Questions/Answers
Question 1
Please briefly describe the initiative, what issue or challenge it aims to address and specify its objectives (300 words maximum)
E-prescription is an electronic document used instead of traditional prescription. E-prescription saves time of patients and doctors. Patient can get e-prescription not only during stationary visit, but also during teleconsultation (e.g. people with chronic disease can obtain prescription without seeing a doctor). E-prescription is delivered by e-mail or sms. It is legible, so reduces the risk of receiving the wrong medicine or wrong quantity. As all e-prescriptions are saved on Internet Patient Account (IKP), it is not possible to loose it. It can be redeemed at any pharmacy in Poland. Patient can redeem medicines on e prescription in different pharmacies. Pharmacist can automatically read data on e-prescription and check availability of prescribed medicines. E-prescription may be issued during teleconsultation. It allows to avoid traditional visit at healthcare facility. It is especially helpful for people from rural area or people with mobility disabilities. However, in order to address also persons digitally excluded, there is a possibility for every patient to ask for a printout of their e-prescription at their doctor’s facility. The solutions therefore responds to the needs of various groups of the society. Its objective is to optimise functioning of the healthcare system.
Question 2
Please explain how the initiative is linked to the selected category (100 words maximum)
The initiative fits within the category: Fostering innovation to deliver inclusive and equitable services. The initiative contributed to increasing access to quality and affordable public services in the field of healthcare. It was addressed to all population of Poland and transformed the service delivery mechanisms (here: prescribing the medication) in order to enhance effectiveness and efficiency in public service delivery in healthcare. It was an important step of digital transformation of healthcare services in Poland.
Question 3
a. Please specify which SDGs and target(s) the initiative supports and describe concretely how the initiative has contributed to their implementation (200 words maximum)
E-prescription supports goal 3.8 (Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all), 10.3 (ensure equal opportunity and reduce inequalities of outcome, including through eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and actions in this regard), 10.4 (adopt policies especially fiscal, wage, and social protection policies and progressively achieve greater equality) of SDGs. It helps people with disabilities or people from rural areas to obtain prescriptions without visiting a healthcare facility.
b. Please describe what makes the initiative sustainable in social, economic and environmental terms (100 words maximum)
E-prescription saves time and transport cost for patients. It ensures equal access to prescriptions for people from rural areas or with mobility disabilities. It reduces queues in healthcare facilities, and thus optimise service providing and limits contact of chronically ill patients with pathogens that may be present in the clinic. It contributes to reducing amount of paper documents and reduces environmental burden related to patients transport to the clinic.
Question 4
a. Please explain how the initiative has addressed a significant shortfall in governance, public administration or public service within the context of a given country or region. (200 words maximum)
Within 6 months of the introduction of the obligation to use e-prescriptions, Poland joined the top countries in Europe, such as Estonia, Denmark and Sweden. E-prescription makes it possible to reduce the number of medical appointments and therefore the benefits of the diffusion of innovative solutions in the area of digital health include: optimisation of resources, beneficial impact on reducing queues to providers, better quality of services through the introduction of high standards and increased access to specialists, better availability of services related to the exclusion of the territorial factor (large centres vs. communes/villages), increased resistance to epidemiological threats and improved continuity of care - a factor which is extremely important in the context of current and future challenges for the health sector.
b. Please describe how your initiative addresses gender inequality in the country context. (100 words maximum)
The service is available for all patients, no matter the gender, age or place of living. It makes access to health care more available, especially for vulnerable groups of society.
c. Please describe who the target group(s) were, and explain how the initiative improved outcomes for these target groups. (200 words maximum)
The main target groups are: patients - recipients of services; service providers (pharmacies and pharmaceuticals); healthcare professionals; public administration bodies. E-prescription gives the patient much more possibilities than a traditional prescription: it’s always legible, cannot be lost or destroyed, it’s easy to check the dosage of prescribed medicines, each filled e-prescription is available at Internet Patient Account, it can be issued, without visiting the doctor’s office. E-prescription for doctors means e.g.: time savings, better communication, facilitation of the treatment process and greater control over this process, reduction of the number of visits related only to the prescription of medicines. In pharmacy the implementation of e-prescribing means: speed and ease of implementation of e-prescriptions; guaranteed full legibility and reliability of e-prescriptions; simplification of the process of filling prescriptions in a pharmacy; optimization of pharmacists' work time. Benefits for the healthcare system: facilitating the control of prescription and reimbursement of medicines (sealing the system), providing information on whether the patient complied with the recommendations and purchased the prescribed drugs, facilitating the analysis of data on drug marketing and reimbursement through access to data on prescribed and filled prescriptions (e.g. tracking trends and patients' health status) and on the quality of treatment provided.
