|Implemented in this survey?|
To improve patient safety in drug use, a regional pilot project: "Pharmaceutical Safety Belt" was launched in February 2007. While the sample size of this pilot is rather small, first results nevertheless indicate potential that e-medication can improve patient safety and efficiency of drug use. A nation-wide roll-out is planned for 2009. However, uncertainty remains with regard to the acceptance of doctors who up to now seem resistant towards this initiative.
In February 2007 a pilot project was launched to identify possible interactions of drug use at the level of public pharmacies in Salzburg (Pharmaceutical Safety Belt). In spring 2008 first results were presented to the public. The basis for the realisation of this pilot were further developments in e-health in Austria (see also survey (6)2005):
First, full electronic billing of prescription drugs between the clearing house of public pharmacies (Pharmazeutische Gehaltskasse) and the Austrian Federation of Social Health Insurance (HVSV) was introduced in 2005.
Second, the e-card, which was introduced in 2006 (see also survey (10)2007), could by then be used as key for identifying drug interactions on the level of patients.
Third, the implementation of an electronic medical record (ELGA) foresees a stepwise approach with e-medication being the first package to be phased in (IBM : Machbarkeitsstudie ELGA 2006).
While technical developments as described above made the pilot possible, it had no explicit strategic ELGA-led support from the government. The pilot was initiated by the chamber of pharmacists. A special software was developed with an overall investment of 1.3 million Euros. These costs were financed by the clearing house of pharmacists and their chamber. The cost of an Austrian-wide roll-out of the Pharmaceutical Saftely Belt is estimated to be 3 to 4 million Euros. It is envisaged to roll-out the service in the mids of 2009.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
While the sample size of this pilot is rather small, the project is innovative and shows the potential of e-health with regard to patient safety and efficiency. Once implemented on a full scale this initiative will certainly bring more transparency in the area of drug use.
By now the public seems to be supportive. This may change if doctors' resistance towards e-medication increases and if they are able to influence patients' decisions to participate in such a programme. Such a programme may well run in other health care systems as it is more a technical challenge rather than a system-dependent strategy.
|Implemented in this survey?|
The Minister of Health welcomes the initiative and supports a nation-wide roll-out of the Pharmaceutical Saftey Belt; however, there has been no committment to support the necessary investment (up to four million Euros) for a nation-wide application. In addition, the Minister of Health claimed it necessary to better involve doctors in this inititative.
Doctors claim to be left out from the process of implementing the pilot and they seem skeptical with respect to the benefits of such an initiative. There is not much information about attitudes towards the initiative from other providers but the opposition of doctors may well send "negative" signals to other providers.
While no specific concerns are reported regarding this e-medication initiative, data security is an important issue in this context. Participation in the project is voluntary and patients may even claim to have their file deleted if they wish to. However, the Pharmaceutical Saftey Belt is the first application of the Electronic Health Record (ELGA); issues of data security are not yet entirely resolved (see survey (12)2008).
The industry welcomes all these developments. Commissioned by the clearing house of pharmacists, the software for the Pharmaceutical Saftey Belt was developed by Siemens who likely will also be involved in up-grading the software for a nation-wide roll-out.
|Ministry of Health||very supportive||strongly opposed|
|Doctors||very supportive||strongly opposed|
|Pharmacists||very supportive||strongly opposed|
|Other Providers||very supportive||strongly opposed|
|Patients||very supportive||strongly opposed|
|Data Security Experts||very supportive||strongly opposed|
|Patient advocates||very supportive||strongly opposed|
|Private Sector or Industry|
|IT Industry||very supportive||strongly opposed|
|Ministry of Health||very strong||none|
|Other Providers||very strong||none|
|Data Security Experts||very strong||none|
|Patient advocates||very strong||none|
|Private Sector or Industry|
|IT Industry||very strong||none|
The pilot was a joint initiative by the chamber of pharmacists and their clearing house. A special software was developed with an investment of about 1.3 million Euros financed by the chamber and their clearing house.
