GB2370377A - System for managing the prescibing and dispensing of medical items - Google Patents

Abstract

A system for managing the prescribing of medical items by prescribing practitioners and the dispensing of prescribed medical items by dispensing practitioners. A prescribing practitioner selects an item for a patient from a master database, and prescription data is generated comprising an identifier for a prescribed item, a patient identifier and a prescribing practitioner identifier. The prescription data is supplied to a dispensing site where the data is analysed and the prescribed item dispensed. Dispensed prescription data is generated and transmitted to a managing site for analysis. The prescription data may be supplied to the dispensing site as a printed prescription form which carries both human readable information and machine readable encoded information such as an array of dots which can be scanned.

Description

System for Controlling Prescription and Dispensing of Medical Products This invention relates to a system for controlling the prescription and dispensing of medical products, such as pharmaceuticals, medical appliances and so forth. It is particularly applicable to environments in which there is centralised control of prescribing, such as in the United Kingdom which has a National Health Service. However, it will also be applicable to other environments.

Currently, many medical practitioners operating in general practice (GP's) have computerised"Patient Medical Records"systems (PMR's) which enable the practitioner to issue a prescription for a patient. The PMR includes basic information about items that can be prescribed, which enables the practitioner to make an appropriate prescription. A printed script is produced and given to the patient, who takes it to a pharmacy. At the pharmacy, a pharmacist dispenses the prescribed product in accordance with the script. There may be a computerised system to assist in this, for example printing labels for prescribed products and overprinting "endorsement"details on the original script.

Endorsement occurs when the particular product prescribed is unavailable but there is an equivalent for the pharmacist to choose, or when the pharmacist wishes to communicate a particular set of circumstances to a "Prescription Payment Authority" (PPA). The dispensed scripts, carrying any overprinted endorsements, are batched together weekly and transmitted to the PPA. This eventually arranges for reimbursement of the pharmacy, taking into account any payments that may have been made to the pharmacy by the patient at the time of dispensing.

The present invention is concerned with improving the prescription and dispensing of medical products, and

providing facilities for greater control and analysis.

Viewed from a first aspect, the present invention provides a system for managing the prescribing of medical items by prescribing practitioners and the dispensing of prescribed medical items by dispensing practitioners, wherein: prescribing practitioners, dispensing practitioners and a managing site are provided with access to a master database on data processing means, the master database containing entries for medical items available for prescription, the entry for a medical item in the master database including a unique identifier for the item and containing fields for identifying the medical product concerned, and the form in which the product is to be supplied; wherein a prescribing practitioners selects an item for a patient from the master database using data processing means, and prescription data is generated comprising at least the identifier for the item, a patient identifier and a prescribing practitioner identifier; the prescription data is supplied to a dispensing site, the data is analysed by data processing means, the prescribed item is dispensed, and dispensed prescription data is generated comprising at least the identifier for the item, the patient identifier, the prescribing practitioner identifier and a dispensing practitioner identifier; and the dispensed prescription data is transmitted to the managing site for analysis.

In accordance with this aspect of the invention there will be a master database of items for prescription, each item being a unique combination of parameters. Thus for example, if a pain killer such as paracetamol is available in the form of tablets in bottles of twenty five or fifty, or in the form of a syrup in bottles of lOOml or 200ml, there would be four unique items. Each would have paracetamol as the product, but the form and quantities would be different.

This database is available to a medical practitioner,

who will choose the appropriate item for a patient. Data will then be generated which identifies the item being prescribed by reference to its identifier in the master database, and which also identifies the patient and the prescribing practitioner. This data will be provided to a pharmacy via a number of possible routes, where the prescribed item is dispensed. The original data is then supplemented by at least a dispensing practitioner identifier, and then the complete data can be transmitted to the management site. At the management site the data can be analysed for the purposes of reimbursing the dispensing practitioner, or for checking for unusual patterns which might indicate fraud, or for checking for changes in prescribing or dispensing patterns, or for any other purpose. The master database may be held centrally for remote access by users as live data in real time, or may be downloaded at appropriate intervals to users of the system who will then access their local copy.

By means of this aspect of the invention, there is integrated control of prescription, dispensing and management, using a common database of the items available for prescription. The entry for a particular item may have fields for containing a range of different features of the item, including those necessary to identify the precise item that will be dispensed, specifying its form, strength, number of units and so forth.

