Development of eHealth in Slovenia - Critical Issues and Future Directions

Although the basic informatization of the health care system was established relatively early, Slovenia still does not have an interoperable and comprehensive health information system (HIS). Fragmentation of information systems (IS) and their limited interoperability significantly compromise further development of the health care system and adversely affect the quality of health care services. Overcoming the aforementioned challenges requires the progressive implementation of eHealth project, which is one of the key long-term goals of the Slovenian public sector. The main objective of eHealth is the comprehensive integration of distributed IS and connection of a widespread network of stakeholders within the health care system. The paper presents the review of eHealth projects in Slovenia, Austria and Denmark, and provides a comparative analysis of the eHealth development in designated countries. Focusing on the Slovenian experience, the paper summarizes the main deficiencies in the current eHealth settings, and finally outlines a set of applicable guidelines for an effective development and implementation of highly intricate and complex eHealth project. 

Management of IT Outsourcing in the Slovenian Public Sector – Material and Procedural Aspects

Public sector management in Slovenia has been following the trends in information technology (IT) outsourcing since the mid-nineties of the last century. Being aware of the complex role of IT in modern public sector organizations and its ubiquitous implications, the paper focuses on in-depth analysis of the critical success factors, benefits and risks within the concept of IT outsourcing, while employing the international studies and primarily the results of own research examining the current situation and identifying the main drivers for IT outsourcing in Slovenian municipalities. The paper additionally analyses the material, procedural and other relevant aspects within the process of IT outsourcing, provides an overview of its potentially positive and negative implications and eventually presents a contextual framework for management of IT outsourcing along with applicable guidelines for effective utilization and implementation of IT outsourcing in the public sector

Management of health care workforce: Conceptualizing a structural model of human resource planning in healthcare in Slovenia

The healthcare system’s effectiveness depends mainly on healthcare workers’ knowledge, skills, and motivation, particularly during the COVID-19 pandemic. Systematic planning of human resources is, therefore, an essential prerequisite for ensuring the sustainability and efficiency of the health care system. This article outlines a structural human resource planning model in health care and explores the complexities involved. A detailed analytical framework is proposed, drawing on various materials and evidence to outline the factors that influence human resource planning in health care. The in-depth analytical process employs an extensive literature review to provide greater credibility to research findings. It investigates numerous sources and materials, both in national and international contexts. The purpose of human resource planning initiatives in healthcare is to calculate the needed number of healthcare workers in the future based on past and current data and assumptions about future supply and demand trends. The research findings reveal this is a very challenging task, as there are typically many unknowns when planning for the future. In addition, planners often need more reliable data and systemic deficiencies. Furthermore, the study shows that unplanned and delayed solutions concerning human resource needs in healthcare can only alleviate problems. Still, they cannot replace effective strategic measures and timely structural changes within the healthcare ecosystem

Functionalities and use of the zVEM Patient Portal and the Central Registry of Patient Data

Introduction of eHealth is one of the key long-term goals of digitalising the public sector in Slovenia. Despite certain challenges, great progress has been made in the field of eHealth solutions. The paper presents an in-depth analysis of the functionality and use of the Patient Health Portal zVEM and the Central Registry of Patient Data (CRPD) in recent years, especially during the COVID-19 epidemic. The comprehensive methodological approach was based on the literature review, the examination of project documentation and technical specifications, the expert opinion of eHealth managers, and actual statistics from administrative and business intelligence modules. The results imply that during the epidemic the zVEM took on an important role in informing and raising public awareness. From the patient\u27s point of view, the zVEM is certainly one of the major gains in recent decades. Accordingly, the use of the zVEM and CRPD has been growing exponentially. However, although eHealth solutions have undergone unprecedented development in recent years, much effort will have to be made by all stakeholders in the future, and additional human and material resources will have to be provided if we want to maintain progress and perhaps even accelerate the development of healthcare informatics in Slovenia

The role and significance of strategic and normative factors in public policy design and implementation in Slovenia: A Content Analysis

Policy processes are complex systems and require an in-depth and comprehensive analysis. Literature review reveals a lack of methodological approaches that in the broadest sense analyse and evaluate the successfulness of public policies. Especially, factors that affect policy design and policy implementation as two important phases of policy cycle have not been sufficiently explored. To address this gap, the application of several relevant public policy theories can help identify and investigate key factors relevant for analysing public policies. The principal objective of this paper is to define, analyse and study the relationship between two critical factors that influence the successful policy design and implementation of public policies in Slovenia, namely the strategic factors and normative factors. In order to study selected critical public policy factors twenty-two structured interviews and object-oriented discussions were conducted with the prominent public policy experts in Slovenia. The interviews were performed from February to September 2017, covering various relevant fields of public policies. Subsequently, the exploratory qualitative content analysis was applied in order to investigate the role and significance of the selected factors for successful design and implementation of public policies in Slovenia, and their interdependence and impact on the performance of public policies. The findings from this analysis reveal that although strategic factors are identified by the interviewees as the most important among all factors, the role of normative factors is also of utmost important and should not be underestimated. For various reasons, in practice, the normative factors often turn out to be crucial

