E-Prescription

Jonathan Sudharta
CEO Halodoc
INDONESIA
 Total Mobile Smartphone
Population Subscription Penetration

262 371 55%

Million Million
Digital in Indonesia

51% 34% 14% 39%

Growth (vs Jan 2016)

Internet Users

According to Google & Temasek’s joint research in 2016, SEA is the world’s fastest growing internet
market (~480m users by 2020); Indonesia is the fastest growing nation in the world.

The biggest growth

Social Media

3rd

2nd 4th
E-commerce in Indonesia
WHAT IS E-PRESCRIPTION
E-prescribing
is the use of health care technology..
-  To improve prescription accuracy
-  To increase patient safety

Physicians simply have to send prescriptions electronically into the

pharmacy’s computer system

Simplifies healthcare
E-prescribing: physician practice – pharmacy
interoperability
E-prescribing is the totally electronic transmission of prescription
information from the prescriber’s fingertips to the pharmacist’s eyes..
-  Computer to computer
-  Electronic data interchange (EDI)
-  NO PAPER! (unless one so chooses)
-  Bi-directional (renewal requests)
-  Clinical decision support upfront
 Opinion from a Leading Pharmacy Chain

Why e-Prescribing?

Prescriptions that make it to the Pharmacy

Paper based E-Rx based

100%
70%

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
 Benefits to Pharmacies

•  Reduction of errors due to misinterpretation

–  Handwriting interpretation
–  Sound alike drugs if prescription is given verbally by phone
–  Fax – poor quality – difficult to read
•  Delay of treatment if missing information
–  Strength – quantity – directions omitted
–  Refill information – patients inadvertently stop treatment
–  Payer information – prior authorization
•  Reduces chance of wrong information
–  Dosage – strength – directions – refills
–  Clinician actually chooses wrong medication
•  E-prescribing applications can check for inaccuracies

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
 Benefits to Patients

•  Complete prescription history available

•  Improved efficiencies
–  Pharmacy of choice
–  Secure
–  Prescription available for pick up upon arrival

•  Higher levels of patient confidence and satisfaction

–  Potential to reduce medication errors by 55%

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
 Added Benefits

•  E-communication leads to additional messaging

–  Transmit diagnosis – lab results
•  Improves consultation at the pharmacy
•  Medication therapy management at the Pharmacy

•  Therapeutic Change Requests

•  Renewal requests – critical information sent from the pharmacy –
integrate with electronic medical records
•  Patient medical record ID
•  Drug codes
•  Patient date of birth
•  Medication History
–  Hurricane lessons learned
–  Pharmacy information includes OTC medications

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
 Approximately 30% of its 700+ million
prescriptions were processed electronically in
2010, up from 20% in 2009

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
 E-prescribing with physician-pharmacy-payer
connectivity benefits all stakeholders
•  Patients •  Pharmacies
–  Increased satisfaction due to fewer trips to –  Reduce errors due to misinterpretation or
the pharmacy transcription
–  Greater confidence in accuracy –  Avoid delay of treatment due to missing
–  Preserves choice of pharmacy information
–  Time savings from reduced calls and faxes
•  Physician practices with physician offices
–  Reduce hassle of faxes and call backs
–  Significant efficiency gains for renewal
–  Save 2-3 hours/day staff time resolving authorizations
prescription issues
–  Eliminate data entry
–  Save 1 hour/day physician time resolving
–  Improved morale given reduced hassle
renewals issues factor
–  Significant efficiency gains for renewal
authorizations •  Payers
–  Improves safety and quality due to clinical –  Cost savings due to improved formulary
decision support at point of care compliance
–  MGMA estimates e-prescribing with –  Reduced costs of patient care resulting
pharmacy interoperability can save a from adverse drug events
practice $10,000 annualy – per physician*
–  Preserve physician choice of medication

Ins6tute for Safe Medicine Prac6ces. A Call to Ac6on: Eliminate Handwri@en Prescrip6ons Within Three Years, 2000.
E-prescription increases Adherence
E-prescription
increases
Adherence
A new study suggests e-prescribing may enhance patient prescription
adherence

In an analysis of nearly 2,500 patients, e-prescribing was associated with a

significant reduction in primary nonadherence, defined as not filling and picking
up all prescriptions within 1 year of the prescription date.

