Alert! "With gold sales" attack and defense war Internet hospital or new battlefield

the | Liang Jialin Executive Director of China Value Medical Research Center based on big data "business unit" and "anti(anti) unit", also known as prescription statistics, refers to the hospital to doctors drug information, drug documents statistics.
The general approach was originally the hospital to strengthen internal operation and management, improve the norms of diagnosis and treatment of the necessary means, however, the general side in the pharmaceutical "with gold sales" and other trend of pollution under the alienation - hospital-specific departments or individuals in addition to the conventional unit, specifically for pharmaceutical marketing personnel to provide doctors or clinical departments within a certain period of clinical dosage information, so as to cooperate with pharmaceutical marketing personnel to issue drug rebates.
this is the so-called "business party".
commercial control is a major problem in the field of pharmaceutical purchase and sale.
as early as 2013, the former National Health and Family Planning Commission issued a document "Strengthening the construction of medical and health practices" (National Health Office issued (2013) No. 49), one of the "no" is "not allowed for commercial purposes."
specifically, medical and health institutions shall strengthen the management of the statistical functions of drug and medical supplies in their information systems, and strictly prescribe statistical authority and approval procedures.
It is strictly prohibited for medical and health personnel to use any means and means to statistics on the amount of medicines and medical supplies used by individual physicians and clinical departments for commercial purposes, or to facilitate the statistics of pharmaceutical marketers.
, business has become a nail in the coffin of medicine's fight against corruption.
recent years, 56 (2014), 31 (2015), 67 (2016), 52 (2017) and 57 (2018) have been criminal cases related to the key words of the "unified party", according to the China Referees' Documents Network.
January 15, the "State Supervision" feature film jointly produced by the Propaganda Department of the State Supervision Commission of the Central Commission for Discipline Inspection and other units revealed the black pharmaceutical industry chain of some medical institutions in Wuxi City.
such as: Wuxi City People's Hospital Information Service staff Wang Wei, over the years also directly to a number of pharmaceutical representatives to sell the company, profit of more than 1.6 million yuan.
Wang Wei said in the feature film, in some hospitals, the information department as a whole staff are holding the attitude of law not to blame the public, to buy and sell the black transactions of the party.
large-scale medical institutions are the battlegrounds of pharmaceutical enterprises, which have a large amount of diagnosis and treatment, a large amount of medication, if not rely on modern information technology, manual statistics alone is not feasible.
, the hospital information system (HIS), which monitors the full amount of drug use data in hospitals in real time, is the "sharp weapon" of commercial management.
In contrast, statistics from the attending physician's workstation, pharmacy drug system there is the possibility of being increased, deleted, tampered with, for example: in the past investigation of cases of violations, some pharmacists will be born out of nothing, the amount of prescriptions added to their relationship with the physician, and with each other to split the "clinical fee."
years, medical big data has become the main battleground of the two camps, "unity" and "anti-unification".
2016, at a press conference of the former National Health and Family Planning Commission, Liu Weizhong, then director of the Gansu Provincial Health and Family Planning Commission, revealed that the province designed "anti-control" software to prevent doctors from taking kickbacks.
the second hospital in Gansu Province at the time of the trial, suddenly found that four doctors in the statistics of prescriptions, and finally all four doctors were given sanctions.
in Baidu search engine input "unity" keywords, you can find a number of anti (anti) party software ads.
these software are to serve the health authorities, hospital discipline inspection room business needs, can be the party's behavior recorded, lock screen or even blocked, and to the relevant institutions automatically issued early warning text messages.
business unit: Internet hospital secret profit point when the commercial unit is prevented (anti) party software to basically block the road, is it gone? Since 2018, a number of venture capital investors (VCs) investors, Internet medical platform practitioners confirmed to the author that some third-party Internet medical platforms - not hospitals self-built Internet hospitals - in providing hospitals with Internet hospital information services, prefer not to make money or even lose money, but also to increase the number of hospitals and market share, support their business models, one is not yet supported by laws and regulations, regulatory rules and in the "grey area" of medical data development, the second is the pharmaceutical industry chain.
outbreak of new crown pneumonia, the Internet medical industry has developed rapidly.
, according to the National Health And Wellness Commission Planning Development and Information Technology Division disclosed in March 2020, the National Health and Health Commission's commissioned hospitals, Internet diagnosis and treatment increased 17 times over the same period last year.
of consultations on some third-party Internet service platforms has also increased more than 20 times over the same period last year, and prescriptions have increased nearly tenfold.
2018, The market size of China's Internet healthcare industry has reached 49.1 billion yuan, and is expected to reach 90 billion yuan in 2020, according to a study by China Business Intelligence Network.
