Estonian Digital Prescription
The Prescription Centre is a centralised database with necessary services that provides access for doctors and pharmacies. The main goal of the Centre is to provide access to all prescriptions issued in Estonia so that the medicine can be bought from any pharmacy in Estonia.
@Photo from Pixabay.
Summary
The Digital Prescription Centre In Estonia has been working since 2010. The Prescription Centre is a centralised database with the necessary services that provides access for doctors and pharmacies. The Prescription Centre is linked to the Health Information System (EHR), Estonian Insurance Fund and different Health Care Providers via the X-road. All digital prescriptions are collected in the Central Prescription Centre in Estonia. The main goal of the Centre is to provide access to all prescriptions issued in Estonia so that medicine can be bought from any pharmacy in Estonia. A doctor prescribes the medicine in their infosystem for a patient (everybody in Estonia has their personal ID-code) and sends to the Prescription Centre via the X-road. When a person goes to the pharmacy, a pharmacist detects the person's identity card and sells the medicine. In case there is a preferential rate for the medicine, the person pays only the preferential price and the pharmacy will receive the remaining amount of the full price from the Estonian Insurance Fund on the basis of automatically generated reports. There is also a securely working solution available when buying medications for family members.
The Prescription Information Centre displays the data to each patient's EHR Portal where all prescriptions can be seen by the persons themselves. Doctors can see the data on whether the patient has purchased the medicine. It is very important for doctors to see all current prescriptions of the patient to be able to evaluate dangerous interactions.
| URL | |
|---|---|
| Focus | Citizens Business Government |
| Start date | 1 Jan 2010 |
| Domain | Health |
| Scope | National/Federal |
| Country | Estonia |
| Nature and status of project | Rolled Out |
| Is the OOP case/enabler mandatory? | Opt-in |
Enabling assets or components
Relevant Enablers
Estonian data exchange layer for information systems (X-Road)
Estonian Public Key Infrastructure
Estonian Catalogue of Public Sector Information (RIHA)
Estonian three-level IT baseline security system ISKE
Legal interoperability
Medicinal Products Act, https://www.riigiteataja.ee/en/eli/516052016002/consolide
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Health ServicesOrganisationAct, https://www.riigiteataja.ee/en/eli/513032017001/consolide
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Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
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Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
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Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
Socio-cultural influence factors
Legal and organizational interoperability: legislation approved by stakeholders
All registers must linked by use commonly accepted keys:
• personal code for citizens,
• code of institution,
• standardised address presentation.
Secure data exchange layer X-Road (https://www.ria.ee/en/x-road.html) is used for gathering data from different registers. X-Road is a technological and organizational environment enabling a secure Internet-based data exchange between information systems. All registers and Statistics Estonia must be a member of X-Road
Information regarding the X-Road members and the services they provide is available via the Administration System for the State Information System (RIHA). RIHA (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) serves as a catalogue for the state’s information system. At the same time RIHA is a procedural and administrative environment via which the comprehensive and balanced development of the state’s information system has ensured. RIHA guarantees the transparency of the administration of the state’s information system and helps to plan the state’s information management.
PKI or the public key infrastructure (https://www.ria.ee/en/public-key-infrastructure.html ) enables secure digital authentication and signing. The infrastructure also allows forwarding data by using an encrypting key pair: a public encryption key and a private decryption key. In Estonia, this technology is used in relation with electronic identity (ID card, mobile ID, digital ID). All members of X-Road are using Digital seal certificates for signing messages. Citizens and officials are using electronic identity tokens.
All participants must be implemented three-level IT baseline security system ISKE (https://www.ria.ee/en/iske-en.html). The goal of implementing ISKE is to ensure a security level sufficient for the data processed in IT systems. The necessary security level achieved by implementing the standard organisational, infrastructural/physical and technical security measures.
Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must followed.
