Electronic prescriptions trial begins

Romania’s e-prescription service became operational at the start of this month for a trial period and will become compulsory in July. By the end of the year it will be working in parallel with offline prescription, the National House of Health Insurance has announced. However, industry pundits question whether Romania is ready for e-prescription.

To begin with, e-prescription has some uncontestable advantages, in the view of some health pundits who discussed the issue at the seventh E-Health Congress in Bucharest.

One important benefit is that it acts as a system of checks and balances, cutting down on the high level of fraud that exists at the moment.

“Health money is not protected; there is currently no internal control system to stop fraud. False prescriptions and the reporting of false services amounts to EUR 400-500 million a year, and we must close this circle of fraud,” said Nicolae Lucian Duta, former president of the National House of Health Insurance.

He also pointed out that when the platform is fully functional, including the patient’s electronic file, “Romania will join the European countries with very up-to-date e-health mechanisms.”

Another advantage is that “e-prescription could guide doctors when prescribing medicines,” indicated Adrian Pana, consultant for health policies. He cited the results of a study carried out in Western Romania which found that in 30 percent of prescriptions there was significant incompatibility among the prescribed medicines, while the doses were up to three times higher than allowed.

However, various questions have been raised regarding the ability of the system to perform, as well as the barriers that doctors will face along the way. In the first half of the year, the consumption of medication in Romania reached RON 2.93 billion.

This was up 21.6 percent against the same period of 2011, but down 12.7 percent on the second half of last year.

The consumption of pharmaceuticals in Romania is estimated to see an 8.9 percent growth this year.

The question is whether e-prescription can deal with this volume?

“This IT system is ready to deal with tens of thousands of simultaneous sessions and see a doubling in its volume of activity, which we believe will happen over the next five years. This is a 21st-century system and at least in the following period we do not expect it to need improvement,” said Dr. Dorin Ionescu, general manager of the National House of Health Insurance. He explained that the system was tested for 10,000 simultaneous users, which exceeds the current capacity of the health system and therefore there should be no problems related to its functioning.

But the simplest things could prove to be a burden. More than one third of family doctors are working in rural Romania and lack access to the internet. Out of 12,000 family doctors in Romania, 3,800 have their practices in villages, some of which lack access to the internet and even electricity, which could impede the implementation of e-prescription.

Doctors in these areas will be able to use offline reporting, Ionescu said. In the meantime, the government is striving to bring broadband internet to all city halls.

Moreover, e-prescription will generate supplementary expenses for family doctors – connected to the price of the internet subscription and the acquisition of a printer and the necessary stationary items – pointed out Sandra Adalgiza Alexiu, secretary of the National Association of Family Medicine.

The necessary investment could amount to over RON 500, and it is not yet clear which funds will cover it, she said.

Additionally, if family doctors do not comply with e-prescription, they will get a warning in the first month, while the next month, their monthly bonus of RON 100 will be cut by 10 percent, and they must pay for the prescriptions they have issued from their own pockets.

“On the other hand, the CNAS does not pay any penalties if the system is not working,” pointed out Alexiu.

Even though, she said, she agrees with the introduction of e-prescription, doctors should be “encouraged to implement this project, since sanctions defy common sense. When this system was introduced in the United States, doctors adhered to it gradually, and while penalties existed, they amounted to 1.5 percent of the doctor’s salary,” she added.

The IT system was the work of Siveco Romania and is part of an integrated platform which also includes the patient’s electronic card. The entire system cost about EUR 9 million and was financed from non-reimbursable European funds.

Otilia Haraga

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