action in the field of public health (2003 -2008);
7. Coucil Decision of 22nd of December 1986 on standarization in the field of information technology and telecommunications (87/95/EEC).

Concerning important international documents that should be regarded, the WHO initiative has to be pointed out. In May 2005  the Fifty-eighth World Health Assembly adopted the E-health Resolution and addressed it to all Member States (WHA58.28, Ninth plenary meeting, @5 May 2005 - Committee A, seventh report). WHO conducts global research on e-health which is monitored by the Global Observators (Goe) that was established this year. It is going to provide the first global questionnaire on e-health.

The other documents important with regard to the issue of e-health and its implementation in Poland are the E-health strategies which constitute parts of the National e-health Implementation Plan:

1. Strategy e-Poland 2001-2006;
2. Strategy e-Poland 2004-2006;
3. Strategy e-health Poland 2004-2006.

The special key role of the centers for strategic information on health care (CSIOZ) should be also stressed in this respect.

The initiatives that have been undertaken before 2004 positively influenced the environment for the creation of electronic services in health care. From 1999-2001 the Silesia Voivodship developed a register of health services based on the use of the electronic health insurance card. A key role also played a World Bank project completed in 2001on the development of information infrastructure in Polish hospitals as well as on creating the grounds for a hospital information system.

Change of government

The change of governemt seems to be not so important in this respect.

Complies with

EU regulations

See section "Political and economic background".

Other

With the 2005 WHO e-health resolution (see section "Political and economic background").

Change based on an overall national health policy statement

National e-Health Implementation Plan and national strategic documents (see section "Political and economic background").

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

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 is to support the cross border mobility of citizens and provision of the ongoing work on e-Health interoperability in this respect. The tools that will be used for the policy achievement are 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 important driving forces behind this idea are private sector companies that are dealing with the design of computer programs, the projection and management of data bases, the management of electronic systems and other connected issues (the health care sector needs a lot of investments in this respect). Consequently the main actors are such companies that offer the external projects, programs and also the management of the created systems, they monitor the functioning of these systems. The other important stakeholders are the MoH and the NHF as payers: both are interested in the improvement of data access, in an optimized monitoring of the health care service process (the introduction of e-health is expected to save money in the system). The example of the Silesia Voivodship that developed a register of health services based on the use of the electronic health insurance card could be recalled in this place as a unique example of the policy idea implementation.

Initiators of idea/main actors

• Regierung: The government has to undertake actions with regard to the accomplishment of EU and other international regulations in respect of cross border mobility of citizens (with the help of e-health).

• Leistungserbringer: Managers of health care units are strongly interested in the introduction of this policy because they expect improvements in manangement methods and data collection. Doctors may not support the idea due to the strict rules of data collection (decrease of finances for services)

• Kostenträger: The NHF is interested in savings - the introduction of e-health may result in such savings. One obstacle is that high financial inputs are needed at the moment and it will take a long time to generate profits.

• Patienten, Verbraucher: Patients should be interested in this issue but at the present moment only some specific groups of patients have enough sources of information and access to e-health services (e.g. cardiovascular patients).

• Wissenschaft: Researchers supported the idea from the very beginning as a precondition for improvement and rationalization in the whole system. They would also like to be involved in the monitoring process.

• Privatwirtschaft, privater Sektor: Private companies are interested in profit - the health care systems needs a lot of investments in the descrtibed sphere. They fully support the idea and policy (probably they were and will be the most influencing forces in this field).

Approach of idea

The approach of the idea is described as:
renewed: The idea originated some years ago but the governmental approach is quite new. The wide discussion and research on the issue lead to the actions showing the real interest (at least at the policy "designing" level).

Innovation or pilot project

Local level - See the Silesia example described above, the Lower Silesia eHealth Network and the Telemedicine Network in Kujawsko-Pomorskie Voivodship
Within institution - Polish telemedicine centers: International centers of hearing disorders in Kajetany, Institute of Cardiology in Anin, the Poznan Supercomputing and Networking center, Krakow center of Telemedicine, Malopolsla Center of Advanced Technologies

Stakeholder positions

As it was pointed out above the government's main objective is to accomplish EU and other international regulations and it is focused on the issue of  cross border mobility of citizens (through the introduction of e-health). The MoH plays a special role in this group of stakeholders - it has a double role as head of the health care sector and payer (in case of particular services). The Minister of Health is interested in a proper, detailed, adequate and easily accessible information on the one hand but on the other hand he fears that the costs for introducing e-health may be quite high at the beginning (due to the necessary investments in "electronic resources": computer programs, equipment and training needed).

Private companies are of course interested in expected profits. They support the idea and policy and are the most influencing forces in this field. However, in the present political situation of anti-corruption activities some practical obstacles may arise: difficulties in public auctions and orders; too many formalities. 

Patients in general are not very well informed about all the problems concerning e-health issues, but some specific groups have already been involved in e-health treatment methods. As the best example cardiovascular patients may be mentioned: some NHF units introduced electronic methods for patient monitoring, periodical examination and also prescriptions available via the internet. Generally patients have not enough sources of information and access to e-health services should be widened for other specific groups (since in the long-term it saves money in the system). 

Researchers have strongly supported the idea from the very beginning. They are of the opinion that e-health may improve the functioning of the whole system, positively influence the rule of transparency and the free movement rule (with respect to cross border mobility of patients). They of course would like to have access to the widest possible range of data which may be realized through the introduction of e-health methods. They would also be interested and involved in the monitoring process.

The NHF is interested in savings in the system but the introduction of e-health causes higher costs at the beginning; the expected savings would only be observable in the future.

