eBtM - Electronic Narcotic Prescription with Blockchain
Sector: Tertiary sector · Industry: Health technology · Organisation: Charité Berlin & Universität Ulm (unterstützt vom BMG) · Maturity level: Concept
The eBtM system is a blockchain-based solution for creating tamper-proof electronic narcotic prescriptions, developed by Charité Berlin and the University of Ulm. The system uses blockchain technology as a tamper-proof backbone to store all transactions redundantly, preventing and detecting fraud. The project won an innovation competition by the German Federal Ministry of Health in early 2019 and is still in the concept phase.
Documentation status
- Project status: Concept
- Evidence: Evidence medium
- Editorial review: Ufuk Avci, 15 April 2026
Description
Controlled substance prescriptions (BTM prescriptions) in Germany are issued on paper using three-colour forms with watermarks. The system is prone to errors: forgeries allow unlawful access to strong painkillers and opiates. In 2019, the federal government highlighted blockchain-based prescription issuance as a promising use case in its national blockchain strategy.
The German BTM prescription system is based on tripartite paper forms (yellow controlled substance prescription) with watermarks and doctor’s signature. Pharmacies must manually verify authenticity and can only detect forgeries to a limited extent. The federal government identified in the 2019 blockchain strategy the possibility of issuing BTM prescriptions based on blockchain: the doctor digitally signs with their cryptographic key; the prescription is anchored as an immutable record on the blockchain; pharmacies check authenticity and redemption status immediately via blockchain query. Double redemption (redeeming the same prescription multiple times) would be structurally excluded. With the introduction of the e-prescription (mandatory in Germany from 2024, FHIR standard), the first step towards digitalisation has been taken. Blockchain integration would significantly enhance the security of the e-prescription: cryptographic signatures instead of a central database, tamper-proof redemption history.
Perspectives
B2B — organisations perspective
Pharmacies could instantly check via a simple blockchain query whether a controlled substance prescription was issued by the actual doctor and has not yet been redeemed — without telephone inquiries to the doctor or manual watermark verification.
B2C — consumers perspective
Patients indirectly benefit from increased security in the prescription of controlled substances and potentially faster processes in medical practices and pharmacies. The risk of misuse through forged prescriptions is reduced.
Employees perspective
Doctors receive digital support when filling out controlled substance prescriptions, reducing form errors and saving time. Pharmacy staff can automatically verify the authenticity of prescriptions instead of validating them manually.
Benefits
General
- Blockchain technology makes controlled substance prescriptions tamper-proof and effectively prevents forgeries.
- Administrative processes are automated, saving time and costs.
- Electronic billing with health insurance funds is fully digitalised and made more efficient.
B2B — organisations
- Medical practices and pharmacies can avoid re-billing cases and associated costs.
B2C — consumers
- Patients receive increased security when controlled substances are prescribed.
Employees
- Medical staff benefit from less manual work and reduced form errors.
Challenges
General
- The system is still in the concept phase with no known pilot projects or live implementations.
- Integration into existing IT infrastructure of medical practices and pharmacies requires technical adjustments.
B2B — organisations
- Companies must invest in new software and train their employees accordingly.
Employees
- Medical staff must adapt to new digital processes and receive appropriate training.
Technology foundation
The eBtM system is based on blockchain technology, which stores all prescription transactions tamper-proof and redundantly. The blockchain acts as a decentralised backbone that enables an immutable record of all controlled substance prescriptions, thereby preventing forgeries and uncovering fraud attempts.
Implementation examples
eBtM concept development Charité Berlin
Charité wanted to develop a solution to the problem of narcotics prescription forgery while simultaneously digitising administrative processes in healthcare. The goal was to prevent cases of prescription rejections and to increase efficiency in prescription creation and validation.
Charité Berlin developed the eBtM concept for blockchain-based narcotics prescriptions together with the University of Ulm.
Dr Christian Sigler from Charité Berlin and Irina Hardt from the University of Ulm developed the eBtM system as an innovative concept for tamper-proof electronic narcotics prescriptions. The project won an idea competition held by the Federal Ministry of Health in early 2019 and uses blockchain technology as the backbone for the secure storage of all prescription transactions. The system is designed to utilise existing hardware such as Securpharm scanners in pharmacies and requires only an additional software installation.
The system addresses the challenge of prescription forgery for narcotics and the associated security risks. Additionally, administrative burdens caused by manual processes and formal errors in prescription creation are reduced.
Tags
Controlled substances, Prescription forgery, Health data, Tamper-proof security, Digital prescription