With the continuation of the two sessions, prescription outflows have escalated into hot topics for pharmaceutical retail this year. Some representatives suggested that in the context of "separation of medicines", a prescription information sharing platform should be established to comprehensively promote pharmacies to undertake "prescription prescriptions."
As one of the earliest companies to practice “prescription outflowâ€, as early as 2017, Baiyang Intelligent Technology launched a city-wide prescription information sharing platform in Ganzhou, Guangxi, which will pass more than 20 secondary and above hospitals in the city. Cooperate with more than 100 pharmacies to access the prescription information sharing platform, and realize the interconnection and real-time sharing of hospital, social security personal accounts and pharmacy information.
"According to the policy requirements, the hospital will implement zero-plus-sales of medicines, and at the same time, it will reduce the proportion of medicines." When talking about the original intention of building a prescription sharing platform, Huang Yunqi, dean of the Red Cross Hospital of Luzhou City, said.
The prescribing information sharing platform seems to be a simple process, but it needs to deal with a series of problems faced by prescription outflows.
The first thing to face is the legality and safety of prescriptions. The prescription information sharing platform is not an independent prescribing system, but a prescription is issued through the hospital HIS system. The doctor logs into the HIS system during the diagnosis and treatment process, selects the type of prescription - "extension prescription", clicks on the "extended prescription", then calls out the extension variety library, selects the corresponding variety in the extension variety library, and clicks with the patient's consent. After confirming, the corresponding information will enter the subsequent process. In this process, because the hospital HIS system is connected, the verification of the doctor's identity is pre-positioned, so there is no fake doctor, and the prescription can be guaranteed to be traceable. It can clearly know under what circumstances and which doctor to issue. Prescription. Because the doctor must prescribe on the computer side of the hospital, there is no problem of remote prescribing, and there is no security problem with remote prescribing.
The policy requires hospitals to proactively provide prescriptions to patients, but the proactive approach is diverse. If the hospital provides the paper prescription to the patient and asks the patient to go to the pharmacy, the patient may not be able to find a suitable pharmacy conveniently, which is equivalent to disguising the patient's choice. If the hospital appoints a pharmacy, it also deprives the patient of the option. And if the prescription information is given to the patient in electronic form, it will involve personal privacy issues. Therefore, the path design is not good, and it is difficult to find an entry point for patients who purchase medicine outside the hospital.
As the provider of technology, operation and service guarantee for the prescription information sharing platform of Cangzhou City, Baiyang Intelligent Technology's “easy review†has well avoided these problems. Ma Guanglei, executive deputy general manager of Yiyi clinic, said that the prescription information sharing platform will carry out the prescription information that the patient has been audited.
Encryption, the encryption process is also a process of desensitizing medical record information and health information. After desensitization, a code and password are sent to the patient in the form of a short message. Patients can view the complete information through APP and official website. At the same time, considering the convenience of the patient's choice of pharmacy, the system will recommend the pharmacy and navigation that can satisfy the entire prescription to the patient.
After the patient arrives at the pharmacy recommended or selected by the system, the encrypted number and password in the short message are sent to the clerk, and the paper prescription is printed with the assistance of the clerk, and then the offline purchase can be completed under the guidance of the clerk.
“There is no online payment and no online drug sales, so in fact, it is only the flow of prescription information, not electronic prescription or online prescription drugs.†Ma Guanglei said that the pharmacy supports the settlement of medical insurance personal accounts, patients can buy medical insurance directly. Co-ordinated account settlement is currently being actively communicated.
In fact, in order to ensure the legality and reasonableness of the flow of prescription information, the whole process needs the support of a strong service system and regulatory system.
The first thing is to ensure the reasonableness of the prescription. According to Huang Yunqi, there are three roles in this program. The first role is hospital. Separation of medicine does not mean that the prescription is out of control. It does not mean that the hospital does not manage the prescription. The hospital must ensure that the prescription for entering the shared platform must be a prescription for rational drug screening. Every prescription issued by a doctor, whether it is a prescription in the hospital or an extension, is in the hospital. Therefore, every prescription should be supervised by the hospital.