This represents a 47% reduction in the risk of primary nonadherence

E-prescription
increases Electronic vs Paper
Adherence 10 days : 57.2% vs 46.2 %
60 days : 78.2% vs 60.8%
E-presciption

GLOBAL SCENE
 E Rx – The Global Scene

Governments across the world are providing incentives for

implementing e-prescriptions, and at the same time penalizing non-
compliance leading to its growing popularity

•  Several countries have enacted laws and implemented policies

•  U.S.A and Europe constitute the two major markets for e-Prescription
systems globally.
–  Of the two, Europe represents the largest market for e-Prescription systems.

Patrick Kierkegaard
e-Prescription Part of European Health Policy

Countries that have adopted fully operational e-Prescription* are :

–  Denmark (97%), Netherlands ( 71%) Sweden (81%)
–  Other countries which use the prescription process routinely are
Estonia, Iceland, England and Scotland.
(*entire prescribing sequence, from issuing one to transfer and dispensation, is done electronically)
E-prescriptions are an important component of digital health
systems for the future,
•  promising increased efficiency,
•  better patient safety through error reduction, and
•  increased patient convenience

The topic is high on the agendas of national and EU

policymakers, particularly as it forms part of the vision for a
single digital market and cross-border healthcare in Europe.
E-Rx permitted from 2013 itself
and Mandatory from 2016

27
 E-prescrip0on in USA
- A Detailed Review
- an experience that can and should be emulated !

28
9 out of 10 pharmacies in the US can accept e-prescriptions. Additionally, 70% of
physicians are e-prescribing using and EHR
Over 95% of US pharmacies are provide e-prescrip6on
connec6vity, including thousands of local independent
pharmacies
 Wuzhen Internet Hospital
established by Wedoctor
(GuaHao)

Internet Hospital Services

include Electronic Prescriptions
 According to the Zhejiang Provincial
Health and Family Planning Commission,
the 59-years-old was one of the 1st
pa6ents to use online medical services
aWer the Wuzhen Internet Hospital,
China’s 1st Internet hospital, opened on
Dec 7.

Clinical services have increased rapidly
since the WIH opened
Pa6ents can register by logging onto the internet or via a mobile phone app.
Once register, they can :
•  choose doctors
•  make reserva6ons
•  consult a doctor via a video link and
•  receive e-prescrip0ons

Once pa6ents have paid the bills online, they wait un6l the drugs are
delivered to their homes by courier companies, according to instruc6ons on
the hospital’s website
Approved by China’s health authori0es, Guahao’s digital
pla\orm (apps, website) offers online hospitals, medical
insurance, a specialist database, appointments for public
hospitals, e-prescrip6ons, test reports, payments, online
follow up and more
GuaHao's Offerings
Founded in 2010, GuaHao is a mobile medical and health consultation platform. Its Weiyi mobile
apps connect patients with hospitals and doctors through the Internet. Typically, to access
healthcare services, patients in China have to go to a hospital, take a token number, and wait for
their turn. A patient scheduling system enables a more efficient allocation of healthcare resources.
GuaHao has an efficient information-sharing system and its well-designed, easy-to-use online
platform allows patients to access their personal calendars, local hospitals and physicians and
helps them make appointments within minutes. Today, it claims to have over

1,600 hospitals listed on its platform,

190,000 specialists,
100 million registered users
Several online appointment registration systems have sprung up in China.

However, GuaHao has the distinction of being authorized by the National Health and Family
Planning Commission of the People's Republic of China (or the Ministry of Health)
Zhang Lin (84) who has suffered from hypertension for
20 years, talked with Chief Physician Chen Xiaomin
about his symptoms via video call on the online
pla\orm of Ningbo Hospital.

AWer reviewing Zhang’s medical record, Chen gave his
advice and submiFed an e-prescrip0on to the cloud.

A day later, Zhang received hypertension-control
medicine at home.
Australia
•  E-prescription in Australia is currently provided by two service
providers, MediSecure and eRx.