In a practical embodiment for use in a country such as the United Kingdom with a National Health Service (NHS), there will be a Drug Tariff Database that uniquely identifies each item (drug or appliance) and its associated attributes (e. g. description, strength, price, treatment, permitted endorsements etc. ) that the NHS Executive determines may be prescribed in a particular period ("Prescribing Period") within the NHS Primary Care system. There will be a Drug Tariff

Database dissemination system that enables each user, e. g. GP and Pharmacist to gain access to the same version of the Drug Tariff Database throughout the Prescribing Period.

There will be a script transaction system that records and tracks item transactions that are (i) originated by GP's (ii) transported physically by patients to their pharmacist of choice, or possibly transmitted electronically (iii) dispensed (including authorised endorsements) and (iv) reimbursed (priced & paid) by an appropriate body.

There will also be an Information System that permits users (such as NHS Executive, Health Authorities, Primary Care Groups, Fraud units, individual GP's, Pharmacists and a Reimbursement Unit) to access transaction data without compromising patient confidentiality as determined by the NHS and public policy.

A preferred embodiment of the system provides maintenance of both the Drug Tariff Database and transaction records within each user's establishment under the control and ownership of the NHS Executive.

The NHS Executive may determine the changes to be made to the Drug Tariff database in advance of each Prescribing Period, so as to control both the scope and cost of items available for prescription within NHS Primary Care. It also provides a batch processing system that i) disseminates monthly changes to the Drug Tariff database to the users and ii) tracks each separate transaction either at suitable intervals such as nightly, or if required in real time. Also provided is a batch process that disseminates only those transaction data elements required for authorised purposes by particular users.

A system as outlined above could rely upon conventional printed prescription forms, or scripts, for providing the prescription details to the dispensing

pharmacy. In that case, data would be entered manually by the pharmacist although, of course, it would be relatively simple to select a prescribed item from the list in the master database and details such as prescribing practitioner or even patient could be selected from a custom database for the pharmacy. The printed prescription could carry printed alphanumeric codes for the prescribed items or other details to further assist matters. There may be available scanners of text or even of handwriting which could read a script, although any errors could have serious effects.

Alternatively, the system could rely upon electronic data transmission from the prescribing practitioner to the pharmacy, directly, or through conventional electronic e-mail systems, or through a closed communication system dedicated to transactions of this type. The system would also be applicable to the provision of entirely machine readable prescription carrying media, such as a smart card, which then patient could take to a pharmacy with a suitable card reader.

However, in a preferred arrangement the invention permits a printed form to be used in a conventional manner, perhaps with the assistance of printed alphanumeric codes, and also in a machine readable manner. Such a printed prescription may be used in other systems also.

Viewed from another aspect, therefore, the invention provides a system for prescribing and dispensing medical items, in which a prescription form is printed which carries human readable information concerning the prescribing practitioner, the patient, and a prescribed item; wherein the prescription form further carries machine readable encoded information which comprises an identifier for the prescribed item, the identifier being obtained from a database containing details of items available for prescription; the encoded information on the prescription form is decoded at a

dispensing site ; and the prescribed article is identified by comparing the identifier with details in the database of items available for prescription.

Thus, when used in conjunction with a system as explained above, using a master database, both the prescribing practitioner and the dispensing pharmacist will have access to the same database which uniquely identifies specific items to be prescribed and dispensed.

Using a script that is both human readable and machine readable means that an implementation process can be undertaken in parallel with existing manual systems making it neither disruptive nor costly to carry out, as it involves minimal changes to current processes and infrastructure. If a dispensing pharmacy is not equipped with the necessary apparatus to decode the information on the script, then the prescription can be handled in a conventional manner.

The encoded information may be in any form, for example encoded in a magnetic strip forming part of the form. However, such an arrangement will require special script forms, and special apparatus for the prescribing practitioner. Preferably, therefore, the encoded information is in printed form. If the system requires only a limited amount of information, for example identifying only the item being prescribed, then a conventional bar code could be printed on the script.

Where a script carries several items, a bar code would be provided for each item. However, preferably considerably more information is encoded than could be incorporated in or reliably read from a conventional bar code. To achieve this, in a preferred system the information is encoded by means of a Snowflakem code printed and read using technology available from Marconi Ploc..

A Snowflakem code provides increased data capture and better readability than bar codes and alphanumeric

codes, in a compact space. For example, a 5 mm x 5 mm code may contain over 100 numeric characters. The code is contained entirely of dots and typically has 360 read flexibility. The code has considerable integrity even when damaged, and can be read even if up to 40% is damaged. The code can be printed using conventional laser printers or high quality ink jet printers, and can be read by fixed or hand held readers such as the Snowgun hand held device from Marconi Ploc..

