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Defining the Database The heart of HID’s approach to drug utilization review and pharmacy benefit management services is its claims database. Each client’s fiscal agent acquires claims from the various drug stores which fill prescriptions for its recipients. Over time (usually a month), the fiscal agent aggregates the claims data and usually places an extract of the data on an IBM 3480 tape cartridge. The data may be submitted in almost any form to HID, as during implementation the format of the data file has been studied and a program written that can parse the data into a format understandable to HID’s systems. Once the claims data have been parsed and errors have been corrected, the database is updated. As availability of a greater quantity and quality of data improve the ability of the client to make decisions, data from other sources are also added to the database to make it as complete as possible. Records of institutional claims providing hospitalization information and physicians’ claims data are added. Demographic data about the recipients is acquired and incorporated. ICD-9 codes, CPT codes, GCN codes, HIC3, AHFS therapeutic class, and GCN sequence numbers are all incorporated. Physician specialty data also can be added as it is provided. This virtual mountain of data acquired from the various sources
is compiled, parsed and added to the database. This is accomplished
through using a relational database with over 250 different data
tables. The database engine chosen by HID to manage this is Progress.
Progress is an expensive, very powerful, relational database engine
that has proven itself capable of handling the heavy demands placed
upon it. HID combines the power and flexibility of its proprietary
DURBase® Version 3 internally written software with the Progress
database engine to perform the functions of RDUR.
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