•  Both services can be integrated into many of the existing clinical

and pharmacy prescribing software systems. Since December
2012, they have become interoperable allowing bilateral transfer of
information
E-prescriptions Netherlands
– New Law in place from 2012
•  Netherlands The implementation of the nationwide EHCR was initiated by the
National IT Institute for Healthcare in the Netherlands (NICTIZ), which was created in
2002.
•  NICTIZ initiated the legal framework for the exchange of patient information and for
communication between GPs and other health providers (in terms of the national
infrastructure, electronic messages, and safety).
•  It also coordinates the implementation of health IT projects and provides a level of
national support, including training, a helpdesk, and maintenance of Web-patient
portals [15].
•  On January, 2012 the Netherlands implemented a new law that requires
prescriptions to be transferred electronically to the pharmacy [16]. Prof. Dr van
der Wal, the Inspector General of the Dutch Healthcare Inspectorate announced
that the switch to an electronic prescription was due to the numerous errors being
made in the dispensation of the medicines.
E-prescriptions Estonia
– System in place from 2010

•  All hospitals and pharmacies in the nation are connected to the system.
Because the e-Prescription system draws on data from the national
health insurance fund, any state medical subsidies that the patient is
entitled to also appear, and the medicine is discounted accordingly.
•  This frees up time for both the patient and the doctor, and reduces
administrative strain on the hospital.
E-Prescription system in Finland

Healthcare digitalisation
E-prescription:

Implementation nearly 100%

•  Pharmacies OK
•  Public sector OK
•  Private sector 70%
•  Approx. 70% of all prescriptions are
e-prescriptions

By legislation obligatory
•  For doctors and pharmacies
•  Obligatory 1.1.2017
E-prescription implemented in Russia
– by Government Order

•  With the development and implementation of electronic technologies in

Russian healthcare system, electronic prescription became part of the
project called EMIAS.
•  EMIAS is the digital system designed to increase the quality and access of
the medical aid in the public health facility
•  The project was designed and being implemented as part of «Digital city»
program in execution of the Moscow Government's order from April 7, 2014
(as Moscow government amended on 21.05.2013 № 22-PP).
The system offers special portal Emias.Info, that provides appointment
service to the patients and client area with different services including e-
Prescription. Government social program allows getting pharmaceutical
products for free or with the discount, depending on the category of the
citizen.
India
•  In India some private hospitals started using electronic prescription.
•  But a major step was taken by government of West Bengal in August 2014
when they started the process of issuing e-prescriptions instead of hand-
written instructions in top government hospitals
•  The biggest advantage of the system is that a patient has all his medical
data stored in the server of state health department which can be
referred to in future
•  In the private sector number companies have initiated to build software to
support Electronic Prescription in India. ERXPAD.COM is one among the
pioneer player offer cloud based electronic prescription software ( erx) in
India.
E Rx – The Global Scene
Na6onwide e-prescrip6on ini6a6ves
E-prescrip6on are part of digital
are on the rise in several countries
health strategies across the globe
within Europe

ESTONIA DENMARK AUSTRALIA CANADA

UK FINLAND CHINA US

SWEDEN NETHERLAND NEW ZEALAND RUSSIA

BELGIUM SPAIN INDIA

E-PRESCRIPTION IN TELEMEDICINE
the #1 Telemedicine Provider
A Leading Telemedicine Provider

MDLIVE is provide delivery of e-prescrip6ons to the pharmacy.

With over 65,000 pharmacies, your precrip6ons are sent instantly to the
pharmacy as soon as your virtual consulta6on is over.
Telehealth and e-prescribing share the same objectives;
•  Expand access to care
•  Reduce costs
•  Increase efficiency
The integration proves to be a win for the patient, physician and pharmacist.
E-prescription improves patient care
by improving efficiency

The global e-prescription market provides solutions that enhance the

efficiency of medical practice

E-prescription systems improve not only the rate of delivering medical

attention, but can also improve the overall quality of healthcare and help
maintain accurate drug utilization systems

The global e-prescription market can also help with the co-pay data, displaying
dispensers and other providers with data on total drug coverage, and
formulary alternatives
Conclusion
End of Presenta6ons

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