In the traditional payment evaluation strategy, a clinical institution issues a prescription and prescribes and pays for your drug on the patient at an insurance policies pharmacy, etc., and afterwards the evaluation request for the healthcare follow is produced towards the evaluation payment institution. Nevertheless, it can be not possible to guage the suitability of the application contents upfront for clinical institutions. Also, the insured / insurance provider (health insurance coverage Affiliation, and so on.) that bears the expense of prescription drugs just isn't entirely educated about information on drugs for example efficacy and price, and it is totally knowledgeable regarding the existence of various possibilities. It is commonly not performed. This is why, the choice of medicines is completely remaining to your judgment of the medical establishment, and it is actually difficult to training the best to pick medicines as a cost bearer and a customer.
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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。
Instead, notify the health care institution, and persuade the healthcare institution to reselect prescription material, Pharmaceutical prescription information inquiry / distribution program characterized by comprising
【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。
The pharmaceutical prescription information inquiry / distribution method In line with claim one, wherein a series of inquiry histories produced by way of the system is dispersed to an evaluation payment Business and an insurance provider.
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。
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It is made up of assumed clinical rate points calculated for each injury and symptom classified In line with scenario, drug price standard of used drugs, insurance coverage details, other details needed for examination of health-related payment particulars, and many others. Pharmaceutical prescription information inquiry and distribution process.
Subsequently, although maintaining the fairness of getting professional medical providers, the insured / insurance provider / assessment / payment institution has the opportunity to pick out a drug that is considered desirable from your viewpoint of effectiveness, selling price, etc. Just isn't presented plenty of. Thus, the condition of your existing invention is that the insured person / insurance provider or evaluation / payment institution desires to prescribe the strongest prescription among options while protecting the fairness of obtaining clinical providers in Japan's medical insurance system.
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From the technique operation stage, the next processing is done in real time. To paraphrase, inquiries relating to The supply of insurance coverage coverage for prescription drugs from health care institutions are created by means of interaction strains in the course of Every single health-related observe, and these inquiries are compared with the enter information and specified disorders on the assessment and payment institutions and insurers described previously mentioned. Then, the evaluation having to pay establishment along with the insurer determine if to reject the insurance coverage software, distribute The end result to your health care establishment, and Show it on the terminal in the health care establishment by an input / output display as proven in FIG. As a result of the resolve, When the information of your inquiry doesn't conform for the enter information and specified problems in the examination and payment establishment plus the insurance provider, a pharmaceutical team fulfilling these is searched and determined and dispersed into the professional medical establishment.
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In the planning phase of your method, the assessment payer and also the insurance provider enter necessary information read more and specify ailments. Examples of information entered through the assessment payer and the insurance company and the required disorders are determined by information on the insurer topic to evaluation, situations such as the insured's age, gender, constitution and past history You will find assumed healthcare price points calculated for every individual sickness and symptom divided, drug value requirements of utilised drugs, coverage details, as well as other info necessary for evaluation of medical fee facts.