The document summarizes Andalusia's digital health strategy and e-prescription system for improving medication adherence. Some key points: - Andalusia has implemented a long-term digital health strategy since 1999 that includes an electronic health record for each resident accessible across primary care, hospitals, pharmacies and other services. - Their e-prescription module called "Receta XXI" allows doctors to electronically prescribe treatments that can be dispensed at any pharmacy in Andalusia. It provides decision support tools to help reduce errors and increase adherence. - Studies show the e-prescription system has helped avoid over 500 million euros in costs since 2001 and increased medication adherence rates. Pharmacists also report

1. e‐Prescription as a tool for improving adherence
The experience of Andalusia Region, Spain

2. Andalusia: a short view
Main features
• 8,437,681 inhabitants (526,942 foreigners)
• 21.6 Million of tourists in 2012
• Political Autonomy from 1981
• Full responsibility at regional level on Public
Health and Healthcare Services from 1984
The Public Healthcare System of Andalusia
1,514 Primary Care Centres
47 Public Hospitals (16,821 beds)
102,000 Healthcare Workers
8,431 M € Budget 2013 (6.00% GDP; 999.19 €/inhabitant)
3,602 Pharmacies (Private Offices regulated as a public service)

3. The Digital Strategy of
the Public Healthcare System of Andalusia
• A long‐term Strategy: From 1999
• A single health record number for all citizens of Andalusia
• A single electronic Health Record for every person
• A individual smart card for each person as a key for access
• Structured information
• A regional eHR shared among:
• Primary care
• Hospitals
• Pharmacies
• Emergencies
• Patients (from 2012)
• Nursing homes (coming soon)

4. Much more than an eHR:
A corporate information system
Appointment Prescription
Radiology
Waiting lists
Functional
tests
Pathology
Lab tests
Inpatient care
Referrals
Outpatient
care
Primary
care
Hospital
admission
Data
warehouse
Emergency
care
8.24 Million
individual eHR
121 Million
e‐prescriptions
yearly
94 Million
appointments
yearly
Health Care Information and
Management Integrated System

5. Ageing, chronic diseases and drug consumption
17,9
23,0
31,6
48,4
73,6
84,3
91,6
16‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75 & +
% of people with at least one chronic
condition, by age. Andalusia, 2011
0,2
0,9
1,7
2,3
3,1
4,5
0 ChC 1 ChC 2 ChC 3 ChC 4 ChC 5 ChC +
Number of different drugs consumed
related to the number of chronic
conditions (ChC). Andalusia, 2011
17.4 % women
13.39 % man
People 65 or older
Andalusia, 2012
% of Noncompliance in Hypertension:
7.1 % ‐ 55.2 % Average: 32.3%

6. White Paper on
Active Ageing Comprehensive
Plan for attending
people with
chronic conditions
in Andalusia
Strategic approaches for health ICT,
active ageing, chronic diseases and adherence
Consensus document about
therapeutic adherence in
chronic patients
Ombudsman Report about
ICT and older people in
Andalusia, 2011

7. ePrescription module: “Receta XXI”
Medical office Pharmacy
Intranet of the Official
College of Pharmacists
The system allows the
dispensation of the
treatment at any
pharmacy in Andalusia
during the time
established by the doctor
Smart card as a key
Intranet of the
Public Healthcare
System
Instruction
sheet for
patient
Treatment
available on line

8. ePrescription utilisation and savings
Savings: 533 Millions €
from 2001
2,7
25,7
46,6
57,7
63
70,9
75,2 77,1 78,6
84
91,1 93,6
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
48,5
49,6
50,1 50,5 50,3 49,9
44,1
43,6
42,9
2004 2005 2006 2007 2008 2009 2010 2011 2012
‐14 %
Electronic prescriptions (millions)
Appointments at Primary Care (millions)
% Prescription by INN (active principle)
0,2 1,2
8,9
30,5
66,3
89,2
105,2
118,6 121,3
2004 2005 2006 2007 2008 2009 2010 2011 2012
Currently: 94.49%
of all prescriptions
are electronic

9. ePrescription: cumulative economic performance
0
50.000.000
100.000.000
150.000.000
200.000.000
250.000.000
300.000.000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
EUR
Present value of cumulative costs Present value of cumulative benefits
Case studies. European Commission. http://www.ehr‐impact.eu/cases/cases.html

10. Decision support tools for prescribing
• Single medicines record
• Updated catalogue (Nomenclator)
• Prescription by International Nonproprietary Name
• Help in filling up dosage
• Warnings for duplicated prescription
• Evidence‐based guide by Scientific Societies and HTA Institutions
• Info on drugs
• Allergies and contraindications
• Help reporting adverse reactions
• Interactions
• Warning maximum daily doses
• Warning therapeutic redundancy
• Forms included

11. ePrescription avoiding duplication
Electronic tools may contribute
to minimize prescription errors
detecting duplicate drugs or
family drugs in the same patient.
Use of DSS Prescriptions Duplications %
Before 27,088 1,667 6.15%
After 22,672 273 1.20%
Pilot study on DSS for
detecting duplication
on the most frequent
therapeutic groups

12. ePrescription usefulness for adherence
Electronic tools may
allow GPs to identify
patients with potential
noncompliance
behaviour and reinforce
individual measures of
education, assessment
and/or motivation.
In addition, ePrescription
module may help to
monitor these patients.

13. ePrescription module: role of the pharmacist
Pharmacy Pharmacist can send
an alert to the
individual eHR and
block a prescription
until the Doctor can
check it and confirm
or not
A warning appears at the patient’s eHR
and Doctor can check the comments
from the pharmacist and confirm this
criteria or maintain the drug
Medical office
Intranet of the Public
Healthcare System
Intranet of the
Official College of
Pharmacists
91,17
8,83
Confirmed Re‐activated
16,220 cases in 2012
%
%

14. Survey on ePrescription
2009‐2010
1,193 pharmacists in Spain
(984 of them in Andalusia Region)
Supported by Almirall©
ePrescription:
Is globally positive for the pharmacy office 78.8%
Increases detection of drug‐related problems 78.7%
Improves therapeutic adherence 80.2%
Improves therapeutic adherence in older people 79.7%
Improves therapeutic adherence in chronic patients 63.3%
Allows the pharmacist more ability for monitoring 68.8%
Patient feels a better control by the pharmacist 54.1%

15. Other tools for enhancing adherence
App for smartphones
or tablets:
“Recuerdamed”
Access to eHR and current
treatment for patients
Patient’s school
Telemedicine
Call centre

16. Thanks for your attention!
José L. ROCHA
General Secretary for Quality and Innovation
Regional Ministry of Health and Social Welfare
Government of Andalusia, Spain
josel.rocha@juntadeandalucia.es
@joselurro