Electronic prescriptions and the establishment of the ePrescription information system are based on Act No 378/2007 Coll. on Pharmaceuticals, as amended. The ePrescription system is administered and operated by the State Institute for Drug Control (SÚKL), which also caters for the operation of data centres where the data is stored. The doctor uses the ePrescription system to issue an electronic prescription (ePrescription) for the patient on the basis of which the medicine is dispensed in a pharmacy. Each ePrescription is allocated a unique identifier. In the pharmacy, the pharmacist downloads the ePrescription identifier and dispenses the prescribed medicinal product.
Simultaneously, information about dispensing is entered into the Central Repository of Electronic Prescriptions (CÚER). CÚER, as one of the components of the ePrescription system, collects and stores all ePrescriptions under conditions stipulated by legislation. The established ePrescription system falls under eHealth services and since 1 January 2018, its operation in the Czech Republic has been mandatory.
The ePrescription information system – along with mandatory electronic prescribing – ensures proper organisation of data, generates savings on the costs of medicines, prevents counterfeit prescriptions and reduces the error rate during prescribing and dispensing of medicines. Moreover, it empowers the patient, enhancing the provision of information, and increases the quality and safety of patient treatment.
The process of modernisation of the entire system commenced as early as 2015, also with regard to its integration into eHealth – the National Strategy of Electronic Healthcare and the 2014+ Strategic Framework of e-Government Development. The ePrescription project implementation strictly followed the schedule and the project was completed in December 2017. The ePrescription system was included in the critical state infrastructure, and hence has been subject to the tightest security measures as per the Act on Cybersecurity and related legal regulations. Great emphasis is placed upon the security of any personal and sensitive patient data.
All costs of the procurement, support and development of the system have been covered from SÚKL’s own budgetary resources. The project has been managed by the ePrescription unit according to the PRINCE2 methodology; the supplier of the solution was selected in competitive public tendering opened by SÚKL. SÚKL staff also ensured media support of the project implementation in the last phase of its pilot operation. Throughout the implementation, operation and development, SÚKL has been providing maximum support and cooperation to the suppliers of proprietary systems in healthcare facilities.
The entire system has been built as open and modular. At present, ePrescription is connected to essential state administration systems and fully avails of the e-Government Strategy principle. This includes the Basic Registry Information System (ISZR), through which the system verifies the identity of the patient, to ensure an unequivocal allocation of the ePrescription to a specific individual. Each individual’s identity is verified to ensure the trustworthiness, relevancy and freshness of data kept on the individual. Identity is verified against the Registry of Inhabitants (ROB), which is one of the essential registers of the Czech Republic and stores reference data about natural people. Patient identity verification is necessary for the unequivocal allocation of the specific ePrescription or electronic prescription record to a specific individual. It also completely rules out the possibility of someone being able to see – albeit by mistake – the prescriptions of other people, and the medicinal products prescribed for them, to provide for high protection of personal data. Where such unequivocal verification of identity cannot be achieved, it is still possible to issue the ePrescription; it is stored in CÚER and remains in a common ‘repository’ of all ePrescriptions of patients whose identity could not be verified. Access to such ePrescriptions is then based solely on the identifier (i.e. whoever wants to see the particular ePrescription, has to know its identifier), but these ePrescriptions are not displayed in the patient’s medication list.
Since the very beginning, the system has brought many benefits to its users. The patient no longer needs any paper form to have their medicines dispensed, although they may request a paper ePrescription accompanying record from the doctor. Nevertheless, the ePrescription accompanying record sent by e-mail or the identifier provided in an SMS message (depending on the patient preferences) is sufficient. The patient may also view the record of their prescriptions issued and dispensed, i.e. the medication list available in the patient web or mobile application. The patient may also collect their medicines in a pharmacy based on their ID. All of this greatly enhances the convenience and availability of information recorded about the patient in the ePrescription system. It also facilitates and speeds up the entire drug prescription and dispensing process for the patient, who no longer requires a physical visit to the doctor.
For the pharmacists, the new ePrescription practically rules out the possibility of being counterfeited, unlike paper-based prescriptions. Dispensing of medicinal products has also become much more effective. It is no longer necessary to decipher what has been written on the paper-based prescription filled in by hand; all it takes is to scan the ePrescription identifier (a QR code or barcode of the patient’s ID). This facilitates, for example, the dispensing of medicinal products prescribed on repeat dispensing prescriptions that patients often keep for several weeks. Some formal and systemic checks have been set up in the system, so the pharmacist is always alerted of non-standard situations or any discrepancy concerning the respective ePrescription.