Questions and answers about the eGD

The eGD is a collection of predefined medical data and information such as doctor's reports, laboratory findings, X-rays and medication lists, but also important information such as allergies and intolerances. Technically speaking, this data collection is an electronic database. Health data is no longer scattered and can no longer be lost.

An eGD is provided by the Liechtenstein National Administration for every person insured in Liechtenstein. Treatment-relevant medical data and information are stored in the eGD by the healthcare providers - unless the insured person objects - so that the insured person can release the stored information to other healthcare providers at any time.

The data on the patient in the sense of an electronic medical history (eKG), which is in many cases already recorded electronically by healthcare providers (GDL) today, forms the basis for the electronic health dossier (eGD). However, the eGD is not the sum of all health data in the eKG at the various GDL.

The eGD is primarily intended for patients so that they can view reports and findings at any time and view their current medication schedule or even their vaccination status. Health data is placed in the eGD, which - always assuming the patient's consent - can be of interest to other healthcare providers in a treatment case. However, the eGD is not a complete copy of all eKG. The eGD is a sum of individual treatment-relevant parts of different eKGs. In the eKG, the individual GDL can store additional information and comments, unchanged from today, which will remain accessible only to that GDL itself in the future.

Which data are considered treatment-relevant data, i.e. can be useful for other GDLs in the case of treatment and consequently have to be stored in the eGD by the GDL, is on the one hand regulated by law, and on the other hand further specified by GDLs.

Only health data will be recorded in the eGD from the year 2023 (see also the question "What is the timeline regarding implementation?"). The GDL are not obliged to store health data from the past in the eGD as well (but can still do so on a case-specific basis). Consequently, the scope of the stored health data will be expanded step by step.

The eHealth platform forms the basic infrastructure for storing or exchanging data. The eGD forms the core of this. However, the term eHealth platform also includes peripheral systems, for example for sending information directly from one healthcare provider to another or for connecting to the eGD (e.g., application for blood glucose measurement with automatic storage of results in the eGD).

On the one hand, the eGD is based on the Electronic Health Dossier Act (EGDG), which came into force on 1.1.2022. On the other hand, provisions in this law are further specified in the Ordinance on the Electronic Health Dossier (EGDV). Together, the law and the ordinance form the legal basis for the eGD.

Links to the law and the ordinance:

• Electronic Health Dossier Act (EGDG) of Jan. 1, 2022
• Ordinance on the Electronic Health Dossier (EGDV) of 9.12.2022

For insured persons or patients, there are no obligations in connection with the electronic health dossier (eGD), but only rights.

Every person insured in Liechtenstein is free to decide whether or not they want to take advantage of an eGD for themselves. If a person chooses to do so, they do not have to do anything and their own dossier will be continuously expanded with medical data and information from the time of implementation in the summer of 2023, e.g. after a visit to the doctor or hospitalization by the treating healthcare provider. In addition, the insured person is free to decide which healthcare providers receive access to his or her eGD. Such access can also be blocked again by the insured person at any time. Furthermore, the insured person can delete (irrevocably) or hide (revocably, i.e. the insured person can show the data and information concerned again at a later time and thus make it accessible again to freely definable healthcare providers) individual data and information in the eGD. And last but not least, an insured person can request that his or her dossier be completely and irrevocably deleted at any time.

The insured person thus retains data sovereignty over his or her own data at all times and is completely free to determine which healthcare providers have access to his or her own eGD and which data is displayed in the eGD. However, the eGD can be beneficial if and only if the data and information it contains are as complete and up-to-date as possible.

If a person insured in Liechtenstein does not want to use the eGD, a one-time objection is sufficient and no medical data will be stored in the dossier.

Yes, that is possible. For example, an adult person can assume the proxy role for the aged mother. A right of access in the sense of a deputy role can be set up through the Office of Health. That person with the proxy power assumes all the rights that the represented person would hold himself. The person who has additionally defined a deputy role retains all rights himself.

