Sweden e-Prescription Services

The world’s first electronic prescription was sent in Sweden in 1983. Messaging began to be used in the 1990s, initially in relatively small volumes. Once common standards for health data exchange were introduced in 2000, electronic prescribing became normal practice. Sweden adapted the Electronic Data Interchange (EDI) standard, which Denmark had pioneered, together with a secure mailbox. Around 2001, the EDIFACT standard began to be replaced by an XML message format based on the European pre-standard ENV 13607 and web-based transfer. Following sustained strategic effort to encourage the adoption of ePrescribing, use increased significantly after 2002. In 2016, approximately nine million prescriptions were generated monthly in Sweden, with 98% of these estimated to be e-Prescriptions.

Why was it a success?

• Cooperation between stakeholders
• Standards and format interoperability
• Devoted project group
• Planning
• Step by step and structured
• implementation
• Competition between county councils

e-Prescription services Effect

• 99 % e-prescriptions
• Increased quality
• Patient safety
• Increased citizen service
• Time savings
• Cost savings
• Better knowledge

History

Managing prescriptions for medication, using ICT support, started in the 1970s with the computerization of the pharmacy branch offices where local systems registered handwritten prescriptions and to print labels. In 1984, the first online prescribing started with physicians connected to their local pharmacy system in a pilot test. Then in 1987, the first pilot test started with an off-line system in which PC-based prescriber support systems transferred data to patient-held smart cards that were taken to the pharmacy. In the 1990s, we had the first use of messaging using EDIFACT syntax for prescriptions. These had a relatively small volume until 2000, when an XML version of a European standard based on object-oriented modeling became popular and made electronic prescribing the normal practice, which meant important quality gains.

The prescriber support system developed by Infocard in 1986–88 was innovative in several ways. It received considerable attention from the smartcard community.

This rather advanced decision support system could be presented, with all the previously prescribed medicines, possible allergies and renal function, to the prescribing physician. In addition, it also included information on the products and their use, data that was derived from three sources:

• The Product database used by the pharmacies, updated each month on a diskette, contained the name of the product, its ingredients, strength, packages, and prices.
• The Pharmaceutical information, “Läkemedelsregistret,” included about two pages of information on each product with Indications, Contraindications, Recommended Dose, Side effects, and several more items.
• The Problem-Oriented Drug Book, “Läkemedelsboken,” a five hundred page volume with some twenty chapters for each major disease or problem category (i.e., Pain is not a disease but an important reason for medication). Named experts wrote this book that build on scientific references and various consensus guidelines, and they still publish it regularly. It not only provides advice on the major classes of drugs for illness such as depression, but it also provides guidance for diagnoses and alternative therapies that do not involve medicines. Previously only available in print, it is now also accessible as a PDF version on the web. Our team acquired the magnetic tape used for the typesetting machine at the printers and, because it was systematically organized with various control codes for chapter, subchapters, and so on, they were able to automatically create a very adequate database from this book for use in the local system,

The above-mentioned last part about guidance, based on the intended problem to be treated, was one of the unique features of the support system. Interestingly, now over twenty years later, none of the prescriber support systems has such a feature, partly because the source book does not appear to be a database.

Maryam Ghalandari