An evaluation of e-prescribing at a national level

Abstract

Objective: The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled.

Materials and methods: The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies.

Results: According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains.

Conclusion: The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.

• Electronic prescription
• health information exchange
• impact assessment

DECLARATION OF INTEREST

The authors report no conflicts of interest. Ethical approval was not required for this study, as it did not involve human subjects or identifying information.

Annex 1

Architecture and functions of the e-prescription

The e-prescription service is based on the information exchanged between several databases. The prescription process is initiated in the physician's information system, when the physician enters a person's identification code. This is followed by the pharmaceutical component and dosing information. On the basis of this data, the system acquires the reimbursement rate for the compound and the e-prescription is stored in the PRC database.

The patient can then visit any pharmacy in the country. The pharmacist is able to see all of the patient's prescriptions and the patient can buy all the outstanding prescriptions on his name. A person can also purchase pharmaceuticals prescribed for someone else. Both the person purchasing the drug and the person it is prescribed to need to be identifiable. As the PRC contains all data on prescribed medication, information about paper prescriptions will have to be manually inserted by the pharmacist. Physicians' information systems can request data on whether the prescriptions have been collected.

Technically the PRC is a database built on SAP ERP and PI-platforms that enables information to be written and processed on prescriptions and medical device cards. It communicates with external partners via the X-road where the data is exchanged through XML-based SOAP (Simple Object Access Protocol) messages. The systems is linked to the PRC and is be supported by documents in HL7 format inside the SOAP for some or all functions, depending on the health care provider's information system's preference. All messages are based on UTF-8 encoding.

The Estonian Government has employed uniform security standards that public sector databases and registries need to adhere to. They are based on German Information security standard and modified for the Estonian context. According to this, the PRC applies security level K3 where complete functionality of the system needs to be ensured 99.9% of the time. The maximum amount of downtime is 10 minutes per week according to national regulations (60,61).

Notes

¹ These documents are not publicly available but have been provided by public authorities for the use of this analysis.

² The data for 2013 include the number of prescription forms sold within January–October 2013.