A unified global identification system supports Fujian drug price supervision and medical insurance settlement
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As the prerequisite and basis for the collection, processing and exchange of drug information, drug classification coding and labeling technology, its standardization requires the participation of all relevant parties, and the establishment of a unified information classification and labeling is the basis for coding when building a drug database.
“The big thing about medicine is about life.” As a special commodity, medicine is closely related to the health and life safety of the people. In the process of drug circulation and drug supervision, the inconsistency of drug classification and coding has always been a major problem for my country’s pharmaceutical production and operation enterprises, medical institutions and medical management departments to realize the sharing of drug information resources. Because the drug classification standards used by most pharmaceutical production and operation enterprises and medical institutions are not uniform, it is difficult for drug information resources to be seamlessly transmitted between related parties. This is prominent in two aspects: First, non-standardized drug classification codes. It brings inconvenience to the integration of “purchase, sale, and storage” of drug manufacturers and operators and the sharing of drug information; second, it is difficult for the relevant government functional departments to perform efficient management of drug manufacturing, sales, and use links (such as hospitals, pharmacies) , Accurate and scientific supervision. Therefore, the establishment of a scientific, reliable, and standardized drug classification and identification system, and the use of fast, accurate and convenient information automatic identification methods, to help each department of drug production and operation management apply a unified classification and identification system that is in line with international standards. The key to the demand for information transmission in drug circulation and drug supervision.
The status quo of drug classification code identification
At present, the names of domestic drugs are extremely complicated and their expressions are not uniform. Multiple drug classification schemes coexist. Product barcodes are only used in the POS system of retail pharmacies. It is difficult to realize the sharing of drug information, and it is also difficult for the relevant government departments to implement drug manufacturing, circulation, and distribution. Effective supervision of sales, use, etc. Although relevant departments have proposed a new coding system to solve these problems, there are many shortcomings.
There are many domestic drug manufacturers, and the names of drugs are extremely complicated. There are dozens or even hundreds of names for a drug. However, in the circulation or application process of these drugs, the name expression is not uniform or standardized. Some only indicate the generic name of the drug, and some only indicate the product name of the drug. Therefore, the name of these drugs cannot be uniquely identified.
The coexistence of multiple drug classification and identification schemes makes it impossible to realize drug information sharing among pharmacies, hospitals, medical insurance, and price supervision departments and units. It is difficult for relevant government functional departments to implement unified, efficient, and effective drug manufacturing, distribution, sales, and use. Scientific supervision.
In 2001, in order to strengthen the management of drug prices in Fujian Province and improve the quality and efficiency of drug price monitoring, the Fujian Provincial Price Bureau and the Department of Social and Labor Security jointly developed a new unified drug coding system across the province. The new drug code is 20 digits in length, covering the generic name, specification, dosage form, measurement unit, manufacturer and other related drug attributes, including government-priced drugs circulating in the market in Fujian Province, centralized bidding drugs, and independent pricing by enterprises All medicines and all medical insurance medicines. In recent years, the relevant departments of Fujian Province have successively issued documents to enable the new drug codes in various medical institutions and drug production and business units in Fujian Province, and to trial the new drug codes in provincial medical insurance designated medical institutions and designated retail stores; August 1, 2005 , “Fujian Province Medical Insurance Management System” and “Fujian Province Drug Online Price Monitoring System” completed the switch of new codes.
In 2013, Fujian Medical Insurance established a medical insurance medical consumables coding database based on the full use of drug catalog codes to standardize consumables management; on the basis of real-time credit card settlement for medical treatment in different places in the province, it established a provincial medical insurance relationship transfer and continuation platform, which is mobile Employers provide convenient transfer and connection procedures. At present, “universal medical insurance” is basically achieved in the system, and the goal of “covering everything that should be covered” is being promoted to promote a “fairer” medical insurance system. Comply with the new situation and new characteristics of medical service supervision, extend the scope of monitoring and management from inpatient medical services to outpatient medical services, from designated medical institutions to medical staff and insured personnel, and promote refined management.
As of 2013, there were more than 3,700 pharmaceutical production and business units in the medical insurance drug coding database, and more than 54,000 drug data, including more than 5,000 commodity barcodes.
