Electronic prescriptions have reduced the number of unnecessary medicines

Electronic Prescriptions Have Reduced the Number of Unnecessary Medications

Uzbekistan continues its transition from paper prescriptions to an electronic drug prescribing system, which has helped eliminate a number of problems accumulated over years of using traditional paper document management in healthcare.

This was reported in the "Studiya 24" program of the "Uzbekiston 24" TV channel, which featured Nafisa Kodirova, a specialist at the Republican Center for Digital Healthcare; Jamshid Okhunjonov, head of the DMED system implementation department of the single integrator "Uzinfocom"; Nigora Bozorova, chief physician of family clinic No. 59 of the Yakkasaray district; and Mukarram Mahkamova, chief physician of family clinic No. 37 of the Chilanzar district.

According to Nafisa Kodirova, paper prescriptions had created a range of systemic difficulties for many years: illegible handwriting of doctors often caused errors when dispensing medicines in pharmacies, the documents themselves were lost or damaged, forcing patients to consult a doctor again. In addition, it sometimes happened that different doctors prescribed duplicate or incompatible drugs to the same patient.

As Jamshid Okhunjonov explained, before the launch of the unified system, about 53 separate, disconnected information systems operated in the republic's healthcare sector: patient information obtained in one clinic was not accessible in another medical facility, and citizens had to present paper documents every time.

The situation changed after the Ministry of Health, together with "Uzinfocom," created the unified medical information system DMED. Today, about 4,000 medical institutions are connected to it, and the unified electronic medical record covers around 38 million citizens. The system spans primary, secondary, and tertiary healthcare levels and includes more than 20 functional modules, one of which is the electronic prescription module.

According to Okhunjonov, after examining a patient, the doctor issues a prescription directly in the system and confirms it with their personal code (PIN-FL), which rules out the possibility of writing a prescription under someone else's name. Once issued, the prescription automatically goes to the patient's mobile application, where information about their entire medical history and test results is also available.

Each prescription is assigned a unique barcode, which can be used to obtain the medicine at a pharmacy. The doctor specifies the drug by its international nonproprietary name rather than its brand name, allowing the patient to choose a specific product in the pharmacy themselves, taking into account price and other characteristics.

Nigora Bozorova, chief physician of clinic No. 59, noted that at the first stage, there was some misunderstanding among the population — in particular, whether it was absolutely necessary to go to a doctor for a regular painkiller. According to her, one can find out whether a specific drug is prescription or over-the-counter on the Farmgo website.

Bozorova also said that before the implementation of the unified system, the results of tests taken at the local clinic were not visible during a subsequent visit to a hospital, which is why patients, including children, had to retake tests, which she called an additional stress and financial burden. In addition, according to her, there used to be long queues in clinics, whereas now a patient can book an appointment through the mobile application for a convenient time, including outside the clinic's working hours of 8:00 to 20:00.

Bozorova emphasized that with the introduction of the electronic prescription, the personal responsibility of doctors has increased: each prescription is confirmed by the doctor's personal code, and it is impossible to forge it under someone else's name. According to Cabinet of Ministers Resolution No. 570, a doctor can prescribe no more than five drug names for a single diagnosis — if they try to prescribe more, the system automatically blocks this option. According to Bozorova, it used to be common for a patient to be prescribed two or three drugs of the same pharmacological group, with the total number of prescriptions exceeding ten items.

Mukarram Mahkamova, chief physician of clinic No. 37, said that the system checks the prescribed drug against the diagnosis in real time using the ICD classifier and highlights incompatible or non-matching drugs in red font, warning the doctor before final confirmation of the prescription. According to her, before confirmation, the system prompts the doctor to double-check the prescription and, if necessary, return it for editing; however, once confirmed, the prescription can no longer be changed — only fully recalled.

Okhunjonov added that the system features a separate analytical dashboard that allows heads of institutions and specialists of the Ministry of Health's situation center to see prescription statistics, including cases of incorrect prescriptions, across the entire republic.

Answering a question about elderly patients who do not use digital services, Nafisa Kodirova noted that when issuing a prescription, a doctor can specify a trusted person — a guardian or a responsible individual who can obtain the prescription instead of the patient. Also, according to her, if a printed prescription is lost, the data is still saved in the DMED application, and the required prescription can be found using the patient's identification data through a doctor or pharmacist.