Analitično hierarhični procesni model odločanja za zunanje ali notranje izvajanje informacijskih storitev v javnem sektorju

Article uses an in-depth analysis of contemporary pro et contra arguments and presents research findings concerning IT outsourcing and insourcing in Slovenian public sector. In Slovenia the use of com­petitive tendering and outsourcing of IT services has been growing rapidly, many will say unfounded and irrational. Reported expenditures on contracting out in public sector in last years have doubled and in the time of global economic and financial crisis reach, roughly estimated, tens of mil­lions of euros. Contribution outlines some methodological, contextual, procedural and other considerations and eventually presents Saaty’s analytical hierarchical multi criteria decision model for planning IT outsourc­ing projects and provides guidelines on critical assessing IT outsourcing projects in Slovenian public sectorČlanek se osredotoča na poglobljeno analizo sodobnih pro et contra argumentov in predstavlja raziskovalne izsledke glede zunanjega oziroma notranjega izvajanja (outsourcing oziroma insourcing) IT storitev v javnem sektorju v Sloveniji. Kljub dvo­mom mnogih strokovnjakov v upravičenost in racionalnost projektov zunanjega izvajanja, smo priča velikemu številu javnih razpisov z namenom sklepanja pogodb za zunanje izvajanje IT storitev. Po nekaterih ocenah se je višina stroškov za pro­jekte zunanjega izvajanja v slovenskem javnem sektorju v zadnjih letih podvojila in v času aktualne gospodarske in finančne krize dosega po grobih ocenah več deset milijonov evrov. Prispevek analizira metodološke, vsebinske, postopkovne in druge pomembne dejavnike ter ponuja Saatyjev analitično hierarhični procesni model za večkriterijsko odločanje pri načrtovanju zunanjega izvajanja IT storitev in smernice za kritično vrednotenje tovrstnih projektov v slovenskem javnem sektorju

A case report of severe recurrent varicella in an ankylosing spondylitis patient treated with adalimumab – a new side effect after 15 years of usage

Background: Tumor necrosis factor-α (TNF-α) antagonists, most of which are monoclonal antibodies, became a widespread treatment for autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, psoriasis, psoriatic arthritis, hidradenitis suppurativa and uveitis. Their use is based on the blockage of TNF-α, which plays an important role in granulomas formation, development of phagosomes, activation and differentiation of macrophages, immune response against viral pathogens. The multiple adverse effects of TNF-α inhibition have been identified, including a two-to four-fold increased risk of active tuberculosis and other granulomatous conditions and an increased occurrence of some other serious bacterial, fungal and certain viral infections. ----- Case presentation: A 34-year-old male patient with disseminated varicella and pneumonitis was admitted to our hospital. The diagnosis of varicella was established serologically by enzyme immunoassay (EIA) and by polymerase chain reaction confirmation of the virus in vesicular fluid. The patient has been receiving adalimumab and methotrexate for the last 3 years due to ankylosing spondylitis and was seropositive to varicella zoster virus prior to the introduction of TNF-α antagonists. Acyclovir was administered for 10 days with the resolution of clinical illness and radiological signs of pneumonitis. ----- Conclusion: Due to the use of biological agents, particularly TNF-α inhibitors, as a well-established therapy for some autoimmune diseases, new potential adverse events can be expected in the future and we wanted to point out one of them. To our knowledge this is the first case of recurrent disseminated varicella in a patient taking TNF-α antagonists

Modelling the Health Information System in Slovenia – Operative, Construction and Implementation Aspects

Fragmented and non-interoperable information systems (ISs) generate poor quality information and adversely affect the provision of healthcare services and the management of the Slovenian healthcare system. Advanced implementation of the eHealth project, encompassing the construction of a national health information system (HIS), could play a pivotal role in overcoming these challenges, which significantly compromise further development of the Slovenian healthcare system. This paper initially presents a review of the recent developments concerning HIS and identifies its main operative deficiencies. Subsequently, the paper outlines the construction of a 3LGM2- based conceptual HIS model and provides generally applicable recommendations and guidelines for effective implementation of HISs. This research employs a single explanatory/exploratory case study design, while the validation of the hypothesized constructs was undertaken through structured interviews with 15 prominent experts from the Slovenian healthcare system. The findings provide valuable insight into the operative, construction, and implementation aspects of HIS, which can, subject to proficient coordination with other ecosystem factors and pending structural reforms, ensure better utilization of public healthcare resources and provide tangible public health benefits