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Albania

Electronic System of Registration of e-Prescription in the Republic of Albania (AL0058)

Overview

At-a-Glance

Action Plan: Albania Third Action Plan 2016 – 2018

Action Plan Cycle: 2016

Status: Inactive

Institutions

Lead Institution: Ministry of Health

Support Institution(s): Pharmacies

Policy Areas

E-Government, Health, Public Service Delivery, Records Management

IRM Review

IRM Report: Albania End-of-Term Report 2016-2018, Albania Progress Report 2016-2018

Starred: No

Early Results: Did Not Change

Design i

Verifiable: No

Relevant to OGP Values: Not Relevant

Potential Impact:

Implementation i

Completion:

Description

This commitment is intended to replace medical prescription on papers to electronic prescription nationwide. Fulfilling this commitment brings increased efficiency of drug reimbursement medical funds and accuracy of determining medical drugs impacting directly on improving the quality of patients' health and health care. Among other things, e-prescriptions will bring: • Reduced possibility of errors resulting from misunderstandings in writing between physicians and pharmacists; • Reduced administrative time communication between patient - physician, patient - pharmacists, pharmacist - Compulsory Insurance Health Care Fund (CIHCF); • Increased level of compliance of drugs given to a patient and increase patient's comfort and in accessing these medicines; • The system will enable gathering of a historical record of actual medication that the patient received. Status quo or problem addressed by the commitment So far, the generation of medical prescriptions has been performed only on paper. The volume of processing recipes on paper is difficult to manage since it has increased significantly. Ministry of Health after successfully piloting the electronic prescription system in the district of Durrës, will extend this system all over Albania. The lack of a computerized registry for the registration of prescriptions issued by doctors favors: • Possibility of high performing errors; • Errors of interpretation in delivering drugs; • Requires very large volume of work with prescriptions on paper; •Extensive efforts in data entry of recipes on paper in a register for calculating pharmacy reimbursement for reimbursable drugs. Main Objective The objective of this commitment is to substitute medical prescriptions on paper to electronic prescriptions nationwide. Through this system we aim to achieve: 1. Increase the efficiency of drug reimbursement funds and accuracy of determining medical drugs impacting directly on improving the quality of patients' health and healthcare. 2. Reduce the possibility of giving false medical drugs for patients. 3. Reduce the possibility of errors that result from writing misunderstandings between doctors and pharmacists. 4. Reduce administrative time communication between • Patient - Doctor • Patient - Pharmacist • Pharmacist - (CIHCF) 5. Increase the level of compliance of drugs given to a patient and increase patient comfort and in accessing these drugs. 6. The system will enable establishment of a historical record of actual medication that the patient received. 7. Conveniences and profitabilities for pharmacists are, as follows: o Reduce chance of errors; o Increase accuracy in delivering drugs; o Reduce paper work with prescriptions.

IRM Midterm Status Summary

15. Pilot e-prescription

Commitment Text:

Title: Electronic system of registration of e-prescription in the Republic of Albania

This commitment is intended to replace medical prescription on papers to electronic prescription nationwide. Fulfilling this commitment brings increased efficiency of drug reimbursement medical funds and accuracy of determining medical drugs impacting directly on improving the quality of patients' health and health care.

Among other things, e-prescriptions will bring:

- Reduced possibility of errors resulting from misunderstandings in writing between physicians and pharmacists;

- Reduced administrative time communication between patient - physician, patient - pharmacists, pharmacist - Compulsory Insurance Health Care Fund (CIHCF);

- Increased level of compliance of drugs given to a patient and increase patient's comfort and in accessing these medicines;

- The system will enable gathering of a historical record of actual medication that the patient received.

Responsible institution: Ministry of Health

Supporting institution(s): Pharmacies

Start date: 2016 End date: 2017

Editorial Note: For full commitment text, please refer to https://www.opengovpartnership.org/wp-content/uploads/2001/01/Albania_NAP3_ENG.pdf.

