Patchy uptake
The European leaders in electronic prescribing are Sweden and Denmark, but the concept is gaining momentum in the Netherlands.
In 2002 the Dutch government established the National IT Institute for Healthcare (Nictiz) to introduce IT solutions into
the field of healthcare. Nictiz initially focused on gathering the medication history of patients based on dispensing information
retrieved from community pharmacies. It has now implemented solutions for electronic prescribing, but has acknowledged difficulties
in convincing all physicians of the benefits of the system.
Despite this, most general practitioners in the Netherlands now register their prescriptions electronically. Patients tend
to first be treated by a GP before being referred to specialists, and Nictiz has noted that it is the specialists giving the
consultation who often still seem reluctant to use electronic devices to enter patient data. There could be several reasons
for this. Doctors may feel as if they are losing control by handing everything over to an electronic system, or they could
be way about the promises of electronic systems, which largely remain untested on a wide scale.
In the Netherlands, electronic prescriptions will be equipped with an electronic signature from the prescriber, which will
make the paper version obsolete. European legislation requires a signature to be on a prescription, but Dutch law has been
amended to accept an electronic signature as valid from a recognised prescriber. As well as improving the acceptance of electronic
prescriptions, it is necessary to have adequate intervention systems in place. Although the telephone still acts as an emergency
option, the hope is to have electronic intervention systems that can automatically flag anomalies. The speed of such systems
is critical. For example, when patients have been discharged from the hospital, it will be important that medication instructions
do not get overlooked as their care is transferred to others outside the hospital.
Other countries in the EU are only cautiously exploring electronic prescribing. For example, an electronic prescriptions project
was launched in April 2011 by the Czech State Institute of Drug Control, but the system seems only electronic in name as each
prescription tends to be accompanied by a paper version. Czech health insurance funds do have no access to the electronic
prescription system, which means they are unable to check that a particular prescription was actually filled by a doctor.
Consequently, this affects reimbursement decisions for the medicine, but Czech health insurance law is currently being amended
to close this gap. To date, the electronic prescription system has only been used by eight doctors and eight pharmacies, with
512 electronic prescriptions issued, but the entire project has cost more than €6.99 million (5). The Czech situation illustrates
the need for an approach to electronic prescribing that takes into account all stakeholders in healthcare, which is why the
EMA has made efforts to include a wide range of participants in their workshop.
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