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。
本発明により、医薬品流通市場における、医療機関・保険薬局といった供給者・処方者と、審査支払機関・保険者・被保険者といった需要者の間で、医療用医薬品の処方・購入に関わる取引に関しリアルタイムに当事者間の合意形成の有無を明確にすることが可能となる。これにより、審査支払機関・保険者は医薬品選択に関わる実効的な意思表示の機会を得ることとなり、自らが希望する医薬品処方につき選択肢が拡大、満足度・費用対効果を向上させることが可能となる。これにより、例えば、審査支払機関がより効能の高い医薬品の処方優先順位を上げることで多くの医療機関で当該医薬品が処方され、結果として被保険者間の医療サービスの質やコストの公平性が促進される。また、同等の効能を持つ複数の医薬品の中で最も安価の医薬品の処方が増加することによる保険者・被保険者の医薬品費用の低減、といった効果も得られる。
【解決手段】保険医療機関が処方する医薬品について、代替品情報、保険者の処方希望優先順位情報を入力・保持する手段、審査支払機関によるレセプト審査承認のための条件・基準を入力・保持する手段、医療機関から診療行為毎に、処方医薬品の保険適用可否に関する照会を受付け、被保険者の症状等の個人情報に基づき、照会内容が保険者・審査支払機関の指定条件に合致しているか否かを判定する手段、上記照会内容が指定条件に合致していない場合は、保険者が指定する医薬品の中から、症状等の被保険者の情報に基づき指定条件を満たす他の医薬品を検索し代替品として医療機関に通知、医療機関にて処方内容の再選択を促す手段を有するシステム。
医療機関からの照会後、処方医薬品を確定した段階で医療機関から最終の処方内容が情報システムに送信される。保険薬局から処方箋記載の医薬品の保険適用の可否について照会があった場合には、医療機関との照会履歴の有無、結果を配信する。
The current creation relates to a pharmaceutical prescription information inquiry / distribution device, a pharmaceutical prescription information inquiry / distribution method, as well as a pharmaceutical prescription information inquiry / distribution approach.
Upcoming, the stream through which the suggests on the present creation is executed might be described in time collection with reference to FIG.
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Cautions Inform: U.S. Boxed Warning - The FDA-accredited labeling includes a boxed warning. See Warnings/Precautions segment for any concise summary of this information. For verbatim wording from the boxed warning, check with the merchandise labeling or . Warnings/Safeguards - Precautionary considerations, hazardous circumstances associated with use of the drug, and disease states or patient populations in which the drug need to be cautiously made use of. Boxed warnings, when current, are clearly discovered and so are adapted with the FDA-accredited labeling. Seek advice from the product labeling for the precise black box warning through the maker's or perhaps the FDA Sites. Checking Parameters - Laboratory exams and patient Actual physical parameters that should be monitored for safety and efficacy of drug therapy Pregnancy Possibility Aspect - 5 types set up by the FDA to point the potential of a systemically absorbed drug for resulting in danger on the fetus Pregnancy Considerations - A summary of human and/or animal information pertinent to or related to the usage of the drug since it pertains to scientific effects on the fetus, newborn, or pregnant lady Lactation - Indicates In the event the drug listed while in the monograph is existing in breast milk and the manufacturer's recommendation for use when breast-feeding (when advice of yankee Academy of Pediatrics differs, notation is designed) Patient Education - Unique information pertinent with the patient
From the prescription information inquiry / distribution procedure Based on claim 1, when the prescription medicine inquired from your health care establishment for each health-related follow satisfies the specified problems on the insurance company / evaluation / payment institution, the address of your professional medical establishment or insured particular person Drug prescription information inquiry / distribution program that accesses and confirms the handling information / stock information on the drug at numerous insurance policy pharmacies near the pharmacy.
The current creation for solving the above-stated difficulties is made up of the subsequent elements. (one) Enter and keep information on substitutes and prescription priority information of insurers for pharmaceuticals prescribed by insurance plan healthcare institutions for insured individuals (two) Enter and retain the conditions and requirements for receipt overview acceptance via the examination and payment organization (3) Accepting inquiries from health-related institutions with regards to The supply of insurance plan for prescription drugs for every clinical exercise, and building inquiries dependant on own information including the insured's signs or symptoms, clinical heritage, age, and so forth., and information on (1) and (two) earlier mentioned Judgment is manufactured in actual time to determine whether or not the articles meets the disorders specified because of the insurer / assessment and payment institution (four) If the above inquiries will not meet the required circumstances, try to find other drugs that satisfy the required situations based on the insured's information for instance signs and symptoms, and many others. Notify healthcare institutions and persuade them to reselect prescription material.
Very first, in FIG. 1, the events connected to the information program on the current invention will probably be clarified. This information method includes a medical establishment that prescribes prescribed drugs on the insured, an insurance policies pharmacy that dispenses pharmaceuticals according to a prescription issued by the professional medical establishment and gives them to the insured, an insurance provider that bears health-related insurance prices, and An evaluation / payment establishment that examines health-related fee information from healthcare establishments / insurance pharmacies is linked. Each social gathering provides the information program which has a series of required information to generally be explained later.Inside the information process, (one) information on alternatives and prescriptions in the insurance company for drugs prescribed because of the insurance healthcare institution for your insured Enter / hold wanted priority information, (2) Enter / keep conditions / requirements for check here acceptance of receipt overview by overview / payment Firm, (3) Inquire about availability of insurance coverage for prescription drugs from healthcare establishments for every health care follow According to personal information which include acceptance, insured's symptom, clinical historical past, age, etc.
provide the probably of remaining abused, and which could cause well currently being threats from Negative effects if taken incorrectly,
最後に、一連の照会履歴を審査支払機関及び保険者に配信し、情報照会・判定の手順を終了する。