For example, Huang Yunqi said that if the cost of a single prescription exceeds 150 yuan, the system will prompt that the dosage exceeds the standard. According to the "Prescription Management Measures", a prescription cannot exceed five medicines. If six varieties are opened, the system will prompt the box. In addition, some irrational medications such as antibiotics are also limited. Only after a successful review will the prescription enter the prescription information sharing platform.
After entering the platform, there will be a quick manual second check. In order to cope with the lag of the hospital system, the platform will provide the rational drug monitoring system to the hospital, or set up a rational drug use system on the platform to ensure that the platform has a basic judgment after receiving the prescription.
The third role is the pharmacy. After the pharmacy receives the patient's paper prescription, there will be a pharmacist's review. Only after passing the examination can the drug be purchased smoothly.
The prescription information sharing platform gives certain data ends to the health care, medical supervision, social security and other departments. The actual operation of the platform is in the real-time monitoring of the government. Another key issue is data security. At present, the platform has established a complete system of data storage, application, and grading, and the platform company permanently saves prescription data and assumes responsibility for data management. Ma Guanglei told reporters that the platform uses a data security management system and has a financial level security protection system to prevent data leakage and fundamentally eliminate the "unification" phenomenon. For pharmacies, the prescription information can only be downloaded once and cannot be retained. This also eliminates some problems in the sales port to a certain extent.
Second, the pharmacy capacity should be standardized.
Pharmacy pharmacists must have sufficient capacity to complete a prescription review. In this regard, the Yi-Re-Care Association and related associations jointly promoted the training of pharmacists, and recommended that pharmacies who access the prescription information sharing platform prioritize the allocation of pharmacists, and promote the pharmacy personnel of some hospitals to be diverted to the corresponding pharmacies for employment through the platform.
In fact, pharmacies are a key part of driving prescription outflows. “We must ensure that pharmacies have both service capabilities and quality assurance.†Huang Yunqi said that before selecting a docking pharmacy, the hospital information center, pharmacy department, outpatient office and other departments jointly formed the “platform pharmacy access qualification application†and “platformâ€. The Measures for the Management of Docking Pharmacies clarified the standardization and follow-up management of the docking pharmacy in terms of management, operation and compliance. In the end, the hospital carefully selected the three most powerful chain pharmacies in the area.
The prescription information sharing platform provides an open and fair access mechanism for pharmacies. As long as the standard is met, the pharmacy can apply for admission voluntarily, and the hospital and the easy review will jointly verify. If the audit is not completed, the pharmacy cannot enter the prescription sharing platform. . The access standard was jointly developed by the hospital and easy-to-review. The content is almost 6 pages, including inventory, store image, and clerk standards.
It is understood that the current prescription information sharing platform is only the first phase of the project, and the second phase of the project under construction will focus on the construction of the medical insurance integrated settlement platform and the drug collection platform.
Specifically, Ganzhou will try to “save a shop†based on the prescription information sharing platform. This mode mainly serves chronically ill patients, and will try the chronic disease continuation first. Patients with chronic diseases can apply for a prescription issued by the prescription sharing platform within two months at the primary health service station and apply for a renewal. Then they can be renewed after being examined and judged by the Pharmacy or Medical Department of Kaifang Hospital. This is the so-called "web booking." After the “net orderâ€, the delivery application will be transferred to the nearest pharmacy through the platform, and the patient can go to the pharmacy to pick it up or choose to send it to the home. This is "shop picking" and "shopping." In Huang Yunqi's view, this can change the habits of patients seeking medical treatment and reduce the waste of resources in large hospitals.
There is a key final step in the continuation to complete - settlement. Ma Guanglei believes that it is very difficult to do this without resolving the reimbursement problem of the unified account. The reimbursement problem of the co-ordination account under the retail system lies in the verification of authenticity, because it is often difficult for the medical insurance department to determine the authenticity of the patient and the authenticity of the prescription, and it is difficult to supervise the pharmacy. Ma Guanglei revealed that the current technical problems have been resolved, and hope that it can be negotiated with the medical insurance department as soon as possible.