Actors and positions

Regierung
MoH	sehr unterstützend		stark dagegen
MoF	sehr unterstützend		stark dagegen
CSIOZ (Center of Informative Systems in Health Care)	sehr unterstützend		stark dagegen
Leistungserbringer
Health care units, hospitals	sehr unterstützend		stark dagegen
Doctors	sehr unterstützend		stark dagegen
Kostenträger
NHF	sehr unterstützend		stark dagegen
MoF	sehr unterstützend		stark dagegen
MoH	sehr unterstützend		stark dagegen
Patienten, Verbraucher
patients already having access to e-health	sehr unterstützend		stark dagegen
others	sehr unterstützend		stark dagegen
Wissenschaft
public health researchers	sehr unterstützend		stark dagegen
Privatwirtschaft, privater Sektor
private companies and firms	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The further development of the idea would lead to different kinds of pieces of formal legislation. At the present moment the Law on the Introduction of IT in Entities Performing Public Functions creates the general conditions for further regulations but it is not specific for health care sector legislation (it concerns all issues that are connected to the functioning of public institutions, also governmental, and to the electronic methods of data collection, transfer and manangement).

Actors and influence

Regierung
MoH	sehr groß		kein
MoF	sehr groß		kein
CSIOZ (Center of Informative Systems in Health Care)	sehr groß		kein
Leistungserbringer
Health care units, hospitals	sehr groß		kein
Doctors	sehr groß		kein
Kostenträger
NHF	sehr groß		kein
MoF	sehr groß		kein
MoH	sehr groß		kein
Patienten, Verbraucher
patients already having access to e-health	sehr groß		kein
others	sehr groß		kein
Wissenschaft
public health researchers	sehr groß		kein
Privatwirtschaft, privater Sektor
private companies and firms	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The adoption and implementation of the above mentioned Law has to be described as consensual (all actors positively involved) but in the sphere of e-health the legislative process has in fact just been started.

Monitoring and evaluation

The actual pieces of internal regulation foresee regular monitoring (reviewing) of the implementation process, its impact, realization of objectives and consistence with national health policy but at this particular stage the detailed and specified mechanisms (tools) have not been defined. The institutional and structural foundations have been established (centers for information management, data collection) and the mission of such entities have been described but still there is a lack of precise methods of monitoring (it is possible that the engagement of  researchers - the scientific community - and medical professionals will grow in this respect). Generally, at this stage of the policy implementation it is too early to talk about the monitoring process and evaluation results.

Expected outcome

The policy of e-health implementation stipulated in the governmental documents and the mentioned law should be described as innovative and introducing the most modern approach to the process of health services delivery, to the issue of data accessibility, to the question of time and energy savings and - very important - financial savings in the whole system.

The realisation of the projected objectives depends in the first place on the availability of financial inputs at the present moment. The management of the health care system (head directors of hospitals and other health care units, presidents of particular NHF units) are strongly interested in the introduction of the policy due to the expected rationalization but medical professionals' (doctors) attitude towards the policy is not so positive. They are not very happy because of the different means of monitoring and controlling that will be introduced.

An unexpected effects may be for instance technical obstacles - and this is not a new problem in the Polish health system. For example, personnel is not adequately trained to manage data bases. Quality of care should improve significantly and the costs should also decrease in the future. Moreover, accessibility to health care services should grow.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The impact on quality of health care services is fundamental: e.g. cardiovascular patients can be quickly diagnosed at home and can be examined with the use of modern technology. The system level of equity also grows: e.g. through better waiting lists manangement. The impact on cost-efficiency is obviously very high: e.g. the proper data collection and management  will not let for misuse of health care services.

References

Sources of Information

1. EU Commission. eEurope 2005: An Information Society for All - An Action Plan. EU Commission COM (2002) 263 final. 2002.
2. EU Commission. Cohesion Policy in Support of Growth and Jobs: Community Strategic Guidelines, 2007- 2013. COM (2005) 299 final; SEC (2005) 904. 
3. Ministerial Declaration Brussels, 22nd of  May 2003 final;
4. EU Commission. E - health - making healthcare better for European Citizens: An Action Plan for a European e-health. EU Commission Communication, COM (2004) 356. 2004.
5. European Parliament. European Parliament resolution on patient mobility and healthcare developments in the European Union (2004/2148(INI)). 2005.
6. European Parliament and European Council. Program of Community action in the field of public health (2003 -2008). Decision No 1786/2002/EC. 2002.
7. European Council. Council Decision of 22nd of December 1986 on standarization in the field of information technology and telecommunications (87/95/EEC). 1986.
8. WHO.  E-health Resolution. Addressed to all Member States (WHA58.28, Ninth plenary meeting, @5 May 2005 - Committee A, seventh report).
9. Strategy E-Poland 2001-2006;
10. Strategy e- Poland 2004-2006;
11. Strategy  e-health Poland 2004-2006.

Author/s and/or contributors to this survey

Mokrzycka, Anna and Iwona Kowalska

Authors work as Lecturers in:

Health Policy and Management Department
Institute of Public Health
Medical College, Jagiellonian University
31-531 Kraków
Grzegórzecka street 20

Tel: (12) 424-13-74, (12) 424-13-61
Fax: (12) 421-74-47
E-mail: amkorzycka@poczta.onet.pl  
ikowalska@izp.cm-uj.krakow.pl

Empfohlene Zitierweise für diesen Online-Artikel:

Mokrzycka, Anna and Iwona Kowalska. "E-health in Poland". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/pl/a10/1