Digitization in healthcare: practical test for e-prescriptions


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Status: 07/01/2023 09:32 a.m

A new way of redeeming electronic prescriptions at pharmacies is starting today – using an insurance card. But the practical implementation could still snag at some points. Doctors speak of a “quick-fix procedure”.

The electronic prescription is intended to put an end to paperwork in doctor’s surgeries and pharmacies. “That certainly makes sense,” says family doctor Christoph Lembens from Mainz. That’s why he now relies on the e-prescription – there’s no way around it in the long term, he says. But he is skeptical that the technology will work properly in the early days. “For example, months later we still have problems with the electronic certificate of incapacity for work,” says Lembens. Now comes the e-prescription by insurance card, the application should be the standard from July. Family doctor Lembens speaks of an introduction “in a hasty procedure”.

So far niche existence

The e-prescription itself is not brand new. So far, it can be redeemed in two ways: via a smartphone app or with a kind of QR code printed on paper. However, this ultimately analogue variant has no practical advantage over the conventional pink paper recipe. The existing app is also rarely used.

So it’s hardly surprising that the e-prescription has so far been a niche market. According to the German General Practitioners Association, only 2.16 million e-prescriptions have been redeemed since the first tests two years ago. By way of comparison: medical practices issue around 450 million prescriptions every year.

New procedure should help e-prescription to breakthrough

The possibility of redeeming it with the electronic health card should now help the e-prescription to achieve a breakthrough. The prescription issued in each case is not stored on the card itself, but on a special server within the data network of the German healthcare system. To call up the prescription, patients have to insert their insurance card into a reader in the pharmacy. This initially applies to those with statutory health insurance. For privately insured people, the e-prescription will come later.

Tests in model regions canceled

The e-prescription was tested last year in two model regions: in Schleswig-Holstein and Westphalia-Lippe. But the tests there were canceled due to privacy concerns. According to the Federal Commissioner for Data Protection, the originally planned procedure with the insurance card was “very susceptible to manipulation”. Because the procedure was not technically checked whether the insurance card used was actually genuine: “By simply knowing the insurance number of a person, unauthorized persons could have gained access to the e-prescriptions of the insured person with simple means.”

In the meantime, improvements have been made here, so that when an e-prescription is requested, it is now also checked “whether the associated card for the insurance number is actually in the reader”.

Introduction with a crowbar?

Just two weeks ago, Federal Health Minister Karl Lauterbach announced in a newspaper interview that patients will be able to access e-prescriptions with their insurance card for the first time on July 1st. This means that the e-prescription is “finally suitable for everyday use,” said Lauterbach.

The National Association of Statutory Health Insurance Physicians speaks of an “introduction with a crowbar”. “The process has not yet been tested,” says board member Sybille Steiner. Their goal was to test the e-prescription using the electronic health card in the model regions – and then, if it works, to roll it out further.

Steiner warns of technical problems if the e-prescription becomes a mass application: “We don’t know whether the system is actually running at high capacity.” In the management systems of some medical practices, the e-prescription processes did not yet function smoothly and in a user-friendly manner. “Creating a digital signature for an e-prescription takes longer than signing a paper prescription.”

Hope and skepticism among general practitioners

The German Association of General Practitioners also expresses concerns. “We hope and expect that the project will finally pass the practical test, but we are cautious after the experiences of the past few years,” says Federal Chairman Markus Beier. “If, as is the case with many other digitization projects in the healthcare sector, there should be a lack of technology in the end, this will lead to considerable additional work in the medical practices.” For example, if an e-prescription cannot be redeemed at the pharmacy, patients would have to go back to the doctor’s office to get a paper prescription. For them, this means a double route, and additional work for the medical practices and pharmacies.

The success of the paperless prescription is therefore also decided in the almost 18,000 pharmacies in Germany. They have been connected to the necessary data network for almost a year. However, for the redemption process with the electronic health card, the respective software providers have to install updates in the pharmacies. According to the Federal Union of German Associations of Pharmacists, this should have happened in all pharmacies in the course of July. Pharmacies also believe that the demand for e-prescriptions could then increase: the option of retrieving them with the insurance card is “the most patient-friendly solution”.

E-prescriptions are to become mandatory in 2024

Whether the e-prescription will soon actually be widespread depends not only on the technology in the pharmacies, but also on whether most doctors will be using the new procedure from July. There is no obligation to do so. According to plans by the Federal Ministry of Health, this should change at the turn of the year: then all practices must be able to issue e-prescriptions.

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