Electronic prescription
The electronic prescription (also e-prescription ) is the digital counterpart to the (classic) paper-based prescription of drugs and medicinal products . The information on the prescription is written by the prescriber onto a carrier medium or a central information system and can subsequently be used by partners in the health system read out and processed further.
The electronic prescription is often discussed in the context of the electronic patient record , especially since this often forms the infrastructure for the electronic prescription.
Concepts
Central approach
Here all parties involved work with centrally stored data sets.
Decentralized approach
Here, a carrier medium is used for data storage with the advantage of being independent of a connection to the central data store.
General evaluation
quality
Transmission error
The following transmission errors are possible with the classic recipe:
- handwritten prescriptions: misinterpreted or illegible prescription
- Typewritten recipes: incorrectly interpreted or illegible due to overlapping of print, template, stamp and signatures, poor print quality
- Damage to the paper recipe due to mechanical stress (folding, incorrect transport, etc.)
The electronic prescription avoids these sources of error and thus increases the process quality.
Fraud prevention
Paper-based recipes can be falsified by reasonable means, e.g. B .:
- Modification of the contents of the prescription (means and quantities)
- unjustified change in the exemption from co-payments
A digital prescription offers various options for fraud prevention, such as data encryption and digital certificates.
reliability
The reliability of the electronic prescription depends primarily on the respective solution architecture and its implementation and must therefore be viewed in particular in the context of the respective situation in the individual health systems of different countries.
In general, it can be said that electronic data processing can generate a high degree of reliability, especially since in this case a large number of media breaks and process steps are simplified.
speed
The electronic prescription offers a multitude of potentials for speed improvement of the processes between the health partners:
- Eliminates the time for paper printouts and manual signatures
- Options for direct, electronic drug ordering during the prescription process
- Online order with immediate electronic delivery of the prescription
- Faster billing processes with the health insurances through direct electronic submission of receipts
- Sending prescriptions in minutes instead of the minimum delivery time of one post day
flexibility
Due to the high process speed and electronic processing, the following new options are available:
- short-term update of recipes
- Re-ordering and delivery of prescriptions possible via digital channels
costs
- high investment costs for health insurance companies, doctors, pharmacies and other partners in the healthcare sector
- Savings in billing with health insurers
- Elimination of postage costs for prescription request, dispatch and service accounting
- Theoretically, there are no costs for prescription fraud
- Savings through leaner processes for all partners involved
- There are no costs for archiving the paper documents
Risks and Criticism
- Misuse of the stored recipe data
- Individual pharmacists and doctors complain that process cost savings only benefit the health insurance companies (source is missing)
- general criticism of the electronic patient record as a carrier medium
- Lack of transparency: patients cannot read what has been prescribed for them
- Data protection concerns - another step towards the transparent patient
- Central solution approaches require a sufficiently high-performance and reliable internet connection, which cannot be guaranteed across the board today
- In practice it will not be possible to avoid cases in which the use of paper recipes still has to be used. Such cases are the loss of the card, the destruction or damage of the card, the failure of the computer system at the doctor or pharmacist, the emergency situation or home visit as well as numerous other exceptional situations. This need for paper forms can lead to more bureaucracy, simply because two systems, one electronic and one conventional, have to be kept.
Situation in Germany
Creation and forwarding of data profiles with the aid of information technology (networks). In particular, one speaks of the electronic (e-prescription) when it comes to a medical prescription.
The previous prescriptions are given to the patient in a form- bound manner ( sample 16 ), thus starting a multi-stage communication process ( doctor - pharmacy - pharmacy computing center - health insurance computing center - health insurance company ). This results in a media break (paper, data record ), but this is put into perspective by the compulsion to digitize the prescription data (Section 300ff SGB V ) and the coupling of the health insurance companies' obligation to pay to correct data delivery. At the moment, data is being sent to statutory health insurances with an extremely low error rate, and this will be further improved by the electronic prescription. The expected cost savings are not determined by the electronic prescription, but by the uses of drug documentation , emergency ID and health records .