In a practical application of such a system, a GP's existing Patient Medical Record System (PMR) accesses a new Drug Tariff Database, in place of its current database. This enables the GP to specify the items and then to print a script in accordance with current NHS policy as set out in the Drug Tariff. Script printing information remains unchanged but for the addition of machine-readable Snowflake codes for each individual data element on the script (e. g. patient and GP identifiers, item details and usage directions). It may be necessary for the GP to upgrade from an existing dot matrix printer to a laser or ink jet printer.

Additionally the script will contain data that uniquely identifies it. It will also be capable of containing new information that may be required by the NHS, such as identification of the medical condition being treated.

The script is then taken by the patient to a dispensing pharmacist.

The prescribing transactions (namely items prescribed and script identifiers) may be uploaded or polled from the GP each night or more frequently for analysis by authorised information users.

The Pharmacist uses a suitable device such as an OCR C-Pen or the Snowgun*"device to scan the codes on the script. This updates the pharmacist's own Patient Medication Record (PMR) and creates a label, which may also contain a code such as a Snowflakew that identifies the script to which the items relate. If the pharmacist

has made an endorsement, this may be printed on the script in both human and machine-readable, e. g.

Snowflakew code form. In accordance with a preferred embodiment of the invention, the master database contains details of permitted endorsements that are available for a particular item, so that there is control over the endorsements that may be made.

Dispensing transactions (items dispensed and endorsements) are uploaded or polled from the pharmacist at suitable intervals, such as nightly each night and supplied to suitable users of the system, such as an organisation for reimbursing the pharmacist.

The pharmacist may be provided with a suitable terminal for reading the codes, storing the main database, and transmitting data to suitable users of the system.

Information from the prescribing practitioner and the dispensing pharmacist will be restricted, and access to limited data sets will be given to users in accordance with their needs and so as to preserve confidentiality. Possible users and their requirements, the context of the United Kingdom NHS system, may be as follows: NHS Executive and Local Health Authorities Aggregate expenditure data by drug and condition type Measures of wastage, fraud and governance Primary Care Groups As for NHS Executive, plus data on individual GP prescribing and governance.

Individual GP's Data on individual GP prescribing Unused Scripts Unused drugs Pharmacists Reimbursement data Pricing Bureau

Reimbursement data Pharmaceutical Supplies Negotiating Committee Aggregate expenditure data by drug and condition type Endorsing data Fraud Unit Ability to trace transactions from GP to Patient or waste Ability to monitor Prescribing and Dispensing trends for GP's and pharmacists One of the users of the system may be a contractor who reimburses pharmacists and then is itself reimbursed at a later date.

It will be appreciated that depending upon the requirements of the system, the data that is required on a script will vary, and may comprise any combination of the fields available to identify an item in the master database.

The invention may be viewed form various additional aspects.

Thus, viewed from a further aspect the invention provides a system for use by a prescribing practitioner for producing a script setting out an item to be dispensed to a patient, wherein means are provided for the practitioner to select an item from a database of items available for prescription, and means are provided for acting upon a selection of an item by the practitioner in order to print a script which contains a printed description of the item selected and an associated printed machine readable code containing data identifying the item prescribed, the patient, and the prescribing practitioner.

Viewed from a still further aspect, there is provided a printed script identifying an item prescribed to a patient by a prescribing practitioner, the script bearing a printed description of the item and an associated printed machine readable code containing data

identifying the item prescribed, the patient, and the prescribing practitioner.

Viewed from another aspect, there is provided a system for analysing a printed script identifying an item prescribed to a patient by a prescribing practitioner, the script bearing a printed description of the item and an associated printed machine readable code containing identifiers for the item prescribed, the patient, and the prescribing practitioner; wherein the system is adapted to read the code and to identify the item to be dispensed by comparing the identifier for the item with entries in a database of items available for dispensing.

Some preferred embodiments of the invention will now be described by way of example and with reference to the accompanying drawings in which: Figure 1 is a schematic diagram of a prescribing and dispensing system; Figure 2 is an example of a code that may be used on a script in the system; and Figure 3 is an example of part of a script incorporating codes for use in the system.

