Scheme of information technology application to control and manage electronic prescriptionsThursday, October 31,2019
AsemconnectVietnam - In Vietnam, medical examination and treatment establishments and medical examination and treatment practitioners are prescribing drugs by using computer software of medical examination and treatment establishments or prescribing medicines directly by hand on paper
I. Legal basis
- Resolution 20 / NQ-TW dated October 25, 2017 of the 12th Central Committee of the Party Central Committee "Enhancing the protection, care and improvement of people's health in the new situation";
- Directive 23 / CT-TTg dated 23/8/2018 of the Prime Minister on: "Strengthening the management of connection of drug supply and sale establishments of prescription drugs";
- Decision No. 4041 / QD-BYT dated September 7, 2017 of the Minister of Health approving the "Scheme to strengthen control of prescription and sale of prescription drugs for the period of 2017-2020";
- Circular 54/2017 / TT-BYT dated January 29, 2017 of the Minister of Health promulgating the Ministry of Information Technology Application Criteria at medical examination and treatment facilities;
- Circular 46/2018 / TT-BYT dated December 28, 2018 of the Minister of Health regulating electronic medical records;
- Notice No. 124 / TB-BYT dated February 13, 2019 announcing the conclusion of the Standing Vice Minister of the Ministry of Health at the meeting on building an electronic prescription system.
- Notice No. 52 / TB-BYT dated January 22, 2019 by Deputy Minister of Health Truong Quoc Cuong at a meeting to resolve problems in deploying the application of information technology to connect drug suppliers.
- Decision No. 1884 / QD-BYT dated May 20, 2019 of the Minister of Health on the establishment of the Steering Committee for the development of electronic prescription system.
II. Actual situation of prescribing drugs at home and abroad
1. In Vietnam, medical examination and treatment establishments and medical examination and treatment practitioners are prescribing drugs by using computer software of medical examination and treatment establishments or prescribing medicines directly by hand on paper (prescriptions or medical records).
The prescription is made in accordance with the Circulars: Circular 52/2017 / TT-BYT issued on December 29, 2017 and Circular No. 18/2018 / TT-BYT dated August 22, 2018.
At hospitals: 100% of doctors have prescribed drugs by computer on hospital management software. Prescriptions are sent to the hospital departments, rooms, pharmacies and sent to the Social Insurance for settlement.
Computer prescription is applicable to both inpatient and outpatient patients. However, each hospital's prescription has a different data format and heterogeneous data block difficult to connect outside the health care facility. For prescriptions without certification identification numbers of medical examination and treatment practitioners and identification numbers of medical examination and treatment establishments, physicians must still print applications from computers and sign them directly for patients.
Under the provisions of the implementation of e-medical records, medical practitioners and medical examination and treatment facilities must subscribe to electronic signatures of their suppliers, however electronic signatures in this format failing to access information on medical examination and treatment practitioners or medical examination and treatment establishments. For example: Number of practice certificates, scope of professional activities or working time, place of work registration ....
Most private clinics (general and specialized clinics) still apply prescriptions by writing them directly in the medical register and it is difficult to control the prescriptions of which patients are prescribed. Where is the doctor also competent to prescribe drugs?
The National Pharmaceutical Software is currently being implemented to manage the import, export and inventory activities of the drug, however, it has not fully controlled the sale of prescription drugs, in particular, it has not controlled the re-purchasing with purchased prescriptions or has expired.
The management of electronic prescriptions with electronic identification numbers of medical examination and treatment practitioners and medical examination and treatment establishments is essential. However, this is a new job, so it is necessary to have many provisions for implementation conditions and accompanying sanctions to ensure that the application is uniformly consistent to bring high efficiency.
2. Through practical study of the management of prescriptions and practitioners, medical examination and treatment facilities in a number of countries such as the US, Europe, Singapore ... The Government manages practitioners and medical examination and treatment facilities. via electronic identifier.