Patient consent to participate and the e-card is used as a key to open files where the list of drugs dispensed to patients appears. The software gives warnings if
are identified. The software also includes all over-the-counter drugs patients have purchased. In many cases doctors have no comprehensive information about the use of such prescription-free drugs.
In February 2007 the project commenced. 71 out of 76 public pharmacies in Salzburg participated. Originally doctors should also participate but claimed that data security issues needed to be solved first. No agreement could be reached between pharmacists and doctors. As a consequence the service was offered to patients by pharmacists. About 9000 patients participated which corresponds to five percent of the population 60+ living in Salzburg.
The main results of the pilot were:
9.218 participants received 174.799 packs of pharmaceuticals. 26.182 security alerts regarding prescriptions and over-the-counter drugs were identified; of these
The chamber of pharmacists estimated that about 150 Mio Euro per year could be saved if the Pharmaceutical Saftey Belt was applied in all public pharmacies including hospital pharmacies. If costs caused by duplications of prescriptions were accounted for additional savings of 78 million Euro per year could be achieved.
Major adverse drug events were identified with Aspirin/Macoumar, with multivitamin/osteoporose drugs and with cholesterol/antibiotics therapy. In about 80 percent of alerts identified the pharmacists could solve problems arising from interactions or from the lack of compliance.
The results of this pilot indicate potential to improve patient saftey and to reduce cost growth in the area of pharmaceuticals. They broadly seem in line with estimated reduction of adverse drug events through e-health applications in the health sector (CBO 2008, Chaudry et.al 2006).
While a nation-wide roll-out of the Pharmaceutical Saftey Belt seems justified it remains uncertain how and to which degree doctors are willing to participate in this initiative. This appears to be a major barrier and their opposition reflects general concerns of doctors towards the Electronic Health Record (ELGA), see survey (12) 2008.
Another barrier for full-scale adoption of e-medication applications are investment costs. The chamber of pharmcists appealed to policy makers for supporting necessary investments but no final decision has been made.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
A systematic identification of adverse drug events has potential to improve quality of care by increasing patient saftey. Thus, the impact of a Pharmaceutical Saftey Belt on quality of care may be rather fundamental.
The level of equity likely remains unchanged. However, more information and patient screening provided by pharmacists may contribute to improve patients compliance and may improve access to quality drugs.
The level of cost efficiency may well rise as "wasteful" prescriptions and drug use may be identified at relatively low cost through a well designed electronic plattform. A recent study looking at costs and benefits of the Electronic Health Record (ELGA) used results from this pilot and estimated cost savings between 0.5 percent and 0.9 percent of total spending on health (Burchert 2008). In this context cost savings from e-medication contributes most to expected overall savings from e-health applications.
BUCHERT H (2008). ELGA - Monetäre Quantifizierung der Kosten und des Nutzen der Kernanwendungen mit den Methoden einer Kosten-Nutzen-Analyse. Debold & Lux, Hamburg: www.initiative-elga.at/ELGA/kosten-infos/Kosten_Nutzen_Analyse_Debold_und_Lux_2008.pdf
CBO - CONGRESSIONAL BUDGET OFFICE (2008). Evidence on the Costs and Benefits of Health Information Technology. Web-exclusive, 23. Oktober 2008.
CHAUDRY B, WANG J, WU S, MAGLIONE M, MOJICA W, ROTH E, MORTON S, SHEKELLE P (2006). "Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care". Ann Intern Med. 144: E-12-E-22.
IBM (2006). Machbarkeitsstudie ELGA, im Auftrag der Bundesgesundheitsagentur, November 2006, Wien: www.arge-elga.at/fileadmin/user_upload/uploads/download_Papers/Arge_Papers/
Various press releases
Maria M. Hofmarcher
Heinrich Burggasser, President of the Chamber of Pharmacists
Claudia Habl, Senior Researcher, Gesundheit Österreich