Question 5
a. Please describe how the initiative was implemented including key developments and steps, monitoring and evaluation activities, and the chronology. (300 words)
On 25 May 2018 the e-prescription pilot started. The first phase of the e-prescription pilot project was completed on 30 September 2018. Over 31000 electronic prescriptions were issued. The pilot involved over 60 pharmacies, e-prescriptions were issued by nearly 70 doctors. Over 5200 patients have used them. More than half of the patients who received them were over 60 years old. 28% were between 61 and 70 years old, and 25% were over 71 years old.
As part of the e-prescription pilot, the following were analysed:
• Procedure for connecting pharmacies and healthcare providers to P1 issuing e-prescriptions by office systems of various providers (including signing e-prescriptions)
• Execution of e-prescriptions in pharmacies participating in the pilot
• Functioning of the Patient's Internet Account (including access using the Trusted Profile)
• Access to e-prescription in the pharmacy (printout, sms or e-mail)
• Settlements between pharmacies with e-prescriptions and the NHF
• Functioning of support channels for users, the adopted model of maintenance and cooperation with external providers
• Information and promotional activities
From January 2019, all pharmacies in Poland could process e-prescriptions From January 2020, e-prescriptions were made compulsory for use throughout Poland. By 26.11.2021 the number of e-prescriptions issued is: 857,349,035 to 38 790 389 patients. E-prescription was implemented as part of the P1 project, co-financed by European funds. The implementation of projects indicators is monitored by the Committee of the Council of Ministers for Digitization (KRMC). The eHealth Centre is obliged to submit cyclical progress reports to the KRMC, where Reports are evaluated. Moreover the Steering Committee monitors the whole progress and takes strategic decisions. The SC is responsible for the evaluation of the project in terms of its compliance with the justification and progress towards the objectives adopted for it.
b. Please clearly explain the obstacles encountered and how they were overcome. (100 words)
There were no fundamental problems that undermined the sense of the whole change. However, there were minor shortcomings both on the side of P1 and on the side of hospital and pharmacy systems.
Lessons learned from the e-prescription pilot - implemented changes:
• Optimisation of the process of creating an account in P1 (especially pharmacies and pharmacy points pharmacies)
• Facilitating IKP login
• Activities optimizing the process of issuing and processing e-prescriptions (including presentation of e-prescriptions and fulfilment documents in pharmacies).
Question 6
a. Please explain in what ways the initiative is innovative in the context of your country or region. (100 words maximum)
E-prescribing makes patient care more efficient. It streamlines the process of getting the prescription, dispensing the medication and improving pharmacy workflow. Patient can get e-prescription not only during stationary visit, but also during teleconsultation(e.g. people with chronic disease can obtain prescription without seeing a doctor). E-prescription is delivered by e-mail or sms, whatreduces the risk of receiving wrong medicine. Before e-prescription implementation, patients had to visit their doctor every time it was needed. The e-prescription has shown that life of a patient, doctor and pharmacist can be easier, it opens the way to other solutions such as telemedicine and AI.
b. Please describe, if relevant, how the initiative drew inspiration from successful initiatives in other regions, countries and localities. (100 words maximum)
The e-prescription has been introduced in Poland as an important part of European strategic policy to improve health care in Europe. The aim of the EU is to have a cross-border electronic healthcare system in Europe which will enable EU citizens to obtain e-prescriptions anywhere in Europe. By implementing e-prescription, Poland has taken steps to implement the EU plans in development of European Health System. Thanks to ambitious experts engaged in that process Poland managed to develop interoperability at a national level. We are aware that thanks to this tools we could help more patients.
c. If emerging and frontier technologies were used, please state how those were integrated into the initiative and/or how the initiative embraced digital government. (100 words maximum)
From January 2020, in cooperation of Ministry of Health and engagement of ITC sector, e-prescriptions are being issued in every medical office in Poland. System also offers access to the history of issued prescriptions, which improves coordination of the treatment process. Development in the area of health care wouldn’t be as effective if not reliable and proven cooperation with hospitals, clinics and medical centres throughout the country. Thanks to digitalisation of Health system doctors and managers build the relationship and the trust of their patients. Thanks to a web application, the handling of e-prescriptions is being performed without unnecessary printouts.
