FR2859298A1 - Medical benefit data processing and exchanging system, has central unit placed in professional cabinet, and computer station placed in domicile and including sub-processing unit and program to control transfer of loaded/unloaded data - Google Patents

Abstract

The system has a central unit (8) located in a professional cabinet (4) of a health professional. A computer station (10) is situated in a domicile (5) and has a sub-processing unit (24) and a program (41) to control transfer of loaded/unloaded data between a data exchanging unit (26) and an Internet connecting unit (30), after/before receiving/sending the data from/to the central unit via an Internet, respectively. The central unit (8) has a sub-processing unit (14), a working memory (16) and a program (40) to process and format raw data extracted from a permanent data base (6) relative to a medical benefit. An independent claim is also included for a method of processing and exchanging data relative to medical benefit.

Description

The present invention relates to a system and method for treating and

  exchange of data relating to medical services.

  It aims in particular at the treatment and the exchange of data between, on the one hand, a health professional when the latter charges a social insured patient within the framework of an act or a medical consultation and, on the other hand, the administrative center, for example national or local, responsible for the reimbursement of expenses incurred by this social insured.

  In many countries, especially France, we are trying to modernize the processing and exchange of these data. Until recently, these data were processed in paper form since the practitioner drew up a paper care sheet on which the identity of the social insured and the costs incurred by him in connection with a claim were recorded. medical consultation, then this paper document was sent to the administrative management center in charge of the social insured. In order to reduce the workload of the management center (s), as well as to improve the quality and speed of reimbursements for the insured persons, these paper care sheets are gradually being replaced by electronic health care sheets which include the same information than that of the paper document, but in digital form. Specifically, when a socially insured patient consults with a health care professional in his office, such as a physician, the latter establishes an electronic care sheet indicating the costs incurred by the patient, who certifies this information by means of a signature. which identifies it vis-à-vis its management center. In France, this electronic signature is made by reading an electronic or magnetic medium identifying the social insured, this medium is currently referred to as a vital card (registered trademark).

  In order to obtain the certification of the social insured, the health professional must have an appropriate reader of vital cards, connected to a central computer-type unit, which manages the formatting of the electronic care sheet.

  For health professionals who travel outside their professional practice to consult or practice medical procedures, portable vital card reading terminals have been proposed in the past. Insofar as, on the one hand, certain data exchanged between the patient, the health professional and the Social Security Management Center are of a confidential nature and, on the other hand, the processing and formatting of Electronic care sheets require a powerful computer tool, these portable readers do not allow the establishment of complex care sheets including for example several medical procedures. Also, for health professionals, such as nurses, who perform a series of care in a patient's home, it is necessary to regularly go to their professional office to connect a wired serial link their portable reader with the unit. central office in order to, initially, load electronic sheets prepared beforehand by means of the central unit, then, after a series of care at the homes of patients, unload their reader portable care sheets certified by the collection of electronic signatures of patients.

  The purpose of the present invention is to propose a system for processing and exchanging data relating to medical services, which removes the obligation for health professionals carrying out care outside their professional practice to regularly in this cabinet their portable reader, thus improving their working conditions.

  For this purpose, the subject of the invention is a system for processing and exchanging data relating to medical services, comprising: a permanent database of raw data relating to medical services, in particular to medical acts, to insured social patients; and to healthcare professionals using the system, - a central unit located in a first building and equipped with both means for processing and formatting the raw data extracted from the permanent base and means of connection to a network of remote communication, and - a portable identification terminal of a social insured, equipped with a storage memory data formatted by the central unit and adapted to collect the certification by the social insured, particularly under the form of an electronic signature, stored data, characterized in that it further comprises at least one computer station located in a second building dist inct of the first building and equipped with both data exchange means, including formatted and possibly certified, with the memory of the portable terminal, connecting means to the remote communication network and control means adapted to control the transfer, between the exchange means and the connection means of the computer station, of data to be loaded into the portable terminal after receiving them from the central unit via the remote communication network and, on the other hand, data downloaded from the portable terminal before sending them to the central unit via the remote communication network.

  By installing the computer station of the system according to the invention, for example at the home of the health professional, the latter can exchange the data relating to the medical acts that he will provide or that he has already provided with his professional office, even if the home and the office of this health professional are distant from each other. This system is economically obtained from a pre-existing sedentary treatment system, that is to say a system implanted only in the office of the health professional, since, on the one hand, the position The computer system according to the invention corresponds to a current personal computer equipped with peripherals known per se, and, on the other hand, data exchanges between the home and the professional healthcare office are supported by a remote communication network such as than a public network of the Internet type. In addition, the main data processing operations, requiring a large amount of computer equipment and the manipulation of large amounts of data, are carried out in the professional's office, while the data arriving at his home, which has been previously formatted, is only have to be loaded in the portable player of the professional. The volume of data exchanged between the office and the home of the health professional is therefore low, allowing this professional to use at home, as a means of connection to the remote communication network, that, for example, a low transmission rate modem. The invention therefore limits the amount of data to be transmitted between the professional practice and the private home of the health professional, thus making possible the use of a low-bandwidth consumer communication network.

