Big Data lend you a pair of eyes: identify drug abusers and misconduct

American Express Scripts, the largest pharmacy welfare management company in North America, plays an interesting role in the hospital Pharmacy and Health care program. This means that they receive 14 billion prescriptions a year and each prescription and related information is included in their database. At present, the number of deaths due to excessive prescription medicine is on the rise. A report by the National Drug Information Centre points out that the health care system costs as much as $7.25 billion a year to "transfer" drugs for recreational purposes. However, only billions of dollars on the books are legal prescriptions issued by the National pharmacy. So how do you fight these rampant frauds? The company formed a team of 100 people trying to find fraud through company-owned data, a team of forensic experts trying to prevent prescription drugs from moving to the black market.

Jo-ellen Abou Nader is the company's senior executive, Michael Klein is the general manager of the company's Pharmacy analysis and reporting Department, and I have communicated with the two executives about how fast-prescribing companies have identified fraudulent practices.

Prescription drug dealers and drug traffickers are careful to hide their tracks, and one drug dealer goes to meet 19 doctors and 21 pharmacies. Every doctor and pharmacy would think they were doing the right thing for the patient because they didn't know that the patient was going to see another doctor to another pharmacy, so the fraud could only be monitored at the system level. Anyone who sees this person's medical records will find the wrong place, but the Express Scripts has more than 100 million people's data, how to monitor it?

Klein says they built an interior?? Sorting algorithm and adjusts it through historical data. The sorting algorithm relies mainly on three main but not independent factors: the number of prescriptions to be received in a given time, the number of independent pharmacies visited, and the large number of certain drugs. "The researchers first looked for people who got high points and then began to collect evidence.

But it turns out their judgment is not always right. Recently, they found that social media, especially bulletin boards, are a treasure trove of information. They check the doctor's comments to see if anyone has noticed a doctor prescribing habits. One patient wrote, "If you go to him, the doctor gives you enough painkillers to kill an adult horse!" As the patient says, the doctor's prescription does have too many painkillers.

Klein also said that they would never use social media posts to prove a particular case, but historically, social media postings are a really good break.

One of the most complicated cases that Nader and Klein told me was that a doctor had prescribed 22000 anesthetics for 30 people, the drugs amounting to 4.6 million dollars. The Doctor is also very smart, he reduced the intensity of the prescription, so that patients with a large number of drugs to write some information is not easy to identify.

The Express scripts will continue to improve their tools, and the company is going to launch a predictive model that will prompt them to know which doctor is at high risk of fraud.

In the "Cloud computing", "Big Data" change today, medical cloud and medical data is the public, government and enterprises are highly concerned about the field. The health administration wants access to the hospital's health data, in order to carry out effective supervision and evaluation of hospitals; medical it developers want to get rid of vicious competition, from selling "It manpower" to "selling services"; companies want to occupy the next wave of gold through medical data ... actually, as individuals, We can do our own doctor. With the development of large data and cloud computing, "quantify self" and "personal health cloud" gradually improve, every consumer can know their physical condition, some simple colds can be based on their own history of medical data to determine what medicine to eat, this will not only reduce the situation of drug abuse by doctors, You can also keep abreast of your physical condition and prevent the emergence of disease.