eHealth country report for AUSTRIA

National correspondent who has collected qualitative and, where available, quantitative information from national sources for this document:

Roman Winkler, Institut für Technikfolgen-Abschätzung (ITA), Österreichische Akademie der Wissenschaften, AUSTRIA

Issue: Current situation regarding eHealth portals for the public/patients

The Federal Ministry for Health and Women's Issues provides on its official homepage a link collection on particular health issues (e.g. on AIDS, cancer, diverse self-help groups etc.) and lists several associations dealing with a wide range of health issues. This homepage is a good starting point for people who look for general and particular information on health issues. Some of the institutions indicated at the Ministry's homepage (e.g. "medlink.at - the medical Internet address book") deliver further and more detailed information and search engines for health portals, doctors, hospitals, databases etc.

The Main Association of Austrian Social Insurance Institutions is the responsible umbrella organisation (there are 25 insurance companies including 17 health insurance funds and 8 insurance institutions) for the preservation of general interests of the social insurance and for the representation of the insurance companies regarding common affairs (e.g. conclusions of treaties with hospitals, doctors etc.). The Austrian Social Insurance contains the Health-, the Accident- and the Pension Insurance. The Association's central portal informs on general insurance issues and on health issues (e.g. information on healthy living etc.).

Regarding private eHealth portals in Austria, the Austrian Chamber of Labour undertook in 2002 an assessment concerning the quality of 13 online health portals. The assessment involved user-relevant aspects, the findability of the portals and the quality and completeness of information related to three selected diseases. Only three health portals fulfilled the assessment criteria, namely www.netdoktor.at ; www.surfmed.at ; and www.medwell24.at . According to the PR department of the Austrian Chamber of Labour, there has been no further assessment undertaken since 2002. Thus, some other health portals might have improved their Internet performance in the meantime. However, it is assumed that the three mentioned test winners of 2002 are still amongst the most prominent Austrian health portals.

Issue: Current situation regarding online health information services

The online portal of the Main Association of Austrian Social Insurance Institutions provides information on healthy living, vaccinations, the usage of medications and general health security tips.

"Netdoktor.at " is an extensive online portal providing issue-oriented health information. There are various sections such as "Men's Health", "Baby and Children", "Sexuality and Relationships", "Medication"; "Diseases and Treatments" etc. Moreover, the portal enables the users to search for doctors, pharmacies, hospitals, self-help groups and insurance. Online Discussion platforms provide the option to discuss various issues with other users and experts. According to the latest statistics, "Netdoktor.at" counted in January 2004 nearly 275,000 visitors. The Online Discussion forum site is one of the portal's highlights (915,229 page visits in January 2004) followed by the section "Diseases" (367,000 page visits in January 2004) and "Sexuality and Relationships" (243,012 page visits in January in 2004). Generally, women visited "Netdoktor.at" more often than men: 63 % of the visitors were female.

"surfMED" is another online portal providing similar information as the previous described portal. The portal co-operates with about 300 medical experts in order to deliver serious and trustworthy health information. According to "surfMED's" principles, the portal provider intends to translate medical information in a way that it can be understood by the broader public. Interactive and personalised information shall help to meet the needs of individuals.

Issue: Current situation regarding online information about available health services

Please see previous issue on eHealth portals

Issue: Current situation regarding health-related administrative transactions

The Main Association of Austrian Social Insurance Institutions provides on its webpage a wide range of online forms. These forms can be downloaded, stored and printed. Some of them can also be submitted online, though, have to be captioned with a digital signature. This particularly applies to those cases which necessitate a personal signature (e.g. pension applications). Since there are 25 public insurance companies, the range of online forms varies. For example, the Vienna Health Insurance Fund provides forms for employers, general health issues (e.g. refund of expenses for particular treatments), psychotherapy, insurance coverage and child allowance.

Issue: Current situation regarding online pharmacies

In September 2004, "e-rating.at" (the biggest and independent online shop information system in Austria) analysed the Internet performance of Austrian pharmacies. Accordingly, only 163 out of more than 1,000 pharmacies had a web site. 46 of them offered the option to conduct online orders and only 10 of them met the requirements of the Austrian e-Commerce law. Three pharmacies provided a SSL-connection for a secure data transfer and five web pages fulfilled the Austrian data protection rules.