As shown in Figure 1, at a General Practice medical practitioner's site there is provided a practice management system which is networked to practitioner terminals and high resolution, e. g. laser, printers. The practice management system includes patient records. It also includes a NHS Drug Tariff Database. This is updated at suitable intervals over a wide area network from a central location. Communicating with the practice management system is a Script Data Logger which serves to communicate with the central location so as to download updates to the Drug Tariff Database and to upload script data.

At a pharmacist's site, there is a pharmacy management system which also incorporates the Drug Tariff Database, updated in the same way as that at the

GP's site. A Script Data Logger carries out this function and also uploads script data from the pharmacist's site.

At the central location, script data is stored for a short while for backup/recovery purposes. Analysis of the data takes place at other sites, such as on an Information Service server, a Fraud Service server or a Contractor Service server.

The Drug Tariff Database is central to the operation of the system. The following is an example of the data which will be stored in the database for a particular item:

Field Type Example Comments Unique Item XWQA Identifier Ingredient Tri potassium nitrate Pharmacological 9.6. 1.2 Classn.

Description for Nitrate tablets label Form Tablets Others could be e. g. syrup Form Detail Enteric coated Administration Oral Product Human Derivation Strength 6 Magnitude Strength Units 4 Base Unit Form Bottle Base Unit Size 50 Base Unit Type Tablets If syrup, could be e. g. ml.

Base Unit Price f : l. 55 Allowed Short Supply Multi field Endorsement Types Allowed XWQB Multi field, Endorsement FTXZ contains codes of Items permitted items.

Thus, by selecting a single item from the Drug Tariff Database, the GP can define exactly what is to be prescribed. Given the unique ID for the item-in the above example it would be"XWQA"a dispensing pharmacist can dispense precisely what has been prescribed by reference to the same Drug Tariff Database. If there is a problem meeting the prescription, for example because the product is in short supply, the pharmacist is given a fixed choice of what can be dispensed instead and thus what endorsements can be made. Similarly, once dispensing data has been transmitted to the central location, what has actually been dispensed and the associated price can be determined.

At the prescribing GP's site, a data set is created in the practice management system which holds the following information: Drug Tariff Database Item Identifier Quantity to Dispense Dosage Unique Script Identifier-Includes the GP ID and the date/time Script Item Number-The sequence if prescribing two or more items Repeat Prescription Flag Patient ID Patient Post Code GP Practice ID

Since this data will be transmitted to be analysed centrally, the full details of the patient are not stored in this data set, such as the full address. Only the post code is stored for the purposes of geographical analysis, and the ID for the patient. It would be possible to analyse what has been prescribed-over a period-for a particular patient of a particular GP, without knowing who that patient is. If the patient ID is a centrally stored ID such as the patient's NHS number, then it will be possible for an appropriate authority to identify a patient in the event of fraud for example, but access to this information can be restricted.

This same data set is provided to the prescribing pharmacy, together with other data, in the manner set out later. A pharmacist's data set is then created which includes the following data: Drug Tariff Database Item Identifier Quantity to Dispense Dosage Unique Script Identifier-Includes the GP ID and the date/time Script Item Number Patient ID Patient Post Code GP Practice ID Endorsement Type Endorsement Substitute Script Charge (whether a patient pays the pharmacist or is an exempt status) Dispensing Date Pharmacy ID This data set is also transmitted to the central location for analysis, so that the pharmacist can be reimbursed-either from the NHS directly or from a

contractor-and so that checks can be made on various matters as discussed earlier.

The data which is transmitted to the pharmacist usually requires more information than is contained in the pharmacist's data set, such as the patient's name and address. Whilst all of this data could be transmitted to the pharmacist electronically as discussed earlier, in the preferred embodiment a printed script is produced which contains some data in encoded form and some in printed form. Some of the data may be in both printed and coded form. Thus, a printed script will be printed containing the following information: Patient Name/Address Printed Patient ID Code, Printed optional Patient Post Code Code, Printed as part of address GP Practice Name/Address Printed GP Practice ID Code, Printed optional Script ID Code Item Ingredient Name Printed Database Item Identifier Code Dispensing Quantity Code and Printed Dosage Code and Printed Script Item Number Code It will be appreciated that further information may be stored in the Drug Tariff Database and be available to prescribing practitioners, such as instructions for use of the prescribed item, and this would also be transmitted to the pharmacist. There may for example be a multi field with options for instructions, the appropriate option being chosen by the practitioner. The chosen option could be included in a code.

