Prescriptions

General Information

The electronic prescription is a medical document issued by a doctor using medical software integrated with National Health Information System (NHIS) or the eRx mobile application for issuing white prescriptions.
The Prescriptions module contains records of all issued electronic prescriptions, divided into three categories: for execution, executed and invalid. Prescriptions from each category are chronologically ordered on the main screen, and each individual e-prescription lists its issuance date; commercial name of prescribed product; National Reference Number (NRN); and completion status (for execution, partially executed, executed, rejected, canceled, partially canceled, and expired).
For execution category shows all prescriptions that are active or partially.
Prescription execution details name of prescribed medical product, and identifying number of respective pharmacy. Only when the entire prescription is fulfilled does it move to the "Executed category.
The Invalid category includes all prescriptions that are rejected, canceled, or expired.
If a patient uses the eZdrave mobile app and has enabled notifications, they will receive status update notifications for their prescription, as well as a warning of approaching deadline for its fulfillment.

Download eZdrave to access your prescriptions or visit my.his.bg

Key functionalities

Each prescription contains a barcode which, when scanned, allows a prescription to be fulfilled directly at a pharmacy without further need for information from patient.

A special color scale indicates the validity period of prescriptions that have not yet been filled. Initially, the scale is colored green, then turns yellow, and as the end of the period approaches, it becomes red.

The prescription contains information about prescribed quantity, instructions for use, duration of treatment, pharmacist substitution of prescribed product, and more.

In Prescription Details, one can see the National Reference Number (NRN) of examination during which it was prescribed. E-examination can be directly accessed through arrow located right of NRN.

Direct contact with prescription-issuing doctor can be made via email or phone number icons next to doctor's name.

Key functionalities

Each prescription contains a barcode which, when scanned, allows a prescription to be fulfilled directly at a pharmacy without further need for information from patient.

A special color scale indicates the validity period of prescriptions that have not yet been filled. Initially, the scale is colored green, then turns yellow, and as the end of the period approaches, it becomes red.

The prescription contains information about prescribed quantity, instructions for use, duration of treatment, pharmacist substitution of prescribed product, and more.

In Prescription Details, one can see the National Reference Number (NRN) of examination during which it was prescribed. E-examination can be directly accessed through arrow located right of NRN.

Direct contact with prescription-issuing doctor can be made via email or phone number icons next to doctor's name.

Stages of issuing and fulfilling an e-prescription

Arrow timeline

  1. 1 Doctor opens a new e-prescription medical document in NHIS or eRx application.

  2. 2 Doctor fills in patient's details (identifier; names matching data from Civil Registration and Administrative Services/Ministry of Interior) as well as their own details, mandatorily providing phone number/email for contact.

  3. 3 Doctor prescribes medical/non-medical products.

    Attributes of Dosage Instructions

    The combination of attributes should not allow any ambiguity of interpretation.
    Sequence:
    Sequence determines order in which dosage instructions are to be applied/interpreted. Identical sequence numbers are treated as simultaneous execution of instructions.

    Dose:
    Dose attributes (Dosage Quantity Value, Dose Quantity Code) indicate amount of medical product to be taken at a time.

    Time:
    Time attributes (Frequency, Period, Period Unit, Bounds Duration, Bounds Duration Unit) indicate duration and frequency of taking the amount specified by dose attributes.

    Event:
    Event attributes (When, Offset) are used when medical product intake depends on a specific event – time of day, before/after meals, etc.

    Free Text:
    Free text attribute (Text) is used to provide additional information when dosage instructions are too complex to describe using other available attributes. Input text should not replace or contradict other attributes.

    Quantitative dosage (Dose Quantity Code) can take two types of values:
    - In accordance with UCUM standard for units of measure – the recommended approach;
    - In accordance with CL035 national nomenclature.
    Dosage form does not necessarily have to match form of medical product.

    Here are 6 main dosage scenarios:

    First scenario:
    2 doses once every 8 hours
    Quantitative dosage (Dose Quantity): 2
    Frequency: 1
    Time interval (Period): 8
    Time unit (Period unit): hour (h)

    Second scenario:
    1 dose once every 7 days
    Quantitative dosage (Dose Quantity): 1
    Frequency: 1
    Time interval (Period): 7
    Time unit (Period unit): day (d)

    Third scenario:
    1 dose 3 times a day
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): day (d)

    Fourth scenario:
    1 dose twice a day for 14 days
    Quantitative dosage (Dose Quantity): 1
    Frequency: 2
    Time interval (Period): 1
    Time unit (Period unit): day (d)
    Duration of intake (Bounds duration): 14
    Time unit for duration of intake (Bounds duration unit): day (d)

    Fifth scenario:
    1 dose 3 times a day 30 minutes before meals
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): day (d)
    When: 19 (Value from national nomenclature CL034)
    Offset: 30

    Sixth scenario:
    1 dose 3 times a week
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): week (wk)

  4. 4 Doctor closes e-prescription document, sends it to NHIS, and after successful registration, receives an NRN unique to said document.

