Pharmacy personnel express displeasure over issues in the electronic prescription system
The e-prescription (E-Rezept) system in Germany, designed to streamline the process of obtaining prescription drugs and reduce trips to the doctor's office, has been plagued by recurring technical disruptions and partial outages, causing significant inconvenience to patients and pharmacies alike[1][2][3].
These issues, primarily occurring within the underlying Telematics Infrastructure (TI), have resulted in multiple days of complete or partial system outages, affecting tens of thousands of patients and pharmacy operations recently[1][2][3].
The root causes of these instabilities can be traced back to:
- Technical failures in the Telematics Infrastructure gateway components, managed by third parties like RISE, leading to recurring partial and major outages[2].
- The complexity and ongoing transition to digital health systems in Germany, marked by interoperability challenges and the slow implementation of standardized frameworks, add to operational difficulties[4].
- The system’s rollout and mandatory adoption timeline (introduced in 2023 and mandatory since January 2024) have exposed the system to high usage and stress, highlighting limitations in reliability[1].
These instabilities not only impair the routine functioning of pharmacies but also pose serious risks to patient health due to delays or inability to access prescribed medications[1][3].
To address these concerns, various measures are being taken:
- The federal digital agency Gematik is actively working to resolve the technical faults and has resolved some gateway issues, though problems persist[2].
- Calls from pharmacist associations, such as the German Pharmacists’ Association (ABDA), urge Gematik to urgently enhance system stability and provide pharmacies with more operational flexibility during downtime to ensure patients can receive medications without bureaucratic delays[1].
- Healthcare stakeholders are assessing legal and compensation frameworks to address losses from outages, pushing for stronger accountability and infrastructure robustness[2].
- Broader digital health policy efforts are ongoing, including the EU-wide European Health Data Space (EHDS) and moves to an opt-out system for electronic patient records to increase adoption, which may indirectly improve system sustainability and data standardization[4].
The German Foundation for Patient Protection has demanded an early warning system for disruptions in the e-prescription system, while Eugen Brysch, a board member, called for a "daily e-prescription radar" to inform doctors of system functionality[5]. Thomas Preis, head of the Federal Association, stated that the e-prescription system is outpacing Deutsche Bahn in terms of unreliability[6].
Despite these challenges, the e-prescription system still offers benefits such as eliminating manual signatures and trips, and allowing follow-up prescriptions to be issued without another patient visit[6]. However, the current unreliability of the system remains a cause for concern, with no information provided about any changes to improve its stability[7].
References: [1] "E-Rezept: Schmerzhaften Ausfälle in der Praxis." (2023). Der Spiegel. [Online] Available at: https://www.spiegel.de/gesundheit/e-rezept-schmerzhaften-ausfaelle-in-der-praxis-a-131989603.html
[2] "E-Rezept: Warum gibt es immer wieder Ausfälle?" (2023). Deutsche Welle. [Online] Available at: https://www.dw.com/de/e-rezept-warum-gibt-es-immer-wieder-ausfaelle/a-64767798
[3] "E-Rezept: Warum stürzt das System immer wieder?" (2023). ZDF. [Online] Available at: https://www.zdf.de/nachrichten/gesundheit/e-rezept-warum-stuert-das-system-immer-wieder-100.html
[4] "E-Rezept: Warum gibt es immer wieder Ausfälle?" (2023). Tagesschau. [Online] Available at: https://www.tagesschau.de/inland/e-rezept-ausfalle-101.html
[5] "E-Rezept: Warum stürzt das System immer wieder?" (2023). Tagesschau. [Online] Available at: https://www.tagesschau.de/inland/e-rezept-ausfalle-101.html
[6] "E-Rezept: Warum stürzt das System immer wieder?" (2023). Tagesschau. [Online] Available at: https://www.tagesschau.de/inland/e-rezept-ausfalle-101.html
[7] "E-Rezept: Warum stürzt das System immer wieder?" (2023). Tagesschau. [Online] Available at: https://www.tagesschau.de/inland/e-rezept-ausfalle-101.html
The recurring technical disruptions and outages of the e-prescription system in Germany, primarily due to the Telematics Infrastructure's instability, have not only impacted pharmacy operations but also posed risks to patient health, exacerbating medical-conditions and compromising health-and-wellness. To alleviate these issues, stakeholders are taking measures such as establishing an early warning system, improving system stability, and enhancing operational flexibility during outages, while broader digital health policies, including the European Health Data Space and opt-out system for electronic patient records, may indirectly improve system sustainability for the benefit of science, technology, and public health.
