Potential of Electronic Health Record ELGA not fully exploited

From vaccination records and prescribed medicine to medical reports: the Electronic Health Record ELGA is meant to digitally support the Austrian healthcare system. However, after setting up the necessary infrastructure and officially launching ELGA in December 2015, the Federal Ministry of Health did not define any further specific goals for it at first. At national level, the legal basis for ELGA is laid down in the Health Telematics Act (Gesundheitstelematikgesetz). Yet, the act was partly inconsistent and difficult to read. The provisions on mandatory storage for healthcare providers in particular allowed for different interpretations at the time of the ACA’s audit. However, a complete electronic health record is required if health service providers and patients are to be given a comprehensive overview of diseases and treatments. This could also avoid unnecessary duplicate examinations and improve healthcare services, for example. The costs generated by ELGA are unknown since there is no overview of the total actual costs. The budgeted funds amounted to around EUR 99 million. The above are some of the ACA’s findings contained in its report on “Electronic Health Record ELGA and ELGA GmbH” („Elektronische Gesundheitsakte ELGA und ELGA GmbH“) published today. The auditors saw potential for improvement regarding the control and implementation of ELGA. The ACA acknowledges that, since completion of its audit, steps to improve ELGA in line with its recommendations have been and are being taken. The period under examination spanned the years from 2018 through 2022.

ELGA applications for medical reports, vaccination records and medicine not yet fully developed

For ELGA’s main application, called “eBefund” (electronic medical report), to be used effectively, healthcare providers have to record all medical reports. However, at the end of 2023, eight years after the ELGA rollout, essentially only physicians in hospitals were writing electronic medical reports. The ACA criticizes the fact that structured documents for specialist medical reports were still not available at the time. Comprehensive recording would also require electronic medical reports from specialists in independent practice, radiology institutes and laboratories. In this context, it is of particular importance to find a solution for the transmission of radiological image data as well as for connecting private laboratories.

However, the ACA is very pleased that the Patient Summary – a standardized summary of basic medical information on each patient –, which was not yet available in 2023, has since been approved as recommended.

Similarly, the so-called “eImpfpass” application (electronic vaccination record) is to be fully developed to ensure that all existing vaccinations are recorded and the notification feature for upcoming booster vaccinations is active. The so-called “eMedikation” application (electronic medication record) was not yet fully developed either. In this context, it must be ensured that medication records and prescribed dose rates are fully recorded.

Lack of an eHealth strategy

According to the Federal Government and the provinces, electronic health services, which are collectively referred to as “eHealth”, aim, on the one hand, at improving the quality of healthcare. On the other hand, they are supposed to realize economic potential, for example, by avoiding duplicate examinations. The Federal Government did not initially define a nationwide strategy that outlines how these objectives should be implemented and who is in charge of implementation.

The ACA noted a lack of concrete objectives as to which areas of the healthcare system should be digitally supported and under what conditions. In the ACA’s opinion, the result of the “Zielbild eHealth 2030” (eHealth 2030 vision) adopted by the Federal Goal Steering Commission in 2021 – which aimed at simplifying and standardizing the already existing systems – was not sufficient to this end.

The ACA’s recommendation to the Federal Ministry of Health of working towards a timely adoption of an eHealth strategy within the Federal Goal Steering Commission while taking into account developments at the EU level has been implemented in the meantime.

Legal bases for ELGA were partly inconsistent at first

The Health Telematics Act 2012 and the ELGA Ordinance 2015 (ELGA-Verordnung) based on said act form the legal bases for the Electronic Health Record ELGA. Prior to the ACA’s audit, only individual provisions had been amended since the act entered into force in 2012. The ACA criticized that the Federal Ministry of Health was not working towards a comprehensive amendment or overhaul. Therefore, it recommended the ministry prioritize efforts to establish a suitable legal framework for the operation and further development of ELGA.

It also encouraged the development of proposals – such as simplifications and clarifications of the legal texts – for an amendment to the Health Telematics Act as well as the ordinances based on it. In July 2024, the National Council voted in favour of a more comprehensive amendment of this kind. The ACA’s audit contributed to this decision.

At the latest from 1 January 2026, all discharge letters, laboratory results and X-ray images have to be uniformly stored – a step towards further deploying the Electronic Health Record ELGA.