Author: Mario Voge

Advancements and Benefits of the E-Prescription in Switzerland

In recent years, e-prescriptions have become increasingly important in Switzerland. Unlike in Germany, doctors and pharmacies in Switzerland have pushed ahead with e-prescriptions.  Since May 2022, the Swiss Medical Association FMH and the pharmacy association pharmaSuisse have been working on a pilot project to develop a simple, secure e-prescription with QR code transmission. The joint solution aims to create a standardized solution for Switzerland. Exactly one year later, the Federal Council wants to develop standardized framework conditions for e-prescriptions and is submitting the partially revised Therapeutic Products Act for consultation in December 2023.

In this blog post, we look at the latest developments, advantages, and hurdles in adapting e-prescriptions in Switzerland.

How does the current e-prescription work in Switzerland?

E-prescriptions are the digital version of traditional paper-based medication prescriptions for patients. Unlike in Germany, where gematik manages the central introduction of e-prescription, various companies can offer an e-prescription solution in Switzerland. Against this backdrop, the Swiss Medical Association FMH and the pharmacy association pharmaSuisse launched a pilot project for a standardized e-prescription for Switzerland in May 2022. It is based on an encrypted QR code that resembles the new payment slip of a Swiss bank. This QR code contains all the details of the prescription medication and the doctor's electronic signature. The electronic signature confirms that the data in the e-prescription is authentic and cannot be falsified and ensures that the digital identity of the issuing doctor or healthcare professional is valid. This protects the e-prescription from forgery and makes it forgery-proof.

The primary aim of this pilot project is to enable doctors and healthcare professionals to issue the e-prescription in their authorized web-based practice software after a consultation or video consultation by using their HIN-ID. The e-prescription is sent to the patient digitally with an attached QR code or handed over as a printout. The patient has complete control over their medication data and can redeem the prescription at their trusted pharmacy or online. The QR code is then scanned at the pharmacy, and the pharmacy software reads the prescription data and validates its validity. The medication is then handed over to the patient, and the e-prescription is validated. This process eliminates the need for time-consuming typing and copying of prescription data, which removes sources of error and makes possible misuse more difficult. According to the FMH and pharmaSuisse, all the e-prescription data is stored decentrally during this process.

Advantages of the e-prescription

The e-prescription offers numerous advantages and opportunities for all parties involved and enormously contributes to the digitalization of the healthcare system. The standardized e-prescription solution enables seamless collaboration and interoperability between doctors, pharmacies, and patients.  It creates an effective and efficient digital supply chain in the healthcare sector and improves patient safety.

For doctors, this means more accessible and faster prescribing of medication. Digital prescriptions can be signed directly by the doctor in the practice software during a consultation with a qualified electronic signature and then transferred to the patient's smartphone. This saves considerable time and reduces the cost of printing paper prescriptions. The e-prescription also enables improved tracking of prescribed medication and reduces the risk of errors.

For pharmacies, the e-prescription opens up the possibility of optimizing their work processes and increasing efficiency. The electronic transmission and fully digital processing of e-prescriptions in the pharmacy software eliminates the manual effort involved in recording and processing prescription data, which minimizes errors. Pharmacists can also better monitor their customers' medication plans and, if necessary, point out possible side effects or intolerances, which reduces the risk of medication misuse.

The e-prescription also offers numerous advantages for patients. Once the doctor has issued the prescription with an electronic signature, the patient has complete control over their prescription data and can fill it flexibly and entirely according to their needs and preferences. This can be done from the comfort of their home via an online pharmacy or in the traditional way at their local pharmacy. This reduces unnecessary waiting times and optimizes the digital customer journey.

Current challenges with e-prescriptions in Switzerland

Although the Federal Council is venturing a new start for electronic medication prescriptions and medication plans with the revision of the new Therapeutic Products Act, there are still some challenges to introducing a standardized e-prescription. This is illustrated by the current adoption rate of e-prescriptions, which is still in the single-digit percentage range.

