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29 November 2024 | Country Update
Centralization of hospital information systems in 2025 aims to foster data standardization and interoperability -
31 October 2017 | Country Update
A newly introduced platform for joint communication in the health sector: the Electronic Health Service Space -
25 February 2013 | Country Update
Implementing a systematic methodology for developing national clinical practice guidelines
2.7. Health information management
A new government decree from October 2024 mandates that starting in January 2025, the Hungarian government takes over the provision of hospital information systems (HIS) from market actors in publicly funded, state-run inpatient and outpatient care institutions.
Providers must transition to a uniform HIS, with full implementation required by 1 January 2026 [1]. This regulatory change follows the acquisition of an HIS by the state, which will serve as the standard system under the new regulation [2]. Planning is underway with the involvement of the National Directorate General for Hospitals and the affected institutions [3].
The centralization aims to standardize data management of collected health data, foster interoperability, and enable the creation of structured datasets, which in turn would facilitate the further use of data, including processing by artificial intelligence [3]. The decree does not apply to non-state-run providers, including medical universities, churches, and municipality-run institutions, but they may voluntarily adopt the system, as announced by the responsible ministry [3].
Authors
The new Health Service Space was introduced by Zoltán Balog, Minister of Human Capacity, in November 2017 and is expected to be fully operational by November 2018.The Health Service Space is an EU-funded project led by the National Healthcare Service Centre. The system aims to connect health care providers on a common communication platform and operate a more transparent and assessable database for the standard data. The system will be introduced in 3 steps:
While in November 2017 the family doctors, specialized clinics, hospitals and pharmacies (step 1) joined the system, by November 2018 the National Ambulance Service and private providers (step 2) will gain access to the Electronic Health Service Space. Until 2019 all data from the last years will be made available (step 3).
“With this new platform multiple medical examinations can be avoided. With the new e-prescriptions and connected database the doctors are able to obtain a more complex picture about the patients and avoid side effects, as well as the patients is lifted of the burden to present the paper based documentation”- said the Minister.
Authors
Since 2002, 493 clinical practice guidelines (CPGs) have been officially released by the Ministry responsible for health in Hungary. As most of the published guidelines were developed in 2005 and 2006, most require updating. In Hungary, guidelines are traditionally developed by professoinal associations. Given the lack of a dedicated guideline clearinghouse with an evidence-based methodological support function, most guideline teams have used non-systematic, non-evidence-based or traditional methods in formulating recommendations. Up until 2013 the ministries responsible for health simply prolonged the validity period of all guidelines several times without revieweing their content. With the rapid progress in medical technology, this resulted in obsolete recommendations leding to both clinical and jurisdictional controversies. To solve these issues the National Institute for Quality- and Organizational Development in Healthcare and Medicines (NIQODH, Hungarian acronym GYEMSZI) set up an expert group to systematically revise existing clinical guidelines and suggest a methodology for guideline development. By the end of 2012, the expert group had assessed the methodological quality of 90% of existing guidelines using the AGREE instrument: most guidelines scored rather low on the stakeholder, rigor of development, applicability and conflict of interest domains. To address this problem, the group asked the Professional College for a statement on each guideline in terms of validity and need for major revision. As a result, the Ministry responsible for health announced the expiration of 98 guidelines at the end of 2012, while the re-development of another 140 was initiated for the short term. Furthermore, the NIQODH established a web-based application to support this project. It incorporats user-friendly tools for adaptation of external (preferably European and evidence-based) guidelines to national settings, based on internationally published methods and materials. Findings of the methodological assessments, together with training material and a ‘guideline for guidelines’, are also made available to guideline developers to help them improve CPG quality in the current updates.
Authors
2.7.1. Information systems
A transparent and consistent strategy for information and communications technology in the Hungarian health system is still lacking. Based on a national IT centre created as part of the first government IT programme at beginning of the 1970s, the Information Centre for Health Care was founded in 1987. That year, the centre began a pilot project to collect cost data in hospitals to be used in the HDG system (1987/1). The Centre played a key role in running the financing reporting system of the providers and in preparing policy decisions, especially with data collection. Since 2004 it has continued its work within the organizational framework of the NHIFA. In addition, the NISHR was assigned to take part in developing eHealth policy proposals by establishing a special management unit (WHO, 2006).
With regard to all contracted and financed services of the NHIFA, the data collection and reporting obligations of the providers are clearly linked to health financing. Even family doctors must send itemized performance reports to the NHIFA despite their being paid, for the most part, through capitation. The structure and content of the reports are strictly regulated by the government (1999/1). Despite the high priority placed on information and communications technology in health investments and reforms in last decades, there are still several problems in the Hungarian health information system, including serious concerns about data quality; a lack of trustworthy and up-to-date master databases; sluggish data delivery, outdated patient record structure and data collection requirements; and data security problems, especially in sharing patient information among providers (Ministry of National Resources, 2010).
To provide patients, health professionals and the wider public with health care information, the State Secretariat for Healthcare developed an internet and call centre-based health information service called Dr. Info (www.dr.info.hu). The service is available around the clock and provides information on a wide variety of topics, including the availability of health care providers (addresses, phone numbers, opening hours) and of civil organizations related to health care; medicines, including price, reimbursement, prescription information; the structure, availability and function of the health care system (summaries of laws and regulations); electronic medical books and dictionaries with descriptions of illnesses; quality indicators of hospitals; general information about lab tests; and an International Classification of Diseases code interpreter.
2.7.2. HTA
HTAs have gradually begun to take root in the Hungarian health care system. Starting in the late 1990s, cost–effectiveness increasingly came to be recognized as an important criterion in reaching resource allocation decisions, and it was first made into an obligatory criterion in purchasing decisions in the case of pharmaceuticals (2000/7, 2001/3). In 2002 the Ministry of Health[7] issued a national guideline on preparing economic evaluation of health care interventions (2002/12). The guideline provides a detailed description of the structure and content of a model economic evaluation, including certain country-specific parameters. This was a significant step towards a systematic application of economic evaluation to support decision-making on services covered by the HIF.
The Hungarian Health Economics Association was created in 2003 by health economists and academic health professionals, but it now has an extensive membership, including experts from the public and the business sector as well as from research and academic institutions dealing with HTA. The real breakthrough in the field of HTAs, however, started in 2004, when the government was obliged by EU law to incorporate Directive 89/105/EC into national legislation. The Directive stipulates that the NHIFA must decide on reimbursement applications by the producers and traders within a maximum period of 90 or 180 days, respectively, after submission. This clearly provided the main incentive for the much more extensive and elaborate use of HTAs in recent years, as well as for the substantial rise in the number of journal publications analysing the cost–effectiveness of medical technologies, especially pharmaceuticals.
In 2004 the NISHR was established, which among other things assists in health policy decision-making through HTA, especially by providing technical support to the Health Technology Appraisal Committee of the NHIFA. This task is performed by the National Institute’s Office of Health Technology Assessment, which carries out a critical review of the evidence submitted by producers. The Health Technology Appraisal Committee, which is responsible for making the final recommendations on the inclusion of new substances in the positive list, appraises this review along with all other available information from the NHIFA and other professional bodies (2004/4). HTA has since been expanded to include other medical technologies and equipment, and will, it is hoped, strongly incentivize further development in the area (2010/3).
- 7.As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources. ↰