Uzbekistan’s E-Prescriptions Reduce Unnecessary Drug Prescribing

Tashkent, Uzbekistan (UzDaily.uz) — Uzbekistan is continuing its transition from paper prescriptions to an electronic medicines prescription system that has helped address a number of problems accumulated over years of traditional paperwork in healthcare.

The issue was discussed on Studiya 24, a program on Uzbekistan 24 television, featuring Nafisa Kodirova, a specialist at the Republican Center for Digital Healthcare; Jamshid Okhunjonov, head of the DMED implementation department at unified integrator Uzinfocom; Nigora Bozorova, chief physician of Family Polyclinic No. 59 in the Yakkasaray district; and Mukarram Makhkamova, chief physician of Family Polyclinic No. 37 in the Chilanzar district.

According to Kodirova, paper prescriptions had created a number of systemic problems over many years. Doctors’ illegible handwriting could lead to errors when medicines were dispensed at pharmacies, while prescriptions could be lost or damaged, forcing patients to return to doctors. There were also cases in which different doctors prescribed duplicate or incompatible medicines to the same patient.

Okhunjonov said that before the introduction of a unified system, around 53 separate information systems operated in Uzbekistan’s healthcare sector without integration. Patient data obtained at one clinic was not visible at another medical facility, meaning people had to present paper documents each time they sought medical care.

The situation changed after the Ministry of Health and Uzinfocom created the unified DMED medical information system. Around 4,000 medical institutions are now connected to the system, while approximately 38 million people are covered by a unified electronic medical record. The system covers primary, secondary and tertiary healthcare and includes more than 20 functional modules, one of which is the electronic prescription module.

Okhunjonov said that after examining a patient, a doctor issues a prescription directly through the system and confirms it using the doctor’s personal PIN-FL code. This prevents prescriptions from being issued in another doctor’s name.

Once issued, the prescription is automatically sent to the patient’s mobile application, which also contains information on the patient’s medical history and test results.

Each prescription receives a unique barcode that can be used to obtain the medicine at a pharmacy. Doctors prescribe medicines by their international nonproprietary name rather than their brand name, allowing patients to choose a specific product at the pharmacy based on price and other characteristics.

Bozorova said that the introduction of the system initially caused some confusion among the public, including questions about whether patients had to see a doctor to obtain common painkillers. She said people can check whether a particular medicine is prescription-only or available over the counter through the Farmgo website.

She also said that before the unified system was introduced, test results obtained at a patient’s local clinic were not visible when the patient later sought treatment at a hospital. As a result, patients, including children, sometimes had to undergo the same tests again, creating additional stress and financial costs.

According to Bozorova, clinics also previously had long queues. Patients can now book appointments through the mobile application at a convenient time, including outside the clinic’s regular operating hours of 8 a.m. to 8 p.m.

Bozorova emphasized that electronic prescriptions have increased doctors’ personal responsibility. Each prescription is confirmed using the doctor’s personal code, making it impossible to issue one in someone else’s name.

Under Cabinet of Ministers Resolution No. 570, a doctor may prescribe no more than five medicines for a single diagnosis. If a doctor attempts to prescribe more, the system automatically blocks the prescription.

Bozorova said that previously it was not uncommon for patients to be prescribed two or three medicines from the same pharmacological group, while the total number of prescribed medicines could exceed 10.

Makhkamova said the system checks the prescribed medicine against the diagnosis entered under the International Classification of Diseases and highlights medicines that are incompatible or do not correspond to the diagnosis in red. This warns the doctor before the prescription is finally confirmed.

Before confirmation, the system prompts the doctor to review the prescription and, if necessary, return it for editing. Once confirmed, however, the prescription cannot be changed and can only be completely withdrawn.

Okhunjonov added that the system includes a dedicated analytical dashboard that allows healthcare institution managers and specialists at the Ministry of Health’s situation center to monitor prescription statistics, including cases of incorrect prescribing, across the country.

Addressing the issue of elderly patients who do not use digital services, Kodirova said that when issuing a prescription, a doctor can designate a trusted person, such as a guardian or responsible individual, who can obtain the medicine on the patient’s behalf.

She added that if a printed prescription is lost, the information remains available in the DMED application. The prescription can also be found using the patient’s identification details through a doctor or pharmacist.