A proxy role can be cancelled at any time, either via electronic health record itself (i.e. the represented person accesses their own eGD themselves and deletes defined proxy roles) or again via Office of Public Health.

Minors also receive an electronic health record (eGD), but have neither rights nor obligations. Thus, they also cannot access their own eGD. However, one or more legal guardians can have access rights set up for them via the Office of Public Health in the sense of a deputy role. Thus, a parent or guardian can access the eGD of a minor child and also release that eGD to GDL. From the age of 14, each person can decide independently whether they want to be able to access their own eGD themselves in the future or whether one or more legal guardians may continue to maintain access to their own eGD. Without actively removing the proxy of the guardians, they automatically retain the authorizations.

Persons who have health insurance in Liechtenstein automatically receive an electronic health dossier (eGD). The prerequisite for accessing one's own eGD is possession of an eID (www.eid.li), a digital identity of the Principality of Liechtenstein. The eID became known and widespread through the eID app for depositing a COVID certificate on the cell phone. People who do not yet have an eID but want to benefit from the advantages of the eGD can obtain one by going in person to the Migration and Passport Office in Vaduz.

With the help of this link, you can access the eGD using eID via secure access.

The electronic health dossier initially only includes administrative data such as surname, first name and date of birth, but no health data. If an insured person wishes the eGD to be blocked from storing health data, he or she can register an opt-out. There are basically two ways to do this:

On the one hand, every insured person can access their own eGD via a secure Internet connection and independently exercise all their rights online, i.e. in particular also file an objection. See the question "How does an insured person gain access to the electronic health dossier?". How to use the eGD is explained in a separate video or instructions can be viewed or downloaded as a PDF (links follow).

On the other hand, all rights can also be exercised via the Office of Health. For this purpose, appropriate application forms will be posted on the homepage of the Office of Public Health starting in January 2023. So, if a person with health insurance is not savvy enough with computers or mobile devices, he or she can instruct the Office to file an appeal, for example. The forms can be found here.

The exercise of these rights is analogous to filing an objection, see the question "How to file an objection to the use of the electronic health record?"

There are three possible ways to do this:

First, the activation can be done via the electronic health dossier itself. For this, the insured person must only access their own eGD. See the question "How does an insured person obtain access to their own electronic health record?". In the own eGD, it is then possible to specify which healthcare providers (GDL) are to be given access to the eGD.

Second, all rights can also be exercised via the Office of Health. For this purpose, corresponding application forms will be posted on the homepage of the Office of Health from January 2023. So if a person with health insurance is not savvy enough with computers or mobile devices, he or she can instruct the Office, for example, to file an objection, delete certain health data, or even grant certain GDL access to the eGD.

Thirdly, the activation can also be carried out directly at the GDL on site, so for example directly in the doctor's office or hospital. Such on-site activation requires an eID (www.eid.li), a digital identity of the Principality of Liechtenstein. The eID became known and widespread through the eID app for depositing a COVID certificate on a cell phone. When called up, the eID app generates a temporary code that can be used for activation. Alternatively, a patient can sign a form on site confirming that he or she grants the GDL access to his or her eGD (see also the question "How can a healthcare provider access an electronic dossier in an emergency?").

To prevent an unmanageably large number of healthcare providers from accessing the eGD over time, access to the eGD is usually blocked again after 28 days (applies to doctors and hospitals, for example) or after a few hours (applies to pharmacies). At the same time, however, it is possible for the insured person to specify one or more trusted physicians (e.g. family doctor). For these trusted physicians, access is only automatically blocked again after 365 days. If a health care provider is denied access to the eGD due to these time restrictions, the insured person can reactivate access at any time.

Every access by a healthcare provider to an eGD is logged and can be seen by each insured person in their own eGD at any time (see also the question "Can a healthcare provider access an electronic dossier in an emergency without prior activation?").

Yes, this is possible. However, in order for a healthcare provider (GDL) to access an electronic health record (eGD) at all, they must have been registered by the Office of Public Health beforehand. Only registered GDLs can access the Liechtenstein eGD.

