After years of planning and collaboration with various stakeholders, in 2017 the Hungarian government launched the Electronic Health Service Area (EESZT): a centralized database of patient records and health interventions with the aim of bringing Hungary in line with other countries at the forefront of digital healthcare
The Road to a National Digital Coverage
The digital health arena is a novel and advantageous development for Hungary
Dr Ildikó Hórvarth, Hungary’s state secretary of health, feels that “the digital health arena is a novel and advantageous development for Hungary, its patients, and the healthcare professionals.” The project was years in the making and involved “close collaboration between information technology experts, the government, and the State Health Care Centre (AEEK),” notes Hórvarth.
Since the EESZT was launched on November 1st, 2017, 26,000 physicians and 13,000 pharmacies have entered the system, recording 200,000 pieces of patient data daily and handling 800,000 e-prescriptions. The system electronically stores information about the patients from publicly funded hospitals, outpatient care providers, general practitioners and in-house pediatricians.
Furthermore, as Judit Bidlo, deputy director general of price support of the National Health Insurance (NEAK) states: “the electronic health record will be combined with NEAK’s database, to create a cloud-based central registry which can be accessed by all healthcare stakeholders.” By November 2018, private providers were asked to contribute by reporting to different implant registers and divulging the same information. The enhanced exchange of information between private and public service providers, would allow for patient data to be assessed from different providers, which is essential for diagnosis and therapy.
The EEZST is a unified information technology environment created from EU resources with the aim of providing effective communication within the healthcare industry with the highest level of data and cybersecurity. The key to this is the ongoing relationship between care providers, physicians and pharmacies, so that information is consistent and accessible to all eligible participants.
Bumps in the Road
Hungary is following the global trend of implementing such registries. In Sweden, one of the countries at the forefront of this trend, Johan Wabörg, general manager of Actelion Nordics, explained that they “provide an unparalleled source of real-world evidence which will play an increasingly crucial role in drug development.”
However, in Hungary the system is still in its infancy and has met several bumps in its implementation. Most notable are concerns regarding the privacy of data and patients’ self-determination. Even though the Privacy Notice of the EEZST stipulates that patients can delete information, there is also a list of 13 reasons explaining that it is virtually impossible to do so. This raises obvious concerns regarding medical confidentiality as the information is accessible even to those not involved in the treatment of the patient.
Furthermore, this new system forces hospitals to become “smart” despite the funding and support needed to make this change often not being readily available. Hence, in certain areas it cannot provide the convenience promised to GPs or patients, as the infrastructural ecosystem is not yet adapted to it.
Nevertheless, industry leaders such as Csilla Léka from the Hungarian affiliate of US contract research organization (CRO), Global Clinical Trials (GCT), anticipate the system creating new opportunities and changing existing paradigms for the better in Hungary. Léka feels that, for clinical trials in particular, the new registries will become the “go-to tool for clinical investigators when looking for patients” which will optimize early access to patients.
Miklós Kásler, Hungary’s minister of human capacity has explained that the project, which started on May 1, 2017, will run until March 31, 2020. Over 500 million data files have already been shared and consolidated into the EESZT and this will only increase.
Minister Kásler has also noted that HUF 23 billion (USD 78 million) is available to expand the databases in an attempt to link primary care workers, specialist care and hospital care at the patient data level. Among the major developments, is a project to implement a national oncology IT system in 19 county and four regional centres, which will include all patient data and an oncotherapy protocol.
Additionally, a national cardiovascular imaging network is being implemented, which will provide unified findings at 21 cardiology centers across the country. The project builds on a central teleconsultation and advanced telemedicine system that strives to harness the potential of information technology to the fullest. The goal is to extend the digital capabilities of all health data to all levels of care and to direct the health system towards prevention; saving on costs and providing better care to Hungarian patients.
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