Pharmacists and patients experience stress due to faulty electronic prescription systems.
In the heart of Europe, German pharmacists are facing operational challenges due to frequent outages and instability in the e-prescription system. These disruptions, which sometimes render the system unavailable for days, have caused significant operational chaos and potentially affected patient health outcomes [1][2].
At the core of the issues are frequent downtimes and partial or complete outages of the telematics infrastructure supporting e-prescriptions, particularly affecting the electronic patient record (ePA) and prescription services [1][2][3]. Specific technical faults related to trust service providers like Medisign, which handle digital signatures necessary for e-prescriptions, have led to doctors being unable to sign prescriptions digitally [4].
External service providers such as RISE and communication services (KIM) vital for medical transactions have also caused problems [3][4]. Recurring disruptions, reported on a high frequency basis, have undermined confidence in the system’s reliability [2].
Thomas Preis, the head of the German pharmacists' association, has publicly urged the federal digital agency Gematik, responsible for the healthcare IT infrastructure, to urgently improve the system's stability and reliability. Preis highlighted that while digitalization is necessary, the current level of unreliability is unacceptable due to its direct impact on patient care [1].
Measures being taken or proposed to address these issues include calls for Gematik to enhance the robustness and uptime of the telematics infrastructure by resolving underlying technical problems, including those linked to external service providers [2][3]. There are also requests for greater flexibility in pharmacy operations, allowing them to supply medications quickly and without bureaucratic hurdles during system downtimes, to prevent delays in patient treatment [1].
Some pharmacy associations are even exploring legal action against Gematik for potential compensation due to operational losses caused by system failures [3]. Gematik works on promptly restoring services during outages and publicly communicates on the causes and status of disruptions to maintain transparency [2][4].
The German Foundation for Patient Protection has demanded a warning system for disruptions in the E-prescription system, and board member Eugen Brysch has called for a daily updated E-prescription radar to inform doctors of system issues [5][6]. Brysch has also demanded that Health Minister Nina Warken instruct Gematik to submit a monthly disruption report [6].
Amidst these challenges, a pharmacist in Zwickau, Daniela Hänel, is currently facing major issues due to the E-prescription system’s technology failures [7]. In the past year, over 512 million electronic prescriptions have been redeemed, highlighting the system’s widespread use [8].
Expert Marie-Clair Koch criticizes the E-prescription system in Germany and suggests Switzerland's approach as a better model [9]. Koch believes that there are many potential issues with the E-prescription system, such as system updates and fiber optic integration [9]. Interestingly, online pharmacies in the Netherlands are benefiting from the German E-prescription due to long-standing drug mail order permits in the Netherlands [10].
Despite these challenges, the E-prescription has been mandatory for prescription drugs since January 2024 [11]. The system is also facing issues such as technology failures and unjust refusal of paper prescriptions by some doctor’s practices [12]. As efforts continue to stabilize the system technically and institute interim operational measures to mitigate the impact on patient care [1][2][3][4], it remains to be seen how these issues will be addressed in the long run.
- The operational challenges faced by German pharmacists, attributable to the frequent downtimes in the e-prescription system, could potentially impact patient health outcomes and require improvements in both the telematics infrastructure and external services for medical transactions [1][2][3].
- To enhance the stability and reliability of the e-prescription system, suggestions have been made for Gematik to focus on resolving technical issues, increasing the robustness of the infrastructure, and providing greater flexibility for pharmacies during system downtimes, as part of an ongoing effort to ensure the timely delivery of medications and maintain patient care [1][2][3].