Since the drug code is a composite code composed of some code segments, these code segments provide the characteristics of the coding object, and these characteristics are independent of each other. The disadvantage is that the multiple attribute characteristics of the medicine result in many characters in each code value, which makes it difficult to adapt to the requirements of new characteristics.
The establishment of an effective information management system must rely on coding solutions that play the role of a “pass” in the information superhighway. However, looking at the history of my country’s pharmaceutical product coding in the past 20 years, it is quite difficult to achieve the goal of “one code connects the world”. There is no national or industry standard for drug coding.
Solutions for pharmaceutical projects
Because there is no authoritative unified standard for drug naming, description, classification, coding and labeling in the fields of drug supervision, medical insurance settlement, drug purchase and sales, etc., the information required by all parties is incomplete, understanding differences, and data cannot be shared. situation. In order to solve this problem, in 2007, the Fujian Provincial Institute of Standardization cooperated with the Price Monitoring Center and the Medical Insurance Management Center to study the application of the Globally Unified Identification System in the Drug Price Supervision and Medical Insurance Settlement System. Circulating government-priced drugs, centralized bidding drugs, all medical insurance drugs, and all drugs priced independently by enterprises are the objects. We will discuss how to use standardized coding systems and labeling technologies to solve the problem of sharing drug information resources between existing drug coding application systems. A more comprehensive solution to the classification and coding standards and identification of drugs is proposed. The contents are as follows:
Unify the main characteristics of drugs
Different medicines have different physical and chemical characteristics. There are many characteristic attributes of drugs, including: classification, product name, dosage form, grade, specification, brand, price, manufacturer, production date, batch number, production unit, production location, sales area, etc. Departments such as drug supervision, medical insurance settlement, drug store, drug production, etc. can set different basic characteristic attribute items according to their own management needs. In the research and development process of the drug monitoring and management system in Fujian Province, taking into account the data sharing needs of drug supervision, medical insurance settlement and other departments, the basic characteristics of drugs are finally determined as: the large, medium, and small categories of drugs, as well as the generic name and dosage form of drugs ,Specification. The main characteristics of unified drugs are the basis and prerequisite for building a unified drug classification and coding system. The key is to realize the standardization of classification specifications, common names, dosage forms and specifications of drugs.
Establish standards for drug classification and coding system
Formulate the recommended local standard “Drug Information Classification and Coding” in Fujian Province, which will standardize the classification, common name, dosage form, and specification coding of drugs. The main content of the standard specification is as follows:
Determine the principles of drug classification. Drugs are classified into three levels: large, medium and small. According to the classification of the chemical properties and efficacy of drugs, in different use environments, unique drug properties can be continuously added to meet management needs. First divide the medicines into two major categories: Chinese medicine and Western medicine; under the major categories, use the line classification method, and refer to the relevant regulations of the National Pharmacopoeia to classify the middle and small categories of drugs and the generic names of drugs; the coding of the generic names of drugs is managed by each The system management party compiles it according to the serialization code and publishes it regularly. The dosage form classification of medicines adopts the surface classification method. The specifications and codes of medicines are compiled by the method of running water codes, and are regularly announced and maintained by the management of the system. There is a fixed drug code table, which is coded in sequence according to the actual situation, realizing one drug and one code, which is convenient for drug identification and information transmission.
Determine the code structure of the drug. Different codes are assigned to objects that are not in the same category, common names, dosage forms, and specifications. The code structure is divided into 6 layers with 15 digits in total. The specific structure is shown in Figure 1.
The first level is the drug category code: represented by an Arabic numeral, “1” represents Western medicine, and “2” represents Chinese patent medicine; the second level is the drug category code: represented by two Arabic numerals, starting from “01” , Arranged in ascending order; the third level is the drug subcategory code: represented by two Arabic numerals, starting with “01”, and arranged in ascending order; the fourth level is the general name code: represented by three Arabic numerals, starting from “001” , Arranged in ascending order; the fifth layer is the dosage form code: represented by three Arabic numerals, starting from “001” and arranged in ascending order; the sixth layer is the product specification code: represented by four Arabic numerals, the first two digits are the packaging unit Code, the last two digits are the measurement specification code, which together form the specification code.