Government authorities (Ministry of Health) provide codes for people and facilities to create basic information to create electronic identifiers. In addition, regulators also issued format standards for electronic identification codes, for prescribing information form as well as connecting ports for sending and receiving prescriptions and identification codes from all sections. Different soft sent. On that basis, enterprises providing information technology services serve as a basis for building software to ensure that standards and meet requirements.
The software of the drug store of the state management agency will store the prescriptions sent by the medical examination and treatment facility for administration as well as for retrieval when needed. The management agency issues standards on application software for practitioners and medical examination and treatment facilities and manages the original data block (prescription drug store) to ensure transparency and management. not related to the supply of software. The government does not conduct the sale of prescription software or provide electronic identifiers. The government only regulates standards and formats and gateways. Businesses create their own software and be proactive in their business as long as they meet the issued standards.
For implemented countries, in order to bring the project to life, it is necessary to have a 01-year roadmap to implement the detailed steps:
- Phase 1 (03 months): Test operation and draw experience to apply when widespread.
- Phase 2 (03 months): Wide application.
- Phase 3 (03 months): Finalizing and evaluating.
1. General objective
Deploying the application of information technology to control electronic prescriptions to ensure safe, rational and effective use of drugs and step by step manage the prescription and sale of prescription drugs; To help management agencies and medical examination and treatment facilities better manage the prescription of medical examination and treatment practitioners and at the same time contribute to the modernization of the health sector, towards international integration.
2. Specific objectives
a) Manage the prescription of drugs according to regulations of the Ministry of Health at state and private medical examination and treatment facilities.
b) Administer the sale of prescription drugs at drug suppliers. Avoid re-selling with medicines sold only on prescription, especially antibiotics and special control drugs.
c) Making statistics, summarizing and analyzing the prescription of drugs in order to trace the origins and responsibilities of each individual organization in case of violations and support the inspection and examination.
d) On the basis of analyzing the data of the prescription drug store, it is possible to create a report that accurately assesses the health status of the people as well as the diagnosis and treatment guidelines of the Ministry of Health and leads to the forecast of the situation. disease patterns and trends, people's demand for medicine in the medical examination and treatment system.
d) Creating electronic prescriptions is one of the important and indispensable components of the electronic medical records, records of electronic health management of each patient.
1. Elaborating legal provisions:
a) Formulating regulations of law on the use of electronic prescriptions, electronic identification codes for medical examination and treatment practitioners, electronic identification codes for medical examination and treatment facilities and connection medical examination and treatment facilities, medicine supply establishments with the national electronic prescribing system.
b) Develop sanctions to implement the above regulations.
c) Developing financial mechanisms to have a budget for operating and implementing the project as well as finding organizations and sponsors for the project.
2. Building an electronic prescription system:
To build a system of software for managing all electronic prescriptions - The national electronic drug storehouse with export, import and access points to ensure the management of prescriptions with separate prescriptions, attached identification code of a physician, identification code of a healthcare facility. Share prescriptions with drug suppliers, electronic medical records, electronic health records, social insurance, and manage prescriptions as well as prescription prescriptions.
1. Professional solution
a) Elaborating legal provisions on electronic prescriptions and guiding the roadmap requiring medical examination and treatment facilities and doctors to use electronic identification codes, electronic prescriptions as well as implement results connecting prescriptions to the national electronic prescriptions. Medical examination and treatment establishments must have equipment and deploy IT application to be connected to the network to manage prescribing activities.
b) Organize communication for the implementation of the electronic prescription system.
c) Organize training courses on application of software, connection of prescribing software, software for providing electronic identification codes for medical examination and treatment facilities and doctors with the National electronic prescriptions and National softwares.
d) Supplementing the provisions of the Decree on sanctioning of administrative violations in the health domain.
