Scandinavia Shows off E-Prescription Success

28th January 2010 (Last Updated January 28th, 2010 18:30)

Scandinavian countries are leading their European neighbours in implementing e-prescription techniques. Steve Rogerson looks at their results, with the hope that one day a universal system could be put in place across the continent.

Scandinavia Shows off E-Prescription Success
Scandinavian countries are using remote telemonitoring products that combine in-home patient devices with the relevant management software.

Using the latest technologies to take the use of drugs and medical devices out of hospitals and into people's homes is being seen as the main driving force behind innovation across Europe.

There are a multitude of new drugs being developed by some of the major players such as Switzerland's Roche, but getting these out to the target patients in a safe and efficient manner is proving a major challenge.

There is a push across Europe to put more patient registration and clinical records in electronic format with easier cross-checking by administrative and medical staff, with particular success witnessed in the Scandinavian countries.

This notion of e-prescribing is seen as important for reducing errors in diagnosis and drug delivery.

Despite efforts by the European Commission, however, there is little consistency in what individual countries are doing and in the speed and way these technologies are being implemented.

Scandinavian success as rest of Europe lags behind

In Spain, for example, electronic health records are well established but this is based on a proprietary system using smartcards that will only work within the country and are no good for those travelling internationally.

The UK has a goal to have a system up and working some time this year. Meanwhile, France and Italy are just in the starting phase.

"There is a push across Europe to put more patient registration and clinical records in electronic format."

In Germany, the medical insurance scheme means that some people have cards that carry medical data, though this is not widespread.

Key to this is that available medicines are listed on a database along with recommended and safe dosage levels, which again makes it harder for mistakes to be made.

Denmark and Sweden are probably the only countries that have really taken e-prescribing to heart, though there has also been movement on this from the Netherlands. The main idea behind e-prescribing is to reduce the number of mistakes with prescriptions.

Frost & Sullivan analyst Luke Thomas says that prescriptions not written on a computer can easily be misread. "If the doctor writes the prescription, the pharmacist may get it wrong because they cannot read the handwriting," he says.

In the few countries that have implemented this on a large scale, the prescription is sent digitally to a pharmacist named by the patient and the patient can collect the prescription on production of the correct identification, sometimes a smartcard. Two related problems with such systems, however, are concerns over security and privacy.

These systems have to be secure to maintain patient privacy and the amount of sharing of information between doctors may not be to some patients' liking. There may be personal reasons why they would not want a particular doctor to see medical records, for example, if the doctor is a member or friend of the family.

Given the goal is to have information shared across not just those countries such as Denmark that are advanced in developing the system but also those in Europe less down the e-prescribing road, the social problems may be harder to overcome than the technical ones.

"Denmark and Sweden are probably the only countries that have really taken e-prescribing to heart."

Healthcare in the home

In the UK most of the budget is going towards home care and less to the hospitals. Here, in what is becoming known as telehealth, information is gathered wirelessly and sent back to the hospital or doctor. "They want to push patients from hospitals to the home," adds Thomas, "so a lot of the emphasis is on home care."

Intel digital health group senior product specialist Ivan Harrow says that in this sector too, there are major inconsistencies with the efforts of different European countries.

"The UK leads for conducting trials for telehealth in Europe," he says. "There is a relatively slow uptake in France. The Netherlands is quite advanced already and there is some interest in Germany."

He adds that there have been a number of major deployments in Scandinavia of remote telemonitoring products that combine patient monitoring devices with the relevant management software. This aims to solve one of the difficulties with in-home care in that the various medical devices are able to communicate with each other.

Though it is good that there has been a growth across Europe in small innovative companies breaking into the medical field, this in itself has produced a variety of technologies that are not always compatible. To help with this, the Continua Health Alliance was set up.

"The goal is to remove the barriers to the adoption of the different technologies used in patient homes," says Harrow. "The different devices don't always speak the same language and that creates a lot of barriers. The alliance is trying to remove some of these challenges so they will work together."

"In the UK, the bedrock systems have matured, such as hospital and pharmacy stock control."

Middleware software provider Cain Medical managing director Stuart Cain says that the number of homecare devices on the market can provide complications in itself.

"There are so many devices in the market that this causes problems. The market is looking to collect clinical data from these devices. Norway and Sweden are very advanced in collecting the data and sending it to clinical systems," Cain clarifies.

JAC Pharmacy marketing manager Jonathan Mills says that the UK is following suit and is likely to have innovations up and running in the near future. "In the UK, the bedrock systems have matured, such as hospital and pharmacy stock control," he explains.

" Clinical systems such as e-prescription at the patient level are in the maturing phase and we will see the emergence of innovations such as computerised medical cabinets and smartcards."

One of the main reasons for the growth in implementing home care is the ageing population across Europe. But this brings with it a secondary problem, in that the nature of these patients means that operating the equipment needs to be straightforward.

In the UK, the National Institute for Health & Clinical Excellence (NICE) has started a programme to evaluate medical devices on this basis following a similar programme in Australia.

"One of the main reasons for the growth in implementing home care is the ageing population across Europe."

NICE director of policy consulting Kalipso Chalkidou says the problem could stem from the lack of regulatory requirements beyond the CE mark. "We have the CE mark but the other requirements for medical devices are not as strong as they are for drugs," says Chalkidou.

"Also, the device companies tend to be small and can't afford to sponsor the trials that are needed."

The main problem here was evidence generation. "More data is needed but who pays for this?" she asks.

"Innovation is about creating new things that help people but you need to collect the evidence to show this. That can be difficult for small companies, so there is a need for support in R&D."

Chalkidou says one reason why Scandinavian countries had a head start in innovation was the quality of their registers when trying out new devices. "The Scandinavians are very good at setting up registers," she explains. "This helps them collect a lot of evidence to see which devices are failing more often and which are working."