Figure 1 Classification and coding structure of drugs
For example, the price attribute of a drug is: Western medicine, antibiotic anti-infective drugs, penicillins, penicillin V potassium, tablets, 20mg/tablet, the drug code is 101010080010301, and the specific structure is shown in Table 1:
Table 1 Drug code structure
The global unified identification system realizes the uniqueness of drug identification
The Global Unified Identification System is an open, multi-link, and multi-domain application of a global unified business language. It is formulated by the International Article Numbering Association (GS1). It is an open standard system that serves the logistics supply chain. It is used in more than 150 countries around the world. (Region) more than 1 million enterprises have been widely used. The system is developed on the basis of commodity barcodes. It includes three parts: coding system, automatically identifiable data carrier and electronic data exchange standard protocol. as shown in picture 2.
Figure 2 The composition of the global unified identification system
These three parts support each other and are closely linked. The coding system is the core of the entire global unified identification system, which realizes the unique coding of different items; the data carrier is to convert the code that can be read by the naked eye into a carrier that can be read by the machine, such as bar code symbols, etc.; and then through automatic data collection The data obtained by technology (ADC) is exchanged through electronic data (EDI&XML) to realize automatic operation with minimal manual intervention.
The global unified identification system is based on the coding system of trade items, logistics units, locations, assets, service relationships, etc., and uses automatic data collection such as bar codes and radio frequencies as data carriers, electronic data exchange, global product classification, global data synchronization, The electronic product code (EPC) and other technical systems are integrated to serve the open standard system of the logistics supply chain. The commodity barcodes that are very familiar to the public for settlement in supermarkets are just one of the applications of the global unified identification system.
The biggest advantage of the coding system of the global unified identification system is that it not only overcomes the closed-loop characteristics of the company’s internal coding system, improves the efficiency and transparency of global trade and supply chain management, but also improves the company’s ability to respond to customers and reduce management costs. The global unified identification system uses barcode,RFIDLabels, etc. are information carriers. Among them, barcode technology has the characteristics of fast information collection, high reliability, flexibility, practicality, and low cost; RFID technology is a non-contact automatic identification technology that entered the practical stage in the middle of the 20th century. In modern electronic and networked information management systems, for the different characteristics of different management objects, barcode technology and radio frequency technology have been widely used, and they have become one of the key information technologies for modern management.
The identification code of the selected drugs adopts the trade item code GTIN, including the EAN/UCC-13, EAN/UCC-8, UCC-12 and UCC-8 codes in the national standard GB12904 “Barcode Code and Barcode Representation of Retail Commodities”. The EAN/UCC-13 code is the most commonly used. Each type of drug package is identified by an EAN/UCC-13 code, and the corresponding barcode symbol is printed on the package to realize the automatic, rapid and accurate data collection for calculation. The EAN/UCC-13 code structure is shown in Table 2, and the bar code symbol is shown in Figure 3.
Figure 3 EAN-13 barcode symbol
The generated drug classification codes correspond one-to-one with the product barcodes of the drugs, forming a basic medical insurance drug code database of Fujian Province, and receiving and distributing various drug-related information in real time. In the Fujian Medical Insurance Settlement System, the drug classification code is based on the Fujian Provincial Local Standard “Drug Information Classification and Coding”. Two attributes are added: level and manufacturer. The number of code digits reaches 20, so that the code can accurately define one type. The price attributes of drugs can cover up to 180,000 drug specifications currently circulating on the market. One-to-one correspondence between the 20-digit drug code and the product barcode constitutes an automatic identification element for the Fujian Medical Insurance Settlement System. As shown in Table 3:
Table 3 One-to-one correspondence between drug codes and product barcodes
So far, the “Fujian Medical Insurance Settlement System” drug coding database has introduced a global unified identification system and applied the Fujian provincial local standard “Drug Information Classification and Coding” standards, so that the basic characteristics of drugs can be accurately defined, and the drug coding is realized. One-to-one correspondence with the product barcode identification. The coding system based on the global unified identification system has the characteristics of science, global uniformity, uniqueness of coding, automatic identification, completeness of classification and coding standards, etc., and finally realizes drug data exchange, information sharing, and real-time efficiency between different departments Information management becomes possible. It can effectively solve the problem of automatic identification of drugs in the medical insurance settlement system management data collection, sorting, data query, data sharing and other activities in Fujian Province.
