Twinning solution

Medicine Shortage Detection System

Twinning type

Knowledge exchange

Main policy priority

Better data to promote research, disease prevention and personalised health and care


Consejo General de Colegios Oficiales de Farmacéuticos (Spain), Agencia Española de Medicamentos y Productos Sanitarios (Spain)


Associação Nacional das Farmácias (Portugal), Ordre National des Pharmaciens (France), Federazione Nazionale Unitaria Titolari di Farmacia (Italy)

Short description

As medicine shortage is an increasing problem across the EU and can put patients at critical health risk, the CISMED medicine shortage detection system aims to identify where medicine shortages occur and how to prevent them. For this, the system will provide an overview of the medication availability in three countries (Portugal, France, and Italy), and will detect, predict and prevent medicine shortages. This data can then be used by the Competent Authorities to put the necessary measures in place in order to prevent future medicine shortages or to mitigate existing ones.
The system is based on the SNOMED CT protocols, which allows better interoperability and transferability of gathered data as well as presenting a real picture of patients’ accessibility to medicines in a medicine shortage scenario. It will give Community Pharmacies the necessary tools to report short supplies automatically and in real time, and uses a variety of parameters, such as medicine shortage definition or medicinal product identification. The twinning solution will allow the adopter countries to learn how to implement or improve a medicines shortages detection system with information collected and treated in a similar way in all countries (normalization), that can be used to predict medicine shortages at regional and (inter-)national and levels.


Twinning activities

The transferred digital solution was CISMED (Center for Information on the Supply of Medicines), the information system that pharmacies have in Spain for communicating problems of short supply of medicines. The General Pharmaceutical Council of Spain, as the originator of the Medicine Shortage Detection System Twinning project in the context of the Digital Health Europe action, led the twinning in terms of sharing CISMED as the innovative practice to predict and mitigate shortages. The twinning also served as a starting point for the exchange of knowledge with other partner countries: Ordre National des Pharmaciens (CNOP) from France, Federazione Nazionale Unitaria Titolari di Farmacia (FEDERFARMA) from Italy and Associação Nacional das Farmácias (ANF) from Portugal. Their contribution was of enormous value in terms of sharing information and weighing up the possibility of levering a national information system at European level. The Spanish Medicines Agency of Medicines and Medical Devices (AEMPS) had a crucial role acting as a special advisor during the twinning. AEMPS provided valuable guidance on the use of international standards to share information and to the medicines that could be prioritized in the analysis.


The main outcome of the twinning is that it brought evidence that it is possible to exchange information of medicines shortages among countries, and the results of this exchange draw valuable information for competent authorities, as supported by the Spanish Medicines Agency. The project also served the purpose of knowledge transfer about the innovation of the information system used in Spain, CISMED. This system not only reports short supplies from pharmacies, and therefore at the level of the patient, but also applies an analytical process to determine which constitutes a problem of supply or shortage, and enables the system to detect the shortage before it occurs. Additionally, the exchange of information was particularly important in the context of the COVID19 pandemic for its impact on the global medicines supply chain.

Added value and benefits

The twinning project showed that it is possible and valuable to set up a mechanism at European level to exchange information on medicines shortages. This exchange was based on the use of SNOMED CT as the international standard for the classification of clinical terms, and on the agreement of certain parameters to trigger the market signals on short supplies.

Barriers and success factors

The critical success factor was the good disposition and flexibility of the team members to learn from each other and to come to agree on how to make the exchange useful and efficient. The barriers or challenges were identified from the beginning: There was no univocal identification of medicines across Europe, there is not a common protocol to notify shortages, there are different configurations of the information systems among the countries, and different definitions of shortages exist even at national level.


The next step will be the technical implementation of an information system for pharmacy-based reporting of shortages at European level, and to raise further awareness of CISMED’s value so more national systems are developed for this purpose.