Prescription without specified recipient (ambulatory)
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In this paragraph, the term ‘prescription’ is used to indicate the message through which a patient may pick up a medicinal product from a supplier. A prescription contains an MA and a VV.
In the Netherlands it is customary to digitally send prescriptions to a receiving pharmacy instead of having to collect prescriptions. This requires that the pharmacy is already known.
This paragraph considers whether more flexibility can be achieved in the logistical processing of prescriptions, without cancelling out current advantages. This paragraph may be seen as a long-term vision that we aim towards.
Basic principles
When considering how to achieve flexibility in the processing of prescriptions, these basic principles have been formulated:
- The patient is free to choose where prescriptions are handled
- The current option for sending prescriptions remains possible.
- The information system must reuse the same functionality as much as possible.
- A prescription may only be dispensed once.
Since the methodology described below uses the existing method of sending prescriptions, the same legal rules and regulations apply to prescription validity. All discussions about electronic signatures are equally applicable to the current method of communicating prescriptions.
Details
A patient may choose from 3 options:
- A prescription is always sent to the same regular pharmacy.
- The patient indicates each time where the prescription has to be sent.
- The patient does not give any indication, and goes to a pharmacy which subsequently requests and processes the prescription.
Options 1 and 2 require a patient portal, in which the patient indicates his preference. For option 2, a patient may define a preferred pharmacy which would be at the top of the selection screen when the patient is asked where the prescription must be sent. If the patient does not give any indication, option 3 can be the only procedure.
The method partly uses a concept called “publish and subscribe”.
It is important that the supplier explains this principle to his customers.
Work process
A physician decides to create a prescription for a patient. This may be during a consultation or even when repeat prescriptions are requested. The physician registers the prescription in his prescribing system (EPS). The physician does not need to consider the pharmacy as the patient handles this through the portal.
After approval of the prescription, a central prescription index is updated. The EVS automatically sends a notification to this prescription registry to facilitate this. Here, the prescription index is seen as a separate registry with the data type “prescriptions”. It is always possible to consider whether or not this can be merged at a later time. Initially, atomic registration in the registry is being considered. However, at a later date, consideration could be given as to whether categorical registration would be sufficient.
It is important to realise that currently only a notification is given when a prescription is ready. After all, the prescription is still in the EVS database with the status “is available”. There is no prescription message yet.
The prescription registry knows from the patient’s preference settings what needs to be done with the notification:
- With the option ‘send to regular pharmacy’, a notification is sent to the subscription holder of the patient with the message that a prescription can be retrieved.
- With the option ‘patient indicates pharmacy’, the prescription registry sends a notification (e.g. SMS) to the patient. The prescription registry then waits until the patient uses a smartphone app or the patient portal to indicate to which pharmacy the notification should be sent.
- With the option ‘no indication’, the prescription registry does nothing. The patient does not have a regular subscription holder.
Processing by pharmacy
A receiving pharmacy can deduce from the transmitted notification signal (data type) that it refers to an open prescription. The signal also identifies who the patient is as well as the source of the prescription.
For patients who selected option 3 (no indication), the process starts now. The patient identifies himself and notifies the pharmacy that a prescription is ready at a certain institution. The supplier may look in the prescription registry to find out which EVS is involved.
The pharmacy information system asks the EVS source system to send the prescription of the respective patient. Since this is a request without medical content, it may even be submitted at lower trust levels.
Sending via EVS
If an EVS receives a request for “sending outstanding prescriptions”, the EVS will check whether prescriptions are indeed outstanding. This prevents a prescription from being retrieved several times. The address of the pharmacy is entered and the prepared prescription message is finally created. The prescription message is sent to the respective pharmacy.
If the prescription has been retrieved before, an error message is sent to the retrieving pharmacy announcing that the prescription is no longer available.
Sending prescriptions is the standard process and already customary for pushing prescriptions. The advantage of this is that the receiving pharmacy only needs to maintain one method for processing received prescriptions. It is noted again that the same legal rules and regulations continue to apply.
After sending a prescription, the EVS also sends a notification to the prescription registry to remove the entry of the outstanding prescription. This indicates that the respective prescription can no longer be retrieved.
