Recently, the Xi'an Food and Drug Administration released a pilot program for implementing electronic prescription services in retail enterprises, which has caused continuous discussions on electronic prescriptions in the industry. The reason is that behind the e-prescription trials, the pharmaceutical retail market pattern may be changed due to prescription outflows. E-prescription is directly related to the outflow of prescriptions, the e-prescribing pilot is released, and the prescription is outflow or simultaneous.
Before and after the Xi'an Food and Drug Administration pilot, the Sichuan Food and Drug Administration and the Guangdong Food and Drug Administration also introduced relevant pilot policies. Electronic prescriptions have become the vane of prescription outflows.
There are many examples of e-prescription applications
In addition to the promotion of the policy level, there is a precedent for the flow of e-prescription between Internet medical platforms and pharmaceutical retailers.
It can be traced back to October 2014. The first online hospital in China, the Guangdong Network Hospital, was launched. It is mainly through a telemedicine platform built by a third-party developer (Youde Medical). It is installed at the network of chain pharmacies. In the video terminal, the patient can seek medical advice from an online doctor. After that, the prescription of the network doctor is printed out by the printer, and the patient takes the prescription to buy the medicine at the pharmacy.
In October of this year, Wang Jianan, the dean of the Second Hospital of Zhejiang Medical College, passed the “first electronic prescription†issued by Wuzhen Internet Hospital. The specific operation procedure is to make an appointment with a doctor through Wuzhen Internet Hospital. After receiving the video diagnosis and treatment, an electronic prescription is issued, and the Chinese medicine is used for the trial, and the electronic prescription is delivered offline after the trial is completed.
In January 2015, Wuhan Central Hospital cooperated with Ali Health Network Hospital. After the appointment was made by Ali Health Network Hospital, the patient issued an electronic prescription and was delivered by Kyushu.
On March 20, 2016, Shanghai Dermatology Hospital issued an electronic prescription for a patient in Jiangsu through the Skinbao APP Medical Platform. At the same time, Shanghai Dermatology Hospital will also sign a contract with Shanghai Pharmaceutical Group's drug flow company, which will be responsible for its electronic prescription drug delivery service.
In the same period, Shandong Zibo Municipal People's Government, Jingdong Group and Xinhua Pharmaceutical signed a cooperation agreement, and Jingdong will build the “Zibo Medical Prescription Information Platform†for Zibo City Health Planning Commission. Zibo City Public Pilot Hospital provides prescriptions to the prescription circulation information platform, allowing users to purchase medicines from the pharmacies of Xinhua Pharmacy in a convenient way using the electronic prescription platform.
In March last year, the micro-medicine relied on the resources of the Wuzhen Internet Hospital to start the layout of the “pharmacy clinic†project, which was to set up remote consultation equipment and related interfaces in the pharmacy. The patient consulted online through the system and issued an electronic prescription to directly take the medicine. According to the data provided by the drugstore, as of June this year, the drugstore has entered 18,000 pharmacies, with an average daily consultation volume of 36,000 and a cumulative number of over 4 million.
In May of this year, Tencent, Liuzhou Workers' Hospital and Guangxi Liuzhou Pharmaceutical Co., Ltd. reached a cooperation. The Liuzhou Workers' Hospital launched the “External Prescription Transfer†service, and through the WeChat public account to undertake the electronic prescription issued by the doctor, the prescription for off-campus purchase can be realized. .
The system is the first to cover eight pharmacies under the Liuzhou Pharmaceutical Group. In the future, patients will be able to take medicines in the hospital or go to the designated pharmacies outside the hospital to take medicines.
Table 1: Existing cases of electronic prescription pilots
Multi-site pilot policy
Xi'an Food and Drug Administration released the “Working Plan for Electronic Prescription Service for Pharmaceutical Retail Enterprises (Trial)†in May this year, and plans to implement electronic prescription services in the drug retail chain enterprises and conditional retail single pharmacies in the city.