2. Information Technology solution
Deploying the application of information technology to control and manage electronic prescriptions includes 03 software with 3 separate groups of solutions but intimately connected to each other through connection ports and comply with common standards. :
a) National Software of electronic prescriptions:
- As a place to receive and store all prescriptions nationwide, is the management of the electronic prescription system.
- National e-drug store prescriptions are sent from State and private medical examination and treatment establishments with practitioners competent to prescribe drugs.
- The National Electronic Prescribing Warehouse creates many statistical and traceable schools to help managers access and provide statistics for management as well as inspection and supervision of medical examination and treatment activities and prescriptions. medicine.
- The national electronic prescription store has its own management authority for state management agencies such as the Ministry of Health and the Department of Health and has the power to issue authentication codes to each medical examination and treatment facility and each person, practicing from which software providing electronic identifiers can create and build electronic identifiers for establishments or practitioners while ensuring facilities and practitioners have been approved by the Ministry of Health or Department of Health inspection.
- Electronic prescriptions ensure high security and stable operation of the system.
The National Electronic Prescribing Software will be implemented by the Department of Medical Examination and Treatment, in coordination with software service-providing companies, upon the request of the Medical Services Administration.
b) Software for providing electronic identification numbers for medical practitioners and electronic identification codes for medical examination and treatment facilities:
* Electronic identifier for practitioners
- Practitioner's electronic identification code: A separate electronic code for each practitioner to attach to each prescription. The electronic identifier of each practitioner will include the following details: Practicing certificate (issued and supplemented), working unit (main working place and working place outside working hours).
- The electronic identifier is issued to each individual and is not the same to distinguish each person on a digital technology environment. When inserting an electronic identifier into a prescription, the algorithm will generate a constant attached to the prescription for verification of practitioners. Each practitioner will have an authentication number (address) issued from the management agency (Department of Health, Ministry of Health) through the software of electronic prescription.
- Through their own electronic identification codes, practitioners can manage their entire prescriptions for patients.
* Electronic identification code for medical examination and treatment facilities
- Is the electronic code for each medical examination and treatment facility.
- The electronic identification code of a medical examination and treatment facility will contain details of each healthcare facility licensed at the Ministry or Department of Health: the scope of expertise, personnel, equipment, license....
- The electronic identification code of a medical examination and treatment facility, which is granted to each facility to clearly distinguish it in a digital technology environment. For each electronic prescription issued in each unit, the algorithm will generate a constant attached to the form to serve the verification of the prescription of each facility. Each medical examination and treatment facility will have a number of authentication (address) issued from the management agency (Department of Health, Ministry of Health) through the software of electronic prescriptions.
All this software will be created by enterprises in the field of information technology and provide services for medical examination and treatment facilities and practitioners to ensure compliance with the standards issued by the electric prescription software. National Prince.
c) Electronic drug prescribing software.
- Being software for creating, prescribing drugs on computers and sending them in the network environment in accordance with the provisions of Circular No. 52/2017 / TT-BYT and 18/2018 / TT-BYT. The electronic prescription has 04 formats:
• Regular prescriptions.
• Prescription H (psychotropic drug)
• Prescription N (addictive drug).
• Inpatient prescription (for prescription with inpatients)
- Electronic prescriptions must ensure the standards prescribed in the Circulars and be standardized in digital format with uniform specifications nationwide.
- All names of drugs and active ingredients in the prescription are used on the basis of an identifier of drugs that the Drug Administration of Vietnam is prescribing and using on the National Pharmacy software according to Decision 540 / QD-QLD.
- Electronic prescriptions must meet the promulgated standards so that they can be sent to the National electronic prescriptions store. Each electronic prescription must be attached: The electronic identifier of the practitioner, the electronic identifier of the medical examination and treatment facility. Electronic prescription software has 2 formats:
+ The existing management and prescribing software of medical examination and treatment facilities has been upgraded according to the promulgated standards of the electronic prescriptions attached with identification numbers of medical examination and treatment facilities, practitioners and linked via API portal for sending to the National Electronic Prescriptions (this section is for medical examination and treatment facilities that have been using the software at their establishments to upgrade themselves up to the standards).