  5. 5 Patient visits a pharmacy.

  6. 6 Pharmacist locates e-prescription, preferably by searching for document's NRN.

    Pharmacist must carefully check medications and their dosage before dispensing them. If substitution of medical product is necessary and allowed, pharmacist amends information about fulfillment of e-prescription and, if necessary, adds new instructions for use.
    If pharmacist discovers an error in prescription issuance, they have the option to either fulfill or refuse it. If pharmacist refuses to fill e-prescription, they must explain reason for refusal. In case of refusal, justification and warning messages can be reviewed by prescription-issuing doctor for cancellation and subsequent correction of e-prescription.

  7. 7 Dispensing medications.

    After a final e-prescription check, pharmacist dispenses medical products to patient. If medication recipient is different from actual patient, pharmacist must make a note when issuing the prescription.

  8. 8 E-prescription fulfillment is then reported to NHIS. Each fulfillment is entered as a separate subordinate document in the system with unique NRN.

  1. 1 Doctor opens a new e-prescription medical document in NHIS or eRx application.

  2. 2 Doctor fills in patient's details (identifier; names matching data from Civil Registration and Administrative Services/Ministry of Interior) as well as their own details, mandatorily providing phone number/email for contact.

  3. 3 Doctor prescribes medical/non-medical products.

    Attributes of Dosage Instructions

    The combination of attributes should not allow any ambiguity of interpretation.
    Sequence:
    Sequence determines order in which dosage instructions are to be applied/interpreted. Identical sequence numbers are treated as simultaneous execution of instructions.

    Dose:
    Dose attributes (Dosage Quantity Value, Dose Quantity Code) indicate amount of medical product to be taken at a time.

    Time:
    Time attributes (Frequency, Period, Period Unit, Bounds Duration, Bounds Duration Unit) indicate duration and frequency of taking the amount specified by dose attributes.

    Event:
    Event attributes (When, Offset) are used when medical product intake depends on a specific event – time of day, before/after meals, etc.

    Free Text:
    Free text attribute (Text) is used to provide additional information when dosage instructions are too complex to describe using other available attributes. Input text should not replace or contradict other attributes.

    Quantitative dosage (Dose Quantity Code) can take two types of values:
    - In accordance with UCUM standard for units of measure – the recommended approach;
    - In accordance with CL035 national nomenclature.
    Dosage form does not necessarily have to match form of medical product.

    Here are 6 main dosage scenarios:

    First scenario:
    2 doses once every 8 hours
    Quantitative dosage (Dose Quantity): 2
    Frequency: 1
    Time interval (Period): 8
    Time unit (Period unit): hour (h)

    Second scenario:
    1 dose once every 7 days
    Quantitative dosage (Dose Quantity): 1
    Frequency: 1
    Time interval (Period): 7
    Time unit (Period unit): day (d)

    Third scenario:
    1 dose 3 times a day
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): day (d)

    Fourth scenario:
    1 dose twice a day for 14 days
    Quantitative dosage (Dose Quantity): 1
    Frequency: 2
    Time interval (Period): 1
    Time unit (Period unit): day (d)
    Duration of intake (Bounds duration): 14
    Time unit for duration of intake (Bounds duration unit): day (d)

    Fifth scenario:
    1 dose 3 times a day 30 minutes before meals
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): day (d)
    When: 19 (Value from national nomenclature CL034)
    Offset: 30

    Sixth scenario:
    1 dose 3 times a week
    Quantitative dosage (Dose Quantity): 1
    Frequency: 3
    Time interval (Period): 1
    Time unit (Period unit): week (wk)

  4. 4 Doctor closes e-prescription document, sends it to NHIS, and after successful registration, receives an NRN unique to said document.

  5. 5 Patient visits a pharmacy.

  6. 6 Pharmacist locates e-prescription, preferably by searching for document's NRN.

    Pharmacist must carefully check medications and their dosage before dispensing them. If substitution of medical product is necessary and allowed, pharmacist amends information about fulfillment of e-prescription and, if necessary, adds new instructions for use.
    If pharmacist discovers an error in prescription issuance, they have the option to either fulfill or refuse it. If pharmacist refuses to fill e-prescription, they must explain reason for refusal. In case of refusal, justification and warning messages can be reviewed by prescription-issuing doctor for cancellation and subsequent correction of e-prescription.

  7. 7 Dispensing medications.

    After a final e-prescription check, pharmacist dispenses medical products to patient. If medication recipient is different from actual patient, pharmacist must make a note when issuing the prescription.

  8. 8 E-prescription fulfillment is then reported to NHIS. Each fulfillment is entered as a separate subordinate document in the system with unique NRN.

E-prescription issuance can be backdated by up to 3 days from current date. Registration of e-prescription fulfillment can also be backdated by up to 3 days.