Discrepancies between ePrescriptions and dispensing in Belgium, 6 years after the launch of the electronic prescribing – a mixed-method study

ABSTRACT

Objectives

The number of electronic prescriptions (ePrescriptions) grows steadily in Belgium as in other European countries. In the future, Belgium wants to dematerialize the ePrescription flow, removing all paper trails. A quality check of the digital content and implementation of national ePrescription guidelines in the field was conducted, comparing the content at both prescription and pharmacy side.

Methods

An explanatory mixed-methods design was applied. In a first phase, potential problems (warning flags) were identified by consulting stakeholders. Secondly, the warning flags were validated to problems (errors) in a random set of ePrescriptions collected in April 2019. In a third phase, explanatory interviews were held with various stakeholders in order to find explanations and to identify the initiators of these errors.

Results

In the first phase, 15 warning flags were identified to evaluate the quality of an ePrescription. In the second phase, a random selection of 11,798 ePrescriptions was validated. The most prevalent errors found, were the digital construction of the messages (18.88%), combined with lots of necessarily deemed substitutions by the pharmacist (3.39%) not following what was prescribed originally. In the third phase, stakeholders indicated that software of the prescriber and the use of inconsistent databases between prescriber and pharmacy can often be seen as the cause and initiator of these problems.

Conclusions

Use of authentic medication databases and well-designed software systems have the potential to solve ePrescription problems. Focus should go to prevention instead of detection.

KEYWORDS:

• Electronic prescribing
• community pharmacy services
• public health
• software evaluation
• mixed methods study

Acknowledgments

The authors would like to thank everybody that was involved in the study, going from the design of setting up warning flags to persons cooperating the interview phase. They also would like to thank Koninklijke Limburgse Apothekers Verbond (KLAV) tarification service for providing the data on which the authors performed this study and for providing valuable insights and discussions around the tarification process. KLAV also was a tremendous help in the manual evaluation of warning flags and the presence of errors within the electronic prescription. The authors also like to thank the Association of Pharmacists Belgium (APB), who gave multiple valuable inputs in the continuation of this project. Lastly, the authors would like to thank all interviewees providing details and answers of why something is a mistake and stating what the current practices are in their opinion.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. KMEHR stands for Kind Messages for Electronic Health Records and is the national XML based standard in Belgium for sending electronic messages related to the health situation of a patient.

2. XPath is a query language for selecting certain nodes from an XML document, like the KMEHR message that represents the ePrescription. With XPath rules defining what fields are required and the minimum or maximum number for certain fields, we are able to verify a correct construction of the ePrescription.