Nigora Bozorova reported that over 1,800 drug names fall into the over-the-counter category, while all prescription drugs — including injectable medicines — are dispensed only by electronic prescription, as their use requires the participation of a medical professional, regardless of whether this occurs at home, in a hospital, or in a day hospital. Checking the status of a specific drug is also possible through the my.gov.uz portal, Okhunjonov added.

Special attention in the program was paid to the control of antibiotics. According to Bozorova, antibiotics have an immunosuppressive effect and side effects, so their prescription must be carried out by a doctor based on clinical standards, specifying the frequency of administration, timing relative to food, and duration of the course in the prescription. She noted that, according to the ministry's order, antibiotics and hormonal drugs are dispensed only by prescription. When asked whether the system can detect a mismatch between dosage and the patient's age, Jamshid Okhunjonov replied that the system provides monitoring that allows for the automatic selection of appropriate drugs based on the diagnosis.

Nafisa Kodirova confirmed that it is currently impossible to buy antibiotics or hormonal drugs without a prescription, while over-the-counter drugs remain available for free purchase. According to her, this was one of the main goals of implementing the system, as previously there was no control over the circulation of potent drugs; now all data — including who wrote the prescription, in which institution, and which pharmacist dispensed the drug — goes into a single database and is used for analytical and statistical work in the situation center of the Republican Center for Digital Healthcare.

Answering a question about the workload on doctors, Nigora Bozorova said that the electronic prescription has simplified the work: while previously a patient had to fill out several logs and obtain the stamp and signature of the department head, now all data is entered under a single ID number, and the prescription is generated and confirmed with a single code without paper processing. If they have the DMED mobile application, the patient does not even need to print the prescription.

Mukarram Mahkamova added that all medical workers involved in the system have undergone digital literacy training and passed the relevant exams at the advanced training center. She also noted that for patients with chronic diseases who are away, there is an option for remote consultation: after an online appointment, the prescription automatically goes to the patient's mobile application, regardless of their location.

When asked about actions during technical failures, Jamshid Okhunjonov replied that if there is no electricity or internet in a medical facility, a doctor can issue a prescription through a mobile application or tablet by manually entering the patient's PINFL; the data still goes into the single database. A similar option is provided for pharmacists when receiving a prescription — in this case, barcode scanning or entering the patient's PINFL is used.

Speaking about the protection of personal medical data, Okhunjonov noted that the system implements role-based access control: a pharmacist sees only the prescription itself without the patient's diagnosis, a registrar sees only the information they need, and full access to the medical history is available only to the treating physician. A special unit at "Uzinfocom" is responsible for the system's cybersecurity, constantly monitoring potential threats.

Among the achieved results, Nigora Bozorova named a noticeable reduction in polypragmasy — the practice of prescribing an excessive number of drugs to a single patient. According to her data, particularly for the Yunusabad district, the number of repetitive and duplicate prescriptions has decreased significantly. She also noted a reduction in corruption risks previously associated with the practice of directing patients to specific pharmacies for specific drugs: since the prescription specifies only the international nonproprietary name of the active substance rather than the brand name, the patient has the opportunity to choose among available analogues, regardless of the country of manufacture.

Answering a question about a situation where a pharmacy does not have the required drug, Jamshid Okhunjonov explained that the system tracks whether the patient received the medicine fully, partially, or did not receive it at all, and allows purchasing the remaining part of the prescription within a month from the date the prescription was issued. Nafisa Kodirova added that thanks to the use of the international nonproprietary name, a pharmacist can offer an analogue with the same active substance but a different brand name if the specific drug is out of stock.

According to Jamshid Okhunjonov, the system is also integrated with the Farmgo database, which makes it possible to exclude counterfeit or unregistered medicines from pharmacy circulation — if a drug is not in the registry, it is impossible to dispense it under an electronic prescription. To date, about 9 million electronic prescriptions have been generated in the system, which allows collecting statistics on the most in-demand drugs and the need for them by region, used for planning preventive measures.

Summing up, Nigora Bozorova noted that the responsibility of doctors has grown, and patients have become more attentive to their own health and understand that effective treatment does not necessarily require taking a large number of drugs.

Mukarram Mahkamova added that the system does not allow entering drugs with an expiring shelf life, which rules out their subsequent sale, and urged patients to demand exactly the drug specified in the electronic prescription when visiting a pharmacy.