Hungary hopes health app will launch new era of care The app will eventually connect patients to a central database they can share with doctors.

A small European country is making a big push to better link its 10 million citizens to medical care.

Hopes are high for Hungary’s new national health app, which eventually will connect patients to a central database of hospital and other medical records they can share with doctors. The goal is to improve public health, honing in on people with chronic diseases, providing lifestyle and treatment advice and ultimately saving money. Hungary has some of the worst health outcomes in Europe, with high rates of costly illnesses, such as heart disease and cancer.

“It’s part of a big rethinking of how primary care should work and provides a living connection between the primary care provider and the patient,” said Sandor Bekasi, the lead doctor advising the government on the app. “As far as I know, Hungary is unique in trying to achieve this.”

Hungary is not alone in incorporating the use of big data to improve its citizens’ health. Countries including Sweden, Denmark and Estonia are viewed as “front-runners in the traditional e-health space,” said Richard Bergström, head of the European Federation of Pharmaceutical Industries and Associations.

But while data analytics projects are taking place in these countries, “I am not aware of many countries that have adopted such an ambitious approach to big data as Hungary,” he added.

A series of events positioned Hungary for this moment: Patients have had a unique ID number since the early 1990s that is linked to their digital records. The 2008 financial crash pushed the government to cut costs, leading to national health reform measures that included shifting hospital records to a central government-controlled server hosting health data. This gave Hungary “a unique amount of data,” said Miklós Szócska, the country's health minister between 2010 and 2014.

Much of the early work was achieved thanks to a $40 million cash injection from the European Union, and the government has built an e-health platform to store all clinical data from both hospitals and community practices. Szócska said every health institution should be shifted to the centrally run cloud database by next summer or fall. Already, it’s been adopted by about half of the state-run health service.

Once centrally managed, these data can “provide information for evidence-based decision-making,” said László Németh, director general of the National Healthcare Services Center (AEEK), which developed the cloud system. The country can look at all of its health statistics, usage and demand and reassess health care delivery.

Linking the app to the central database is the next major task. Legislation for the cloud database was passed last year. Németh’s team is advising the health ministry on the next phase, which would allow the app to access the central database. Szócska is confident it will be approved, not only because patients will see the benefits, but also because Hungary is “progressive” when it comes to data transparency.

“We follow the negative consent model, like organ donation: So you have to say ‘no.’ If not, then it’s considered that you agree,” he said. "If you donate organs, you save lives, and if you donate data, you save lives."

Phase one

The first stage of the free app is already up and running, with 20,000 users since a high-profile launch last year that included a major public relations campaign by the government. It was pitched as an essential, one-stop shop for access to disease information, your doctor, personal health records and a tool to take control of your own health.

Patients can upload information such as details about their diet, weight, blood pressure, glucose levels, exercise and conditions such as pregnancy. The app provides an encyclopedia of health information and advice tailored to the user and has drug finder and pill reminder functions. It also allows the government to tout major digital health developments, said Bekasi, physician adviser for the app.

“It’s hard to explain to people that there are huge developments in our health care system if they can’t see anything different,” Bekasi said.

Patients can also connect directly with their general practitioner. Patients must have an online profile and can choose whom to share it with, including their primary care doctor. The doctor can then see changes in personal health records to build a clearer picture of potential ailments and treatments.

A pilot is in the works to add telemedicine services, allowing patients to receive advice directly from their doctor through a messaging interface.

Patients can also opt out of sharing their data, because although it is centrally collected and stored, they can select which health care workers they want to share it with.

Early savings

The majority of Hungary’s health care system is state-funded by a national insurance fund. With data collection centralized from all hospitals except a handful of religious institutions, health officials can now analyze it from a wider perspective.

This is a unique part of Hungary’s approach.

“Very few [countries] use population-level data [big data] for network analytics for both research and management decisions,” said Bergström, of EFPIA.

The big-picture approach helped Hungary discover a trend in cancer patients traveling to and from key hospitals: there were inefficiencies in the way each center was charging and being reimbursed for therapy.

“So we made the payment of these services between the two institutions more transparent,” the former health minister said. This meant two hospitals providing different cancer treatments for the same patient — such as radiotherapy in one and chemotherapy in another — would share the costs as opposed to billing each other.

The National College of Surgeons said in 18 months, they increased the number of liver metastases operations by 50 percent.

Officials also created so-called centers of excellence — hospitals with good patient outcomes — to improve cancer care.

“We saw that there are too many patients going to too many places. We centralized cancer diagnostics and cancer patient pathways,” Szócska said, adding that “patients might have to travel longer but they will access better care.”

It’s early days, but cancer outcomes are already improving.

The National College of Surgeons said in 18 months, they increased the number of liver metastases operations by 50 percent because the patients requiring this surgery were now on their radar.

This means that before centralization, Szócska said, many patients were lost in the system and never part of the cancer reporting.

This story is part of a POLITICO Special Report: Digital diagnosis: Big data in health care.