ISSRG Information Systems Security Research Group Contact: An Application Programming Interface for the Electronic Transmission of Prescriptions Presented By: D. P. Mundy Other Authors: Prof. D. W. Chadwick, Dr E. Ball ISSRG Information Systems Security Research Group Contact: Synopsis Prescribing in the UK The Pilots and Salford Models Potential Benefits / Problems Present Status Thanks to:

ISSRG Information Systems Security Research Group Contact: Synopsis The United Kingdom (UK) National Health Service (NHS) NHS Plan –Implement ETP by pilot systems –Transcript consortium (Large pharmacies and Pharmed) –Pharmacy2U consortium (An Internet pharmacy) –Flexiscript consortium (Microsoft, SchlumbergerSema)

ISSRG Information Systems Security Research Group Contact: Salford ETP Project Funded by the UK’s Engineering and Physical Sciences Research Council (EPSRC) 3 Year Project commenced September 2000 Carried out in collaboration with Huddersfield University and Hope Hospital, Salford £261k funding

ISSRG Information Systems Security Research Group Contact: Prescribing in the UK 4. Prescriptions Batched and sent to the PPA 1. Creates & signs Prescription 2. Patient Hands Prescription to Pharmacist (Maybe signed to claim exemption) 5. Prescriptions Processed and payment sent back to Dispenser 3. Drugs Dispensed to Patient, money to dispenser if the patient is not exempt

ISSRG Information Systems Security Research Group Contact: Problems with Present Practice Fraud –Stolen Prescription Pads, Altered Dispensation Amounts Data Integrity –Phone Call Clarification, Illegible Scripts Administrative Workload –578 million prescribed items in 2001 Efficiency –60% of Pharmacists believed that the introduction of electronic prescribing would lead to time savings (Kember Associates, 1999) Patient Exemptions / Identification –Pharmacy Check

ISSRG Information Systems Security Research Group Contact: ETP Worldwide Denmark –35 per cent of prescriptions now sent electronically (Middleton,2000) Germany –Electronic health card USA –State ETP systems UK –Hospital ETP systems and Pharmed trial

ISSRG Information Systems Security Research Group Contact: The Pilots and the Salford Model

ISSRG Information Systems Security Research Group Contact: Transcript Consortium Model

ISSRG Information Systems Security Research Group Contact: Transcript Model Perceived Benefits Patient retains freedom of choice and has control over their own privacy No reliance on a central database repository - therefore performance of system similar to present paper based system Mirrors present system just reduces fraud and administrative workload for the PPA

ISSRG Information Systems Security Research Group Contact: Transcript Model Perceived Problems Barcode Readers Complex and Expensive Limit on size of prescription Exemptions not automatic Lost prescription requires GP callback Barcode error rates

ISSRG Information Systems Security Research Group Contact: Pharmacy2U Consortium Model

ISSRG Information Systems Security Research Group Contact: Pharmacy2U Model Perceived Benefits Patient may or may not have freedom of choice Very low chance of lost prescriptions No paper version of the prescription May lead to advanced patient care

ISSRG Information Systems Security Research Group Contact: Pharmacy2U Model Perceived Problems DIRECTED Prescriptions may lead to severe consequences for high street pharmacy May be a problem with patient acceptance

ISSRG Information Systems Security Research Group Contact: Flexiscript Consortium Model

ISSRG Information Systems Security Research Group Contact: FlexiScript Model Perceived Benefits GP And Pharmacy Applications Interface With Model Without The Need For Additional Hardware Patient Retains Freedom of Choice

ISSRG Information Systems Security Research Group Contact: FlexiScript Model Perceived Problems May be performance issues at the relay Patient doesn‘t have complete control over their own privacy and lost script token requires GP callback Prescriptions may be stored in the clear Exemptions not automatic

ISSRG Information Systems Security Research Group Contact: University of Salford Model

ISSRG Information Systems Security Research Group Contact: University of Salford Model Perceived Benefits Patient retains freedom of choice and has protection of their own privacy Automatic Exemption and Authorisation Checking In many ways mirrors present system (just electronically) Only normal barcode scanners required at the pharmacy

ISSRG Information Systems Security Research Group Contact: University of Salford Model Perceived Problems Lost prescription - requires GP call Performance better than Flexiscript model since only encrypting once. (Research currently being undertaken to measure precise advantage)

ISSRG Information Systems Security Research Group Contact: Design Issues Stakeholder Acceptance –Little change to procedures Barcodes - Patient, GP, Pharmacist Recovery procedures –Maintained freedom of choice for patient

ISSRG Information Systems Security Research Group Contact: Security Considerations An Electronic Prescription Processing System must provide:- –Confidentiality > Encryption/Link Security –Secure Authentication > Digital Signatures –Secure Authorisation > Privilege Management Infrastructure –Integrity > Digital Signatures –Non-Repudiation of Origin > Digital Signatures

ISSRG Information Systems Security Research Group Contact: Security Model Comparison (1)

ISSRG Information Systems Security Research Group Contact: Security Model Comparison (2)

ISSRG Information Systems Security Research Group Contact: Present Status An API designed to facilitate the introduction of our proposed electronic prescription processing system design has been built. Disparate applications can call our API to transfer prescriptions electronically –Described within the paper Evaluation Phase –Qualitative Evaluation -Stakeholder Focus Groups –Quantitative Evaluation - Performance Research

ISSRG Information Systems Security Research Group Contact: The API Three subsystems (Prescribing, Dispensing and PPA Operations) Works in conjunction with two digitially signed supporting third party class structures –Security class structure –Directory configuration class structure

ISSRG Information Systems Security Research Group Contact: Security Class Structure EPP Security Abstract Base Class

ISSRG Information Systems Security Research Group Contact: API Operation - Example Prescribing Subsection initialiseEPP PrescribingOperations class (Security,Directory Config) setupPrescription(Patient details) addPrescriptionItem(Item details) signAndStorePrescription() Prescriber application prints prescription Prescription Store Access Established Checks Authorisation Logged in Security class Directory Configuration class getPrescriptionEncryptionKey() getBarcodeKeyValue() Joe Bloggs Age 24 Paracetamol Differin Signature

ISSRG Information Systems Security Research Group Contact: Further Information For further research related to this project please visit

ISSRG Information Systems Security Research Group Contact: Questions