In the pharmaceutical purchase and sale industry chain, in order to support the overvaluation of the first-tier capital market, as soon as possible to make large cash flow and even achieve overall profitability, some third-party Internet medical platforms even began to dabble in illegal commercial management behavior.
Take an Internet hospital information system as an example, the product provides a "prescription quality control" function module at the hospital end, that is, "backstage can query all the online prescriptions issued by the doctor, for the quality control department to query and download and print", and in the "prescription management" function, "through the Internet hospital prescription of drugs, back to the hospital information system (HIS), or docking other systems to be processed."
when the hospital information system (HIS) and the Internet hospital information system to open up to each other, objectively to the commercial management of a different way.
commercial parties are often packaged as "data services" that are paid directly to pharmaceutical companies or indirectly to sales outsourcing companies (CSOs).
To support the "gold sales" of the gray and black industrial chain, in June this year, the National Health Care Commission, the State Health Insurance Administration and other jointly issued "2020 to correct the field of pharmaceutical purchase and sale and medical services in the wrong wind work points" requirements: to crack down on pharmaceutical enterprises and contract marketing organizations (CSO) enterprises colluded, fictitious fees cashed out to pay for illegal marketing costs illegal acts.
, this provision only curbs the flow of funds (the "selling with gold" payer) and does not specify the flow of information (the commercial party).
The comprehensive response of the medical and health care authorities suggests that whether "Internet Plus" medical services can be paid online - rather than at the patient's own expense - determines the breadth of the audience, frequency of use, and the last kilometer of the closed loop of "online consultation - prescription outflow - health insurance payments".
, health care payment rules to promote the compliance of Internet health care, is an important policy tool.
recently, the State Health Insurance Administration issued "Guidelines on actively promoting the payment of medical insurance for "Internet plus" medical services " (Medical Insurance Issue (2020) No. 45) (hereinafter referred to as the "National Health Insurance Administration Document").
medical institutions applying for the "Internet Plus" medical insurance supplement agreement should have the following basic conditions, in order to combat fraud insurance to provide a full range of full-process, holographic data support.
The author selects the following: coding standardization, database integrity: with the national unified medical insurance information business code docking conditions, as well as drugs, medical supplies, medical treatment projects, medical services facilities, diseases and other basic information database.
health care, health care big data exchange sharing: with the health insurance information system data exchange conditions.
real-name authentication: relying on medical insurance electronic credentials for real-name authentication, to ensure the true identity of the insured.
the whole process of diagnosis and treatment data can be traced: can completely retain the electronic medical records, electronic prescriptions, drug purchase records and other information in the process of consultation and treatment of insured persons, to achieve the whole process of diagnosis and treatment, prescription, drug distribution and other traceability.
prior to this, in July this year, the General Office of the State Council issued the Guidance on Promoting the Reform of the Regulatory System of the Health Care Fund (State Administration issued No. 20 of 2020), which, at the national level, extends the scope of supervision and management in accordance with the law, from medical expenses covered by medical insurance payments to medical services that are covered by medical insurance payments, from curbing waste of funds to regulating medical treatment.
As an irreplaceable link in the chain of interests of pharmaceutical "gold sales", commercial management should be included in the comprehensive rectification scope of the Health Care Commission and the Medical Insurance Bureau in accordance with the requirements of the State Council for "co-promoting the reform of the medical service system".
To this, the author suggests: based on the National Health and Safety Commission on Internet hospitals, Internet diagnosis and treatment, telemedicany related documents policy requirements, the provincial health insurance bureaus in the development of Internet hospital filing permits, provincial regulatory platform rules and other policy documents in the process, will be "commercial control" included in the Internet hospital establishment, annual review of the "one-vote veto" matter.
Based on the policy requirements of the National Health Insurance Administration document, the provincial health insurance bureaus, in the process of formulating the "Internet Plus" medical service price and health insurance payment policy document, included "commercial control" in the "one-vote veto" of Internet hospitals to be included in the scope of medical insurance payments.
the National People's Congress to speed up the "information security law" "personal privacy protection law" and other key legislative processes.
In accordance with the requirements of the General Office of the State Council on the promotion and standardization of the development of health care big data applications (State Office issued (2016) No. 47), drawing on the experience of local legislation in Fuzhou, Guizhou and other places, establish and improve the health care big data opening, protection and other regulatory systems, the establishment of security protection, system interconnection, citizen privacy protection and other software evaluation and security review system.
, especially to prevent and combat individual network security, anti-(anti)unit software "thieves shout to catch thieves", illegal development of commercial party behavior.