Dematerialization of medical prescriptions impacts on privacy

WARNING article is based on Italian legislation.

Let’s begin

Once upon a time there was a medical prescription on a white sheet of paper for drugs paid for by the patient. How many times have we complained about the difficulty in understand that is prescribed to us and the abbreviated acronyms of the dosage; sometimes, even in pharmacy, it is difficult to interpret the handwriting of the doctor.

I bet that it has been prescribed q.b. “just enough”, a.p. “as desired”, c.v.f.t.s.f.t. “whatever you want, it’s your business”¹.

News

From 2025, prescriptions on white prescriptions, those not covered by the National Health System, will have to be managed electronically. There are several complications regarding the regions that adhere to the dematerialized prescription. As regards Campania, we have the adoption date set for 05/31/2022 STS link .

Before or then, everything will be digitalized, it’s just a question of time. If you’ve grown fond of blank prescriptions sent via WhatsApp, complete with the doctor’s signature and stamp to show to the pharmacist, prepare to forget about them!

The dematerialization of drug prescriptions paid for by the National Health Service is provided for by Article 54 of the Budget Law, according to which “all prescriptions paid for by the National Health Service, by territorial services for healthcare assistance to flight, maritime and civil aviation personnel (Sasn) and by citizens are carried out in electronic format”.

The article in Il Sole 24 Ore highlights the end to paper prescriptions in favor of an electronic prescription system, scheduled for 2025. However, there are technical and organizational issues that could hinder the transition. Regions have yet to complete the adaptation of their IT systems, and there are problems about data security and staff training. Despite the expected benefits, such as greater efficiency and reduction of errors, the road to digitalization of medical prescriptions presents significant challenges.

The healthcare black box

Similarly to that is happening in the automotive sector, where from 7 July 2024 all new cars sold in Italy will have to be equipped as standard with certain driving assistance systems, ADAS². In short, these driving aids are nothing more than digital sensors that flow into the black box³, just as for cars, the health black box is also being created in the healthcare sector. We are in a model that outlines scenarios of health dictatorship, link STS .

Observations and criticisms, “The dematerialization of the white prescription allows”:

• “a standardization of the prescription, today manually drawn up by doctors and often without the aid of management systems that allow checking that all the mandatory elements that must be entered are present” - Standardizing means unifying the entire prescription process in a homogeneous system, criticizing general practitioners who do not adopt computerized management systems. This lack of digitalization leads to errors, such as the omission of mandatory elements in white prescriptions, making doctors appear as if they were not able to correctly manage prescriptions, practically fools.
• “greater securi ty for the pharmacist on the drugs to be dispensed and for how many times, according to the regulations” - However, not even pharmacists are exempt from criticism, degrading them to mere over-the-counter sellers, throwing their professionalism to the winds in the name of safety .

Observations and criticisms, “The Health Card System carries out real-time checks that allow”:

• “correct patient identification” - Therefore, it is clear that the Health Card System (HCS) requires the patient’s identification data, since the white prescription, although correctly indicating the patient, is not yet digitalized.
• “the correct identification of the doctor” - Be careful doctor, HCS is checking you.
• “the existence of the drug to be prescribed and dispensed, thanks to the interconnection with the AIFA formulary database, as well as the verification of the maximum number of possible repetitions permitted” - Is everything clear? Databases, digital flows, formularies and controls.

Privacy Scenarios

The Pierino on duty will say “I have nothing to hide”, at the moment everything is being digitalized and then what?

Quick observations:

• The general practitioner will be obliged to adopt IT systems and use software, probably in cloud, which will connect electronically to transmit data to the Health Card System (HCS). However, preoccupations arise regarding privacy: our personal information is vulnerable in two critical points, namely in the software used and in the HCS system itself.
• Our sensitive data is not safe, as demonstrated by the numerous hacker attacks suffered by ASL and Ministries. Furthermore, information regarding any attacks on general practitioners is not public, which further increases the preoccupations about the security and protection of personal data.
• All digital? We have already suffered the Cyber Pandemic click here , there is no one without two there is no two without three etc etc.

You don’t complain

• You don’t complain, because if you were to pass away⁴, your wife would not be able to collect the life insurance policy. This is because a risk factor is considered by analyzing the history of prescribed drugs.
• You don’t complain if your doctor cannot freely prescribe a certain over-the-counter drug, as he is bound by a formulary established for the benefit of the patient.
• You don’t complain if, after a car accident not caused by you, the insurance company finds that you are taking opioid drugs for back pain and decides not to reimburse you for the damage suffered.

Solution?

Digital disobedience, we will buy drugs in Vatican City and Switzerland, we will open PO boxes to buy over-the-counter drugs in the European Union and we will move away from Italy.