Context and Objectives

A 2014 World Bank Report found that Albanians pay a higher price for medications than neighboring countries.[Note135: World Bank and Minister of Health Conference, http://www.oranews.tv/shendetesi/shendetesia-gogoli-i-ri-korrupsionit-raporti-i-bb-ja-si-vidhen-shqiptaret/. Date accessed September 2017. Since writing this report, this web link has been taken down. ] And in 2015, a majority of Albanians stated that the healthcare system in Albania is a serious concern.[Note136: Healthcare remains a serious problem according to 67 percent of Albanians, 'Impunity' page 21, IDRA 2015, http://www.idrainstitute.org/files/reports/impunity_2014/impunity_final_report.pdf ] There was some improvement with regards to public trust in the healthcare system, as reported on by the Institute for Democracy and Mediation (IDM) in 2016.[Note137: From 2015 to 2016 the public perception on trust in the healthcare system improved, Public Trust survey (IDM 2016), page 22, http://idmalbania.org/wp-content/uploads/2017/02/IDM-OpinionPoll-2016-EN.pdf. ] However, further efforts are needed to strengthen the quality of healthcare in Albania. One of the concerns that has often been exploited for corruptive practices and illegal benefits is the prescription system.

Over the past few years Albania has undertaken a number of reforms to digitalize the healthcare services. The objective of this commitment is to substitute paper medical prescriptions for electronic prescriptions nationwide. So far, medical prescriptions have only been recorded on paper and the volume of processing paper prescriptions has been difficult to manage. The Ministry of Health, after successfully piloting the electronic prescription system in the district of Durrës, aims to extend this system across Albania. The intended result of this system, as described in the action plan, is manifold. The government intends the e-prescription system to bring about the following changes: establish a historical record of medication patients receive, increase the efficiency of drug reimbursement funds, increase accuracy of determining medical drugs’ impact on patient’s health and healthcare, reduce the number of false prescriptions, reduce error between doctors and pharmacists, increase level of compliance of drugs given to patients, and more.

Despite this ambitious outcome, it is unclear how the establishment of an electronic system will increase the level of compliance when doctors prescribe drugs. The specificity of this commitment is low. While the deliverable is verifiable, the text does not provide the measurable steps the government will take to ensure the new e-prescription system will achieve all the results that have been outlined.

Due to the low specificity, the IRM researcher considers this commitment to have minor potential impact if fully implemented. This commitment sets out to substitute paper prescriptions for an electronic system, which is an incremental step that does not address corrupt practices or low public trust in the healthcare system. A more transformative commitment would detail functionalities to be built into the electronic system that would allow prescriptions to be tracked by a monitoring body, or otherwise include a public accountability mechanism to help raise trust among citizens.

This commitment’s relevance to OGP values is also unclear. Extending the e-prescription system to the rest of the country does not provide greater or improved access to information for citizens, nor does it provide a mechanism for greater civic participation or public accountability.

Completion

No information was provided to the IRM researcher on this commitment. It was difficult to assess whether or not the commitment was on time, given the vague specificity of the commitment. In September 2017, the new Government of Albania restructured various ministries and agencies (including adding social welfare under the Ministry of Health’s purview), and the IRM researcher could not establish contact with the Ministry of Health’s point of contact for this commitment.

The IRM researcher’s monitoring during the implementation period established that the e-prescription system was launched in Tirana in March 2017.[Note138: The e-prescription system, http://www.shendetesia.gov.al/al/newsroom/lajme/receta-elektronike-beqaj-vijon-normalisht-zbatimi-ne-4-ditet-e-para-te-tirane. ] Earlier, in January 2017, 317 healthcare personnel were trained on the use of the e-prescription system.[Note139: E-prescriptions, http://www.shendetesia.gov.al/al/newsroom/lajme/receta-elektronike-ne-tirane-nis-trajnimi-i-mjekeve. ] The application for the e-prescription system is serviced through the e-Albania portal.[Note140: Link to e-prescription application, http://apps.fsdksh.com.al:7777/PublicIdm/;PublicIdmApp=cs4cJY_ICDeXHVPF3IM0WScNP5eYqULi2ENcfxnHaw6kRltz0Nta!1784821236. ] The system’s application is explained through a number of assisting materials (videos),[Note141: E-prescription videos, http://apps.fsdksh.com.al:7777/VideoTutorial/Index.html and https://www.fsdksh.com.al/images/stories/receta_elektronike/Sisitemi_recetes_elektronike.pdf. ] and it is interlinked with the citizen’s health cards.[Note142: Citizen’ health cards registry, https://regjistri.fsdksh.com.al/ahis/faces/Login.jsf. ]

The IRM researcher was only able to establish the use of the e-prescription system in Durres and Tirana. No information was offered by the responsible institutions on results, nor was information offered regarding the plan to extend the system nationally.

