It must be created beneath the supervision in the health-related Specialist or in accordance with pharmacopoeia or formulary Directions. It can be important to fill the containers Utilizing the Completely ready compounds. The container really should be clearly marked by making use of a label.
Initially, in FIG. 1, the functions linked to the information program of the existing creation will likely be clarified. This information system includes a clinical institution that prescribes prescription drugs on the insured, an coverage pharmacy that dispenses pharmaceuticals determined by a prescription issued with the professional medical institution and presents them to the insured, an insurance company that bears professional medical insurance plan charges, and An evaluation / payment institution that examines medical rate specifics from health-related establishments / insurance plan pharmacies is connected. Just about every celebration presents the information program which has a series of needed information to generally be described later on.During the information method, (1) information on solutions and prescriptions of the insurer for drugs prescribed through the insurance plan professional medical institution to the insured Enter / maintain wished-for precedence information, (two) Enter / maintain disorders / standards for approval of receipt review by assessment / payment Business, (3) Inquire about availability of insurance for prescription drugs from healthcare institutions for each healthcare exercise Determined by particular information for instance acceptance, insured's symptom, professional medical history, age, etcetera.
Simultaneously, for pharmaceuticals that satisfy the desired ailments, obtain the insurance plan pharmacy database and check the dealing with and inventory information in the pharmaceuticals at various insurance pharmacies close to the deal with of your healthcare establishment or the insured. . Also, when an coverage pharmacy makes an inquiry concerning the insurance policies application of a drugs explained inside of a prescription issued by a healthcare establishment, the presence or absence of the inquiry historical past Together with the prescription issuing clinical institution and the result are dispersed.
plus the information in (one) and (2) previously mentioned, if the inquiry articles fulfills the specified disorders on the insurance company / evaluation / payment in authentic time (four) If the above mentioned inquiries tend not to match the desired disorders, look for other drugs that meet up with the desired situations according to the insured's information such as indicators from the drugs specified because of the insurance company. Notify health-related institutions instead, Prompting reselection prescription at engine operating these process, speedily and successfully, the selection of formulation medicament, for the opportunity of coverage protection, reach consensus among the events.
以下に、図４を用いて情報照会・判定の手順の一例のフローチャートを説明する。まず審査支払機関・保険者・保険医療機関・保険薬局から必要な情報を取得する。審査支払機関及び保険者から取得する情報・指定条件は前述の通りであり、医療機関・保険薬局からは所在地等の基本情報に加え、使用希望薬剤情報・医薬品取扱情報・同在庫情報等を取得し、取得したデータを格納する。
医療機関による医薬品の処方に際しては、被保険者（患者）が保健医療機関で医師の診察を受け、その診断結果をもとに医師が処方箋を発行、同処方箋に基づき保険薬局にて医薬品が調剤、提供される、という流れになっている。保険が適用される医薬品の費用請求については、被保険者による一部費用負担を除くと、医療機関・保険薬局などが、レセプトと呼ばれる診療報酬明細書に、診療、検査、投薬、手術など医療行為の内容を記入し、月ごとに審査支払機関に提出、医療費を請求する。審査は、社会保険診療報酬支払基金と都道府県支部、国民健康保険中央会と各都道府県の国民健康保険団体連合会にて実施され、かかった医療費をそのまま医療保険から支払う「出来高払い制」を採用されている。
請求項１に記載の医薬品処方情報照会・配信システムにおいて、本システムを介して為された一連の照会履歴を審査支払機関及び保険者に配信することを特徴とする医薬品処方情報照会・配信システム。
このような情報システムの構成の一例を図３に示す。本情報システム例では、審査支払機関・保険者・保険医療機関・保険薬局のそれぞれに設置される通信手段をそなえた通常のパーソナルコンピューターのような、少なくとも、表示及び出力部・入力部・データ格納部、を備えた端末、及び情報照会・判定を行う中央システムとが、インターネットのような通信回線を介して接続される。当該中央システムは、演算部・表示及び出力部・入力部・データ格納部から構成され、演算時に参照するデータファイルの例が図５に示される。
図１は、本発明の医薬品処方情報照会・配信方法を活用したビジネスモデルの一例の概略を示す図面であり、図２は、当該ビジネスモデルをより具体的に示す図面であり、図３は、情報システム構成の一例を示す図面であり、図４は、情報照会・判定の一例を示すフローチャートであり、図５は、本発明の医薬品処方情報照会・配信のための情報システム内のデータファイルの一例を示す図面であり、図６は、当該情報システムと接続した医療機関の端末の入出力イメージの一例を示す図である。
At this time, an information system that replaces the creation and application of the above-pointed out receipt using an electronic approach from a standard published system has now been set into realistic use. Conversely, in The usa, Pharmacy Gain Management (“PBM”) is a business that manages dispensing expenses for policyholders.
In the conventional payment examination method, a clinical establishment troubles a prescription and prescribes and pays for that drug on the patient at an insurance plan pharmacy, and many others., then the examination ask for to the healthcare practice is built on the examination payment Medication dosage information establishment. Nevertheless, it is not possible to guage the suitability of the application contents upfront for health-related establishments. Additionally, the insured / insurance provider (health insurance policy Affiliation, etc.) that bears the price of prescribed drugs is not really completely knowledgeable about information on drugs such as efficacy and value, which is fully informed with regards to the existence of multiple alternate options. It is frequently not finished. Because of this, the selection of medicines is completely left towards the judgment of a healthcare institution, and it is difficult to physical exercise the proper to decide on medicines as a price bearer in addition to a purchaser.
How over and over Have you ever left the health care provider’s Business office, only to locate you forgot to mention a significant bit of information?
Turn out to be. Subsequently, by way of example, the assessment / payment agency raises the prescription priority order of more practical medicines so a large number of medical institutions can prescribe the medicines. Subsequently, the quality of health-related expert services and the fairness of fees amid insured people Promoted. In addition, an increase in prescription of The most affordable drug among the a plurality of drugs having exactly the same influence will also be obtained, such as reduction in drug costs for insurers and insured persons.
請求項１に記載の医薬品処方情報照会・配信システムにおいて、医療機関から診療行為毎に照会される処方医薬品が、保険者・審査支払機関の指定条件を満たす場合、医療機関や被保険者の住所の近くに存在する保険薬局数軒での当該医薬品の取扱情報・在庫情報を保険薬局のデータベースにアクセスし確認を行うことを特徴とする医薬品処方情報照会・配信システム。