Establishment of Fujian Province Drug Coding Application System
Based on a unified drug code database, the Fujian Medical Insurance Management Center has established a medical insurance settlement network based on the Provincial Medical Insurance Management Center through networking with medical institutions and drug production and business units throughout the province, as shown in Figure 4.
Figure 4 Topology of Fujian Medical Insurance Settlement System
The Fujian Medical Insurance Management Center declares the basic drug information of the drug manufacturer or sales business unit, classifies and codes the drugs according to DB35/T844-2008, and makes the drug codes correspond to the product barcodes one-to-one to generate a unified Fujian drug code database.
The medical insurance center of Fujian Province is connected to the medical insurance centers of various cities through SDH lines. At the same time, it is connected to designated hospitals and pharmacies of medical insurance in Fuzhou through the DDN dedicated line or PSTN public telephone network; the medical insurance centers of various cities also communicate with each other through the DDN dedicated line or PSTN public telephone network. All medical insurance designated hospitals and pharmacies are networked. Government-priced drugs, centralized bidding drugs, and all drugs priced independently by enterprises, including all medical insurance drugs, that circulate in the market in Fujian Province, have all realized information sharing.
The main functions of the drug price supervision and management system are:
Drug classification code generation
After entering the interface shown in Figure 5 (see next page), you can directly apply for and obtain the drug code. According to the information reported by the drug manufacturer or sales business unit, according to the standards of “Drug Information Classification and Coding”, add the attributes: level, manufacturer, specification, packaging type, etc. A total of 20 codes.
Code entry of product barcode
After entering the interface shown in Figure 5, enter the product barcode code corresponding to the newly generated drug code. The code of the product barcode will be used as the index subject of this drug record, and the corresponding search will be performed.
Drug coding data query
You can query related drug code information based on retrieval conditions, such as product barcode code, manufacturer code, drug name, and other retrieval conditions.
Figure 5 List of drug code registration data
Drug pricing standard registration
Register the pricing standards for designated drugs, and timely distribute the drug pricing standards to the central warehouses of various cities and cities and forward them to all pharmaceutical business units.
Drug pricing information query and change
According to the search conditions, search for pricing information, such as a new price adjustment of a drug, and adjust its price directly after finding the relevant drug.
Drug price monitoring
Select pricing standards for the drugs sold by designated units and charge items for price monitoring, and trigger the response mechanism in time through the pre-set grading fluctuation range, and automatically generate reports. Provide timely and accurate reference materials for relevant functional departments to formulate corresponding policies.
Monitor medical insurance settlement and reduce financial expenditure
The real-time monitoring of medical insurance settlement by the system is shown in Figure 6, which fundamentally prevents hospitals and pharmacies from prescribing drugs and prescribing high drug prices in order to reduce financial expenditures and ensure the standardized use of medical insurance funds.
Figure 6 The interface of the drug settlement system
Public drug prices, multi-party supervision
The system discloses drug prices through websites or hospital pharmacies publicizing the system, allowing consumers to have more choices for drugs with the same curative effect.
The construction of the drug classification and coding system unifies the description and codes of the main characteristics of drugs as the fields and values of the drug database; the drugs are uniquely identified by the GS1 code identification system, and this code is used as the keyword for the drug database query , Effectively and reliably solve the application problem of drug identification and description code at different points in time.
Government-priced drugs, centralized bidding drugs, and all drugs priced independently by enterprises in the market in Fujian Province, including all medical insurance drugs (except hospital preparations, Chinese medicine decoction pieces, and some imported drugs) correspond to commodity barcodes. Current data The total amount reached about 54,000.
A coding database of medical consumables for medical insurance in Fujian Province has been established. All levels of medical insurance centers, medical insurance designated hospitals (358) and designated pharmacies (313) share database information, realize multi-entry real-time drug information retrieval, and ensure the balance of drug prices and medical insurance settlements. accuracy.
Commodity barcodes and drug classification codes play an important role in the Fujian Medical Insurance Settlement System.
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