- An independent prescriptions page that meets the promulgated standard of the electronic prescription, enclosed with the identification code of the medical examination and treatment facility, the practitioner and connected via API gateway to send to the National Electronic Prescriptions warehouse (This software is for medical facilities that do not have management software and is still implementing drug prescriptions on medical records)
This entire software will be created by enterprises in the field of information technology and provide services to medical examination and treatment facilities or modify and upgrade software inherent to medical examination and treatment facilities but must ensure that ensure compliance with standards issued from the National Electronic Prescription software.
3. Financial solution
Funds for the development of the National Electronic Prescription Medicine software and annual maintenance cost (operating costs, administration, server rental, data warehouse rent) of the system from the following sources:
- Support from international organizations
- Contributing, sponsoring of individuals and businesses.
VI. Implementation plan
In order to implement the nationwide electronic prescription system, an expected roadmap is needed within 1 year. The pilot phase (03 months) applied in some localities will then be applied simultaneously at state and private medical examination and treatment facilities nationwide.
2. The stages of the project
- Phase 1: The first 03 months from the implementation of the project: Developing legal documents and piloting at a number of Department of Health, medical examination and treatment facilities to learn from experience.
- Phase 2: 03 subsequent months: Preliminary workshop to draw experience from the pilot implementation. Continue to improve legal documents and regulations for the electronic prescription system. Officially putting information technology application to control and manage electronic prescriptions.
- Phase 3: 03 subsequent months: Bringing the implementation of the electronic prescription system into practice, proceeding to press the interconnect button to open the connection ports to the national electronic prescriptions. Conduct communication nationwide, train medical and pharmaceutical practitioners and software practitioners on software and usage requirements. Connecting software of many suppliers to electronic prescriptions.
- In the next 3 - 3 months: Urge medical examination and treatment facilities and practitioners to use the electronic prescription system.
- Period of 4-03 months: Completing the assessment of the number of medical examination and treatment facilities and practitioners who have used the electronic prescription system. Continuing to draw experience from assessing the works already done.
3. Responsibilities of related units:
3.1 Department of Administration of medical examination and treatment: Acting as a focal point to organize, coordinate and deploy with relevant Departments / Departments to implement the project "Deploying the application of information technology to control, manage prescription of electric drugs.
- Clue considering and amending Decree on conditions for practicing medical examination and treatment. Guide the roadmap requiring healthcare facilities and doctors to make electronic prescriptions, use electronic identifiers and connect with the National Electronic Prescribing Warehouse.
- Construction of the national electronic prescription warehouse.
- Reviewing and amending and supplementing legal documents on drug prescriptions.
- Elaborating and promulgating standards of electronic prescriptions, standards for connecting prescriptions, standards of doctor identification codes and identification numbers of medical examination and treatment facilities.
- Analyzing data of electronic prescriptions, contributing to providing evidence on assessing the current state of health of people, observing the diagnosis and treatment guidelines of the Ministry of Health and leading to the situation forecast disease patterns and trends and people's demand for medicine in the medical examination and treatment system.
- Direct drug information centers and monitor adverse reactions of national and regional drugs to coordinate and analyze and assess rational and safe use of drugs effectively after deploying information technology application to control and manage electronic prescriptions.
3.2 Information Technology Department
Coordinate with the Department of Medical Services Administration to promulgate standards for electronic prescriptions, standards for connecting prescriptions, standards for identification of doctors, identification numbers of medical examination and treatment facilities.
3.3 Drug Administration:
- Direct the implementation of the sale of drugs with electronic prescriptions and send the reports of sold prescriptions to the National e-drug store in drug supply management software.
- Share data on drug identification codes from the national pharmacy with the Administration of medical examination and treatment to implement this project.
