Barcelona Health Hub offers you this article written by Luis Vilanova Blanco, leading auditor in electronic private prescription.

These days that has been written so much about telemedicine, remote assistance, digital patient or as we want to give the same name as the medical act to a patient using the current “commodity” mechanisms of video-chat-remote assistance, I would like to stress the importance that these actions be executed in a safe framework, both legal and technological, that ensure confidentiality and privacy of the information we share between doctor and patient, availability of systems when they need to be used, integrity of prescriptions or prescriptions, traceability of the actions that the doctor has performed as well as identity that the doctor and patient is who he is.

In the private sphere there is the approval of a private prescription that any software that allows to carry out the aforementioned actions must comply with and that, as the leading auditor in Spain in this matter, I want to make a summary that describes how important it is to comply with these issues.

The electronic private medical prescription communicates the private medical prescription with the dispensing office or pharmacy generally:

There are multiple scenarios where not using an approved tool in digital health care opens the door to many risky situations. I will describe 5 of them that I think can give a general idea of the problem.

Scenario 1. Telemedicine by Whatsapp, Zoom, Skype, phone, etc.

Suppose I am cared for by any of the above tools, by a person who claims to be my doctor, sometimes I probably do not see your face, as we ensure that this doctor is enabled, as we assure you that what you prescribe is in accordance with my allergies, contraindications, controls the posology of narcotics or is it simply stored in my medical history? Absolutely impossible, is it more, how do we ensure the privacy of my conversation? How do we ensure data protection? We understand that while as a very urgent doctor solves the tip of the iceberg of the problem, it does not meet most issues that at least I as a patient would like to have under control.

Electronic private prescription approval ensures that prescriptions are based on certain drug databases, with medical protocols, prescription control, dosage, units, duration, etc. self-calculated, allergy control, patient privacy record, data protection compliance, etc.

Scenario 2. Where is my recipe, where it has been saved, how can I reapply? Is it more like I know you actually sign my doctor? How can I check it months later if I have changed my smartphone, computer, etc? How to show that I prescribed more doses than recommended or that I did not take into account other ongoing medications? How do we know the duration of treatment was 3 weeks if I remember perfectly that you told me 4? In short, where is my recipe with a legal value so that I can exercise my rights as a patient and citizen? We see that things get complicated.

Private prescription approval requires the keeping of signed prescriptions digitally associated with the patient, unalterable over time and recoverable whenever necessary for a few specific years.

Scenario 3. Who took care of me a year ago? 

Suppose I am served today using a service of the many that predominate on the internet without the approval of an electronic private prescription and within a year, nor do I remember what the application was called, as I will remember which doctor prescribed me? If I don’t have anything on paper, physical, everything was virtual, how can I recover or prove that someone, somewhere in the world, told me to take a medication?

One of the issues that guarantees to use approved software is the identity of the patient and that the doctor is enabled for prescription.

Scenario 4. Like I do for the pharmacy to dispense me with the medicine.

If I have been taken care of online as I request now my prescription at my usual pharmacy? How can I submit a valid prescription? How does the pharmacy know that the doctor was collegiate and enabled for the function? How do I know I haven’t ordered any more packages than the doctor has included in my digital prescription? How does the pharmacist talk in the case of a doctor’s problem?

The approval of electronic private prescription interconnects with pharmacies through Nodofarma allowing the dispensing of medicines, cancellation of the same, pharmaceutical-medical conversation, control of the number of packages delivered, control of the high privacy of prescriptions of high level of confidentiality, etc.

Scenario 5. My illnesses have been published without my consent.

How sure are the computer systems of the doctor who has taken care of me? Are you protecting my confidential information from cyberattacks? How do I know that even my recipe history is not accessed by third parties without my consent?

Private prescription approval includes dozens of measures aligned in some cases with ISO27001 and ISO27017 to reduce the risk of malicious cybersecurity attacks that may occur, prevent access by non-enabled third parties, and other information security measures that increase the level of security of patient information.

I will now try to explain the problems and advantages from the point of view of the patient, doctor and pharmacist in the pharmacy office to require the use of an electronic private prescription solution in order to be treated, prescribe and dispense the medication in question.

Patient’s point of view

The patient who needs to be treated telematics must understand the need to use a tool that has WTO approval for multiple reasons. From them I want to explain some that I find fundamental:

A few days ago I was interviewed for a telemedicine document and report and asked what my opinion was regarding using Whatsapp to be cared for by a doctor. We understand that if we do not use a WTO-approved system there may be no trace of the prescription, we cannot guarantee that the doctor is who he is, there is no traceability that the pharmacy gives me, the privacy policy of my information is not informed and if I have any legal or other problems I probably will not be able to claim.

In non-approved software the pharmacy may not accept the prescription, more so, it may completely reject such a prescription. There is also a level of high confidentiality so that your recipe is left with a maximum level of privacy.

The signature of the recipe, which is essential for it to be registered, is not altered and can be valid before third parties does not occur. This is a document of no legal value.

Doctor’s point of view

The approval of the electronic private prescription is based on Royal Decree 1718/2010 specifying all the characteristics and requirements that the private prescription, on paper or digital, must meet, being mandatory at present. I am currently passing more than a dozen solutions that allow the doctor to prescribe through a secure IT solution. Beyond the obligation of Royal Decree 1718/2010, I will again name three practical advantages that the use of such WTO-approved solutions brings to the doctor:

• Use of an updated vademécum, patient registration, control of prescriptions and treatments we have made to the patient, control of allergies, automatic restrictions on narcotics.
• Automated delivery to the prescription patient electronically signed with a legal value and maximum traceability. We are talking about the complete digitization of prescription processes and recipe tracking.
• Automated communication of the prescription to the pharmacy.

Pharmacist’s point of view

The pharmacist, as one of the key links in the prescription-oriented telemedicine process, should encourage the use of approved digital prescription software (such as REMPE, the only one to date where I was lucky enough to be its auditor). Among the many advantages I go on to name some of them:

• Access to the active medication sheet only with the patient’s ID.
• Digital consultation of the dispensings made.
• Digital communication with the doctor, correction of prescriptions, etc.

Conclusion

In short, the approval of electronic private prescription computer solutions is key to the safe operation between doctor-patient-pharmaceutical ensuring a legal framework for any type of problem that may arise, ensuring privacy, data protection, confidentiality, availability and unalterability of the prescription, among many other advantages.

By Luis Vilanova Blanco, electronic private prescription auditor.