Slovak healthcare is undergoing an important change: electronic agreements are being created between patients and doctors, and the ELAB system is being launched for exchanging laboratory requisitions and results. E‑agreements already serve as the basic register of the relationship between a patient and their general practitioner, pediatrician, or gynecologist. ELAB is expected to bring fewer duplicate tests, faster communication, and cost savings.
E‑agreements: a clear relationship between patient and doctor
An e‑agreement is an electronic contract for the provision of healthcare between a patient and a capitating physician. NCZI, together with insurers, transformed it into an electronic repository that clearly determines which doctor a patient belongs to. Based on this register, insurers pay capitation payments and there are fewer disputes about who has the patient “in care”.
For patients, changing doctors is easier: at the new doctor’s office, it is enough to insert the ID card into a reader and the agreement is confirmed, without the need for a PIN or an activated e‑mailbox. If the patient does not have an eID, the agreement is printed and signed; it is still recorded electronically. The original doctor receives a notification and the medical documentation becomes accessible to the new one from the following month. According to NCZI, the database has high “purity” – errors are less than one per thousand – and thanks to its connection to the state’s reference register, duplicates are eliminated (e.g., after deaths or departures abroad).
ELAB: electronic requisitions and results from laboratories
ELAB connects outpatient and hospital software systems with laboratories, insurers, and NCZI. The doctor sends a requisition electronically, the laboratory returns the result electronically as well, and the doctor can also see the patient’s previous results from other clinics. The insurer simultaneously checks whether the same test has not been performed recently, which prevents duplication, saves the patient’s time, and reduces unnecessary costs.
In practice, ELAB is already running with two major vendors and others are implementing it; interest has been reported from roughly 20 of the 25 approached suppliers. Laboratories are covered for about 30–35 % of the market (six large ones are connected), others are undergoing certification. Insurers are inserting an obligation for electronic requisitions into contracts, and with Všeobecnou zdravotnou poisťovňou a contract already exists. The goal is for the entire system to expand over the course of next year, ideally in the first to second quarter.
Challenges, timelines, and what it will bring patients
The biggest challenge is aligning different software and data structures between insurers and laboratories, including secure signing and data exchange. Gradually, more vendors are joining and doctors’ interest is growing, although some of them are conservative toward digitalization. Workshops and support from the ministry as well as insurers help overcome technical and organizational barriers.
For patients, the changes mean less paperwork and fewer repeated blood draws. E‑agreements do not require an activated e‑mailbox or a PIN; an ID card is sufficient, or a manual signature that is recorded electronically. In the future, system integration could also help the emergency medical service, which should be able to access relevant data faster and decide on treatment sooner. Digitization is thus moving toward clearer, more economical, and more patient‑friendly healthcare.