Additional time expenditure due to e-prescriptions
The electronic signature represents a major problem with the e-prescription. The prescribing doctor must use this to indicate that the prescription is genuine. For this purpose, the use of the electronic doctor's ID in connection with the input of a personal identification number ( PIN ) is provided. The time required to make an electronic signature for each recipe will put a considerable strain on everyday practice. It is foreseeable that cheating mechanisms will creep in, for example in the form that the electronic doctor's ID and the PIN are freely available in the practice registration. Such practices contradict the idea of the electronic signature.
Technical and organizational concept
The e-prescription is to be introduced with the electronic health card , because it allows proof of entitlement to a prescription.
Two concepts are discussed:
- Recipe in the network-based information network (server solution)
- Prescription on health card
The prescription data represent data worthy of protection and must be encrypted cryptographically . For reasons of legal security, the doctor's digital signature is necessary.
For certain cases, the exact handling of the e-prescription on the health card is currently still being defined. How can, for example, the medicine be picked up from the pharmacy by a third party without having to hand over the health card? An abbreviation is introduced here, which enables the problem-free collection by third parties.
According to plans by Federal Health Minister Jens Spahn from the beginning of 2020, doctors should only be able to enter e-prescriptions using a central e-prescription app. The app is to be developed by gematik GmbH. Patients should then be able to use this or another app to send a prescription, for example with their smartphone , to a pharmacy. Such a standard app, which is to be developed by 2021, is planned for the draft law for the protection of electronic patient data ( PDSG ).
See also: CPOE , Adverse Drug Reaction , Drug Information System , LOINC
Implementation status
The electronic prescription is based on the Law for More Safety in the Supply of Medicines (GSAV), which came into force on August 16, 2019. The necessary foundations for using the electronic prescription must be created within seven months. The testing of model projects and the technical specifications based on them are then planned by the end of June 2020.
Situation in Austria
On March 16, the umbrella association of social insurance agencies prematurely released parts of the program for e-prescriptions due to the COVID-19 pandemic in Austria , so that patients can have necessary medication apart from corona illnesses prescribed by the doctor by telephone and then directly in the The pharmacy can be picked up using an e-card. The licensing requirement of the chief physician has been temporarily suspended for most drugs. At the same time, it is now also possible to report incapacity for work by telephone. These measures are intended to drastically reduce direct patient contact, including with resident doctors.
literature
- D. Balthasar: Integration of insured person data into telematic structures of the health system, taking into account the acceptance problem. 2003, ISBN 3-8386-7443-X .
- D. Kraft: Telematics in Healthcare. (= DuD specialist articles ). Deutscher Universitäts-Verlag, 2003, ISBN 3-8244-2166-6 .
- Heike E. Krüger-Brand: Electronic prescription. It should work in the second attempt. In: Deutsches Ärzteblatt. Volume 117, Issue 1–2, January 6, 2020, pp. B 8 - B 12.
Individual evidence
- ↑ A process for this is described at Gesundheitskunde.de ( Memento from December 16, 2005 in the Internet Archive ).
- ↑ Jennifer Evans: No flaws - no monopoly for the e-prescription app. In: pharmische-zeitung.de. February 3, 2020, accessed February 8, 2020 .
- ↑ New digital law: ten euros for doctors per patient record. In: aerzteblatt.de. January 30, 2020, accessed February 8, 2020 .
- ↑ The e-prescription is coming! Federal Ministry of Health, September 9, 2019, accessed on March 24, 2020 .
- ↑ Philip Pfleger: Coronavirus: Electronic prescription - this is how it works - news.ORF.at. In: ORF.at. March 17, 2020, accessed March 18, 2020 .
- ^ ÖGK: Easier doctor-patient communication on ORF from March 13, 2020, accessed on March 13, 2020.