SVENSK FÖRENING FÖR
SWEDISH FEDERATION FOR
History of electronic prescriptions in
Sweden from time sharing systems via smartcards to EDI
History of Nordic Computing 3,IFIP
Gunnar O Klein, M.D. Ph.D.
Researcher in medical informatics at KI
Primary care physician
Scientific secretary of SFMI
Råcksta Vällingby Närvård
• Developer of a test system for the
Pharmacy printers at Philips Bank
Terminal Systems AB in Vällingby 1972-73
• Director, Infocard company 1987-92
• EU project leader for secure communication and standardisation at
Spri - Swedish Institute for Health Services Development and Karolinska Institutet 1993-2005
• Medical informatics academic and a prescribing general practioner
• Decision support to the prescribing physicians to improve quality of medication selections to optimize the chance of efficacy and minimize the risk of adverse reactions.
• Improving cost-efficiency for the pharmacies moving from hard to read paper scripts to computerized support for retail, billing and safety checks.
• Improved services to the customers/patients
• Apotekens Terminalsystem ATS
• Minicomputer DG and terminals at the
• Pricing, Sales statistics and printing of labels with dosage information
• Already 1970ies almost all pharmacies where computerised
• Prescribing doctors in the same building as the pharmacy were conected to the local Pharmacy terminal system and could make prescriptions. Access to database of products but no decision support
• No networks to the doctor’s office
• Slow telephone modems 9600 baud
• Authentication and confidentiality issues
• Microprocessor (Smart Cards) with
• The card as a bearer of medication history
• The card as a bearer of prescriptions
• The Tjörn trial
• 1990ies when electronic health record systems at the desktop of the outpatient clinics went from
5 to 90% prescription functionality was added to the record systems. From Printer to EDI.
• Denmark was a pioneering country for this and on a European scale an EDIFACT message was developed to represent an electronic prescription.
• This was adapted to Sweden and used until about 2001.
• The card trial included the patient as a controller of the data and a legitimate user
• It was not until recently that the citizens have access to their prescriptions on-line
1. Klein GO. Infocard in Pharmacy. Proceedings of the North American Conference on
Patient Cards, New Orleans March 1992. pp 1-3. (1992)
2. Klein GO. Aktiva kort - En nyckel till säkrare IT och effektivare vård. Fakta och visioner om personal- och patientkort. Spri rapport. 90 sidor (1997).
3. Klein GO, ISO/TR 22790 Health informatics – Functional characteristics of prescriber support systems (2007)
4. Klein GO. Final report of the project Trustworthy Health Telematics 1 (Trusthealth).
Deliverable D1.4. 16 pages. (1998)
5. Klein, G.O.: Security principles for patient card systems in the Proceedings of the
Fourth Global Congress on Patient Cards and Computerization of Health Records
(Köhler, C.O. and Waegeman eds), Newton, Mass, USA: Medical Records Institute,
6. Klein GO. Smart Cards - a tool for carrying medical information by patients and creating digital signatures by professionals. Conference of the International Federation of
Information processing/TC 11 Security. Cape Town. Annex "Information Security on the
Electronic highways of Sweden" In Information Security – The next decade,
Chapman&Hall, 1-20 (1995)
7. Klein GO. The Swedish Prescription Card Trial - A technical report. Published by
Apoteksbolaget in the co-operation between Sweden and the French Ministry of Health.
29 pages. (1992)