Digital trends transforming healthcare in the Adriatic
Barbara Matijašič
The Western Balkans are undergoing healthcare transformations driven by global digitalisation trends. Factors such as increased life expectancy, evolving lifestyles, and complex treatment regimens are catalysts for change. Technology plays a central role in reshaping healthcare, improving efficiency, cost-effectiveness, and patient care quality. Some countries are quite ahead on their digitalisation journey, while others are still in the early stages.
The healthcare landscape in Slovenia has seen significant advancements in recent years. The National eHealth Backbone is the foundation for the Slovenian National Shared Care Record, the most complex public information system in Slovenian healthcare. It is a unified system for collecting and exchanging health data about patients, connecting over 1,400 healthcare providers across the country, while also offering a national patient-facing app (zVEM) for patients to access their health records. Currently there are over 486,2861 (with a constant monthly growth of around 1500) patient records stored in the registry while the patient portal attracts over 100,000 users per month.
Key legislative changes
This rapid digital transformation in Slovenian healthcare has been facilitated by key legislative changes. Notable among these is the ZZPPZ law, designed to streamline health data exchange, and the EU Directive 2011/24/EU, which enhances both cross-border healthcare rights and data usage regulation.
“Slovenia intends to significantly modernize ZZPPZ and, in accordance with the constitution, continue collecting data on the lives and health of patients (as allowed by the GDPR regulation) with the new Healthcare Digitalisation Act”, says Alenka Kolar, Director General at Slovenian Ministry of Health’s Directorate for Healthcare Digitalisation. “This is to fulfil the proposal in the strategy for urgent legislative changes and to ensure a regular influx of funds to reduce the technological debt that has accumulated from 2015 to the present. To achieve as much of this as possible, we hope for the efficient use of NOO (National Health Insurance Institute) resources. We also wish for a unified body that will provide guidance to all stakeholders in digital healthcare, so that information solutions will no longer be fragmented but modularly built on patient-owned data.”
The healthcare digitalisation strategy for Slovenia for the period 2022-2027 is multi-faceted. Its key objectives include legislative reforms aimed at enabling more efficient data exchange, the development of patient-centric digital solutions, and the reduction of administrative burden on healthcare professionals. Equally central to this strategy is the implementation of a standardised electronic patient record supporting medical imaging and creating a national framework for telemedicine. The strategy also aims to enable the secondary use of data in preparation for Slovenia to participate in the European Health Data Space. The future of healthcare in Slovenia is clearly digital, patient-centric, and marked by a commitment to excellence and efficiency.
Modernising healthcare post Covid
Serbia’s healthcare sector is undergoing modernisation with a focus on digitalisation through implementation of electronic health records and telemedicine services. The catalyst for this transformation was the COVID-19 pandemic, which prompted the Serbian government to develop and commit to a comprehensive healthcare digitalisation plan known as the Program for Digitalisation of the Healthcare System 2022-2026. One noteworthy project within this programme is the Telemedicine initiative, which enables specialist consultations via online video calls, irrespective of a patient’s location. Another key objective is achieving a 95% e-prescription usage rate by the end of 2023. This ambitious plan necessitates significant technological upgrades, extensive staff training, and public education initiatives. Up until March 2023, the ePrescription system has facilitated the implementation of approximately 450 million prescriptions, and includes over 5,000 pharmacies, 7,000 pharmacists, and more than 300 healthcare institutions. The Serbian government estimates it save around EUR 2m annually by having the prescriptions issued electronically instead of on paper.
Finally, addressing legal challenges related to health data management, privacy, and cybersecurity also require attention for a smooth digital transition in Serbia.
Croatia’s digital advancements
Croatia has made significant progress in digitizing its healthcare system, with the widespread use of electronic health records and a national health information exchange (HIE) system. In July 2023, Croatia reported to the European Commission that telemedical services were improved and extended to ensure interoperability with the national health information system and suitability for future cross-border exchange, with significant investments being made in teletransfusion to improve access to health services. Furthermore, to improve the efficiency, quality, and accessibility of the health system, the Healthcare Act and Compulsory Health Insurance Act have been amended, and a health performance measurement framework has been set up.
My appointment system in North Macedonia
North Macedonia’s health strategy (2020) aimed to revolutionise healthcare through digitalisation. The MojTermin (My appointment) system was introduced to streamline patient management and improve the patient experience with health dashboards and e-services. Furthermore, the Health Insurance Fund portal offers convenient e-services, but challenges in data analysis persist. Based on available information, MojTermin consolidates data from over 70 sources but is not fully utilised for health policy and quality improvement. Despite these challenges, North Macedonia has made significant strides in digital health.
Complex landscape
Bosnia and Herzegovina comprises two entities (the Federation of Bosnia and Herzegovina and the Republika Srpska) and one autonomous district (the Brčko District of Bosnia and Herzegovina). It has complex health systems, with 13 health insurance funds and 14 ministries in charge of health. Some regions have implemented electronic health records and telemedicine services, while others lag behind in terms of digitalisation. The digital health strategy objectives are outlined in the country’s development strategy2, but at this point it seems that progress on implementation has come to a halt.
e-Health initiatives
Montenegro began computerising its health system in 2004 and offers eHealth services to all its citizens. However, electronic health records are still not widely used and, according to Global Health and Security index, they still lack structure and standardisation. The Strategy for Integrated Health Information System and e-Health 2018–2023 has been published, though its details are not accessible online.
While it is evident the Western Balkans are gradually embracing digitalisation in their healthcare systems, they are doing so at varying paces. While some countries, like Slovenia, Serbia and Croatia, are making significant strides with comprehensive digitalisation plans, others are facing challenges in implementing digital healthcare solutions. Most of the region is still in the early stages of its digital healthcare journey, and there’s a long road ahead to achieve widespread transformation.
South-eastern Europe Health Network (SEEHN) has also verified some of the data. The network is a regional intergovernmental organization founded in 2001 with the aim of promoting collaboration, common values, and encouraging mutual efforts towards peace, health, and well-being among the member states of SEEHN.