Each access of a GDL to an eGD is logged and can be seen by each insured person in their own eGD at any time: each insured person can check at any time who has accessed their eGD. If a GDL, who has previously been granted access by the insured person (see the question: "How can a healthcare provider be granted access to one's own electronic health record?"), accesses an eGD, this access is visibly listed in the eGD for the patient. However, in an emergency, a GDL may access an individual's eGD without having received prior access authorization. This access is also logged and listed in the eGD, but in addition such access without predefined authorization is specifically indicated in the eGD with a warning. Because all GDL are aware that every access is logged, no unjustified accesses will take place, otherwise an insured person may confront or even take legal action against a GDL who has accessed the eGD without authorization and without the presence of an emergency situation. 

Certain healthcare providers (GDL) are obliged to record medical data and information in the case of treatment in the electronic health dossier (eGD) of an insured person or patient. These include doctors, the Liechtenstein National Hospital, the Liechtenstein Old Age and Sickness Assistance, medical laboratories, pharmacies, chiropractors and dentists. However, this obligation naturally only applies if the insured person has not objected to the use of the eGD (see the question "How can objections to the use of the electronic health record be submitted?").

Inversely, these healthcare providers have the right to retrieve and view data and information from the eGD in the event of treatment. Provided the insured person has granted access accordingly (see the question "How can a healthcare provider be granted access to one's own electronic health record?"). However, depending on the health care provider, only certain data and information can be viewed. For example, a pharmacist only has access to medication data, but not to more extensive data and information in the eGD. 

The Office of Public Health is responsible for enforcing the law and the ordinance. Among other things, it is responsible for providing the electronic health record (eGD) for each insured person and for recording administrative data such as name, address, personal identification number (IDN). In addition, certain rights of insured persons can be asserted via the Office of Public Health (e.g. deletion of the eGD).

The Office of Informatics is responsible for the provision, operation and further development of the eGD or the eHealth platform as a whole.

The law and regulation stipulate that treatment-relevant data are stored by healthcare providers (GDL) in the electronic health record (eGD), provided the insured person has not objected. However, one hundred percent complete data collection cannot be guaranteed. In many cases, for example, even a list of medications taken can provide crucial information for avoiding incorrect drug treatment. For example, when prescribing antibiotics, the doctor can avoid penicillin allergies if this fact has already been determined in the past and stored accordingly in the eGD. However, ensuring complete data is not the sole responsibility of healthcare providers, but just as much the responsibility of patients. What the patient conceals, the physician cannot know and cannot file in the eGD. It is essential that the patient sees for himself the benefits that arise thanks to data that is as complete and up-to-date as possible. The eGD is primarily intended for the patient.

Data quality is only as good as the data is collected and maintained. This is a challenge for healthcare providers in particular. It should be noted, however, that in recent years digitization in the healthcare sector has made enormous progress, for example in hospitals, but especially also in doctors' practices. For example, many medical practices already keep high-quality electronic medical records (ECRs) in the conviction that this will ensure better patient care in the medium and long term. This advancing digitalization forms a crucial basis for structured data maintenance, which in turn is an important prerequisite for high data quality in the eGD (see also the question "What is the difference between electronic health dossier (eGD) and electronic medical history (eKG)?").  

At this point, it is important to note that all patient health data is considered very personal and must be protected accordingly. The aim of an eHealth platform or an electronic health dossier is to exchange the data in a coordinated and controlled manner or to make it accessible to authorized persons. Without eHealth, the problem would increasingly arise that data would be exchanged in a largely uncoordinated manner using different (physical or electronic) processes via a wide variety of communication channels, which is unfortunately already the case in many cases today. Today's communication by means of e-mail, chats, faxes and letters offers neither a high level of data protection nor a high level of data security - on the contrary! The eGD can counteract this risk.

The data sovereignty always remains with the insured person or the patient. He alone decides whether data should be stored in the eGD and which authorized healthcare providers should have access to this data.