Data handling / data exchange
Type of data sharing
Actual data
Data handler
| Stakeholder name | Stakeholder type | Stakeholder role | Kind of data |
|---|---|---|---|
Prescription Register (Health Insurance Foundation) | Government | Data provider | Health data |
| Health Information System (TEHIK) | Government | Data controller | Health data |
| Population Register | Government | Data provider | Data about person |
| Business Register | Government | Data provider | Business data |
| Citizen as Patient (via www.eesti.ee or www.digilugu.ee ) | Citizen | Data subject | Health data |
| Address Data System | Government | Data provider | Address data |
| Pharmacists | Business | Data consumer | Health data |
| Health Care providers (GP, Hospital, Emergency service, Dentists, nurses) | Business | Data provider | Health data |
| Medicines Coding Centre – ATC code and Medicines (State Agency of Medicine) | Government | Data provider | Semantic assets |
| Register of Handlers of medicines – Licences of Pharmacies and pharmacists (State Agency of Medicine) | Government | Data provider | Semantic assets |
| Medical devices Registry (Health Care Board) | Government | Data provider | Semantic assets |
| Health Insurance Status Register (Health Insurance Foundation) | Government | Data provider | Insurance data |
| Health care providers Register (Health care Board) | Government | Data provider | Semantic assets |
| Health professionals Register (Health care Board) | Government | Data provider | Semantic assets |
| HIS X-Road MISP – Portal for GP | Business | Data consumer | Health data |
| HIS X-Road MISP – Portal for Pharmacies | Business | Data consumer | Health data |
| HIS X-Road MISP – portal for Emergency Mobile Stations | Government | Data consumer | Health data |
| State Information Board (X-road, eID, Mobile-ID, ID-card, www.eesti.ee ) | Government | Data consumer | Health data |
Architecture
Lessons learned
Benefits:
• A patient can buy a prescription medicine from any pharmacy in Estonia
• Persons can buy prescription medicines for their relatives as well
• Each attending doctor is able to see whether a patient has bought the prescribed medicine of not
• For patients` is important to meet the right level of reimbursement, get an E-consultation or second opinion
• Log data available for every prescription
• For doctors` is important to prescribe the right level of reimbursement, give an E-consultation
• For doctors is available the possibility the detection of medicines over- or misuse, access the full medicines history
• A physical visit to the doctor is not required for issuing a recurrent prescription for chronic patients, as the attending doctor can simply renew the digital prescription
• Each attending doctor is able to see which prescriptions (both historical and current) a patient has from other doctors in order to assess pharmaceutical interactions (DP, DHR)
• For Pharmacists’ :Less data to enter into system, Easier invoicing, Less illegible paper prescriptions
• For State is available the good statistics and an efficient tool for policy changes
• Various public agencies can order aggregate and anonymised statistics
• Scientists can conduct research based on different linked databases, subject to a permission of the ethics committee
Enablers:
• Legal, organizational, technical, social-cultural, fiscal and professional interoperability
• Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used, The use of X-Road ensures complete security of the exchange of data
• The unique personal identification code provide opportunity to merge personal data from different registers.
• The unique company commercial registry code provide opportunity to merge business data from different registers.
• eID and PKI infrastructure needed. Citizen, Doctors, Pharmacists and nurses can use for login IDcard, mobileID or digiID
• Prescription Centre meets very high security requirements for trust reasons (Baseline security system ISKE)
• Master data in registers must described in catalogue RIHA properly
• All e-health classificators are regulated by government act and published at publishing center https://pub.e-tervis.ee/ and identified by OID register
• The Data security guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed by all counterparts.
Barriers:
Economical motivation is needed for stakeholders
High development costs (harmonizing the work flow processes and data models among different health care providers, implementing the international standards and indicators )
High standardization cost (medical terminology and international standards adaptation)
Organisational interoperability – different health care rules in the states
Global and local market policy barriers
Source: https://scoop4c.eu/cases/estonian-digital-prescription
Disclaimer: Please note that this article is a result of the SCOOP4C Pilot Project, not an application of a CEF Building Block.