What is the e-prescription?
An e-prescription is an electronic document that will replace the traditional paper prescription. The e-prescription is issued and signed by a doctor and then transmitted to a secure central system. From there it can be made available for patients, authorized carers, and pharmacies.
Advantages of e-prescription implementations
The electronic form of e-prescriptions brings tangible advantages, e.g.:
- The electronic form of e-prescriptions brings tangible advantages, e.g.
- The electronic prescription is always readable, minimizing the chance of a patient receiving the wrong medicine
- It cannot be lost, as it is always accessible from the central system
- It can be filled in parts, so that selected medicines from an e-prescription can be bought at one pharmacy and the remaining drugs in other pharmacies
- It is difficult to forge because of the digital signature, and it can also be invalidated if doctors’ certificates are stolen.
Patients can pick up an electronic prescription without having to visit a doctor’s office when treating chronic diseases or during remote consultations with a doctor. A properly adapted practice management system (PMS) will facilitate and speed up prescribing and reduce errors in issuing prescriptions in which they:
- shorten patient queues,
- increase the convenience of patients and their carers by reducing unnecessary visits,
- optimizing doctors’ working time,
- ensuring the accuracy of the prescriptions issued,
- with the patient’s consent, inform the doctor of all prescriptions issued.
An important feature of the e-prescription is also the possibility to easily check where the medication is available. This in turn would reduce queues at pharmacies and save time for patients.
Features of a secure electronic prescription
The introduction of e-prescription offers tangible and undeniable benefits but requires a high level of security in its implementation.
That is why it is important that the following features are ensured:
- Authenticity: the knowledge of the identities of the doctor and the patient
- Integrity: the guarantee that the data will only be used for the intended purposes
- Confidentiality: the assurance that electronic prescriptions are only made available to authorized persons
- Indisputability: the certainty that the prescription was actually issued by a specific doctor and filled at a specific pharmacy
- Reliability: Continuous and trouble-free operation of the IT system that processes electronic prescriptions
Ensuring the above characteristics required proper organization of the issuing and fulfillment of electronic prescriptions, as well as the use of appropriate cryptographic techniques and the implementation of specialized and certified IT systems.
Introduction of e-prescription in selected countries:
Poland
In Poland, e-prescription was introduced as part of the national e-health system (P1). P1 is a platform that enables the collection, processing, and sharing of digital resources on medical events and electronic health records (EHR) of patients. This system applies to all medical institutions, regardless of the source from which the services are financed.
The format of Polish e-prescriptions is part of the Polish national implementation of HL7 CDA (Health Level 7 Clinical Document Architecture), which is the official specification of the rules for creating EHR. It was developed and published by the Centrum e-Zdrowie (e-Health Centre) – a budgetary unit under the Polish Ministry of Health.
The authenticity and integrity of the e-prescription are guaranteed by the electronic signature of the doctor (which can be verified). Security is also provided by:
- A special certificate issued by the ZUS (Zakład Ubezpieczeń Społecznych – Social Insurance Institution)
- A trustworthy profile (an official instrument for confirming identity in electronic administration systems)
- A qualification certificate
- E-prescriptions are issued in the healthcare facilities’ systems and then processed in the central P1 system, from where they can be made available to the pharmacy system through:
- The patient’s PESEL number and a 4-digit code sent via SMS to access the e-prescription, or
- The e-Prescription identifier, which can be found in the form of a barcode on the so-called information printout or included in a PDF document sent by email
Patients can access e-prescriptions issued for them and their wards via their internet patient account (IKP) or via the mobile app myIKP. From 8 January 2020, e-prescription became mandatory in Poland. Current statistics on e-prescriptions issued are available on the website e-Zdrowie.
Germany
In Germany, the e-prescription was to be introduced as early as January 1, 2022, through an extended nationwide test phase. This test phase revealed some technical problems and weaknesses that had to be worked through. Then, on September 1, 2022, the e-prescription rollout started in one of the KV regions. However, due to data protection-related issues, the further rollout process was stopped on November 3. The hope now is that e-prescription will be introduced across Germany in 2023.
The big problem is the lack of digitization in Germany. There are numerous medical practices that do not have the technical capabilities or the knowledge to issue e-prescriptions securely and correctly. Many insured people also still lack the prerequisites to use e-prescriptions, such as NFC-enabled health cards (with CAN and PIN), which are required for the use of e-prescriptions.
Issuing an e-prescription works as follows:
- A physician creates an e-prescription in his or her primary system and signs it directly with the electronic health professional card (eHBA). The prescription is then encrypted and transmitted to the e-prescription service in the telematics infrastructure (TI) – e-prescription server, where it is available for 100 days.
- Insured persons then have the option of displaying the prescription directly in the e-prescription app or printing it out as a data matrix (QR code).
- The prescription can then be filled digitally at any pharmacy. The QR code can also be scanned and redeemed at any pharmacy.
- With the help of e-prescription, an information request can be sent to pharmacies – with the transmitted prescription information, stock levels for requested drugs can be checked.