Issue: Current situation regarding websites of GPs/public health clinics and specialists

The Austrian Federal Institute of Health Issues (Österreichisches Bundesinstitut für Gesundheitswesen) is a public institute which undertakes research in various health related fields (e.g. health economy). According to the Institute's director, Dr. Michaela Moritz, the Institute has not yet conducted any surveys on the Internet performance of Austrian medical doctors or public health clinics. However, there are some portals providing lists with doctors who provide online information. One of them is www.arztverzeichnis.at which provides access to an online database including all Austrian physicians. Patients are enabled to receive information on the specialist fields of the listed doctors, opening hours, additional qualifications and contracted health insurance companies. Some doctors provide more information on their personal homepages which can also be accessed via this homepage.

Brosch estimates that about 80% of the Austrian physicians use ICT equipment for their daily data procedures. However, the percentage rate of those who also use ICTs for consultations etc. is very low. There are several pilot projects on the online exchange of medical test results in Vienna and in other Austrian provinces.

Issue: Current situation regarding online interaction with one’s own doctor

There are some health portals (e.g. "Netdoktor.at") providing the option to discuss health issues online with medical experts. There are also several doctors who offer the option to make online appointments, however, there is no statistical data available concerning the extent of online interactions for the reception of test results or prescription renewals.

Issue: Availability of online diagnosis

No data available.

Issue: Current situation regarding telephone consultation

Basically, most of the Austrian physicians offer the option for telephone consultation. There are also radio and TV programmes for general medical questions. However, there is no data available on the extent and nature of private telephone consultation. According to Dr. Brosch , Head of Unit IV/A/2, eGovernment and New Media at the Federal Ministry for Health and Women's Issues, here is also the problem of liability. Telephone consultations do not correspond to the Austrian "medical culture". The Austrian medical system is mainly based on direct interaction between the doctor and the patient and involves face-to-face communication.

Issue: Overall supply-demand match regarding eHealth services

Most Austrian eHealth services are still pilot projects. Although there have been developed some very ambitious eHealth services, the up-take rate is still rather low. The introduction of the "e-card" in 2005 may promote the development and implementation of eHealth services, though. The number of eHealth information services is relatively high (see H1). Patients are enabled to access health-related information on various issues and there are also some well-established (public and private) online portals. Basically, eHealth services mainly offering online information are available for a wide range of Austrians. With regard to the horizontal and vertical comprehensiveness, health services have hitherto mainly been offered "offline" i.e. face-to-face communication is core to most Austrian health services. The increasing usage of ICTs may change communication patterns between physicians, medical institutions and patients by reducing organisational barriers and ease administrative processes. The application of ICTs in medical treatments is expected to play an important role in the future (e.g. combining medical technology with ICTs to transfer medical measurement data). The consideration of user needs will have to be a condition sine qua non since acceptance appears to be in sensitive life-areas (such as health) of utmost importance. One of the most decisive factors in this context is to ensure that patients are provided trustworthy, easily accessible and user-friendly eHealth services.

Issue: Existing policies to encourage eHealth services for the public/ patients

Currently, one of the most prominent initiatives set in the field of eHealth is the introduction of the "e-card" in 2005. This card will be the key to the health insurance system and to e-government and intends to simplify life for all actors involved (patients, doctors, ambulances etc.). It will be sent automatically to all insured who were entitled for benefits from the legal health insurance system within the past 9 months. The basic advantages of the e-card are seen to be:

• "The e-card facilitates the access to medical treatment
• The e-card guarantees more privacy
• The e-card will finish with bureaucracy
• The health insurance voucher is valid for one quarter - the e-card eternally
• With the e-card the administration can also be contacted out of office hours.

The e-card is a smart card which will substitute all health insurance vouchers. Medical treatment will then in principle be accessible for all insured and their dependants without any paper documents. However, the e-card is not only an electronic health insurance voucher. It is prepared for electronic signature and therefore can also be used as Citizen card. By means of electronic signature it will be possible to sign electronic documents to handle transactions with public authorities round the clock at home.