- Coordinate with the Department of Medical Examination and Treatment Management to promulgate a connection standard connecting to software of drug suppliers in receiving electronic prescriptions from the National Electronic Prescribing Store to suppliers. and send a complete report of the prescription.
- Coordinate with Administration of Medical Examination and Treatment to analyze data of electronic prescriptions, contributing to providing evidence on assessing the health status of the people and leading to predictions of disease situation and trends and people's need for medicine.
3.4 Legal Department:
Acting as a focal point to formulate and issue sanctions for medical examination and treatment facilities and practitioners not using electronic prescriptions, electronic identification codes and failing to update electric prescriptions regularly. on the National electronic prescription system.
3.5 Plan - Finance Department:
- Guiding cost estimating units and allocating funding for project implementation: including software construction and regular operation funding.
- Searching for organizations and individuals capable of funding the project.
3.6 Department of Communications, Emulation and Reward:
- Provide information to the press agencies on the need of the electronic prescription system so that journalists can understand and then publish the information promptly and accurately.
- Collaborate with the Administration of Medical Examination and Treatment to widely communicate on the use of information technology applications to control and manage electronic prescriptions.
Coordinate with Department of Examination and Treatment Management in project implementation.
3.8 Local health departments:
- Develop a plan to implement the electronic prescription system in their localities.
- Establishing working groups to implement the electronic prescription system led by a comrade to lead the group and make detailed plans of the team. Assign the person in charge of managing the National Electronic Prescribing Warehouse according to the decentralization of the province.
- Examine, monitor, supervise the implementation of electronic prescriptions, sell drugs according to electronic prescriptions to ensure the maintenance of IT application at medical examination and treatment facilities and sustainable drug supply establishments.
- Develop communication plan and implement communication on the use of electronic prescription system in the province.
- Coordinate with relevant units to organize training and guidance for medical examination and treatment facilities, drug suppliers and doctors to apply, use and operate the national electronic prescription system.
3.9 Directors of medical examination and treatment facilities:
- Strictly comply with the regulations on the application of the electronic prescription system at their establishments.
- Using electronic identification codes for medical examination and treatment facilities at their establishments in prescribing medicines.
- Responsible for urging physicians at the grassroots level to use electronic prescriptions, using electronic identifiers for doctors to prescribe.
- Connecting the electronic prescription of the establishment with the electronic prescription system.
VII. Benefits of the scheme
The project of the electronic prescription system applied nationwide does not only meet the requirements and direction of the Government and Leaders of the Ministry of Health but also brings many practical benefits to the community for people and for the manager.
The manager will ensure the control of practitioners, medical facilities in prescribing drugs, administering treatment regimens and ensuring the inspection, supervision and traceability of each individual's responsibility. Related organizations if violations occur.
People will receive many benefits from this project such as: getting a warning about prescriptions, receiving warnings about drugs that have to be sold by prescription ... and drug suppliers to ensure the sale of drugs according to as directed by the Ministry of Health.
In addition, on the basis of governance, analysis of the data block of prescriptions, the State management agencies can give appropriate policy directions in management and administration in order to better carry out the tasks by you. Through comprehensive and comprehensive solutions, people will be able to use drugs appropriately, safely and effectively.
VIII. Difficulties and challenges
Bringing the electronic prescription system into practice has encountered many difficulties:
- A part of medical examination and treatment practitioners currently prescribe drugs by direct writing and have not yet applied information technology in medical examination and treatment activities.
- Sanctions if not issued concurrently with the application of the electronic prescription system will leave the practitioners and medical examination and treatment facilities with no pressure to deploy.
- Up to this point, there is no mechanism and budget for ordering software production or hiring public services, making the project's funding difficult and difficult to find funding.
Along with the development trend of the 4.0 era, in order to meet the needs of innovation in management and international integration, the application of the electronic prescription system to reality is essential. . With the implementation of this project, it will contribute significantly to the safe and rational use of drugs to take care of people's health.
Source: Vitic / thuvienphapluat.vn
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