E-prescription introduction: guide for doctors

Since January 1, 2024, e-prescriptions have been mandatory for all prescription medicines that are billed via statutory health insurance. This is an important part of the digitalization offensive in the healthcare sector - just like the electronic patient file. Pharmacies throughout Germany are now able to fill e-prescriptions.

Time to take a closer look at the e-prescription - what is behind it, what advantages are associated with it and what laws apply here? What should doctors and patients absolutely know and what applies to private patients? We explain.

What is the e-prescription?

The e-prescription is the digital form of the traditional doctor's prescription on paper. It is an electronic document that can be created by the doctor and redeemed by the patient at the pharmacy. The main advantages at a glance:

• Digitization: The e-prescription supports doctors, patients and pharmacies in efficient communication and documentation. The amount of paperwork is reduced. With the e-prescription app, for example, follow-up prescriptions can be automated and prescribed medications can be ordered to the pharmacy of choice.
• Patient safety: From interaction checks to a medication plan to medication reminders, the e-prescription in combination with corresponding apps enables attractive new functions.
• Anti-counterfeiting: The e-prescription reduces the risk of fraud, forgery or loss of the prescription. Security protocols are implemented to ensure data protection and the integrity of the prescription.

What is a digital prescription?

Digital prescription is a synonym for e-prescription. The Federal Ministry of Health (BMG) speaks of "e-prescription" - so this is the official spelling in Germany. In addition, there are synonyms and related spellings such as digital prescription, electronic prescription or also eRezept.

What is the legal basis?

The legal basis for the e-prescription is an interplay of many different laws. The most important ones are summarized below:

• The E-Health Act (Act for Secure Digital Communication and Applications in Healthcare) stipulates that e-prescription will be mandatory for all prescription drugs from January 1, 2024.
• The eGK Act (Electronic Health Card Act) regulates the introduction and use of the electronic health card (eGK) in Germany. The eGK is a prerequisite for the use of the e-prescription.
• The DVG (Digital Prescription Act) has set the course for the introduction of e-prescription in Germany. It promotes digitization in the healthcare sector.
• The PDSG (Patient Data Protection Act) regulates data protection in the context of the electronic patient record and e-prescription. It ensures that patient data is stored and transmitted securely.

In addition, other laws and standards apply that regulate the handling of medical prescriptions and medications or data protection.

How does the e-prescription work?

The e-prescription is issued by physicians and stored in a central database of the federal government's telematics infrastructure, to which pharmacies also have access. In this way, the patient can redeem his e-prescription at his preferred pharmacy at any time.

Technical requirements & terms

To better understand the processes for issuing and redeeming an e-prescription, here is first a brief explanation of the most important terms:

• The telematics infrastructure (TI) is a digital platform for healthcare in Germany - provided by the National Agency for Digital Medicine (gematik).
• gematik's e-prescription app is called "Das E-Rezept" and was developed for NFC-enabled smartphones. NFC stands for Near Field Communication and is a standard for wireless communication that is implemented in most current smartphones.
• The electronic health professional card (eHBA) is a personalized, forgery-proof document used by physicians in Germany to authenticate and sign themselves in the TI.
• A qualified electronic signature (QES) is a type of digital signature to ensure the authenticity and integrity of a document.
• The electronic health card (eGK) is a chip card that people with statutory health insurance receive from their health insurer in Germany. It is also known colloquially as a health card or insurance card.

Issuing the e-prescription - what doctors need to know

The physician creates an e-prescription in his electronic medical practice software. The basic requirements for this are an eHBA and a QES. The e-prescription is stored in the telematics infrastructure and can thus be accessed using the patient's eGK or e-prescription app.

If the patient has neither a suitable app nor an eHC, the e-prescription can simply be printed out in the practice if necessary.

Redeeming the e-prescription - what patients need to know

The patient can redeem his e-prescription at online pharmacies as well as at local pharmacies. Three options are available for this purpose:

• Redeeming via app: To log in to the gematik e-prescription app, the patient needs an NFC-enabled eGK and a PIN from his or her health insurer or an existing log in to the electronic patient record app (ePA app) of his or her health insurer.
• Redemption via eGK: The patient can redeem the e-prescription with his eGK at a pharmacy. No PIN is required. The pharmacy can then retrieve the e-prescription from the central database and dispense the medication.
• Redemption by paper printout: If neither an eGK nor an app is available for redeeming the e-prescription, the patient can ask their doctor for a printed version of the e-prescription. Each e-prescription has a unique prescription code that can be scanned at the pharmacy - similar to a QR code.

The e-recipe for Android and Apple

The gematik e-prescription app called "Das E-Rezept" is available in the Google Play Store as well as in the Apple App Store and in the Huawei AppGallery. To register, the patient needs:

• An existing enrollment in his or her health plan's ePA app OR
• An NFC-enabled smartphone, an NFC-enabled health card and a PIN, which must be requested from the health insurance company beforehand.

Special cases: the e-prescription for private patients and third parties

Private patients do not have access to an eGK. Therefore, registration in gematik's e-prescription app is also not possible. In fact, the federal government's plans for private prescriptions have not yet been finalized, and physicians may continue to issue private prescriptions by prescription pad.

If an e-prescription is to be filled by a third party, the representative requires the patient's eGK or a paper printout of the e-prescription. Alternatively, responsibility can be transferred in the e-prescription app, for example with the family function.

Participating doctors and therapists: Who issues e-prescriptions?

In Germany, the authorization to issue e-prescriptions is regulated in the same way as for conventional prescription drugs.

• Physicians: All licensed physicians who are authorized to prescribe medications can issue e-prescriptions to the same extent. This includes general practitioners, specialists and dentists.‍
• Psychotherapists: Medical psychotherapists who have studied medicine are allowed to prescribe prescription drugs, unlike psychological psychotherapists.‍

Psychologists, physiotherapists, alternative practitioners and other health professionals are not authorized to issue prescriptions in Germany.

How secure is the e-prescription?

The e-prescription is considered highly forgery-proof and brings many advantages for doctors, patients and pharmacies. The following precautions ensure that no unauthorized persons have access to the sensitive data surrounding the e-prescription:

• The need for an eHBA and QES ensures that only authorized physicians can issue e-prescriptions.
• Unique recipe codes prevent duplication and facilitate tracking and validation.
• Both the issuing medical practices and the redeeming pharmacies are connected to the federal government's telematics infrastructure through secure interfaces .
• The telematics infrastructure is a nationwide network operated by the health insurance funds and the Federal Ministry of Health. The network consists of a number of data centers within Germany, the exact location of which is not publicly known for protection.

The e-prescription & digitization

The e-prescription is an important part of the answer to the desire for greater efficiency and convenience in healthcare. Digitization in the doctor's office is a necessary step to relieve medical staff and provide better care to patients. The seamless integration of current technologies such as smartphones takes the doctor-patient experience to a new level of convenience.

This is exactly where Nelly comes in. Whether digital patient admission, simple document management or convenient payment processing - Nelly provides the basis for a digital workflow. The practice saves resources, gains efficiency and benefits from modern communication channels. Interested? We will advise you on your individual case free of charge and without obligation!

Contact Nelly now!

The personal designations used in this article always refer equally to all persons. For the sake of better readability, we have refrained from using double or opposite names.