From 2009 to 2017, the Ministry of Health paid CZK 130 million for health care registers. Some of them have never been used.
Press release for audit No 17/03 – 5. 2. 2018
The Supreme Audit Office examined computerisation of healthcare and health information systems in this department. Auditors focused on the health registers that are part of these systems and verified how the registers work, whether they fulfil their functions, and what costs are related to them. The Ministry of Health manages computerisation of healthcare. Audits were also carried out at organisations that are under this department management - the Coordination Centre for Departmental Health Information Systems1, which had managed the health registers, and the Institute of Health Information and Statistics of the Czech Republic (IHIS), which had collected and evaluated data for registers. Auditors identified the shortcomings related to the development and the use of some registers. In this connection, the SAO reported the breach of budgetary discipline of CZK 27 million to the tax office. Some of the problems resulted from the fact that the Ministry of Health developed a strategy for computerisation of healthcare many years after computerisation had begun.
The Ministry of Health created the strategy of computerisation of health care in 2016, eight years after it had started to work on the strategy. The strategy envisaged building a National e-Health Centre. This centre was planned to co-ordinate the already initiated computerisation of healthcare and related projects. However, the centre had not been established until the end of the audit.
One of the consequences of the missing strategy was the development of two registers for more than CZK 4.7 million, which were not put into operation or were not used. One of them - the Intensive Care Register - was not launched due to the fact that while setting it up, the Coordination Centre had not started cooperation with the hospitals despite the fact it was designed for them. The hospitals later refused to use the register and to upload their data there and continued to use their information systems. The Coordination Centre acquired the register despite the fact that the Ministry of Health had not authorized the Centre to create it and the establishment of the register did not arise either from law or from other legislation. The SAO assessed the development of this registry as a breach of budgetary discipline of almost CZK 2.5 million.
For other registers, auditors revealed shortcomings in the tenders. That was for example the Register of Non-medical Staff and the Register of Research and Innovation Projects on a unified technology platform. It showed that the Coordination Centre violated the Public Procurement Act because it awarded contracts to selected suppliers through a framework contract which did not concern these specific systems. This method was also assessed by the SAO as a breach of budgetary discipline for over CZK 24 million.
Between 2009 and 2017, 43 medical registers were developed for almost CZK 130 million, with annual operation of over CZK 70 million.
In 2016, the IHIS begun to set up a National Registry of Paid Health Services. The register aims to improve significantly the quality of health information that the state has at its disposal. Unlike existing registers that collect data from physicians, hospitals, and other healthcare providers, this register will collect data from health insurance companies. However, it had not been put into operation until the audit was completed. The reason was that the transfer of data to the register created by the IHIS was based on the use of e-government services operated by the Ministry of the Interior - specifically, the service concerning the data anonymization of insured persons. At the time of the preparation of the register, these services were not easy to use and the cooperation with the Ministry of the Interior was necessary. The Ministry of Health failed to resolve this fundamental prerequisite for functionality before the end of the SAO audit.
Supreme Audit Office
1] Less than a month after the start of the audit, the Minister of Health dissolved the Coordination Centre and assigned the task to the IHIS.