An exception exists in a situation in which the patient himself can no longer decide which healthcare provider he wants to grant access to and whom not (e.g., in an emergency situation or when the patient is unconscious). In such situations, authorized healthcare providers, i.e., those registered by the Office of Public Health, can access an eGD even without the patient's consent. However, each access is accurately logged (see the question "How can a covered person control who has accessed their eGD?"). Ultimately, however, this ability to access a patient's eGD can be of critical benefit!

Although Liechtenstein's healthcare system is very closely linked to Switzerland and also to Austria, it has its own legal basis and consequently also its own requirements in individual areas. In order to take these circumstances into account and ensure the greatest possible flexibility, an eHealth platform tailored to Liechtenstein's specific needs is required.

Liechtenstein, however, does not want to take on a pioneering role in the development and expansion of an eHealth platform. The country is too small for this. The provision of such a platform requires major development work and high up-front investments.

At the same time, this platform must meet international standards and consequently support a connection to other solutions, especially to the eHealth solutions of neighboring countries. This means, for example, that a Liechtenstein physician can access eGD data stored for one of his patients in Switzerland or Austria - and vice versa. Always provided that the patient gives permission for this.

Correspondingly, the solution used in Liechtenstein is an established eHealth platform from Siemens Healthcare AG, which is in use in many countries, especially also in Austria (under the name "ELGA: Electronic Health Record) and in Switzerland (in cooperation with Post AG) and is used by thousands of people every day.  

The solution complies with various international standards (e.g. IHE, HL7, DICOM) with the aim of standardizing and harmonizing data exchange between IT systems in the healthcare sector.

At the same time, the solution allows adaptation ("customizing") to Liechtenstein needs, e.g. with regard to the application of eID for the authentication of insured persons and healthcare providers.

An additional advantage of this solution is that Liechtenstein can benefit from further developments, which Siemens Healthcare AG will continue to pursue in the future due to its international orientation with a local presence in over 70 countries worldwide. 

All data is stored in encrypted form in two geo-redundant high-security data centers in Switzerland.

There is never 100% data security anywhere. Regarding data security, the most modern security measures are taken, from encryption of the data, to a state-of-the-art IT architecture, to vulnerability checks and penetration testing and more. In terms of data protection, the solution meets the DSGVO criteria (General Data Protection Regulation on the part of the EU/EEA)

Healthcare providers are required by law to store treatment-relevant data in the eGD from July 2023. Depending on the practice information system, this will involve effort. Healthcare providers will not receive separate compensation for this. However, they can also benefit from the solution, because in the future they will have easier access to data and information about their patients that was previously recorded by other healthcare providers. The benefits and simplification for all stakeholders involved will depend a priori on how widely and consistently the solution will be used. 

As shown in the question on the benefits of an eGD, all stakeholders concerned can benefit. In particular, the eGD should also help to avoid or reduce duplication and complications, which in turn can help to slow down the development of costs in the medium and long term. The eHealth platform with the eGD as its core element is the basic infrastructure for this. Based on these considerations, the eGD will be established and operated through investments and by assuming costs on the part of the state.

There are no additional costs for insured persons or patients.

For healthcare providers, a web-based solution (using an Internet browser application) for accessing the electronic health record is provided free of charge. This solution allows all legal obligations to be met, but manual effort is involved. For a connection of an existing software solution ("integrated interface" e.g. for practice or clinic information systems) to the electronic dossier with the aim of automating the processes as much as possible (e.g. automatic upload of certain document types from the local software solution to the eGD), costs may arise which are to be borne by the healthcare providers and may vary depending on the software used. 

No, this is excluded by law. 

From January 2023, the electronic health dossier (eGD) can be used by people with health insurance in Liechtenstein. In a first step, however, the eGD will only contain administrative data such as name, address and date of birth, but not yet health data.