Two separate laws - no harmonization

In contrast to Germany, e-prescriptions and electronic patient dossiers are subject to different legal provisions in Switzerland. While the electronic patient dossier is subject to the EPD Act and the associated EPD Ordinance, the introduction of the e-prescription is anchored in the Swiss Therapeutic Products Act. These differences in the legal framework pose a challenge to introducing a standardized e-prescription. Whether the Federal Office of Public Health (FOPH) will prescribe a uniform law for digitalization in the healthcare sector is questionable. However, harmonizing these laws could set consistent standards and clear guidelines for e-prescription, simplify implementation and application, and unify the current heterogeneous data systems of the various service providers in the EPR. This requires close cooperation and coordination between the players in the healthcare sector and the legislator.

A uniform interoperability standard is needed.

As various companies offer the existing e-prescription solutions in the Swiss market in the healthcare sector, they also differ in terms of their technical composition, different cryptographic security and e-signature standards, and usability during the redemption process in pharmacies. This leads to a situation in which there is a lack of a uniform interoperability standard, and instead, there is a decentralized infrastructure with various isolated solutions and data silos.

However, standardized interoperability is crucial for successfully implementing a Switzerland-wide e-prescription solution. It is necessary that doctors, pharmacies, service providers, and patients can communicate seamlessly with each other, regardless of which e-prescription solution they use. On the other hand, a decentralized infrastructure with various isolated solutions leads to complications and increases the administrative burden for everyone involved. Furthermore, the existing e-prescription solutions do not follow a uniform international standard, which could make cross-border collaboration and the exchange of healthcare data more difficult.

Lack of technical requirements

To ensure broad acceptance and widespread use of e-prescriptions, medical practices, pharmacists, and other service providers must ensure that their administrative systems meet the technical requirements. These systems must comply with international security standards and can securely store, exchange, digitally sign, and process e-prescription data. This includes important measures such as protection against unauthorized access, encryption of data, and regular updating of security protocols. Implementing these technical requirements requires investment in the corresponding infrastructure.

To ensure smooth communication and the secure exchange of e-prescription data, the legislator must clearly define guidelines and standards. This enables compatibility between the various systems and provides the secure transmission and exchange of e-prescription data. A uniform and standardized approach is the key to the success and acceptance of e-prescriptions in the healthcare sector.

Current developments and outlook

In Switzerland, significant milestones have recently been reached in implementing e-prescriptions. In 2020, a pilot project was launched to test the technical implementation, the security of data transmission and storage, and the user-friendliness of the digital prescription. The auspicious results showed that e-prescriptions can be successfully implemented in Switzerland and quickly filled out by patients.

Patients in Switzerland currently have the opportunity to redeem e-prescriptions in 356 pharmacies. The FMH and pharmaSuisse associations are working continuously to establish e-prescriptions on a large scale and to build the trust of doctors, patients, and pharmacies in this digital solution. They are also in regular dialogue with various software providers to continuously expand the number of participants in the pilot project and establish uniform technical infrastructures and standards for e-prescriptions. Other telemedicine providers will likely join the pilot project shortly.

The associations are also actively engaged in dialogue with the legislator to ensure that the e-prescription is optimally compatible with the electronic patient dossier (EPD). The associations aim to realize a seamless integration of the e-prescription into the EPR and a smooth interaction between the two systems.

On 8 December 2023, the Federal Council submitted a corresponding revision of the partially revised Therapeutic Products Act for consultation. According to the article in Netzwoche, the revised draft law will make it possible to prescribe and redeem medicines electronically. According to the new ordinance, e-prescriptions must also be created in the electronic patient dossier (EPD) exchange format. With this measure, the Federal Council aims to promote the dissemination and further development of the EPR. In addition, the revised draft law creates the legal basis for the digital medication plan, which is also to be made and updated electronically. The consultation process for the partially revised therapeutic products legislation is scheduled to run until 22 March 2024. It will then become clear how medical practices, pharmacies, telemedicine providers, and other service providers can connect to this technology as part of the statutory e-prescription standard and how long the transition periods for adaptation will be.

It remains to be seen how e-prescriptions will develop in Switzerland in the coming years and essentially replace conventional paper prescriptions.

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