“e-Rețeta is not just a replacement of a paper prescription. It is one of the most important reforms in the health care system,” said Ion Dodon, President of the CNMC, at the press conference.
Scale of the system
During two years of operation, it has been used by about 900 thousand unique patients, which is about 38% of the country’s population with permanent residence. During this period, more than 2.5 billion lei of public funds were utilized through e-Rețeta. In the first two months of this year, more than 200 million lei were utilized through the system. The NCMS estimates that by the end of 2026, this figure will amount to about 1.4 billion lei.
Logic and digitalization
According to Gabriela Železny, head of the Department of Medicines and Medical Devices of the NCMS, the electronic prescription has become more than just a tool of digitalization – it has restructured the entire logic of interaction between the patient, the doctor and the pharmacy.
“The reform has made it possible to move from paper-based processes to such an integrated digital system where all participants – doctor, pharmacist and NCMS – work in real time,” notes Zhelezny.
The system “thinks” together with the doctor
During the prescribing process, the doctor can see the patient’s prescription history. Consequently, when a diagnosis is established, the system itself offers a list of drugs acceptable for this diagnosis, taking into account the insurance status and age of the patient. The system also warns about standardized maximum dosages and prescribing rates. For chronic conditions, the doctor can copy the prescription with one click and make changes if necessary. In essence, the system “thinks” together with the doctor.
“These are primarily family doctors, but also outpatient specialists, doctors providing home care, palliative care, and emergency room doctors,” Ion Dodon specified.
You quickly get used to good things
The electronic prescription system provides integration with pharmacy programs and data exchange. During the dispensing process, the pharmacist sees the list of trade names for the prescribed active substance, as well as information on the degree of reimbursement, which allows to quickly offer the patient options. The fixed amount, reimbursement amount and patient copayment are automatically calculated.
The company’s management recognizes that initially there were concerns about the ability of specialists to quickly adapt to the new system. In this regard, a special handbook was even developed for pharmacists.
“But the system proved to be easy to use, and medical professionals and pharmacists had no serious problems in mastering it,” said the director of the NCMS.
Since its launch, the system has already been used by about 2,500 doctors from 1,400 medical institutions, including rural ones, and almost 3,000 pharmacists dispense medicines through it.
Talking to Logos Press correspondent, Aurelia Bagrinovski, deputy director of the State Polyclinic, notes that the implementation of the electronic prescription system is already bringing tangible results. First of all, the number of medical errors has decreased:
“Previously, when prescriptions were written manually, there were often problems with legibility due to illegible handwriting or the correctness of the dosages, which could lead to misinterpretation. Now, the system automatically checks prescribed medications and dosages and alerts the physician if it detects possible duplications or inconsistencies. In addition, the prescribing process has become much simpler. Doctors can use templates – matrices – of previously issued prescriptions, make necessary changes to the dosage or method of administration, which saves time”.
The specialists admit that at the first stage they had to “step out of their comfort zone”, but rather quickly the discomfort was replaced by professional satisfaction with the convenience and efficiency of their work.
In addition, the amount of paperwork has been significantly reduced – the need to manually fill in documents has virtually disappeared.
What not to do
With the introduction of the system, the right of appointment has been expanded. If previously this was done mainly by family physicians and individual specialists, now all specialists at the outpatient level have this right.
A family doctor can prescribe drugs for all diagnoses on the list, while a specialist can prescribe drugs only within his specialty. For chronic diseases, treatment started by a specialist may be continued by the family physician (including through prescription copayment).
The system does not allow prescribing drugs from one therapeutic group at the same time, which helps to avoid polypragmasy.
It is not possible to dispense more than prescribed by the doctor. Except for technical cases – when, for example, the package contains less quantity/volume of the drug than prescribed. Also, the system does not allow dispensing at a price higher than the established limit. For 265 items, NCMS negotiates with manufacturers and fixes the price. It should be understood that their number will continue to increase.
The pharmacist has no right to substitute the medicine prescribed by the doctor. Prescription validity periods have been established: 60 days for long-term treatment, 15 days for episodic treatment and 30 days for psychotropic drugs. It is allowed to dispense part of the medication and then receive the remaining part within the validity period of the prescription.
Drugs are dispensed exclusively in pharmacies operating under contract with the NCMS, with mandatory identification of the patient by IDNP or prescription barcode.
Development of functions for patients
The new system has introduced new features for patients. While previously the pharmacy dispensed prescription drugs in a lump sum and kept the prescription, now it can be used in installments during the validity period. Also, a patient can get medications from different pharmacies instead of just one.
Plans are in the works to introduce notifications for patients, including reminders for chronic disease management, as well as introducing personal account functionality.
“The system also provides for the possibility of specifying a trusted person if the patient cannot come to the pharmacy in person: in this case, his contact number is entered, and he can receive medication. In addition, we can track whether the patient has received the medication, whether he or she is taking it, and see whether it has been dispensed in full or in part,” notes Aurelia Bagrinowski.
The possibility of cross-border data exchange is also being considered, which will allow patients to use prescriptions outside the country.
The advantage of the NCCM, and thus of the state, is that the system allows real-time monitoring of consumption, making forecasts and planning financial resources. Its development is ongoing.