Question 7
a. Has the initiative been transferred and/or adapted to other contexts (e.g. other cities, countries or regions) to your organization’s knowledge? If yes, please explain where and how. (200 words maximum)
Taking into account the directions set by the European Union, Poland is among the top countries implementing digitalisation in the health system.
The Scandinavian countries are leading Europe in deploying e-Prescription. Countries which use the e-prescription process routinely are Norway, Denmark, Finland, Sweden, Belgium, Holland, Italy, Iceland, Greece, England, Scotland, Wales and Northern Ireland. The European Union is pushing for more cross border health data exchange.
The My Health @ EU IT system, implemented from 2019 in EU countries, allows to use two electronic cross-border health services: e-prescriptions and patient summaries (patient cards), translated into the language of the healthcare professional.
Within a few months, Poland and Holland are going to join group of countries using My Health @ EU IT system. Ultimately, the system is to be implemented in 25 EU countries by 2025.
b. If not yet transferred/adapted to other contexts, please describe the potential for transferability. (200 words maximum)
Nowadays eHealth refers to the use of Information and Communication Technologies (ICT) in health products, services and processes, combined with organizational changes in healthcare systems. eHealth covers the interaction between patients and health-service providers, the institution-to-institution transmission of data and peer-to-peer communication between patients and/or health professionals. The use of a wide range of technologies like apps, telemedicine, electronic medical records leads to the transition from healthcare to eHealth.
Despite the implementation of such tools as e-prescription, e-referral and Internet Patient Account (IKP), the wave of the COVID pandemic has shown how important it is to develop IT tools in the health sector. The Ministry of Health in cooperation with the ITC sector, specialists in various medical fields and medical partners from other countries, take joint action to develop telemedicine in health sector. E-prescription is one of the tools transferred to telemedicine context which also will be adopted to My Health @ EU IT system.
Question 8
a. What specific resources (i.e. financial, human or others) were used to implement the initiative? (100 words maximum)
E-prescription was implemented as a part of P1 platform (Electronic Platform for Collection, Analysis and Sharing of Digital Medical Records), whole project cost PLN 277 024 681,72. Other parts of the platform are e-referrals, providing medical employees with access to electronic data on patients' health status, provision of data on medical events to patients in an electronic form, providing recipients (patients) with electronic history of performed: diagnoses, services, referrals, prescriptions, providing access to information enabling current monitoring and responding to threats to appropriate institutions, enable ongoing analysis of data on medical events.
b. Please explain what makes the initiative sustainable over time, in financial and institutional terms. (100 words maximum)
E-prescription is part of P1 platform, a national platform for e-health in Poland. Integration with other parts of the system allows the doctors to see the full history of patient prescriptions and treatment and therefore makes the diagnostic process more accurate. In the future it will allow to integrate prescription system with other, similar solutions used throughout Europe.
Question 9
a. Was the initiative formally evaluated either internally or externally?
Yes
b. Please describe how it was evaluated and by whom? (100 words maximum)
E-prescription was implemented as part of the P1 project, co-financed by European funds. Project indicators were defined in the application form for co-financing. The implementation of indicators is monitored by the Committee of the Council of Ministers for Digitization (KRMC) . The eHealth Centre is obliged to submit cyclical progress reports to the KRMC., where reports are evaluated..
Moreover the Steering Committee internally monitors the progress of the project and takes strategic decisions. The SC is responsible for the evaluation of the project in terms of its compliance with the justification and progress towards the objectives adopted for it.
c. Please describe the indicators and tools used (100 words maximum)
Number of:
- public services made available on-line with a maturity of at least 4 - transaction
- intra-administrative services made available (A2A)
- ICT systems launched in entities performing public tasks
- employees of entities performing public tasks (not IT employees) covered by training support
- employees of entities that perform public tasks (not IT employees) covered by training support
- public registers with improved interoperability
- cases settled via an on-line public service
- value of eligible expenditure allocated to actions related to COVID-19 pandemic.
