Electronic prescriptions on the way

Sunday Business Post - Best Business: Healthcare supplement - Sep 28 2008

The technology for electronic prescriptions has been developed and tested by a consortium of Irish companies including Helix Health, Health Ireland Partners and DMF Systems, which are currently involved in a EU supported market validation project called ePrescript. However, until changes are made to the law a fully electronic prescription process is impossible.

"The legislation means we must produce a paper prescription for the doctor to sign,” said Declan Fitzgerald, DMF’s managing director. “Ideally you would want to lose the paper, but to deliver that we need a legislative change."

Ongoing discussions on unrelated matters between the HSE (Health Services Executive) and the Pharmaceutical Society of Ireland (PSI) also form a hurdle to a full rollout of the technology, according to Fitzgerald.

"We got held up quite a lot due to the issues between the HSE and the pharmacists," he said. "This meant it was very difficult to get an implementation up and running in a pharmacy. But we believe that dispute is coming closer to resolution at the moment."

Declan Rossiter, managing director of Health Ireland Partners said the ePrescript project had demonstrated exactly how an efficient and secure electronic prescription model could work.

"The idea of the ePrescript project is to demonstrate how the practice management system in a GP's surgery could issue a prescription," he said. "Instead of writing it on a prescription pad, or printing it on a piece of paper, it is sent to a web portal broker and sits there. When the patient goes to a pharmacy, the pharmacist has an identification code to log on to the web broker and draw down the prescription for the patient. A message is then sent back to the GP to say that the medication has been dispatched by the particular pharmacy."





During the ePrescript trials, funded 50 per cent by the participants and 50 per cent by the EU commission, the technology was installed and tested in three Irish pilot sites. Similar trials are also underway in Belgium and Poland.

Those involved in the ePrescript project have adapted the system to deal with the challenges imposed by Irish law, according to Howard Beggs, managing director of Helix Health.

“We have changed the doctor software so that as well as printing the prescription it also prints a 2D barcode beside all the details,” he said. “It is very similar to the barcode used for online check-in by Aer Lingus. The doctor signs it in ink so it is compliant with the law, and then the patient takes the piece of paper to the pharmacy. The pharmacist simply scans it with a barcode reader and the information is transferred into his system."

A primary benefit of electronic prescription is the elimination of human errors or misreadings, according to Beggs.

"The doctor knows that what he has prescribed is exactly what is dispensed," he said. "There is no room for keystroke or other error with the barcode. If the doctor wants 25Mg, that is what gets dispensed.”

Electronic prescription also offers efficiencies for both pharmacist and patient, according to Rossiter.

"Instead of having to type in details of a prescription, the pharmacist can spend time talking to the patient about how to use their inhaler or whatever the medication might be," he said.

Rossiter also said that electronic prescription was more secure than the present paper-based system.

"It eliminates the possibility of fraud and duplication, which are big concerns," he said. "The prescription can only be used once, the patient cannot go to another pharmacy, and get another lot of the medication."

Beggs said that the HSE could use the new system to implement much greater centralised oversight and analysis of prescription trends in Ireland.

"From a budgeting point of view the country spends more than €2 billion a year on dispensing drugs through the PCRS (Primary Care Reinbursement Service) service," he said. "They will be able to analyse patterns of use and prescribing."

Beggs also said that similar technology had already been rolled out in Britain.

"In the UK it took approximately four years to get electronic prescriptions fully up and running,” he said. “The paper is completely gone out of their system. That is in a population of some 50 million."

Everyone within the Irish healthcare sector was positive about fully electronic prescribing becoming a reality, Beggs said.

"This technology has great buy-in from all the stakeholders," he said. "The minister has seen it and likes it, the ICGP (Irish College of General Practitioners) has seen it, the IPU (Irish Pharmaceutical Union) have had a delegation here in the office looking at it.”

“Raising public awareness by running pilot projects and getting consumer feedback is important,” Beggs added. “We need people to be asking 'why are we not doing this?'"

Fitzgerald said he was optimistic the legal and administrative hurdles could be overcome.

"The appetite from the GPs and pharmacist is certainly there, and the technology already exists,” he said. “Fully electronic prescription could be introduced and up and running certainly within a year."