NUI Galway – UL Alliance First Annual ENGINEERING AND - ARAN ...

National E-Prescribing Systems in Ireland: Lessons from Other Countries and Domains
James Brennan BBS ACMA MICS MSc (Health Informatics)
PhD Candidate, Department of Computer Science and Information Systems, University of Limerick
james.brennan@ul.ie
Abstract
Ireland is at the beginning of the national e-health
journey. The challenge that lies ahead for the Irish
healthcare domain is to build a solid foundation for
national e-health systems, including e-prescribing. This
will involve choosing appropriate strategies for the
construction and adoption of e-health and e-prescribing
systems in the years ahead. In this context, it is useful to
compare the experience of successful national systems
in other countries, and also in other domains, in order
to provide a reference point for informing public policy
on e-health and e-prescribing in Ireland. The research
proposes to investigate the key factors common in
countries that have successfully adopted national eprescribing
systems, and also investigate and compare
a successful public e-government system in the Irish
Revenue domain. A framework will be used to identify
these factors as organisational, regulatory, technical
and adoption.
Introduction
Delivering healthcare involves an element of risk. It has
been estimated that up to 7,000 people die in the United
States of America each year from medication errors,
and it is suspected that the situation is similar in other
countries [1, 2]. A growing body of evidence over the
past twenty years has indicated that the introduction of
electronic prescribing (e-prescribing) can reduce
medication errors and improve patient safety, and many
countries are pursuing this goal. In the early years of the
last decade, some policy makers viewed e-prescribing
as the “low hanging fruit among information
technologies that could improve the quality and
efficiency of healthcare” [3].
The decade ended recently, but has the promise of eprescribing
been realised in many countries? Which
countries have successfully adopted e-prescribing?
What were the critical success factors that influenced
the development and adoption of e-prescribing? What
are the lessons for Ireland on the e-prescribing journey?
Are there successful national systems in other Irish
public domains that can inform the health domain and
the e-health context in Ireland?
Methods
Qualitative methods will be mainly used, including
fieldwork. The evaluation of national information
systems in healthcare is complex and difficult [4], so
quantitative methods will also be used, but only where
the data is factual and comparable.
Definition
The definition of e-prescribing chosen for this research
is “a prescriber’s ability to electronically send an
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accurate, error-free and understandable prescription
directly to a pharmacy from the point of care”[2]. This
definition clarifies that e-prescribing is not sending
prescriptions by fax, telex or e-mail, but the
replacement of the written or printed prescription with
an electronic file, and includes the electronic
transmission of prescription (ETP) as an intrinsic
element.
Preliminary Findings
Preliminary research found that a good deal of up-todate
detailed information was available for many
countries on the use of e-prescribing as part of an
electronic health record (EHR) by general practitioners
(GPs) in the primary sector. However relatively little
information was available on the ETP aspect of eprescribing,
which was found to be the most
problematic area in all countries, as in figure 1.
Country % of GPs
using
EHRs
% of GPs
using eprescriptions
% GPs using eprescriptions
&
ETP
Netherlands 98 85 90
Denmark 99 95 85
Sweden 99 70 70
UK 95 90 24
Norway 98 95 No data
Finland 99 100 No data
New Zealand 92 78 No data
Australia 79 81 No data
Ireland 60 34 No data
Germany 42 59 No data
USA 29 20 7
Canada 20 11 No data
Japan 10 No data No data
Figure 1 Adoption of EHRs, e-prescribing and ETP by
GPs in selected countries (2009)
Further study
Further study is under way into the national Revenueon-line
(ROS) system. Also, research is ongoing to
establish the current status of e-prescribing and ETP
systems in the leading countries.
References
[1] IOM, ed. To err is human : building a safer health
system. 2000, Institute of Medicine, USA.
[2] Fincham, J.E., ed. E-Prescribing: The Electronic
Transformation of Medicine. 2009, Jones & Bartlett
Publishers. 64-65, 73.
[3] Friedman, M.A., A. Schueth, and D.S. Bell, Interoperable
electronic prescribing in the United States: a progress
report. Health Aff (Millwood), 2009. 28,(2) 393-403.
[4] Protti, D., I. Johansen, and F. Perez-Torres, Comparing
the application of Health Information Technology in
primary care in Denmark and Andalucia, Spain. Int J
Med Inform, 2009. 78,(4) 270-83.