Medical assistants can now issue e-prescriptions. What do the nurses say? [comment]

Problems with the collection of nursing prescriptions in pharmacies are reported on a daily basis, because in many pharmacy systems, nurses are listed as unauthorized to provide this service. Meanwhile, e-prescriptions may already be issued by a new professional group – medical assistants.

Pursuant to the new provision (on July 19, the Sejm passed the act on the implementation of e-health solutions), medical assistants will be able to issue e-prescriptions. There are more changes and they are necessary, but the question is, what about nursing advice? Will pharmacists take over …?

The competences of other medical professions are expanding, forgetting about the lack of facilities for nurses. In the e-revolution of the Ministry of Health, apart from medical assistants, pharmacists were also considered. In the draft act on the pharmacist profession, which has just been sent for public consultation, it was proposed that pharmacists would provide pharmaceutical care as a guaranteed service. This means that pharmacists will receive remuneration from the National Health Fund for taking care of a certain number of patients.

As part of patient care, the pharmacist:

1. performs a review of the medications that the patient is taking,
2. will provide advice on the purchase of appropriate pharmaceuticals without a prescription and will prescribe new ones as part of continuing pharmacotherapy that was previously prescribed by the doctor,
3. will be able to order the patient basic diagnostic tests, measure pressure or body weight. And if necessary, they will consult a general practitioner or even a specialist, provided that they have access to the patient’s medical history.

Pharmacists must therefore have access to the patient’s online account (IKP), which is currently a problem as few people set up an online account. Currently, the patient only has access in IKP to information on which healthcare services he has benefited from and for what amount they have been assessed by the National Health Fund.

It is puzzling whether pharmacists will also be obliged to complete the courses: “physical examination” and “prescribing drugs and prescribing prescriptions”, ie those required of nurses after vocational studies or specialization. Will they also need to have a written order from a doctor to continue medications and medical devices?

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Coming back to AOS nursing advice. After the initial draft of March 22, 2019, she is stuck in a vacuum and the nursing community is still waiting for specific decisions.

In the opinion of the local government, this advice should be valued as an additionally contracted service. It was supposed to be a breakthrough, an improvement in operation, and complicated, unclear rules for providing benefits were proposed. Additionally, a requirement for a medical order was introduced, which deprived the nurse of the ability to independently decide on the provision of a service.

Getting acquainted with the documentation, physical examination, selection of treatment, issuing a prescription, completing the documentation, issuing a certificate for a doctor and financial liability to the National Health Fund, all these should be assessed adequately to the liability resulting from the above-mentioned services provided by the nurse.

E-health, e-prescriptions, e-waivers, e-referrals are promoted, while nurses have not had the basic tools to implement them for several years.

What’s more, they don’t even support writing paper prescriptions. Many of them complain about the problem with individual access to the eWUŚ system, despite the fact that they conduct individual nursing practices.

The problem is also the unclear provisions on the “MODEL” order for the continuation of prescriptions and the reimbursement list that changes several times a year.

Problems with the fulfillment of nursing prescriptions in pharmacies are reported on a daily basis, because in many pharmacy systems, nurses are listed as unauthorized to provide this service! An example is the possibility of continuation of prescription drugs by nurses, regulated by the regulation of the Minister of Health, which undermines the National Health Fund. Many cases of calling nurses and midwives to submit unjustified explanations and inspections at the National Health Fund are reported.

There is a lack of support from all sides, the nurses are left to themselves with problems.

The e-prescription is the future, but you should start with attitudes that are very lame. Without an electronic signature with a qualified certificate, which doctors received free of charge, we are far behind. Nurses and midwives who issue e-prescriptions in the private sector today must purchase an electronic signature with their own money. The first-time cost is on average PLN 230, and its renewal is PLN 120 per year.

Apparently, this is to change in the “near future” … We are waiting impatiently, as for the basic rights.

Meanwhile, medical assistants and pharmacists may soon become operational, and nurses, as usual… The old proverb is true of all this: where two fight, the third one benefits.

On July 19, 2019, the Sejm passed the Act on the implementation of e-health solutions

The Act introduces the possibility of:

1. authorizing medical assistants by medical workers to issue e-prescriptions and e-referrals on their behalf,
2. introducing new functionalities of the Patient Online Account and putting out the Integrated Patient Guide,
3. extending the scope of application of the public mobile application to ICT systems, and
4. extending the catalog of people authorized to issue prescriptions under the “Leki 75+” program
5. providing electronic medical documentation and data processed in registers.

Thanks to the act, it will also be possible to:

1. implementation of a cross-border e-prescription,
2. receiving free medicines under the 75+ program also from a specialist doctor and on discharge from the hospital,
3. setting up an Internet Patient Account (IKP) in a primary healthcare facility and confirming a trusted profile there,
4. remotely submitting a declaration of choosing a doctor, nurse and midwife,
5. browsing the current list of entities having a contract with the National Health Fund along with information about the scope of services offered and the next free date,
6. electronic submission of an application for a European Health Insurance Card,
7. obtaining information on the offer of preventive examinations financed from public funds, tailored to the needs.

In addition, patients will be able to:

1. receive an SMS or e-mail about the withdrawn medicines that they bought at a pharmacy,
2. use the registration at a medical facility using the mObywatel application,
3. fulfill an e-prescription using an e-ID card,
4. have access to IKP on a mobile device and use an interactive survey to assess the quality of medical services financed by the National Health Fund.

The new regulations will enable:

1. introducing a mechanism that automatically determines the level of drug payment on an e-prescription based on a medical indication,
2. extension of the e-prescription fulfillment period to 360 days,
3. automatic sharing of the patient’s data contained in the e-health platform with admitting doctors.

Thanks to the changes, the catalog of people covered by the so-called pro familiae prescriptions for people living together and for other family members.

The regulation will allow the physician to choose between reimbursable equivalents for the drugs specified in the reimbursement notice.