Early Results

Participants in focus groups, organized by the IRM researcher, were familiar with e-prescriptions and with the health card, its interlinked component. While many of them praised these projects as a significant step forward in improving public services, some participants expressed skepticism with regards to its actual results in the fight against corruption. 'This is petty corruption. The Government should fight the grand corruption in the system of procurements in the healthcare system,' said one stakeholder.[Note143: Participant at the IRM focus group with youth.] Private sector operators (i.e. pharmacists) agree to a limited extent, emphasizing that 'e-prescription includes a monitoring element which will enable in the future eradication of corruption in the relations patient-healthcare personnel-pharmacists'.[Note144: Interviews with Pharmacists in Tirana, September – October 2017.]

Next Steps

The e-Prescription system, the citizen’s health card and other e-services in the healthcare system provide an important foundation for greater transparency and accountability measures. In this context, the IRM researcher suggests that other follow-up commitments should be undertaken, specifically those that offer public access to data and other information gathered through e-systems, in compliance with legal requirements for personal data protection. Such actions would include:

· Publish data about the usability of e-Prescription;

· Publish information about 'customers’ satisfaction'; and

· Publish information about the performance of all operators involved in the e-prescription system, including financial data.

IRM End of Term Status Summary

15. Pilot e-prescription

Commitment Text:

Title: Electronic system of registration of e-prescription in the Republic of Albania

This commitment is intended to replace medical prescription on papers to electronic prescription nationwide. Fulfilling this commitment brings increased efficiency of drug reimbursement medical funds and accuracy of determining medical drugs impacting directly on improving the quality of patients' health and health care.

Among other things, e-prescriptions will bring:

  • Reduced possibility of errors resulting from misunderstandings in writing between physicians and pharmacists;
  • Reduced administrative time communication between patient - physician, patient - pharmacists, pharmacist - Compulsory Insurance Health Care Fund (CIHCF);
  • Increased level of compliance of drugs given to a patient and increase patient's comfort and in accessing these medicines;
  • The system will enable gathering of a historical record of actual medication that the patient received.

Responsible institution: Ministry of Health

Supporting institution(s): Pharmacies

Start date: 2016 End date: 2017

Editorial Note: For full commitment text, please refer to https://www.opengovpartnership.org/wp-content/uploads/2001/01/Albania_NAP3_ENG.pdf.

Commitment Aim:

The objective of this commitment was to replace paper medical prescriptions with electronic prescriptions nationwide. Prior to the commitment, medical prescriptions had only been recorded on paper and processing the volume of paper prescriptions was difficult to manage. The Ministry of Health, after successfully piloting the electronic prescription system in the district of Durrës, committed to extending this system across Albania. The intended result of this system, as described in the action plan, was manifold. The government intended the e-prescription system to bring about the following changes: establish a historical record of medication patients receive, increase the efficiency of drug reimbursement funds, increase accuracy of determining medical drugs’ impact on patient’s health and healthcare, reduce the number of false prescriptions, reduce error between doctors and pharmacists, and increase the level of compliance of drugs given to patients.

Status

Midterm: Limited

The e-prescription system was launched in Tirana in March 2017. [87] Earlier, in January 2017, 317 healthcare personnel had been trained on the use of e-prescription. The application is serviced through the e-Albania portal; [88] it is explained through a number of assisting materials (videos) and interlinked with citizens’ health cards.