According to the plan, enterprises that carry out pilot projects should obtain one license and two certificates (business license, drug business license, and new version of drug management quality management standard certification) in Xi'an, and obtain “basic trustworthiness†in the credit evaluation of pharmaceutical enterprises in Xi'an. Above the level, and there are no major violations of laws and regulations in daily supervision.
Eligible pharmaceutical retail enterprises can choose third-party medical service institutions with relevant network technology and hardware equipment conditions to establish a remote physician diagnosis and treatment and electronic prescription application platform according to the actual situation of the enterprise. The remote physician should be qualified as a practicing physician and registered and managed in a legal medical institution.
The e-prescribing should comply with the relevant regulations of the health department, and the doctor's electronic signature is printed on the prescription. The electronic prescription issued by the remote physician is equivalent to the ordinary prescription. The electronic prescription should be kept in the company's store for reference, and the shelf life is the same as the ordinary prescription.
The Xi'an Food and Drug Administration also requires that the participating stores should have relevant remote medical treatment terminals. At the same time, each store terminal must be able to check the detailed records of each prescription and review of the prescription within the specified time. The enterprise-side electronic prescription system must be able to communicate with the practitioner's clear and smooth video, save the consultation recordings and video files in the background, and facilitate the spot check.
After the prescription is issued, the prescription drug should be sold and signed or stamped (electronic seal) before being approved by the licensed pharmacist; the prescription drugs should not be changed or replaced without authorization, and the prescription for incompatibility or overdose should be Refuse to deploy.
On the 13th of the month, the Food and Drug Administration of Xi'an reissued the paper and gave guidance on the sharing of electronic prescriptions. In the “Opinions on Promoting the Sharing of Electronic Prescriptions for Chronic Diseases in Internet Hospitalsâ€, Xi’an Food and Drug Administration also dropped the pilot work of electronic prescriptions on the follow-up of chronic diseases through Internet hospitals.
The Opinions are no different from the aforementioned “Proposals†in the qualifications and process specifications of retail enterprises, but the definitions of third-party medical service institutions are refined.
The "Opinions" require that third-party medical service institutions have a "business license" and "medical institution practice license" or third-party medical service licenses confirmed by other levels of health departments to ensure the quality and safety of remote diagnosis and treatment.
The third-party medical service platform shall take practical measures to ensure that the medical personnel who join the remote medical service have legal professional qualifications and conduct medical treatment according to legal procedures. Institutions providing third-party medical services should assume legal responsibility for the quality of medical services performed on their own platforms.
The shared e-prescribing must be true, effective, and complete, and should be recorded in the patient's electronic medical record for the patient's lifetime inquiry.
Before the Xi'an Food and Drug Administration, the Chengdu Food and Drug Administration launched a commercial prescription for retail pharmacies in the city last September. According to the data of the Chengdu Food and Drug Administration, as of the end of last year, the total number of prescriptions exceeded 500,000. The Xi'an e-prescription pilot policy can basically be seen as a replica of the pilot program.
One of the operators behind the Chengdu e-prescription pilot is “micro-diagnosisâ€. The company’s CTO Zhou Congjun introduced the arterial network. The micro-experience has been involved in many e-prescription trials in Sichuan, Hubei, Hunan and Shaanxi. Online pharmacies offer online video consultation and e-prescribing services.
We have cooperated with local hospitals, opened network clinics, and equipped full-time specialist doctors. The number of doctors reached more than 2,000, and the number of cooperative pharmacies reached 15,000. The daily prescriptions reached more than 30,000.
The billion-dollar value chain is forming
The above-mentioned methods of electronic prescription and pharmaceutical retail cooperation can be basically divided into three categories: one is electronic prescription + retail pharmacy, the other is electronic prescription + medical e-commerce, and the third is electronic prescription + drug delivery.
Behind the e-prescription is the outflow of prescriptions. Under the background of medical reform, policies such as separation of medicines, zero-plus, and proportion of controlled drugs continue to deepen, and the trend of prescription outflows is becoming more and more obvious. All stakeholders are also preparing for the market.
