E-prescription: Why electronic prescriptions are not going to work for the time being

The e-prescription is the never-ending story in the German healthcare system. It actually sounds simple: Instead of holding a printed or handwritten form in their hands, patients should in future also be able to receive prescriptions from their doctor digitally. This makes it easier to redeem and makes remote treatment via telemedicine really possible.

Until then, it should be still take a while, because now the project is faltering again. The Westphalia-Lippe region and the state of Schleswig-Holstein have been selected as model regions – the next stage of the roll-out should start there from September 1st, before the e-prescription is to become the standard for patients with statutory health insurance.

However, the Schleswig-Holstein Association of Statutory Health Insurance Physicians announced yesterday that they would be withdrawing, at least temporarily. Data protection concerns of the country’s top data protection officer are given as the reason.

A photo of the recipe via WhatsApp is enough

The advantages of a digital prescription are actually obvious: Instead of first picking up a prescription from the doctor and then taking it to the pharmacy, you can simply send the QR code digitally to the pharmacy. This would give the pharmacy direct access to the original prescription on the servers of Gematik, the national agency for digital medicine. Mail order pharmacies in particular could benefit from this, since they no longer have to request prescriptions by post.

The problem of the privacy advocates: Anyone who sees this QR code could also use it to call up the recipe. Even if doctors don’t send the QR code token by email or SMS, patients will do so in everyday life at the latest. It is enough to take a photo of the printout with your mobile phone and send it via messenger, for example. So the problem of data security remains. You could call it an architectural flaw.

That’s why the critics insist that this QR code should be end-to-end encrypted. In other words, the patients would first have to log in to call up their prescription and then send it (via the Gematik system) to the pharmacy. The Association of Statutory Health Insurance Physicians decided that it was far too complicated. So once again there is a problem with digitization, and once again in the area of ​​conflict between comfort and security.

This dispute is probably about something else. It is not so much the inefficiency in the system that prevents the electronic prescription. It’s more of an unwillingness. Doctors have a lot of work with it, pharmacists risk being attacked by mail-order pharmacies. And most of the patients who are not digitally savvy redeem their prescription in the pharmacy that is in the immediate vicinity of their doctor, and then also have hardly any advantage from the digital prescription.

There are significant shortcomings in the implementation

Some in the industry sense that the panel doctors in Schleswig-Holstein were only sent ahead to introduce delay. The decision has a signal effect. A component of the agreed test phase is now temporarily missing; if it stays that way, the whole schedule will shake. Actually, the project should be extended to six other test federal states as soon as in the model regions 25 percent of prescriptions are made electronically. That too could now be delayed. It’s like an unloved new development area in the neighborhood: A citizens’ initiative can delay it with more or less plausible arguments, but usually not prevent it completely.

Now the Association of Statutory Health Insurance Physicians is far more powerful than citizens’ initiatives. Ultimately, however, the Federal Ministry of Health could use the legal supervision, in this case the Ministry of Social Affairs in Schleswig-Holstein, to call the panel doctors in the north to reason. But it is unlikely that Federal Health Minister Karl Lauterbach, SPD, will escalate the dispute. On the one hand, he has not yet appeared as a fervent advocate of projects for digitization in the healthcare system that are as quick as possible. On the other hand, he probably does not want to start a war with the medical profession before the expected Corona fall. Perhaps the motto of the panel doctors is: leave us alone with the e-prescription for the time being, then we will help again with the vaccinations.

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In addition to the data protection problem, there are other shortcomings in the implementation of the e-prescription that are worth considering. There are actually only three ways of transmitting the prescription data: the Gematik app (which hardly any patient has installed), a paper printout (an e-prescription that is intended to replace the paper prescription is printed out) or the electronic health card (the delivery of which is delayed). delayed in many places due to lack of chips).

More on the subject

  • Jens Spahn baut sich ein Digitalisierungsdenkmal
  • At the end e Doctors and patients decide

    Nevertheless, Lauterbach would be well advised not to put too much pressure on the medical profession. After all, doctors and patients ultimately decide how they want to issue or receive a prescription. Many players in the healthcare sector believe that private prescriptions on paper must still be possible for decades to come – at least as a practical makeshift.

    The news of the exit in Schleswig-Holstein caused concern on the stock exchange yesterday. The stock prices of online pharmacies such as Zur Rose or Shop Apotheke have recently lost value. Pharmacy delivery services such as Mayd shouldn’t have been enthusiastic about the news from Bad Segeberg either.

    They all depend on e-prescriptions so that their business model can work to its full potential. More than the panel doctors in Schleswig-Holstein.

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