The IRM researcher was only able to establish the use of the e-prescription system in Durres and Tirana. No information was offered by the responsible institutions on results, nor was information offered regarding the plan to extend the system nationally. [89]

End of term: Limited

This commitment made progress between October 2017 and October 2018. The system is online and functional [90] and according to the representative of the Public Health Fund, is being used by nearly 1,500 doctors in public health institutions. [91]

However, the e-prescription is not fully implemented at the national level. Out of 12 regions, in nine of them the system is being used according to Ministry of Health officials (October 2018) – Tirana, Durres, Fier, Shkodra, Elbasan, Korca, Vlore, Berat and Dibra. Furthermore, the IRM researcher established that e-prescription is not used in the health institutions of all municipalities in these nine regions. While acknowledging this fact, the Ministry of Health is focusing on the regional health institutions with the objective to cover all 12 regions by the end of 2018. According to the Ministry, all the prescriptions for the reimbursement drugs are prescribed via the e-prescription system. This includes 413 health care centers, 1600 primary health care physicians, and 13 hospitals. [92]

An investigative report by the media based on information coming from the State Supreme Audit suggested that the e-prescription is not functioning in an adequate way due to poor internet connection. [93] Alfred Leskaj (Inspector of the Supreme Audit) reported that health institutions in nearly 69 percent of the present coverage of the e-prescription system still continue to prescribe medicines in writing and are unable to use the system due to low internet connection.

Did It Open Government?

Access to Information: Did Not Change

Civic Participation: Did Not Change

Public Accountability: Did Not Change

This commitment did not contribute to any changes in government practice on access to information, citizen participation or public accountability, despite the expected improvements as regards the quality of service for citizens.

Carried Forward?

At the time of writing of this report, Albania had not published its next action plan. If a commitment regarding medical prescription is included in the next action plan, it should clearly focus on advancing OGP values.

[87] Ministry of Health, link to e-prescription system, http://www.shendetesia.gov.al/al/newsroom/lajme/receta-elektronike-beqaj-vijon-normalisht-zbatimi-ne-4-ditet-e-para-te-tirane

[88] Link to e-prescription application, http://apps.fsdksh.com.al:7777/PublicIdm/;PublicIdmApp=cs4cJY_ICDeXHVPF3IM0WScNP5eYqULi2ENcfxnHaw6kRltz0Nta!1784821236

[89] IRM Albania Progress Report 2016/17, https://www.opengovpartnership.org/wp-content/uploads/2001/01/Albania_Mid-Term_2016-2018_EN_for-pub-comm.pdf

[90] Link to e-prescription application, http://apps.fsdksh.com.al:7777/PublicIdm/;PublicIdmApp=os_gOeZL5BzKJRh9F5NP8oDS0Q8A9T-Ml_vmE925G0M_JHyTzWFM!-70656013

[91] Public Health Fund official, interview by IRM researcher, September 2018.

[92] The IRM received the following information from the Ministry of Health and Social Protection during the pre-publication period of this report on 3 July 2019.

[93] Top Channel TV, “The electronic prescription does not work, KLSH finds a number of problems”, July 2018, http://top-channel.tv/2018/07/31/receta-elektronike-sfunksionon-klsh-konstaton-nje-sere-problemesh/


Commitments

  1. Transparency of Government Reporting

    AL0061, 2018, E-Government

  2. e-Government

    AL0062, 2018, E-Government

  3. Improved Business Regulation

    AL0063, 2018, Capacity Building

  4. Safe Communities

    AL0064, 2018, Anti-Corruption Institutions

  5. Improvement of Database/Portal with Coordinators’ Data of the Right to Information and Transparency Programs

    AL0044, 2016, E-Government

  6. Budget Transparency

    AL0045, 2016, E-Government

  7. Integrated Registry of Citizens’ Housing

    AL0046, 2016, Citizenship and Immigration

  8. Establishment of Electronic Registry for Public Notification and Consultation

    AL0047, 2016, E-Government

  9. Digital Archive

    AL0048, 2016, E-Government

  10. Creating a Database for Archiving and Publication of Research Funds and Programs in Albania

    AL0049, 2016, E-Government

  11. Commitment to Publish Online Central and Local Government Legislation in Open Systems and for Free

    AL0050, 2016, Capacity Building

  12. Commitment to Open Standards for Contracting

    AL0051, 2016, E-Government

  13. Starred commitment Implementation of the Law "On Protection of Whistleblowers", Capacity Building, Amendments and Its Bylaws

