Although the execution with the usually means in the existing invention is carried out as a result of an information procedure, this execution is approximately divided into two phases: a system preparation stage and an Procedure phase.
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。
During the procedure operation phase, the next processing is carried out in real time. In other words, inquiries regarding The provision of insurance policies coverage for prescription drugs from health treatment institutions are created by way of interaction traces during Just about every health-related practice, and these inquiries are when compared With all the enter information and specified conditions in the evaluation and payment institutions and insurers pointed out higher than. Then, the assessment having to pay institution as well as insurer establish if to reject the insurance plan software, distribute The end result towards the clinical establishment, and Display screen it on the terminal of the health-related institution by an input / output screen as shown in FIG. On account of the perseverance, If your content of the inquiry does not conform into the input information and specified situations in the assessment and payment institution plus the insurer, a pharmaceutical group gratifying these is searched and discovered and dispersed to your professional medical institution.
Turn out to be. Subsequently, one example is, the examination / payment agency raises the prescription precedence order of more effective medicines so a large number of health-related establishments can prescribe the medicines. Consequently, the caliber of medical expert services and also the fairness of charges among the insured persons Promoted. Moreover, an increase in prescription of the cheapest drug amid a plurality of drugs owning a similar result can be received, which include 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、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。
システムの運用段階では、以下の処理をリアルタイムで実施する。すなわち、個々の診療行為に際して保健医療機関からの処方医薬品の保険適用の可否の問い合わせが通信回線を介して行われ、この問い合わせを前述の審査支払機関及び保険者の入力情報や指定条件に照らし合わせて、審査支払機関及び保険者が保険適用を却下しないか否かを判定し結果を医療機関に配信し、図６に示されるような入出力画面によって医療機関の端末に表示される。尚、判定の結果、問い合わせ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。併せて、指定条件を満たした医薬品については、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。また、保険薬局が、医療機関が発行した処方箋に記されている医薬品の保険適用につき照会を行う場合には、処方箋発行医療機関との照会履歴の有無、結果について配信する。
Currently, There's an example that aims to Increase the do the job effectiveness by digitizing the health-related fee evaluation request as opposed to creating, but This can be directed at labor conserving of office operate at the health care establishment.
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How over and over have you still left the health care provider’s office, only to uncover you forgot to mention a significant piece of information?
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。
1st, in FIG. one, the get-togethers connected to the information procedure on the existing invention are going to be clarified. This information program features a health care establishment that prescribes prescribed drugs to your insured, an coverage pharmacy that dispenses prescribed drugs determined by a prescription issued via the healthcare institution and provides them to the insured, an insurer that bears professional medical coverage expenditures, and An assessment / payment establishment that examines health-related payment particulars from professional medical institutions / insurance coverage pharmacies is linked. Every bash delivers the information method which has a series of important information to become described later.From the information method, (1) information on solutions and prescriptions in the insurance provider for drugs prescribed from the insurance plan medical institution for your insured Enter / hold wanted priority information, (2) Enter / hold situations / criteria for acceptance of receipt critique by critique / payment Corporation, (three) Inquire about availability of insurance policy for prescription drugs from health-related institutions for every professional medical exercise Dependant on own information which include acceptance, insured's symptom, medical history, age, and many others.
While Every single line has a definite character, with each other they variety a complete medication determination support solution, serving a wide array of healthcare markets and presenting constant articles and aligned methods encompassing each drug reference and drug info.
If your professional medical Expert would really like the pharmacist to present you with a particular brand of medication, they need to Specially Detect this or sign-up the Area furnished.