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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。
指定条件を満たしていると判定した場合には、次に、医療機関・保険者の住所から近くに存在する複数の保険薬局に対して、処方対象医薬品の取扱状況・在庫状況を確認、結果をあわせて医療機関へ配信する。一方、指定条件を満たしていないと判定した場合には、審査支払機関及び保険者の指定条件に合致する範囲内で医療機関が提示した被保険者情報をもとに導出される処方推奨対象となる医薬品のリストを医療機関に配信、医療機関にて再選択を促す。医療機関にて処方推奨医薬品が選択されると、近隣の保険薬局での取扱状況・在庫状況を確認、結果を通知する。
Develop into. Therefore, as an example, the assessment / payment agency raises the prescription precedence order of more effective medicines so a large number of health-related establishments can prescribe the medicines. Subsequently, the caliber of professional medical providers and the fairness of charges among the insured persons Promoted. Also, a rise in prescription of The most cost effective drug amongst a plurality of drugs obtaining the same result will also be attained, like reduction in drug expenses for insurers and insured individuals.
The prescription information inquiry / distribution program Based on assert 1, accepting inquiries from insurance pharmacies for insurance coverage protection of prescription drugs described in prescriptions issued by clinical institutions, and presence of inquiry heritage with prescription issuing medical institutions Pharmaceutical prescription information inquiry and distribution system characterized by distributing final results.
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Now, There may be an here instance that aims to Increase the operate efficiency by digitizing the professional medical price assessment request rather than crafting, but That is aimed at labor conserving of Business perform within the clinical institution.
) offered through the health care institution at time of inquiry and information acquired upfront As well as in actual-time whether or not the required disorders of your insurance company to whom the insured is affiliated as well as the examination and payment Corporation in cost are happy.
The pharmaceutical prescription information inquiry / distribution procedure In line with assert one, wherein a series of inquiry histories manufactured by using the method is distributed to an evaluation payment Group and an insurance provider.
The current creation for solving the above mentioned-mentioned challenges is composed of the following sections. (one) Enter and hold information on substitutes and prescription priority information of insurers for pharmaceuticals prescribed by insurance policies medical institutions for insured people (two) Enter and manage the circumstances and standards for receipt evaluate acceptance by the examination and payment Business (3) Accepting inquiries from health care establishments about The provision of insurance coverage for prescription drugs for each medical apply, and creating inquiries depending on private information such as the insured's signs and symptoms, medical history, age, etcetera., and information on (1) and (2) higher than Judgment is designed in true time to determine whether or not the information satisfies the situations specified with the insurer / examination and payment establishment (4) If the above mentioned inquiries usually do not meet the specified ailments, seek out other drugs that meet the desired conditions based upon the insured's information including indications, and so on. Notify clinical establishments and motivate them to reselect prescription written content.
1st, in FIG. 1, the events connected to the information program in the present invention will probably be clarified. This information program includes a healthcare institution that prescribes prescription drugs to your insured, an insurance plan pharmacy that dispenses prescribed drugs based upon a prescription issued because of the health care institution and presents them to your insured, an insurance company that bears healthcare insurance policies fees, and An assessment / payment institution that examines medical cost specifics from medical institutions / coverage pharmacies is connected. Each individual get together delivers the information method that has a series of important information to be described later on.From the information system, (1) information on alternate options and prescriptions with the insurance provider for drugs prescribed from the insurance policies clinical establishment for that insured Enter / keep wished-for precedence information, (two) Enter / maintain problems / benchmarks for acceptance of receipt evaluate by evaluate / payment Corporation, (three) Inquire about availability of insurance plan for prescription drugs from clinical institutions for each medical observe Dependant on particular information for instance acceptance, insured's symptom, health care background, age, etc.
have the possible of remaining abused, and that can lead to properly being threats from Adverse effects if taken improperly,
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、判定の結果、照会内容が審査支払機関及び保険者の入力情報や指定条件に適合しない場合には、これらを満たす医薬品群を検索・同定し、医療機関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。