Sick leave e-certificate
The sick leave e-certificate was introduced to reduce the administrative burden related to the processing of sick-leave paper certificates, both for institutions and inhabitants, as well to provide complete data on issued certificates in Latvia. Since 2018 sick-leave certificate are issued only electronically in the national E-health system which provides processing and circulation of certificates electronically among health care institutions, patients, employees and social insurance institution.
Sick leave e-certificate is one of the modules of the national eHealth system supervised by National Health Service. The national eHealth system, including sick leave e-certificate has been implemented through the digitization of health care to improve the quality and efficiency of health care services and to decrease the administrative burden, both for institutions and for the patients. To reduce the administrative burden related to the processing of paper sick-leave certificates, both for institutions and for inhabitants, to provide complete data on issued sick-leave certificates in Latvia sick leave certificate can be issued only electronically in the national eHealth system since 2018.
Before the introduction of sick leave e-certificates health care institutions issued sick leave certificates in paper format. The processing of paper forms created a certain administrative burden for both patients and institutions. For example, if a patient had several employers doctor had to issue several copies of sick-leave certificate. To claim for sickness or maternity benefit to State Social Insurance Agency the paper form sick leave certificate had to be submitted either by post or by appointment, which, in turn, created additional costs and was time-consuming. In its turn for State Social Insurance Agency it meant the necessity to serve customers in customer service centers, as well processing and storage of paper forms.
These were also no complete data on issued sick-leave certificates. Considering that the sick pay is covered by the employer from days 2 to 10, the data on sick leave paper certificates issued for the first 10 days (including) were not centrally collected and available for policy planning.
In the processing of sick leave e-certificates following institutions and persons are involved: health professionals, patients, State Revenue service and employers, Health inspectorate, State Social Insurance Agency, National Health service, State Labour Inspectorate.
Functionalities provided by sick leave e-certificate module
1.For health professionals:
a)to issue the sick-leave e-certificate and to cancel it if it was issued unreasonably,
b)to see the data about sick-leave e-certificates issued to patient by other health professionals, if it is necessary for the treatment process.
Health professionals can issue and access sick-leave e-certificates in eHealth portal (www.eveseliba.gov.lv) or in the health care institution’s information system which is integrated with eHealth system.
Benefits for health professional: time and resource savings - less paper, fast and easy to issue, no need to issue several copies of certificates if the patient has more than one employer, fast and easy to overview data about all issued sick-leave e-certificates by him/herself.
2. For patients:
a)to view sick-leave e-certificates, print them out (if necessary) send information to the employer (or other person) about the sick-leave. Patient can access his/her sick-leave e-certificate in his/her Electronic Health Record in eHealth portal.
b)to apply for sickness/maternity allowance electronically in eHealth portal or national e-service platform www.latvija.lv.
Benefits for inhabitants: time and money savings - if submitted electronically to State Social Insurance Agency for sickness/maternity allowance.
a) the data about issued sick-leave e-certificates to employees’ is available for employers in the State Revenue Service’s Electronical Declaration System the next day after doctor has signed the e-certificate.
b) employee can send the information about the e-certificate to employee before doctor has signed it.
Benefits for employers: less paper, fast and easy access to sick leave e-certificates issued to employers.
Health Inspectorate can access sick leave e-certificates in eHealth system in order to fulfill its functions in the field of the quality of work capacity checks.
Benefits for Health Inspectorate : more effective control options.
5. National Health Service, Ministry of Health, Ministry of Welfare etc.
Benefits: access to the statistics on all sick-leave certificates issued.
6. The State Social Insurance Agency
a)to access sick-leave e-certificates electronically if the applications for the granting of a sickness or maternity benefit has been submitted by patient.
Benefits for The State Social Insurance Agency: time and resource savings – no need to store and process paper forms, less clients in the customer service centers, as the application for a sickness or maternity benefit can be submitted electronically.
7. State Labour Inspectorate
Has the right to process in the eHealth System sick-leave certificates in which an accident at work has been indicated as the cause for incapacity for work.
Benefits: fast and easy access to the information about the cases of the incapacity to work due to accidents at work.
What Makes Your Project Innovative?
Sick-leave e-certificate circulation process between health professionals, patients, employers and State Social Insurance Agency is a process of digitalisation. Since 2018, certificates are issued only electronically in the eHealth system and institutions and persons involved in the process can access them electronically and there is no need to print out the certificates in paper format.
What is the current status of your innovation?
Sick-leave e-certificate project is implemented. The module is available for users since 3rd quarter of 2016, but since 2018, sick-leave certificates are issued only electronically in the eHealth system. However, in collaboration with eHealth System users the necessary usability developments of sick-leave e-certificate module are identified.
Collaborations & Partnerships
National Health Service was responsible for development and implementation of the sick-leave e-certificate module. It was developed by company chosen in the procurement procedure. In the development of the module also other institutions (State Social Insurance Agency, State Revenue Service, Health Inspectorate) and health professionals were involved. Health professionals were involved in the testing, including usability testing of the module.
Users, Stakeholders & Beneficiaries
Results, Outcomes & Impacts
In 2017 State Social Insurance Agency have received 381 600 applications for sickness/maternity benefit, 3,4% (13 000) of them were submitted electronically, using e-service. On the contrary, in 2018 (January-August) State Social Insurance Agency has received 319 400 applications for sickness/maternity benefit, 52% (166 700) of them were submitted electronically, using e-service.
The sick-leave e-certificate module is available for users since 3rd quarter of 2016, but since 2018, sick-leave certificates are issued only electronically in the eHealth system. The main goals of the innovation has been reached – to reduce the administrative burden related to the processing of paper sick-leave certificates, both for institutions and for inhabitants and to provide complete data on issued sick-leave certificates in Latvia. In general, medical practitioners who issue sick-leave e-certificates evaluate this module positively and indicate that its use is convenient and fast.
Challenges and Failures
1.The technical complexity of the project: the development and implementation of sick-leave e-certificate module took place simultaneously with the development and implementation of other modules of the eHealth system and eHealth portal. Due to the technical complexity of the project, its implementation has been extended several times.
2. Doctors' resistance to the implementation of the module and unwillingness to use e-forms of the sick-leave certificates instead of paper forms. The main reasons of the resistance were insufficient digital skills and fear of the transparency. Due to the resistance the term from which the sick-leave certificates should to be issued only electronically was postponed. To reduce the resistance and raise awareness about the utility of the module and its implementation goals trainings for health professionals were organised. Also eHealth Help desk and the possibility to submit proposals for the necessary improvements of the module are provided.
Conditions for Success
1. Health professionals’ involvement in the development and implementation process. It is particularly important to involve opinion leaders, as well as to provide feedback.
2. Well managed change implementation.
3.Sufficient time for doctors to get to know the system before it is implemented mandatory by regulation.
4. Competent and sufficient number of professionals in Help Desk.
The lessons learned during implementation process of sick-leave e-certificate will be used when implementing other modules of the eHealth System in the future.
1. Involve health professionals in the development and implementation process. It is particularly important to involve opinion leaders, as well as to provide feedback.
2. Be well prepared for change implementation (including team, responsibilities of team members, management of the team, goals, tasks, terms e.tc.).
3.Provide sufficient time for doctors to get to know the system before it is implemented mandatory by regulation. If the decision about mandatory implementation is done, don’t let to postpone it only because of the resistance of the users.
4. Provide competent and sufficient number of professionals in Help Desk.