    AL0052, 2016, Anti-Corruption Institutions

  14. Provision of Electronic Services

    AL0053, 2016, Capacity Building

  15. Establishment of Multifunctional Centralized System for Building Permits

    AL0054, 2016, Capacity Building

  16. Establishment and Distribution of Digital Counters

    AL0055, 2016, E-Government

  17. Service Passport Standardization

    AL0056, 2016, Capacity Building

  18. Citizen Card

    AL0057, 2016, Capacity Building

  19. Electronic System of Registration of e-Prescription in the Republic of Albania

    AL0058, 2016, E-Government

  20. Electronic Monitoring System of Forests

    AL0059, 2016, Anti-Corruption Institutions

  21. Integrated Electronic System for Professional Licensing of Individuals and Legal Entities That Will Operate in the Field of Study Design and Supervision of Commissioning of Construction Works

    AL0060, 2016, E-Government

  22. Standardization of Corruption Complaints

    AL0031, 2014, Anti-Corruption Institutions

  23. Electronic Registry of Energy and Industry Permits

    AL0032, 2014, E-Government

  24. Implementation of Public Expenses Module in "Open Data" Format

    AL0033, 2014, E-Government

  25. Promoting OGP Values Among Local Authorities

    AL0034, 2014, OGP

  26. Database on Economic Assitance Beneficiaries

    AL0035, 2014, E-Government

  27. Electronic Portal on Water Resources Administration and Management

    AL0036, 2014, E-Government

  28. Single Window

    AL0037, 2014, E-Government

  29. Electronic Access to Protected Areas

    AL0038, 2014, E-Government

  30. National Geoportal

    AL0039, 2014, E-Government

  31. e-Albania

    AL0040, 2014, E-Government

  32. e-Document

    AL0041, 2014, E-Government

  33. Starred commitment Law on Whistleblowers Protection

    AL0042, 2014, Legislation & Regulation

  34. Police Service Offices

    AL0043, 2014, E-Government

  35. Open Data Portal

    AL0001, 2012, Open Data

  36. e-Acts

    AL0002, 2012, E-Government

  37. e-Parliament

    AL0003, 2012, E-Government

  38. Extension of the Governmental Network, GOVNET

    AL0004, 2012, E-Government

  39. e-Government Interoperability Framework, e-GIF

    AL0005, 2012, E-Government

  40. Government Datacenter

    AL0006, 2012, E-Government

  41. Excise System

    AL0007, 2012, E-Government

  42. Starting of the e-Tax System

    AL0008, 2012, E-Government

  43. Starred commitment Online State Matura

    AL0009, 2012, E-Government

  44. The Regulation on Ethics in Research and Publishing

    AL0010, 2012, Education

  45. Digitalization of Higher Education Accreditation Process

    AL0011, 2012, E-Government

  46. U-Gov System

    AL0012, 2012, E-Government

  47. Online Inspections of Courts and Judicial Hearings

    AL0013, 2012, E-Government

  48. Digitalization of the File Transfer Process

    AL0014, 2012, Judiciary

  49. e-Employment Project

    AL0015, 2012, E-Government

  50. e-Concessions Procedures

    AL0016, 2012, E-Government

  51. Amendment of the Law “On the Right to Information for Official Documents”

    AL0017, 2012, Justice

  52. Drafting a New Law on "Notice and Consultation"

    AL0018, 2012, Legislation & Regulation

  53. Tracking Project

    AL0019, 2012, E-Government

  54. Digitalization of the Notary Register

    AL0020, 2012, E-Government

  55. Online Citizens’ Claims in the Judiciary System

    AL0021, 2012, E-Government

  56. Work Inspection, Online Complaint

    AL0022, 2012, E-Government

  57. Financial Module of All Educational Institutions

    AL0023, 2012, Education

  58. Starred commitment Audio and Video Recording of Judicial Hearings

    AL0024, 2012, E-Government

  59. Starred commitment e-Albania Portal

    AL0025, 2012, E-Government

  60. e-Inspection Portal

    AL0026, 2012, E-Government

  61. Starred commitment Portal Www.Gjykata.Gov.Al

    AL0027, 2012, E-Government

  62. Disclosure of the List of Payments Made Daily by the Government Units

    AL0028, 2012, Fiscal Transparency

  63. e-Procurement System for All Small Purchases of Public Procurement

    AL0029, 2012, E-Government

  64. Implementation of the EITI Recommendations

    AL0030, 2012, Extractive Industries