Bom dia and tere too! Since the end of July it’s been possible for Estonians to pick up medications prescribed by their Estonian doctors while staying in Portugal. Portuguese citizens have been able to do that in Estonian pharmacies since 2020, making the ePrescription services at last reciprocal.
The reason for this two-year gap is that it takes time to link up different pharmacy information systems, and integrate them into the European crossborder e-Prescription service, according to Karilin Engelbrecht, head of communications for TEHIK, Estonia’s Health and Welfare Information Systems Center, which manages Digiretsept, Estonia’s e-Prescription service.
“To put it simply, we have made our health data suitable for the central software provided by the European Commission and Portugal has made it possible to accept our data from the central services,” Engelbrecht said.
Spain and Poland to follow
The process is ongoing and similar interoperable e-Prescription services will be rolled out between Estonia and Spain and Poland by the end of the year too. The work is part of a longstanding effort to make it possible for Europeans to obtain prescription medication anywhere in Europe.
“The plan for the coming years is for the cross-border digital prescription to work in 25 European countries,” Engelbrecht confirmed.
Crossborder digital prescription services were pioneered in Estonia and Finland, Engelbrecht noted, in part because both had functional e-Prescription platforms that could be easily integrated. Estonia introduced Digiretsept more than a decade ago and is one of the most used digital services in the country. Using Digiretsept, a physician needs to enter the prescription into a patient’s electronic health records, and it can be picked up at any pharmacy after showing an identity card or passport.
Since June 2020, Estonians have been able to obtain medicines prescribed to them in their home country while visiting Finland. Finns have been able to buy their prescription medicines in Estonia since January 2019. According to TEHIK, Estonians have used the crossborder services 6,200 times since it was introduced, and Finns have used the reciprocal service more than 17,000 times. Estonians have also been able to pick up their medications in Croatia since August 2020.
This streamlining of ePrescription services around Europe has been undertaken in line with two European initiatives. The first, called ePrescription and eDispensation, support the efforts to make it possible for the citizens of one EU country to obtain their prescription in another EU country. The second, called Patient Summaries, will make it possible for doctors to obtain a digital summary of a patient’s health data in their language of choice, almost anywhere within the EU. Twenty-five of the 27 EU member states are taking part. The exceptions are Denmark and Romania.
The EU has introduced its own eHealth Digital Service Infrastructure to support the cross-border exchange of health data. This includes a common ICT infrastructure and crosscutting services. Those with their own ePrescription platforms can then link those to the infrastructure via a National Contact Point for eHealth (NCPeH). This allows participating countries to interface their systems with the data exchange platform to share data with other European countries.
As such, the ability to obtain digital prescriptions is dependent on the readiness of other countries as they join the service. Countries that already have working a crossborder e-Prescription service have had it somewhat easier, while other countries have needed to build their services before linking them up to the NCPeH, Engelbrecht said.
For Estonia, the deployment of the service has required a large amount of work, Englebrecht acknowledged, not only in regards to technical challenges, but also legal, organizational, and semantic questions.”That’s also why countries deploy services at different times, according to their national readiness,” she said.
Continuous testing plays an important role in the service and to ensure the interoperability between different countries, Engelbrecht continued. While making the Digiretsept IT solution available for foreigners to use within Estonia, as well as accessible to Estonians abroad has been relatively simple, TEHIK has collaborated extensively with the Estonian Ministry of Social Affairs regarding legal aspects, as well as the Estonian Health Insurance Fund. And innovation continues.
“Since the whole project is ongoing, TEHIK still has an active role to play in it,” Engelbrecht said. This involves developing and maintaining the service, making any necessary upgrades, and also resolving semantic issues related to translations, for example. TEHIK also undertakes testing of the system with other countries, and actively participates in eHDSI workgroups, she said.
Crossborder e-Prescription services have been well received so far, Engelbrecht added. She noted that Finns frequent the pharmacies around Viru Keskus, a major shopping centre in Tallinn, and that the use of cross-border prescriptions there is already a regular part of the pharmacies’ operations today.
One drawback is that only one prescription can be sold at a time to non-Estonian customers, while Finns sometimes want to fill multiple prescriptions at a time. Engelbrecht said that this technical limitation is at the national contact point level. As such, there is room for improvement.
“Otherwise, the attitude of pharmacists is very positive and they like this kind of innovation,” she said.