Achievement of indicators is verified in periodic reports.
d. What were the main findings of the evaluation (e.g. adequacy of resources mobilized for the initiative, quality of implementation and challenges faced, main outcomes, sustainability of the initiative, impacts) and how this information is being used to inform the initiative’s implementation. (200 words maximum)
As part of the e-prescription pilot, the following were analysed:
• The procedure for connecting pharmacies and healthcare providers to P1 issuing e-prescriptions by office systems of various providers (including signing e-prescriptions)
• Execution of e-prescriptions in pharmacies participating in the pilot
• Functioning of the Patient's Internet Account (IKP) (including access using the Trusted Profile)
• Access to e-prescription in the pharmacy (printout, sms or e-mail)
• Settlements between pharmacies with e-prescriptions and the NHF
• Functioning of support channels for users, the adopted model of maintenance and cooperation with external providers
• Information and promotional activities
Lessons learned from the e-prescription pilot - implemented changes:
• Optimisation of the process of creating an account in P1 (especially pharmacies and pharmacy points pharmacies)
• Facilitating IKP login
• Activities optimizing the process of issuing and processing e-prescriptions (including presentation of e-prescriptions and fulfilment documents in pharmacies).
The above-mentioned findings helped to improve the service in national implementation.
Question 10
Please describe how the initiative is inscribed in the relevant institutional landscape (for example, how it was situated with respect to relevant government agencies, and how the institutional relationships with those have been operating). (200 words maximum)
E-prescription was implemented as part of the P1 project – the development of an e-health platform in Poland, co-financed by European funds. eHealth Centre in Poland is responsible for the project implementation under the guidance and direction of the Ministry of Health. Development of the initiative wouldn’t be as effective if it hadn’t been for a reliable and proven cooperation with hospitals, clinics and medical centres throughout the country.
The leading role in digital health system transformation and strong inspiration for changes in this field in Poland has been played by the Undersecretary of State at the Polish Ministry of Health, Mr Janusz Cieszyński. In the development phase of the initiative he i.a. strove for the service to properly address the need of both doctors and patients and was pivotal in coordinating the whole process.
Question 11
The 2030 Agenda for Sustainable Development puts emphasis on collaboration, engagement, partnerships, and inclusion. Please describe which stakeholders were engaged in designing, implementing and evaluating the initiative and how this engagement took place. (200 words maximum)
The Committee of the Council of Ministers for Digitization (KRMC) is an auxiliary body of the Council of Ministers and the Prime Minister established in 2012 to ensure coordination of the implementation of government IT projects and preparation of government documents related to digital transformation. KRMC is responsible for ensuring consistency of IT projects with the strategic activities of the Polish State.
As part of the P1 Project, a Steering Committee was established, consisting of:
1) Chairman of the P1 Steering Committee - Undersecretary of State at the Ministry of Health;
2) Main User - Director of the Innovation Department
3) Main Supplier - a representative of the Contractor
4) A representative of the National Health Fund
5) A representative of the e-Health Centre.
The P1 project is characterised by having a significantly large stakeholder group.
1) Recipients - approx. 38 million;
2) Service providers, including:
• Healthcare entities - approx. 20 thousand,
• Professional practices of doctors and dentists - approx. 121 thousand
• Professional practice of nurses and midwives - approx. 22 thousand,
• Pharmacies and Pharmacy Points - approx. 16 thousand;
3) Medical Employees - approx. 500 thousand;
4) Central public administration entities
Question 12
Please describe the key lessons learned, and how your organization plans to improve the initiative. (200 words maximum)
The results of the survey showed that patients have high hopes for the computerisation of health care. They expect that, medical services such as: making appointments; receiving test results; obtaining information about the quality of care at a selected provider; obtaining information about the availability of a medicine in a pharmacy will be available via the Internet.
Digitalisation of the healthcare system is one of the priority actions. The SARS-CoV-2 pandemic has shown that the development of digital solutions is justified and makes it possible to relieve the burden on the health sector while maintaining the appropriate quality of services.
During the implementation of various activities in the area of digitalisation of healthcare in the context of supporting vulnerable groups (e.g. seniors) and counteracting digital exclusion, it is particularly important to adapt tools to this target group in terms of ease of use, accessibility and convenience. In addition, it is also necessary to constantly raise awareness, disseminate information about available tools and ways to use them through appropriately adapted information channels.