Greece e-Prescription Services

The introduction of e-prescription was swift: development started in 2010, a pilot was run in October of the same year and the official launch was on January 24th 2011. By the fall of 2011 around 40% of prescriptions were covered, and by fall 2013 almost full coverage was reached. E-prescription was one of the initiatives that contributed to the reduction of the total pharmaceuticals’ expenditure by approximately 33% between the years 2009 and 2011.

Before the introduction of e-prescription prescribing was supported by prescription booklets issued by Greek social security funds. These booklets were kept by the patients and used during their interactions with doctors and pharmacists.

Process of prescription in paper based system

The booklets were personalised: they contained a photo, identity information such as name, birth date, address, registration id (for the fund’s internal registry), national tax id and a unique identification number per booklet. Each booklet contained fifty double-sided prescription pages and their carbon copies (a white coloured original and a yellow coloured copy).

Each prescription page had on the one side fields to be used by the prescribing doctor (including doctors’ information, diagnosis, drugs description and quantity) and by the dispensing pharmacist (including pharmacist information, drugs’ cost and patient’s cost share) and on the other side a template for attaching identifying adhesive labels from the packaging of the drugs dispensed. These labels are mandatory for all drugs circulating in Greece. Drugs carry a serial number that identifies each pack uniquely. Serial numbers are used for preventing reimbursement fraud and monitoring consumption and expenditure. The booklet format was defined in 1998 and revised in 2008 to include the national insurance number (AMKA) and a barcode.

Patients carried with them their prescription booklets when visiting a doctor. Doctors would use a page for prescribing drugs, sign and stamp the page and hand the booklet back to patients.

Afterwards, patients could visit any pharmacy, hand the booklet to the pharmacist who would then complete the remaining fields on the front of the prescription page, sign and stamp, tear off the page (the yellow copy remained in the booklet), fetch the prescribed drugs from storage, detach the identification labels from the drug packages and attach them to the page, handover the drugs to the patient and collect payment (patient’s share of cost). Periodically, pharmacists would send to social security funds lists with filled prescriptions attaching the white prescription pages in order to be reimbursed. The booklet’s yellow pages served as records for the medication history of each patient.

Process of e-Prescription

Access is controlled at the user level (registered users go through a username and password identification process) and a central repository of all prescriptions is maintained nationally. Hospitals access the service over the closed secure network Syzefxis, all other healthcare users use their private internet connections. Prescribing doctors register key information (including the patient’s name and social security number, the diagnosis encoded according to ICD-10, and the medications prescribed) and then, print a summary page which is handed to the patient. Patients can visit any pharmacy in order to obtain prescribed medications. Pharmacists take the printed prescription summary page and scan the barcode to retrieve the prescription from the national central repository (alternatively they can type). Before delivering medications, pharmacists scan the medication packages’ barcodes which are then matched to prescription details. In case of mismatch an error message appears on the screen and processing cannot be completed.