National health models and the adoption of eHealth and ePrescribing in primary care – new evidence from Europe

Definitions and methods

ePrescribing has been defined as a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care.29 This definition was used in this study and explicitly includes the electronic transfer of prescription (ETP) as an integral part of the ePrescribing process.

A literature review was carried out to capture the spread of ePrescribing in Europe from 2000 to 2014. An online search for journal articles related to the subject of national ePrescribing between the years 2000 and 2014 was carried out using PubMed, Medline, Web of Science, Academic Search Premier, Business Source Premier and Google Scholar. This search found that a significant body of research has been published on many aspects of ePrescribing in recent years.1,30^–59 For example, a qualitative review of 108 systematic reviews on the impact of eHealth interventions in 201160 found that ePrescribing was the most commonly studied intervention in a study that included picture archive communication systems (PACS), EHR systems, computerised provider order entry systems and computerised decision support systems. Many published research papers, conference papers and reports on national ePrescribing projects were also included in this study.

The EC has undertaken extensive research into the adoption of eHealth in European countries in the last decade, and this material was used in the study. This included surveys of eHealth in primary care in 2002,9 200716 and 2013,10 surveys of eHealth in acute hospitals in 201012 and 2013,14 and a review of national eHealth strategies in 2011.61 Independent reports have also been published about the European health systems, including eHealth and ePrescribing indices in 2009,62 201263 and 2013,64 and this research was included. The European Patient Smart Open Services (EPSOS) project was an EU-funded project (2008–2014) to promote the transfer of patient summaries and ePrescriptions between European countries, and published reports and other data from this project were also included.6,65

Data were gathered and verified on the adoption of ePrescribing in both primary and secondary care in the 28 EU countries and three other countries where comparable data on ePrescribing were published – Iceland, Norway and Turkey. All of this literature was reviewed and analysed to identify trends in ePrescribing in Europe at this time in the following six thematic areas:

1. General eHealth adoption in primary care

2. ePrescribing in primary care

3. ePrescribing in secondary and tertiary care

4. National ePrescribing strategies and projects

5. Recent European ePrescribing indices

6. An EU-funded ePrescribing project EPSOS (2008–2014).

It was clear from the research data that ePrescribing in primary care is a very different proposition than ePrescribing in secondary or tertiary care.

In primary care, a wide range of routine services are provided by a number of different professionals (GPs, dentists, pharmacists, physiotherapists, public health nurses and so forth) in a variety of different outpatient settings,66 which vary from country to country.15,67,68 Because of the geographically widespread and fragmented nature of primary care, ePrescribing in this environment explicitly demands the transmission of prescriptions electronically from GPs and other prescribers to community pharmacists over national networks using ETP infrastructures, and in turn community pharmacists transmit dispensed medication records electronically to GPs and other prescribers, and also to national reimbursement services or national medication registries.

On the other hand, secondary or tertiary care is generally provided by specialists in hospitals66 (often referred by a professional in primary care) and ePrescribing in hospitals is a different challenge, with special requirements (medication is prescribed to be directly administered), technologies and regulations. It usually takes place within a single institution or campus in a secure private network, with a different degree of complex interoperability and data regulation than that required in the primary care sector, but with a more urgent medical need and a higher risk factor. Because the ETP challenges in hospitals are not as great as those encountered in the primary sector, hospitals are more likely to attain ‘the gold standard’, which is ‘a closed-loop medication administration system that may include medication reconciliation and adverse drug event monitoring’.12^,69 In the interest of clarity, ePrescribing in hospitals was excluded from this study, and the focus was exclusively on ePrescribing in primary care.

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