The State Council deepened the requirements for the 2017 key tasks of the medical and health system reform, and comprehensively reformed the public hospitals by the end of September 2017. All public hospitals canceled the drug addition (except for Chinese herbal medicines). In 2017, the proportion of medicines in public hospitals in the first four batches of 200 pilot cities (excluding Chinese herbal medicines) fell to around 30%.
For the public medical system that has long been "medical for medicine", there will be no small policy cost pressure, and the separation of medicines has become inevitable.
In order to pave the way for social pharmacies to take prescription outflows, the State Council Medical Reform Office took the lead and instructed the Ministry of Commerce, the Ministry of Human Resources and Social Security, the Health Planning Commission, the Food and Drug Administration and other medical regulatory authorities to collaborate to pilot the classification and management of retail pharmacies, encourage the development of chain pharmacies, and explore medical institutions. Prescription information, medical insurance settlement information and drug retail consumption information are interconnected and shared in real time.
According to IMS statistics, the scale of China's prescription drug market in 2015 was about 990 billion, accounting for about 70% of the total drug market. As far as the specific channels are concerned, since the sales of prescription drugs must rely on prescriptions and doctor's orders issued by doctors, the proportion of prescription drugs sold in the hospital is higher. The three major channels (hospitals, retail pharmacies, and third terminals) in the prescription drug market in 2015 were 77%, 10%, and 13%, respectively.
With the popularity of Internet medical and electronic prescriptions, retail sales of pharmaceuticals and prescription drugs are changing at a rapid pace. According to related research, the sales of prescription drugs outside the hospital will reach 1/3 of the total in the next 5 years, and the sales amount will be about 800 billion. The 800 billion market will be mainly undertaken by retail pharmacies, medical e-commerce and so on.
Why is a retail pharmacy? First, retail pharmacies have good geographical conditions, high coverage, and the first convenience factor to reach consumers. Second, retail pharmacies have certain medical professional services, plus Internet medical empowerment, retail pharmacies or become The supplement of basic medical care has crowded out the market owned by third terminals such as clinics. The third is that pharmaceutical e-commerce, pharmaceutical O2O and other scales are still small, and will not threaten the main position of retail pharmacies in the short term.
The market structure has changed, so how will all stakeholders respond? The first is the pharmaceutical company. As a product exporter, although the market structure has changed, the market scale is still growing, and the sense of crisis will not be so urgent. However, the sales channels of pharmaceuticals will increase from in-house to retail, and the sales model of pharmaceutical companies will inevitably change.
For pharmaceutical companies, the original market channels are mainly in the hospital, and the marketing focus is naturally placed in the hospital. The marketing methods include academic promotion and medical representative promotion. The purpose is to allow doctors to prescribe more drugs and monitor the amount of prescriptions prescribed by doctors.
The difference between Internet medical treatment and the old model is that the diagnosis and treatment behavior is uncertain. Before the medical treatment is connected, it is difficult to identify the doctors and patients from there, and it is impossible to judge the output of the diagnosis and treatment. And promotion.
Even if it can be connected to the Internet medical platform, the electronic prescriptions will be monitored, and the number of doctors that need to be covered will be more dispersed. It is a big challenge for the original promotion system of pharmaceutical companies.
Followed by retail pharmacies, the current e-prescribing pilots are in full swing, but the crab is only a small part of it. With 440,000 pharmacies nationwide, pharmacies involved in electronic prescription circulation may not be able to get a fraction. The trend is that Internet-based medical e-prescribing must be done, but how to do it becomes a problem.
It is not easy to open up the corresponding areas for the equipment needed for remote consultation, to equip or train the corresponding personnel to assist users in the diagnosis and treatment, to cooperate with the Internet medical platform to determine access, and to accept electronic prescriptions in retail pharmacies.
Any new sales channel will have an impact on the original interest chain. Behind the e-prescription based on Internet medical treatment, the 100 billion market brought about by prescription outflow has also formed a new chain of interests, and enterprises and people in this chain need to cope with the pressure brought by the new model.
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