Background

In the search for efficiency and excellence, the Estonian Health Insurance Fund and the Ministry of Social Affairs launched an e-Prescription project in Estonia in 2010. The previous paper prescription system wasted the time of all parties involved in the prescribing and the buying and selling of medications. The scarce resource of a doctor’s appointment time was wasted on writing recurring prescriptions and the patients had to spend time waiting for their appointment.

Some prescriptions would get lost, some would include the wrong percentage of subsidies by the Estonian Health Insurance Fund. The collection of statistics and data is costly, and all parties must waste time on reporting the same data at different times.

The new e-Prescription system was designed as a centralized and paperless system to be used by all doctors, patients, and pharmacies.

The central e-Prescription system was developed by the Estonian state in cooperation with Helmes.

The information systems of medical practices and pharmacies were integrated and updated by their service providers. Helmes also developed a central online interface for doctors and pharmacies who have fewer prescriptions to process or whose developments were not ready by the time of launching the e-Prescription system.

Launching the e-Prescription System

Project highlights

Many countries have attempted e-Prescription projects before Estonia and have spent countless hours on establishing an e-Prescription system. Estonia launched its e-Prescription service after three years of software development. The overall project lasted for five years, including all the preparations necessary to issue prescriptions digitally.

The e-Prescription system was launched at the beginning of 2010 and by the end of the first year, 84 percent of prescriptions were issued digitally. Although the transition hit some minor bumps, the uptake of e-Prescription was very fast, because it instantly delivered convenience and saved time for all parties.

The e-Prescription project involved a very big number of partners from different governmental bodies and registries, hospitals and medical personnel, and pharmacies and their software providers. All the organizations involved had different technological platforms and standards, making the implementation of the system more complex.

From the organizational side, a large challenge was that not all parties were committed to the transition, as their software development activities were not controlled by the project partners and were not centralized.

Although the project itself lasted for five years, the technical solution was developed in three years. Despite the low quality of registries, limited time-frame and finances, Helmes was highly motivated, managing to create the most innovative of Estonia’s e-Health solutions. The project partners are proud to have provided the system in less time and budget than any other country has done until today.

The e-Prescription system has improved the openness and transparency in the authorization of medicine, and more importantly, opened a whole new way for future developments which aim to share information and statistics and improve the medical care and also the quality of decision making among policy makers.

Read also: Custom Health-Care Software & Self-service Solutions in Estonia´s Foremost Hospital

Solution highlights

e-Prescription is understood as the process of the electronic transfer of a prescription by a health-care provider to a pharmacy for retrieval of the drug by the patient.

The central e-Prescription system enables medical personnel and pharmacies to monitor and manage the issuing of prescriptions. All hospitals and pharmacies in the nation are connected to the system.

When a doctor prescribes medicine using the e-Prescription system, he or she does so electronically, with the aid of an online form. The system stores incoming prescriptions (messages) and sends patients’ prescriptions on demand to a pharmacy’s information system. The e-Prescription is then immediately accessible in every pharmacy on request.

There are three types of Digital Prescriptions:

• Private prescription – only the patient can use the prescription
• Delegated prescription – patient and nominated persons can use the prescription
• Public prescription – anybody who presents a valid ID and the patient’s ID code can use the prescription

The pharmacist, who is logged on to the system through the sales software or through the Estonian “X-Road” data exchange platform, identifies a person using his/her ID card and receives the prescription from the central database. If a person buys drugs for someone else, then it is necessary to know the personal identification code of the patient (provided that at the time of issuing, the prescription was classified as public). Patients have the possibility to follow the log attached to every prescription and see when and who has accessed the data. Information about the purchase is submitted to the Estonian Digital Health Record.

Doctors are most appreciative of the system feature that enables the automatic calculation of the correct rate of reimbursement on medications compensated by the Health Insurance Fund. As the e-Prescription system draws on data from the National Health Insurance Fund, any state medical subsidies that the patient is entitled to also appear, and the medicine is discounted accordingly. The doctor prescribes medication to the patient, then the system checks the Health Insurance Fund to see if there is any discount percentage for the prescription. The prescription is then confirmed by the doctor and submitted to the register.

Furthermore, the e-Prescription system can provide an overview of the prescriptions issued for a patient by other doctors and the actual purchasing information regarding these prescriptions. Automated processing of this information in the future helps to evaluate the interaction of pharmaceuticals prescribed by different doctors, patient adherence to treatment recommendations, misuse of medications, etc.

Main benefits of e-Prescription

The e-Prescription project makes the health-care system environmentally friendlier. Since the data communications are digitized, it significantly reduces paper usage throughout the health-care sector.

With approximately 8 million prescriptions issued each year, the e-Prescription solution enables the saving of a significant amount of time for all parties. This frees up time for both the patient and the doctor and reduces administrative strain on the hospital.

Doctors spend significantly less time issuing prescriptions. They will get feedback as to whether the medication was actually purchased by the patient. In terms of treatment, it is very important for doctors to know whether their patients have purchased the medications that have been prescribed to them. If a patient’s health does not improve, then it is easier to know whether the problem is with unsuitable medication or with a patient who has simply not followed instructions. The lives of doctors are simplified by the fact that the discount percentage is selected by the system. The system protects doctors from unforeseen costs related to the inaccurate use of subsidies.

Pharmacies spend significantly less time filling prescriptions and can pay more attention to serving clients. For them, things are simplified by the fact that the greater part of prescription data on the prescription is already entered into the e-Prescription system by the doctor, which is why they are only required to add to the prescription information data on the medication that was actually delivered and relevant sales data; in most cases this can be done using a barcode reader. The prescription is then ready for e-invoicing to the Health Insurance Fund.

Patients no longer worry about carrying a paper prescription or losing the prescription. Another major advantage of the e-Prescription system is that doctor visits are no longer needed for routine refills. Patients with chronic illnesses needing a new prescription for their regular medication would only have to contact their doctor by e-mail, Skype or phone, and the doctor can issue refills with a couple clicks of the mouse. After that, the patient can have the drugs collected from the pharmacy by a third party, providing they have the patient’s ID number and show their own ID.

The Health Insurance Fund is provided with fast and accurate reporting. From the authorities’ perspective, this means less paperwork, more time for individual patients, more reliable health statistics, better monitoring of compliance.

Results

Just 15 months after launch, 84 percent of prescriptions are issued digitally. More than 95 percent of pharmacies are ready to process e-Prescriptions. According to a survey of citizens’ satisfaction with health and health care in Estonia, 97 percent of users of digital prescriptions are satisfied with the service.

Two awards

The e-Prescription system ranked first in the category of e-health and environment projects at an e-service contest, which included 71 new Estonian e-solutions. The e-Prescription service is thus representing Estonian e-services at the World Summit Awards.

The Estonian Health Insurance Fund also received a quality innovation award in 2011 in the ‘public sector organizations’ category for the creation and implementation of the Estonian e-Prescription system. The Quality Innovation Awards competition is open to the participation of Estonian, Finnish, and Swedish organizations.