An Evaluation of the Technical Quality Within the Belgian Electronic Prescription: A Cross-Sectional Study

The increased use of eHealth services has shifted focus towards quality and interoperability. This study quantifies the technical quality of the ePrescription in Belgium by validating the construction of the Kind Messages for Electronic Health Records (KMEHR) used for communicating between prescriber and pharmacist, and by validating the digital signature within the ePrescription. A two-way cluster randomized subset of prescriptions of the tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) is used (n=82,952). Here, 38,032 prescriptions (45.85%) were handled electronically, but 180 prescriptions (0.22%) contained an empty KMEHR message at tarification. All 37,852 ePrescriptions (100%) passed the XSD Schema validation, but only 29,428 ePrescriptions (77.74%) passed the Software Development Kit (SDK) XPath validation rule set of the national Recip-e project. 37,622 ePrescriptions (99.39%) passed the validity test for having a correct digital signature. Improvement towards the construction and the digital signature is required in order to fully dematerialize the ePrescription workflow.