March 13, 2024, 3:16 pm | Read time: 6 minutes
Since early 2024, the e-prescription has been available to simplify the collection of medications. No more paper printouts, the prescription is always on the health card. What sounds good, however, still doesn’t work smoothly months after its introduction.
Since the beginning of the year, patients can obtain medications via electronic prescription–or e-prescription for short–at pharmacies. During the preliminary test phase, not everything went smoothly. Even at the start, pharmacies and medical practices expressed significant concerns about whether the technical infrastructure would function reliably. An initial interim report shows: There are still hiccups.
Ongoing Issues with E-Prescription
Since the introduction of the e-prescription, reports of new problems have been constant. These are often technical in nature. Currently, there are increasing outages and restrictions in the so-called telematics infrastructure, the central platform for digital applications in the German healthcare system. The e-prescription is stored on it after being approved by the doctor, and pharmacies can retrieve the prescription with the corresponding key–if everything works. However, there are problems with storing or retrieving the e-prescription, which affect the entire process.
Tatjana Zambo, president of the State Pharmacists’ Association (LAV), explains: “Disruptions in the central system act like a handbrake, because either the doctor’s office cannot generate an e-prescription at all, or a stored prescription cannot be retrieved in the pharmacy–or both. This is usually inexplicable to patients.” As the LAV reports, the telematics infrastructure was at least partially unavailable or only accessible on four of the past ten days. Pharmacies are therefore demanding “immediate action to ensure reliable stability.”
Gematik, the national agency for digital medicine, confirms the issues, which are said to occur mainly in the morning hours. However, Medisign, one of four approved providers of electronic health professional cards (eHBA) and practice and institution cards (SMC-B), is responsible and not a direct contractor of Gematik. They are working hard to solve the problem. Both Gematik and Medisign are in intensive and constant communication. “Inserting the insurance card multiple times in the pharmacy or trying again after a few minutes can help in the meantime,” says Gematik.
Read also: How to Properly Use the New E-Prescription
Waiting Times in Pharmacies
Not only due to such outages is there currently the most reason for complaints in pharmacies. This is where the frustration of patients is directly expressed when the e-prescription cannot be redeemed. The pharmacists are the ones who suffer. However, they are the wrong recipients when there are technical problems.
Initial surveys among pharmacists show that non-functioning server connections via the established telematics of the healthcare system are not even the biggest problem. The bottleneck is in the medical practices, criticizes the ABDA, the Federal Union of German Associations of Pharmacists.
Doctors release prescriptions using a so-called batch signature. However, many do this only in the afternoon or even later. Those who go directly to the pharmacy after a doctor’s visit to redeem their e-prescription with the electronic health card may end up going home without medication. Either because the doctor has not yet released the prescription by signature, or because the release has not yet been transmitted (this can also take some time).
Especially for people who rely on pain-relieving medications, the delay is frustrating. For this group, multiple visits to the pharmacy are hardly acceptable. Although in such cases, the pharmacy’s delivery service can also be used. Still annoying, because a digitalized prescription raises the expectation that the entire process would be accelerated.
Therefore, some pharmacies are calling on Federal Health Minister Karl Lauterbach to abolish the batch signature. The Federal Ministry of Health has already responded: Abolition is not possible because the software used does not allow it.
Medical Practices Identify Weaknesses
There is also quiet criticism of the e-prescription from the medical community. New processes raise a multitude of questions. Therefore, the advisory effort in practices has increased with the introduction of the e-prescription. Especially older patients are uncertain when they are supposed to go to the pharmacy without the usual prescription slip.
It should be noted again at this point: Practices must still print a prescription upon request. However, inconsistent regulations cause further confusion. For example, people with diabetes receive the necessary insulin via e-prescription. However, the syringe required for this is still provided as a paper prescription. A uniform solution is needed here in the medium term.
Medical practices also complain about technical difficulties and server outages. However, there are far greater concerns. For example, for people who rely on care, either at home or in a facility.
Some doctors criticize that in this case, the e-prescription poses a real problem. Because it always requires a person with the necessary time to present the electronic health card at the doctor’s office and later at the pharmacy. As a result, care in the usual scope is not always guaranteed.
While a paper prescription must also first be picked up at the practice to be redeemed at the pharmacy. The delivery problem has existed for people in need of care long before the e-prescription. Responsible organizations must fundamentally come up with a better solution here.
For example, the e-prescription could be sent directly to a pharmacy if a power of attorney is in place from the person in need of care. The pharmacy then delivers the medications via delivery service. Time-consuming trips would be eliminated, and the entire process would be automated, in the interest of the patients.
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Widespread Satisfaction Among Patients
Interestingly, the least criticism comes from patients. According to a representative Deloitte survey, nearly 90 percent of respondents are satisfied with redeeming the e-prescription. Most respondents use the electronic health card to redeem the e-prescription–65 percent do it this way. The app developed specifically for the e-prescription is used by 19 percent. The rest still rely on the paper printout.
And something else has become apparent: The concerns of pharmacies and medical practices regarding older patients and the e-prescription are not justified according to this survey. The highest satisfaction with the e-prescription comes from the group of those over 65 years old.
The Positive Prevails
There is reason for hope. Every innovation comes with challenges. The important thing is: All parties should sit down together at the right time and openly discuss all weaknesses regarding the e-prescription.
In conclusion, it remains to be said: It was and is an overall bumpy start for the e-prescription. But despite justified criticism, the positive outweighs all feedback.