Short revision on the current status of the electronic prescription module of the eHR in Andalusia Region and the available tools improving patient safety. CDSS may avoid interactions, unnecessary duplications, undetected allergies and many others.

1. José L. ROCHA
General Secretary for Quality and Modernisation
Regional Ministry of Health
Government of Andalusia, Spain
josel.rocha@juntadeandalucia.es

2. Andalusia
8,302,923 inhabitants
87,597 Km2
Andalusian Public Healthcare System: Main features
1,146 Primary care centers
360 Auxiliary offices for primary care
49 Public Hospitals (16,821 beds)
102,000 Healthcare professionals
9,390 M € Health Budget 2011, 6.67% GDP

3. The Digital Strategy of the Public Healthcare
System of Andalusia: The Project
• 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
• A regional eHR shared among:
• Primary care
• Pharmacies
• Hospitals
• Emergencies

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

5. Functional architecture of the eHR in Andalusia
De‐centralised structure for Hospitals: Admission, Clinical
Stations for inpatients, outpatients and emergencies. Internal
Local Bus for connecting tools: Lab tests, Functional tests,
Local PACS
PACs, Pathology…
Central Bus for Hospital‐Primary Care connection, data
exchange and shared tools: lab module, RIS/PACs, Referrals.
Also for some centralised tools: surgical waiting list, etc
Centralised electronic Clinical Station and tools for primary care:
C.S appointment, e‐prescription, vaccines
Centralised (duplicated) substructure: Citizens data base,
Operators Module, Resources Structure
Centralised replicated database for data mining, indicators and
evaluation reports

6. Current extension of the eHR in Andalusia
Completion level Tool Population Cases in 2010
▌▌▌▌▌▌▌▌▌▌ Clinical Station 100% 7.9 M Pat / 39.7 M Sheets
▌▌▌▌▌▌▌▌▌▌ Appointment 100% 83 Million
▌▌▌▌▌▌▌▌▌▌ Referral tool 100% 39.7 Million
▌▌▌▌▌▌▌▌▌▌ e‐Prescription 99.8% 105 Million
▌▌▌▌▌▌▌ Radiology (RIS) 71% 3.4 Million
▌▌▌▌▌ Lab tests 49% 360,000
▌▌▌▌▌▌▌▌▌▌ Clin Station ‐ Hosp. Emergencies 100% 3.4 Million
▌▌▌▌▌▌▌▌▌▌ Clinical Station – Outpatients 100% 1.5 Million
│▌▌ Clinical Station – Inpatients 26% 916,890
▌▌ Admission 18% 60,000
▌▌▌▌▌▌▌▌▌▌ Appointment 100% 12 Million
│▌▌▌▌▌ e‐Prescription 56% 505,862
│▌▌ Lab tests 25%
▌▌▌ Radiology (PACS) 29% 3.4 Million
▌▌ Out of Hosp. Emergencies 20%

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

8. Use of the e‐Prescription module in Andalusia
105.218.987
89.240.751
66.315.635
30.520.106
8.982.319
247.545 1.245.313
2004 2005 2006 2007 2008 2009 2010
Number of e‐Prescriptions in the Andalusian Public Healthcare System
from 2004 to 2010

9. Use of the e‐Prescription module in Andalusia
Hand‐written Printed by PC e‐Prescription
2004 2005 2006 2007 2008 2009 2010
Year
Percentage of the different types of prescription in the Andalusian Public
Healthcare System from 2004 to 2010

10. Use of the e‐Prescription module: primary care
appointments after introducing this module
38 Million visits
‐15.28%
saved from 2006
56.522
47.910
Before After 6 months trial with the
same cohort of population

11. Use of the e‐Prescription module: % of
prescriptions done by INN (international
nonproprietary name) and estimated savings
84
446.1 Million € 77,1 78,6
75,2
saved from 2001 70,9
63
57,7
46,6
25,7
2,7
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

12. Use of the e‐Prescription system in Andalusia:
cumulative economic performance
300.000.000
250.000.000
200.000.000
EUR
150.000.000
100.000.000
50.000.000
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Present value of cumulative costs Present value of cumulative benefits
Case studies. European Comission. http://www.ehr‐impact.eu/cases/cases.html
07/2009 The socio‐economic impact of Receta XXI, the regional ePrescribing system of Andalucía’s
public health service.http://www.ehr‐impact.eu/cases/documents/EHRI_case_Receta_XXI_final.pdf

13. Much more than an e‐Prescription module: a
Decision support system
• Single medicines record
• Updated catalogue (Nomenclator)
• Prescription by International Nonproprietary Name
• Help in filling up dosage
• Warnings for duplicated prescription
• Evidence‐based guide by Medical Primary Care Society
• Info on drugs
• Allergies and contraindications
• Help reporting adverse reactions
• Interactions
• Warning maximum daily doses
• Warning therapeutic redundancy
• Forms included

14. Medical decision support system: selection of the
recommended treatment from the approved Guidelines

15. Medical decision support system: selection of the
active principle (INN) vs. commercial brand

16. Medical decision support system: avoid a drug already
prescribed in the current treatment by other doctor

17. % of unnecessarily repeated drugs avoided in elderly
patients receiving multiple medication after the
introduction of a Medical Decision Support System
for prescription
Andalusia average:
55% of reduction
67
64
62 62 62 63
59 59 59 59 60 60
57 57 57 57
54 54 54 55 55 55 55
52 53 53
50 51
48 48 49
43
41
S
DM
N
U
C
X
GR
SC
BC
E
N
SG
HC
S
CS
L
JS
DC
O
AA
A
JN
N
G
PO
JC
Primary care Districts

18. Medical decision support system: detection of
pharmacological interactions between drugs

19. Medical decision support system: detection of
allergies or previous intolerance to drugs

20. ePrescription module: Role of the pharmacist
11,182 cases in 2010
Pharmacist can send an alert to
Pharmacy the individual eHR and block a
7%
prescription until the Doctor can
check it and confirm or not
93%
Confirmed Re‐activated
Medical office
Intranet of the
Official College of
Pharmacists
A warning appears at the
Intranet of the patient’s eHR and Doctor can
Andalusian Public check the comments from the
Healthcare System pharmacist and confirm this
criteria or maintain the drug

21. The electronic prescription as a tool for
improving patient safety
Adverse events are a main cause of mortality and
morbidity.
In Andalusia 6.93% of hospitalized patients and 1.01%
of primary care patients have an adverse event (ENEAS
Study, 2005 and APEAS Study, 2006)
28.8% of adverse events in medical areas in Andalusia
are drug‐related
Electronic prescription tools may play a tremendous
role improving patient safety throughout the entire
healthcare process, avoiding mistakes in denomination
The Andalusian Strategy for
and dosage, duplicity, interactions or incompatibilities,
improving Patient Safety checking for previous allergies and intolerance
Furthermore, e‐prescription systems can facilitate the
collaborative work between pharmacists, doctors and
other professionals, and provide information about
drug compliance.

22. Thank you very much!
Merci beaucoup!