Norway, Sweden, Denmark and Finland introduce digitally shared medication lists
Patients can expect less medication errors.
The Nordic countries of Denmark, Finland, Norway and Sweden are in various stages of introducing systems for digitally shared medication lists (SML).
The aim is to provide healthcare professionals with up-to-date and accurate information about patients' medication. The aim is to improve patient safety and reduce medication errors.
The systems in the Nordic countries are similar, but also have some differences.
Researchers from the Norwegian Centre for E-health Research and the other Nordic countries have now compared the systems for shared medication lists in the Nordic region. The findings have been compiled in a scientific article.
Nordic differences
Denmark and Finland have already introduced digitally shared medication lists.
Norway and Sweden are in the process of testing and introducing their systems.
The goal of introducing the system has been virtually the same in all countries:
- Up-to-date and correct medication lists available between the municipal health service, GPs and hospitals.
- Reduce medication errors and increase patient safety.
All countries have had e-prescription for over ten years. Despite this, researchers have found that even this is not good enough to provide up-to-date information on patients' medication use.
In Norway, we have the Prescription Disseminator. This is a database available to all doctors and pharmacies in the country. It contains all active prescriptions, but does not provide a complete overview of the patient's prescribed medicines.
- Prescriptions expire after one year. They will then no longer appear in Prescription Finder. But that doesn't mean that the patient should stop taking the medicine anyway. It is in such cases that the system we have today is not good enough, says pharmacist and researcher Anette Vik Jøsendal at the Norwegian Center for E-health Research.
The patient's medication list
In Norway, a system has now been developed for digitally shared medication lists, called "Pasientens Legemiddelliste" (PLL). This shows all medicines prescribed by the doctor, regardless of whether the patient has a prescription for the medicine or not.
PLL has been tested and trialed in Bergen since 2021. A national introduction is planned to start in 2024.
One of the key differences between the solutions in the Nordic countries is the information available in the list.
The Norwegian and Danish solutions use drug orders, known as prescriptions, as the basis for the lists. Finland and Sweden are based on prescriptions.
In addition, the extent to which previous drug treatments can be viewed in the different systems varies.
As of today, none of the systems include information about medicines administered during hospital stays, and none give patients direct access to be able to change or comment on their own medication list.
How digitally shared medication lists work in each country
- Norway: Patient's Medication List (PLL).
Pilot testing since 2021 in one region (Helse Vest). National introduction planned to start from 2024. - Sweden: Nationella läkemedelslistan (NLL).
Introduced in 2021, but still lacks integration with doctors' patient records. Planned full integration with all systems by December 2025. - Denmark: Fælles medicinkort (FMK).
Introduced in stages since 2014. Integrated with local health systems in hospitals, general practices and municipal health services. - Finland: Kanta and prescription service (ePS).
Introduced in stages since 2010, mandatory since 2017. Planned further development of medication list including drugs given in hospitals from 2027.
The patient must be more involved
These systems have the potential to increase access to information and reduce discrepancies between medication lists. However, there are challenges associated with updating and involving patients.
Healthcare professionals do not always update such a system correctly, and patients do not currently have the opportunity to edit or state their compliance with the medications in the lists.
– Ultimately, it's the patient who decides what medicines they actually use. If we want the list to provide a complete picture of the patient's medication use, the patients themselves must be involved and have the opportunity to enter information, says researcher Unn Sollid Manskow at the Norwegian Center for E-health Research.
You cannot edit the list yourself
None of the SML solutions in the Nordic countries provide fully updated information on medication use during hospital stays.
Citizens have access to view their digitally shared medication list, but none of the solutions allow citizens to edit or provide feedback to prescribers on actual medication use.
To ensure an accurate and complete medication list, it will therefore be necessary to involve patients more.
Many countries are developing solutions for digital shared medication lists, but knowledge about the effects of these systems is still limited.
This study uses a common terminology to describe the systems in the Nordic countries. This will make it easier to compare the effects of such systems across countries in the future.
The researchers write that further work should explore advanced technology, the patient perspective and privacy issues related to SML systems.
Reference:
Anette Vik Jøsendal mfl.: Nationally Shared Medication Lists – Describing Systems in the Nordic Countries. European Federation for Medical Informatics (EFMI) and IOS Press, 2023. DOI: 10.3233/SHTI230104