Sweden has had widespread ePrescribing since 2008, when 80% of primary care prescriptions were electronic. Physicians appreciate ePrescribing for its speed, ease of renewal, and overview of patient medications. However, areas for improvement include drug selection complications and inadequate cancel/return functions. Most patients and pharmacy employees are also satisfied. Currently, the Swedish ePrescribing model connects caregivers, patients, and pharmacies within a region through electronic health records and prescription databases. Going forward, plans include utilizing prescription data for drug utilization reviews and alerts to improve patient safety. The ultimate goal is a unified, up-to-date record of a patient's complete medication history accessible by all care providers.

1. ePrescribing – and then…?
Swedish experiences and plans

2. Mats Larson
Chairman of the Board

3. ePrescribing is easy

4. ePrescribing is quite complex

5. Swedish eP-growth 1980-2008
2008; 80% of all prescriptions in primary
care where made electronically
Million eP

6. Doctors like it
What strengths do you associate with
ePrescribing?
Fast and easy 30 %
Easy to renew prescriptions 21 %
Gives a good overview, particularly the list of drugs 13 %
prescribed to a patient within the health care region
Information transfer between different features of 12 %
the EHR-system, e.g. prescribed drugs are
automatically archived in the patients health record
The overview of patient's prescribed drugs 9%
“Physicians' attitudes towards ePrescribing – evaluation of a Swedish
full-scale implementation” Hellström, Waern, Åstrand m fl. 2009 n=200

7. But things can be improved
What weaknesses do you associate with the
EHR-system that you use for ePrescribing?
Drug selection is complicated 21 %
No link between ePrescriptions and dose-system 12 %
Complicated in general, e.g. application tech. 11 %
The cancel-/return function is inadequate 9%
Several patients can be displayed at the same time 4%
ePrescription for extemporaneous preparations, 4%
non-approved drugs, and to patients seeking asylum
is impossible
“Physicians' attitudes towards ePrescribing – evaluation of a Swedish
full-scale implementation”Hellström, Waern, Åstrand m fl. 2009. n=200

8. What other stakeholders say…
• 95% of the patients said they would like to ”use
ePrescribing next time around”. N=1560 (Stockholm County Council)
• 98% of employees at the Pharmacies were
”generally satisfied with ePrescribing”. N=259 (Apoteket AB)

9. The Swedish model today
Caregiver Patient

10. The Swedish model today
Caregiver Patient
The patient´s
Dispensed
prescriptions, form
medication
the same region
The
EHR I Pharmacies
Db

11. The Swedish model today
SoS kval.indikatorer
Graviditet och Länkbibliotek
amningsklassificering
(Fass) Utsättning
Fass online
Interaktioner Apodos-sortiment
Sfinx Rekommendationer Biverkningsöversikt
T LV förmånsinformation Mallordinationer
Warnings Kortnotationer
Product information Interactions
Different Decison Support systems
Caregiver Patient
The patient´s
Dispensed
prescriptions, form
medication
the same region
The
EHR I Pharmacies
Db

12. The Swedish model today
SoS kval.indikatorer
Graviditet och
Länkbibliotek
amningsklassificering
(Fass) Utsättning
Fass online
Interaktioner Apodos-sortiment
Sfinx Rekommendationer Biverkningsöversikt
TLV förmånsinformation Mallordinationer
Warnings
Kortnotationer
Product information Interactions
Different Decison Support systems
ePrescription
Caregiver Patient Dispensing
The patient´s
Dispensed
prescriptions, form
medication
the same region
The
EHR I Pharmacies
Db

13. … and tomorrow
SoS kval.indikatorer
Graviditet och Länkbibliotek
amningsklassificering
(Fass) Utsättning
Fass online
Interaktioner Apodos-sortiment
Sfinx Rekommendationer Biverkningsöversikt
TLV förmånsinformation Mallordinationer
Warnings Kortnotationer
Product information Interactions
Different Decison Support systems
Caregiver Patient Dispensing
The patient´s
Dispensed
prescriptions, form
medication
the same region
Drug Utilization
Review
The
EHR I Pharmacies
Db
Alarms?

14. This is what the review found…
Category Number of Signals % Signals
Early Refill 1 334 296 38
Duplicate Therapy 1 049 216 29
Drug-Drug Interaction 518 138 14
High Dose, 18-65 years 223 941 6
Drug-Drug Interaction, level 2 131 193 4
Drug Disease Inferred 130 805 4
Patient Age, Senior 120 373 3
High Dose, Senior 31 985 1
Patient Age, Pediatric 19 977 1

15. Still not good enough…
SoS kval.indikatorer
Graviditet och Länkbibliotek
amningsklassificering
(Fass) Utsättning
Fass online
Interaktioner Apodos-sortiment
Sfinx Rekommendationer Biverkningsöversikt
TLV förmånsinformation Mallordinationer
Warnings Kortnotationer
Product information Interactions
Different Decison Support systems
Caregiver Patient Dispensing
The patient´s
Dispensed
prescriptions, form
medication
the same region
Drug Utilization
Review
The
EHR I Pharmacies
Db
Alarms?

20. In our dreams – and plans…
GENERAL
SPECIALIST CITIZEN HOSPITAL
PRACTICIONER
One,
unique, updated
record of the patients
complete medication
history and valid
prescriptions
ACCIDENT & NURSINGHOME PHARMACY HOMECARE
EMERGENCY

21. Mats Larson
Mats.Larson@Caritea.com