ePrescribing in EU and Ireland: FHIR-Based Electronic Prescriptions

Electronic prescribing (ePrescribing) is transforming medication management across Europe and Ireland, replacing error-prone paper prescriptions with secure digital workflows. This comprehensive guide covers the regulatory landscape, FHIR-based implementation patterns, and practical code examples for building compliant ePrescribing systems.

Executive Summary

ePrescribing delivers significant benefits: reduced medication errors (up to 70%), improved patient safety, better adherence tracking, and streamlined pharmacy workflows. In the EU, the Cross-Border Health Directive and eHealth Digital Service Infrastructure (eHDSI) provide the framework for cross-border prescription recognition. Ireland’s Health Service Executive (HSE) is actively implementing ePrescribing aligned with EU standards.

Regulatory Landscape

EU ePrescription Framework

Ireland-Specific Requirements

Ireland’s ePrescribing implementation is led by the HSE, integrating with the national Health Identifiers (IHI for patients, HPI for practitioners). Key considerations include:

• Individual Health Identifier (IHI) – Unique patient identification required
• Health Practitioner Index (HPI) – Prescriber validation and authentication
• PCRS Integration – Primary Care Reimbursement Service for drug scheme eligibility
• Controlled Drugs – Additional requirements for Schedule 2-5 substances
• Medical Council Registration – Prescriber must be registered and in good standing

FHIR Resources for ePrescribing

FHIR R4 provides the foundation for ePrescribing systems with specific resources designed for medication workflows.

MedicationRequest Example

{
  "resourceType": "MedicationRequest",
  "id": "prescription-001",
  "status": "active",
  "intent": "order",
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "318127009",
        "display": "Amlodipine 5mg tablets"
      }
    ]
  },
  "subject": {
    "reference": "Patient/ihi-1234567890",
    "display": "John Murphy"
  },
  "authoredOn": "2025-05-19T09:30:00Z",
  "requester": {
    "reference": "Practitioner/hpi-98765",
    "display": "Dr. Sarah O'Brien"
  },
  "dosageInstruction": [
    {
      "text": "Take one tablet daily in the morning",
      "timing": {
        "repeat": {
          "frequency": 1,
          "period": 1,
          "periodUnit": "d",
          "when": ["MORN"]
        }
      },
      "doseAndRate": [
        {
          "doseQuantity": {
            "value": 1,
            "unit": "tablet",
            "system": "http://unitsofmeasure.org",
            "code": "{tbl}"
          }
        }
      ]
    }
  ],
  "dispenseRequest": {
    "numberOfRepeatsAllowed": 5,
    "quantity": {
      "value": 28,
      "unit": "tablet"
    },
    "expectedSupplyDuration": {
      "value": 28,
      "unit": "days"
    }
  }
}

ePrescribing Workflow

sequenceDiagram
    participant GP as Prescriber
    participant EHR as EHR System
    participant NPS as National Prescription Server
    participant Pharm as Pharmacy
    participant Patient
    
    GP->>EHR: Create prescription
    EHR->>EHR: Clinical decision support
    EHR->>NPS: Submit MedicationRequest
    NPS-->>EHR: Prescription ID + barcode
    EHR-->>GP: Confirmation
    EHR-->>Patient: Notification (SMS/App)
    
    Patient->>Pharm: Present ID/barcode
    Pharm->>NPS: Query prescription
    NPS-->>Pharm: MedicationRequest details
    Pharm->>Pharm: Dispense medication
    Pharm->>NPS: Submit MedicationDispense
    NPS-->>EHR: Dispensation notification

Implementation Best Practices

Key Takeaways

• ✅ EU eHDSI enables cross-border prescriptions – Build for interoperability from day one
• ✅ FHIR MedicationRequest is the core resource – Learn it thoroughly
• ✅ Ireland requires IHI/HPI integration – National identifiers are mandatory
• ✅ Clinical decision support saves lives – Integrate drug-drug and allergy checking
• ✅ GDPR compliance is non-negotiable – Document consent and data handling
• ✅ Controlled substances need special handling – Separate workflows and reporting

Conclusion

ePrescribing represents a fundamental shift in medication management, improving patient safety while enabling cross-border healthcare in the EU. By building on FHIR standards and adhering to eHDSI specifications, Irish healthcare organizations can create interoperable systems that serve patients both domestically and across Europe. The investment in standards-based implementation pays dividends through reduced errors, streamlined workflows, and future-proof architecture.

References

• EU Cross-Border Health Services
• FHIR MedicationRequest Resource
• HSE Prescription Services
• IHE Pharmacy Technical Framework
• Health Products Regulatory Authority (Ireland)