Legal basis: By the 56th amendment of the ASVG (General Law on Social Insurance) the Main Association of Austrian Social Security Institutions was entrusted with the introduction of a health insurance smart card (e-card) as a basis for an electronic administration system (ELSY) for Austrian Social Security. ELSY shall support the administration processes among insured, employers, contractual doctors (NOTE: there are more than 12,000 contractual physicians in Austria) and people equal to them as well as Social Security Institutions. It has to be designed in the way that the laws to be executed by the Social Security Institutions largely can be executed without paper documents (56th amendment to the ASVG, § 31a (1)). The smart cards to be used within the ELSY have to substitute all kinds of health insurance vouchers. For this purpose they have to be submitted on the occasion of any consultation of a contractual partner - starting with the date of their introduction (§31c (1)). Essential instructions for the electronic administration system: 1. Key-card design of the e-card; 2. Access to personal data after approval of the patient; 3. Reloadability of health data on the smart card

Data on the e-card: The e-card is the central component of the system and is designed as a keycard. It is the access key to system-supplied services and data. The smart card itself is not a carrier of application data, but contains the necessary data and keys for the identification and control of access authorizations. Only administrative data of the cardholder are stored on the e-card, for instance name, insurance number, data of birth, etc. On the reverse side of the e-card the European Health Insurance Card (EHIC) will be implemented. It will substitute the international health insurance voucher (form E111) for the claim of medical treatment during temporary visits (e.g. holiday) in member states of the European Union, the European Economic Area and Switzerland. Additionally, the e-card is prepared for electronic signature. This means that - after purchase of an adequate certificate - the e-card can also be used as citizen card.

In the start-up period the e-card only will substitute the health insurance voucher. Further extensions are planned and partly are already under preparation:

• Integration of hospitals and pharmacies (electronic prescription).
• Integration of the keycard function in connection with electronic signature into the "eSV" interet-portal of the Social Security Institutions.
• Extension of the e-card to a European-wide accepted health insurance smart card (EHIC, substitution of the international treatment certificate E111). Preparations have already been started within the Netc@ards project, in which Austria is participating.
• Integration of Social Security registration procedures.
• Application of the e-card as a keycard for the transmission of sensitive data on the health sector (i.e. secure transmission of diagnostic findings)".

Issue: Role of user orientation in national eHealth strategies

According to Dr. Brosch, national strategies do not particularly take account of user orientation. Nevertheless, strategies pursue the objective to facilitate patients' access to online information. The provision of extended online information on health issues is a first step to open up administrative structures and to improve the information level of the public. Thus, information on opening hours of ambulances, hospitals and physicians or the range of self-help groups are considered as basic eHealth services. Moreover, the current Austrian Government envisages a nation-wide "health reform" which shall partly come into power at the beginning of 2005 and which also sets the first steps for the introduction of a "patient online file". This shall ease the handling of patient data, avoid double examinations which often arise by medical referrals and cause high expenditures (e.g. for X-rays or laboratory tests etc.). Both, patients and medical doctors shall benefit from such an "online file" and reduce administrative barriers.

Issue: Existing specific policies/regulations for online or telephone-based consultations

There are neither policies which encourage nor discourage online or telephone-based medical consultations in Austria (for further explanations see also interview answers of Dr. Peter Brosch outlined under issue: Nature and extent of telephone consultation in the country).

Issue: Country-specific barriers to implementation and uptake of eHealth services

According to Dr. Brosch, the federal structure of the Austrian state partly hinders the implementation and uptake of eHealth services. Given that most of the decision-making is done by the regional governments, all decisions related to investments and technological systems are taken on a sub-federal level. This makes it more complicated to develop and establish a national eHealth strategy and causes additional costs. However, in order to make full use of eHealth services, federal and regional actors have to co-operate more closely.

Issue: Country-specific facilitators which encourage implementation/uptake of eHealth

There are no "Austria-specific" factors encouraging the implementation and uptake of eHealth services. However, Dr. Brosch stresses four points that might be favourable towards the implementation of eHealth services in Austria:

1. Austrian health institutions (hospitals, ambulances) and the Austrian physicians have very good ICT equipment. This provides a good background for the implementation of eHealth services.

2. The introduction of the "e-card" will open up options to introduce advanced eHealth services in the future.

3. The awareness of the importance of data protection and the sensitive handling with personal data.

4. The wish expressed by the regional governments that the Federal Ministry for Health and Women's Issues takes a stronger co-ordination function to improve the co-operation between the "Laender", the municipalities and the Federal Ministry in the field of eHealth.

Issue: Characteristics of national health care system which affect usage of eHealth

There are no policies or "Austrian-specific" factors encouraging or discouraging the use of the Internet to search for health-related information. Certainly, there are several federal information campaigns on health issues (e.g. initiatives calling for constant medical precaution examinations or anti-smoking campaigns). Regarding the co-operation between general practitioners and specialists, there is a well-established co-operation in terms of mutual medical referrals. Basically, Austrian citizens can choose their physicians or specialists by themselves. Thus, Austrians can get more than one medical opinion if they wish so.