After the inquiry with the healthcare institution, the ultimate prescription information is transmitted in the health care establishment towards the information technique in the event the prescription drug is determined. When an insurance pharmacy inquires about the availability of insurance policies for prescription drugs explained in prescriptions, the existence / absence from the inquiry record While using the health-related institution and the outcomes are distributed. Ultimately, a series of inquiry histories is distributed towards the examination and payment institution and the insurance provider, as well as information inquiry / judgment technique is finished.
To start with, in FIG. one, the parties linked to the information method of your existing creation are going to be clarified. This information system features a professional medical establishment that prescribes prescribed drugs for the insured, an insurance policies pharmacy that dispenses pharmaceuticals according to a prescription issued with the health care institution and presents them on the insured, an insurer that bears professional medical insurance plan charges, and An examination / payment establishment that examines healthcare rate information from healthcare establishments / insurance pharmacies is linked. Each individual get together presents the information program which has a series of required information being explained later.Inside the information process, (one) information on options and prescriptions on the insurance provider for drugs prescribed by the insurance coverage health care institution with the insured Enter / keep desired precedence information, (two) Enter / maintain problems / criteria for acceptance of receipt overview by overview / payment Firm, (3) Inquire about availability of insurance coverage for prescription drugs from healthcare establishments for every health-related apply According to personal information which include acceptance, insured's symptom, health care background, age, etc.
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As a substitute, notify the clinical institution, and encourage the clinical institution to reselect prescription written content, Pharmaceutical prescription information inquiry / distribution program characterised by comprising
While in the system operation phase, the subsequent processing is performed in serious time. Basically, inquiries concerning The supply of coverage coverage for prescription drugs from health care institutions are created by means of interaction strains throughout Every single clinical practice, and these inquiries are in contrast With all the input information and specified situations on the evaluation and payment institutions and insurers described previously mentioned. Then, the evaluation paying out institution as well as insurance provider identify whether to reject the insurance policies application, distribute The end result into the healthcare establishment, and Exhibit it about the terminal from the medical establishment by an input / output screen as revealed in FIG. Because of the determination, Should the articles from the inquiry won't conform towards the enter information and selected situations of your examination and payment institution as well as insurer, a pharmaceutical group gratifying these is searched and discovered and distributed for the professional medical establishment.
Any time a health care establishment prescribes medicines, the insured (patient) is examined by a doctor with the health medical institution, the health care provider problems a prescription based upon the analysis result, as well as the medication is dispensed for the insurance pharmacy according to the prescription , Presented. Regarding professing the expense of medicines included by coverage, medical establishments and coverage pharmacies, etcetera.
従って、本発明の課題は、わが国の医療保険制度の中で、医療サービス受給の公平性を維持しつつ、被保険者・保険者もしくは審査支払機関が、代替品の中から最も強く処方を希望する医薬品を、医療機関・保険薬局が、他の代替品の中から優先的に採用する機会を提供することを可能にさせる、医療用医薬品処方情報照会・配信システムを提供することにある。
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【選択図】図３[Issues] To provide a process for giving a chance for any healthcare establishment / insurance plan pharmacy to preferentially adopt a drugs that an insured / insurance company or assessment / payment institution wants to prescribe during the health care insurance coverage procedure. Presented. [MEANS FOR Fixing PROBLEMS] Getting into / Keeping information on options, prescription priority order information of the insurance provider, and circumstances / criteria for acceptance of the receipt examination by an examination / payment institution for your drugs prescribed by an insurance coverage health care establishment Inquiries about whether or not insurance policy for prescription drugs is accessible for Each individual medical practice in the indicates and healthcare establishment, and whether or not the inquiries match the desired problems of the insurance provider / evaluation and payment Business dependant on personal information for instance signs in the insured Indicates to ascertain whether the above mentioned inquiry information will not match the required problems, look for other drugs that fulfill the desired disorders through the drugs specified from the insurance company according to the insured's information for instance signs and symptoms A technique having implies for notifying a professional medical institution as a substitute and prompting the health care establishment to reselect prescription contents. [Selection] Figure 3 Description
This A Portion of the prescription also features the energy of your drug (the quantity of milligrams, for example) furthermore the tablet, capsule, or other type by which your Health care assistance provider would really like you to definitely unquestionably consider it. A Consider Observe discovered as "Disp" refers to this information regarding how the drug needs to be dispensed.
An illustration of the configuration of this sort of an information procedure is proven in FIG. In this instance of information process, at the least display and output unit / input unit / facts storage such as common notebook computer with interaction means set up in Just about every of assessment paying establishment, insurer, insurance coverage medical institution, insurance policy pharmacy Along with a central program that performs information get more info inquiry / willpower are linked by way of a communication line like the net.
The health care prescription information inquiry / distribution process according to assert 1, wherein the healthcare prescription is been given from a healthcare institution for each medical practice, and insured information (health care insurance coverage related information, personal injury and ailment) offered in the medical establishment at time of inquiry.
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。
・ It's not intended to expand the choices for prescribed drugs of insurers and decrease the cost of prescription drugs. On top of that, PBM in The us provides drug Charge management services for firms such as firms as the primary customers and would not go over all citizens. will not be.