Bozorova said more than 1,800 medicines are classified as over-the-counter products. All prescription medicines, including injectable drugs, are dispensed exclusively through electronic prescriptions because their use requires the involvement of a healthcare professional, whether at home, in a hospital or in a day hospital.

Okhunjonov added that the status of a specific medicine can also be checked through the my.gov.uz portal.

The program also focused on controls over antibiotics. Bozorova said antibiotics have immunosuppressive effects and side effects, meaning they should be prescribed by doctors based on clinical standards. The prescription must specify the frequency of administration, the timing in relation to meals and the duration of treatment.

She noted that under a ministry order, antibiotics and hormonal medicines may only be dispensed with a prescription.

Asked whether the system can identify dosages that do not correspond to a patient’s age, Okhunjonov said the system includes monitoring that can automatically select appropriate medicines based on the diagnosis.

Kodirova confirmed that antibiotics and hormonal medicines can no longer be purchased without a prescription, while over-the-counter medicines remain freely available.

She said this was one of the main objectives of introducing the system, as there had previously been no control over the circulation of potent medicines. Now all relevant information — including who issued the prescription, at which institution and which pharmacist dispensed the medicine — enters a unified database and is used for analytical and statistical work at the situation center of the Republican Center for Digital Healthcare.

Regarding the workload on doctors, Bozorova said electronic prescriptions have made their work easier. Previously, patients had to fill out several registers and obtain the department head’s stamp and signature. Now all information is entered under a single ID number, while the prescription is generated and confirmed with one code without paper processing.

Patients with the DMED mobile application do not even need to print the prescription.

Makhkamova added that all healthcare workers involved in the system have received digital literacy training and passed the relevant examinations at a professional development center.

She also said that patients with chronic diseases who are away from home can receive remote consultations. After an online appointment, the prescription is automatically sent to the patient’s mobile application regardless of their location.

Asked what happens during technical failures, Okhunjonov said that if a medical facility loses electricity or internet access, a doctor can issue a prescription through a mobile application or tablet by manually entering the patient’s PINFL. The data will still be transferred to the unified database.

Pharmacists have a similar option when processing prescriptions, using either barcode scanning or manual entry of the patient’s PINFL.

On the protection of personal medical data, Okhunjonov said access to the system is divided by user roles. A pharmacist can see only the prescription and not the patient’s diagnosis, while a registrar has access only to the information required for their work. Full access to the medical history is available only to the treating physician.

A specialized unit at Uzinfocom is responsible for the system’s cybersecurity and continuously monitors potential threats.

Among the results achieved, Bozorova highlighted a noticeable reduction in polypharmacy, or the practice of prescribing excessive numbers of medicines to a single patient.

According to her, the number of repeated and duplicate prescriptions has fallen significantly, including in the Yakkasaray district.

She also noted a reduction in corruption risks previously associated with directing patients to specific pharmacies to purchase particular medicines. Because prescriptions specify only the international nonproprietary name of the active substance rather than a brand, patients can choose among available equivalents regardless of the country of manufacture.

Asked what happens if a pharmacy does not have the prescribed medicine, Okhunjonov said the system tracks whether the patient received the medicine in full, partially or not at all. The remaining part of the prescription can be purchased within one month from the date it was issued.

Kodirova added that because medicines are prescribed using international nonproprietary names, pharmacists can offer an equivalent containing the same active substance under a different brand name if the specific product is unavailable.

Okhunjonov said the system is also integrated with the Farmgo database, helping to prevent counterfeit or unregistered medicines from entering pharmacy circulation. If a medicine is not included in the register, it cannot be dispensed against an electronic prescription.

Around 9 million electronic prescriptions have been issued through the system to date. This allows authorities to compile statistics on the medicines in greatest demand and regional requirements, which are used to plan preventive measures.

Summing up, Bozorova said doctors now bear greater responsibility, while patients have become more attentive to their own health and more aware that effective treatment does not necessarily require taking large numbers of medicines.

Makhkamova added that the system does not allow medicines with approaching expiry dates to be entered, preventing their subsequent sale. She urged patients visiting pharmacies to request exactly the medicine specified in their electronic prescription.