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

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.

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.

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/