Health care providers (GDLs) are expected to gain access to the electronic health record (eGD) in March 2023 and will be able to store health data in the eGD from that date. Consequently, if patients do not want health data to be stored in their eGD, they will have sufficient time to file an objection at the beginning of 2023 (see the question "How to file an objection to the use of the electronic health record"). Since GDLs will be required to store health data in the eGD as of July 1, 2023 (unless there is an objection), it is up to them to decide whether to start earlier in order to be able to set up appropriate workflows and processes early.

Yes - as of January 1, 2023, there will be a hotline at the Office of Public Health specifically for the electronic health record.

The hotline number is: +4232304333. 

"eHealth" refers to the integrated use of information and communication technologies (ICT) to design, support and network all processes and participants in the healthcare system.

Today, information about patients is scattered in many ways, whether at the patient's home, at various doctors' offices, at the hospital, at the pharmacy, at the nursing home, and so on. As a result, it is not available independently of time and place. Modern eHealth solutions, especially the so-called electronic health dossier (eGD), can alleviate this problem. At the same time, they can help minimize risks (e.g., in connection with medication incompatibilities) and improve the quality of care (e.g., avoid duplication of treatment). Especially in emergency situations, an electronic health dossier can save lives by, for example, allowing the emergency physician to access important medical information of an unresponsive patient. 

The eHealth Strategy of the Principality of Liechtenstein lays the foundations for the sustainable development of an IT-supported and modern healthcare system in the Principality of Liechtenstein. The electronic health dossier is at the center of this.

Liechtenstein does not want to reinvent the wheel, but to build on existing and proven solutions wherever possible and sensible. In close alignment with the "Vision eHealth Switzerland", the "Vision eHealth Liechtenstein" accordingly reads as follows:

People in the Principality of Liechtenstein can access medically relevant information about themselves and obtain services from the healthcare professionals of their choice, regardless of time and place.

They are actively involved in decisions regarding their health behavior and health problems, thereby strengthening their health literacy.

Information and communication technologies are used in a way that ensures the interconnectedness of health care actors and that processes are of better quality, safer and more efficient.

Main objectives are:

• Improve quality of care and patient safety by providing access to relevant patient information by practitioners
• Increase efficiency by avoiding unnecessary multiple consultations and incorrect treatments and by reducing the risk of drug incompatibilities
• Medium and long-term cost reduction through quality improvements

These goals also correspond to the main objectives according to the eHealth Strategy Switzerland.

Additional goals for Liechtenstein are:

• To ensure a modern healthcare system in Liechtenstein with the principle of "smart follower" instead of "first mover"
• Connection to the healthcare systems of neighboring countries

The focus is on the benefits for patients. Thanks to the electronic health dossier (eGD), they can access their own health data at any time. In addition, they can decide which healthcare providers should have access to their data.

Initially, the eGD will involve additional work for healthcare providers (GDL, e.g., doctors' offices, state hospitals/clinics, laboratories, pharmacies). Conversely, however, over time eGD will simplify the processes of obtaining information in the course of treating patients, which in turn will benefit healthcare providers.

This can create benefits for the healthcare system as a whole. Broken down into the various perspectives, the following benefits may accrue to diverse stakeholder groups:

For patients:

• The right information at the right time in the right place - always available
• No more role as "mailman" of medical documents
• Data can no longer be lost (e.g., vaccination booklet)
• Life-saving data is stored (e.g. allergies)
• Fewer unnecessary multiple examinations
• Fewer complications (eg, reduction drug intolerances)
• Smooth transition between treatment sites
• Higher quality of care For healthcare providers (physicians, dentists, hospital/clinic, pharmacies, laboratory, etc.):
• Availability of up-to-date health data in case of treatment
• Rapid and uncomplicated access to patients' eGD
• No more time-consuming information procurement from different sources
• Less administrative overhead in the medium and long term
• Case-specific potentially helpful information in case of emergency

For the public sector:

• Ensuring affiliation with modern healthcare system
• Ensuring connectivity with neighboring countries and beyond
• Optimizing care processes
• Increased cost transparency and efficiency