In addition, the platform can draw the patient's preferences and whereabouts through data analysis, plus platform cloud computing capabilities, provide decision information for pharmacies, help them choose the right variety and inventory, which can greatly improve the pharmacy through the platform The enthusiasm of the drug. With enthusiasm, the platform can negotiate prices with manufacturers and distribution companies, and ultimately achieve a reduction in drug prices under a multi-win system.
Again, there must be some reproducibility
At present, the prescription information sharing platform has been piloted in six cities, including Harbin and Qingdao in Guangdong Province, covering more than 40 hospitals. This is due to the continued overweight from the national to local policy level.
The key tasks of the 2016 medical reform issued by the State Council clearly stipulate that “the hospital is prohibited from restricting the outflow of prescriptions. Patients can choose to purchase medicines in hospital outpatient pharmacies or prescriptions to retail pharmacies.†The State Council issued the “Regulations on Further Reform and Improvement of Drug Production and Circulation Policy†"Several Opinions" further proposed "exploring the prescription information of medical institutions, medical insurance settlement information and drug retail consumption information interconnection and real-time sharing". The key tasks of medical reform in 2017 reiterated this requirement.
It is understood that 26 provinces have proposed in the policy that medical institutions should actively provide prescriptions to patients. Patients can choose to purchase medicines at medical institutions or retail pharmacies. Medical institutions must not restrict outpatients from purchasing drugs at retail pharmacies.
The Luzhou Red Cross Hospital is the first to explore the sharing of prescriptions and is also encouraged by the policy. In 2016, the implementation plan for the comprehensive reform of the public hospitals in Ganzhou City was proposed to establish a hospital prescription sharing network platform to realize the sharing of hospital prescriptions and conditional social retail pharmacies, so that patients can choose their own hospital pharmacies. , or by prescription to the social retail pharmacy to buy medicine."
Ma Guanglei revealed that the reason for the easy return visit was to choose the platform for sharing prescription information in Zhangzhou. First, the policy of Ganzhou was open, and the second was the determination of the government and the hospital. It took only six months from the initial contact to the landing. He believes that the timing of prescription outflow is mature, and the path of copying the prescription information sharing platform in Zhangzhou is very clear: first, the policy is determined to be sufficient; second, the scheme design should be reasonable; third, it must be carried out in stages.
In the first stage, the habit of seeking medical treatment for patients is changed, and the phenomenon of hospital queuing is reduced. In the second stage, as the hospital effectively supervised the in-hospital prescription behavior of doctors, the hospital management capacity was greatly improved. In the third stage, the hospital's income structure has undergone fundamental changes and a benign operation has been achieved.
Despite the voice, after the implementation of zero-addition of drugs, the incentives for hospitals and doctors to obtain hidden benefits of drugs are still there, and the prescription outflow is destined to be heavy, but the industry generally believes that prescription outflows are no longer the policy objectives of staying in the document. It is gradually accelerating in the retail pharmacy channel.
According to IMS data, the three major channels of the prescription drug market (hospitals, retail pharmacies, and third terminals) accounted for 77%, 10%, and 13%, respectively. According to the industry's estimate of the amount of prescriptions that can be discharged outside the hospital during the process of separation of medicines, it is roughly judged that the prescription outflows account for about one-fifth of the total prescriptions in the next five years, and show a rapid growth. Combined with the growth of the overall pharmaceutical retail market, it is expected that by 2018, the prescription outflow will bring more than 250 billion yuan to the retail pharmacies. By 2020, the market size will be close to 800 billion yuan.
Regardless of the short-term or long-term perspective, prescription outflows are an unstoppable trend. How to deal with new challenges and opportunities will test the decision-making and wisdom of hospital administrators.
Source: Wen / "Chinese Hospital Dean" reporter Liu Wensheng
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