In the preferred embodiment, the printed script contains printed machine readable codes such as the Snowflake'*"codes referred to earlier. An example of such

a code is shown in Figure 2. An example of part of a script which sets out the items to be dispensed is shown in Figure 3. Each printed item is also provided with a Snowflakew code which contains all of the relevant data, so that each item's data is self sufficient, and contains the Patient ID, Patient Post Code, GP Practice ID, Script ID, Drug Tariff Database Item Identifier, Dispensing Quantity, Dosage and Script Item Number. The code for each item is read by a suitable reader connected to a terminal linked to the pharmacy management system, so that the items can be dispensed, labels printed, records updated and the necessary data set updated. Software associated with the reader locates the contents of the various fields encoded within the Snowflake.

The pharmacist may make endorsements as described earlier, this being controlled by available endorsements within the database entry for the item prescribed. In any event, a label is produced and affixed to the product supplied to the patient, carrying details of the product, instructions for usage and so forth. The pharmacist's data set is produced and eventually transmitted to the central location.

The system preferably uses secure communications techniques to avoid tampering and maintain confidentiality.

It will be appreciated that many variations to the system are possible, whilst still retaining at least some of the advantages of the systems described above.

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Claims (14)

1. A system for managing the prescribing of medical d items by prescribing practitioners and the dispensing of prescribed medical items by dispensing practitioners, wherein: prescribing practitioners, dispensing practitioners and a managing site are provided with access to a master database on data processing means, the master database containing entries for medical items available for prescription, the entry for a medical item in the master database including a unique identifier for the item and containing fields for identifying the medical product concerned, and the form in which the product is to be supplied; wherein a prescribing practitioner selects an item for a patient from the master database using data processing means, and prescription data is generated comprising at least the identifier for the item, a patient identifier and a prescribing practitioner identifier; the prescription data is supplied to a dispensing site, the data is analysed by data processing means, the prescribed item is dispensed, and dispensed prescription data is generated comprising at least the identifier for the item, the patient identifier, the prescribing practitioner identifier and a dispensing practitioner identifier; and the dispensed prescription data is transmitted to the managing site for analysis.

2. A system as claimed in claim 1, wherein a prescription form is printed which carries human readable information concerning the prescribing practitioner, the patient, and a prescribed item; and wherein the prescription form further carries machine readable encoded information which comprises the prescription data; the encoded information on the prescription form is decoded at a dispensing site; and the prescribed article is identified by comparing the

identifier for the prescribed article with details in the master database.

3. A system as claimed in claim 2, wherein the encoded information is in the form of an array of dots.

4. A system as claimed in claim 1,2 or 3, wherein at the dispensing site an endorsement is made, the master database containing details of permitted endorsements.

5. A system for use by a prescribing practitioner for producing a script setting out an item to be dispensed to a patient, wherein means are provided for the practitioner to select an item from a database of items available for prescription, and means are provided for acting upon a selection of an item by the practitioner in order to print a script which contains a printed description of the item selected and an associated printed machine readable code containing data identifying the item prescribed, the patient, and the prescribing practitioner.

6. A system as claimed in claim 5, wherein the machine readable code is in the form of an array of dots.

7. A printed script identifying an item prescribed to a patient by a prescribing practitioner, the script bearing a printed description of the item and an associated printed machine readable code containing data identifying the item prescribed, the patient, and the prescribing practitioner.

8. A printed script as claimed in claim 7, wherein the machine readable code is in the form of an array of dots.

9. A system for analysing a printed script identifying

an item prescribed to a patient by a prescribing practitioner, the script bearing a printed description of the item and an associated printed machine readable code containing identifiers for the item prescribed, the patient, and the prescribing practitioner; wherein the system is adapted to read the code and to identify the item to be dispensed by comparing the identifier for the item with entries in a database of items available for dispensing.

10. A system as claimed in claim 9, wherein the machine readable code is in the form of an array of dots.

11. A system for managing the prescribing of medical items by prescribing practitioners and the dispensing of prescribed medical items by dispensing practitioners, substantially as hereinbefore described with reference to the accompanying drawings.

12. A system for use by a prescribing practitioner for producing a script setting out an item to be dispensed to a patient, substantially as hereinbefore described with reference to the accompanying drawings.

13. A system for analysing a printed script identifying an item prescribed to a patient by a prescribing practitioner, substantially as hereinbefore described with reference to the accompanying drawings.

14. A printed script identifying an item prescribed to a patient by a prescribing practitioner, substantially as hereinbefore described with reference to the accompanying drawings.