  According to other features of this system, taken separately and in any technically possible combination: the computer station comprises a working memory associated with the control means and adapted to temporarily store the data transferred between the exchange means and the means of connection of the computer station; the central unit and the computer station are respectively equipped with their own means of encrypting and decrypting the data sent to or coming from their respective means of connection to the remote communication network; - The central unit and the computer station are respectively equipped with data integrity control means sent to or from their respective means of encryption and decryption; the portable terminal is provided with an identification interface for a social insured, in particular in the form of a reading cell of an electronic or magnetic medium specific to the social insured, and a part of adapted memory for storing raw data relating to this social insured made available by the identification interface, the computer station being adapted to transfer the raw data stored in the memory portion of the portable terminal to the central unit via the communication network remotely while the central unit is adapted to store, in the permanent database, the raw data received from the computer station; the connection means of the computer station consist of a modem with a low transmission rate; the transmission rate of this modem is less than or equal to 128 kbit / s; the remote communication network is an Internet type public communication network.

  The subject of the invention is also a method for processing and exchanging data relating to medical services, in which: - raw data relating to medical services, in particular to medical acts, to insured patients are permanently stored; social services and health professionals who use a process implementation system, - at the level of a first building, the raw data extracted from the permanent base are processed and formatted informally and a communication center is contacted. centralized management of medical services, and - a portable identification terminal is used for a social insured, equipped with a data storage memory formatted and adapted to collect the certification by the social insured, in particular in the form an electronic signature, data stored in this memory, characterized in that, at a second building separate from the first building the data is exchanged with the memory of the portable terminal, including data formatted and possibly certified, which, via a remote communication network, have been received from or will be sent to the first building.

  According to an advantageous characteristic of this method, data is transmitted between the first and second buildings through an Internet-type network (2), particularly in the form of e-mails.

  The invention will be better understood on reading the description which follows, given solely by way of example and with reference to the drawings in which: FIG. 1 is a block diagram of the architecture of a system according to the invention; - Figures 2 to 5 are views similar to Figure 1, respectively illustrating successive phases of implementation of the system according to the invention; and FIG. 6 is a schematic representation of a variant of a data processing and data exchange system according to the invention.

  FIG. 1 shows a system 1 for processing and exchanging data relating to medical services, connected to a remote communication network 2, for example an Internet-type public network, as well as an administrative center 3 of management of social insurance.

  The system 1 is intended to be handled by one or more health professionals installed in a professional cabinet 4. In the context of a medical consultation or a patient's care, this system is adapted to shape a patient. electronic care sheet, ie to create a computer file containing both the identification of the social insured patient who benefited from medical acts, the nature and the billing of the acts, as well as the identification of the professionals who performed these acts. Once this electronic sheet has been certified by the patient, that is to say once it has its electronic signature obtained by a vital card type card, it is, in a manner known per se, transmitted via the network. Internet 2, from the firm 4 to the administrative center 3 so that the social insured benefits from at least partial reimbursement of the costs he has incurred and / or that the professional is paid.

  According to the invention, the system 1 is able to manage the transmission of such electronic care sheets without it being necessary for the health professional to bring in person to his office 4 the file certified by the patient having received the care .

  More specifically, the system 1 essentially comprises a permanent data base 6, a central processing unit 8, a computer station 10 and a portable terminal 12 for identifying a social insured. The base 6 and the central unit 8 are physically located in the professional cabinet 4 of the health professional, while the computer station 10 is separate from the central unit. It is fixedly located for example in the private home 5 of the health professional, which can be very far from the cabinet 4.

  The permanent database 6 contains, among other things, raw data intended to be processed by the central unit 8. This raw data concerns in particular the designation and the cost of medical acts, the identification of insured social patients, the identification of or health professionals practicing in the cabinet 4, etc. The central unit 8 comprises a processing sub-unit 14 connected to the database 6 and consisting for example of one or more micro-processors able to be controlled by a single user preferably present in the cabinet 4, working memories 16 and 17, means 18 for digital encryption and decryption, and means 22 for connection to the remote communication network 2.

  The computer station 10 includes a processing sub-unit 24 associated with a working memory 25, means 26 for exchanging data between the portable terminal 12 and the sub-unit 24, digital encryption and decryption means 28 and means 30 for connection with the network 2. In FIG. 1, the exchange means 26 are represented as internal to the station 10, but they may alternatively be constituted by a peripheral at the station 10.

  For example, the encryption used by the means 18 and 28 is a block encryption David Barton (R2 method).

  The portable terminal 12 comprises a storage memory 32 able to communicate with the exchange means 26 of the station 10, via a wired serial link 34 provided at its free end with a connection head 34A adapted to be removably connected. with an additional head 26A belonging to the exchange means 26. The terminal 12 also has an interface 36 for identifying a social insured, for example in the form of a reading cell of an identification medium such that an electronic chip or a magnetic tape specific to each social insured and located on a vital card type card.

  The terminal 12 further comprises means 38 for manually entering data, the identification interface 36 and these means 38 being connected to the memory 32.

  To understand the operation of the system 1, we will consider an example of use according to which a nurse of the cabinet 4 knows that she will soon go to a known patient to perform a number of medical procedures, for example a series of bites. The first implementation phase of the system 1 is shown in Figure 2 in which the flow of data is shown schematically by arrows a to o.

  Prior to the actual visits, the nurse, during one of his visits to his office 4, or the secretariat of his office prepares an electronic care sheet mentioning the nature of care, ie the series of bites , the identification of the nurse and the identification of the predetermined patient. For this purpose, a program 40 implanted in the sub-processing unit 14 extracts the corresponding raw data from the base 6 (arrow a) and processes them so as to shape them, that is to say so as to generate the desired electronic care sheet. This electronic care sheet is encrypted by the encryption means 18 (arrows b and c), before being memorized in 16 (arrow d), as well as other electronic care sheets prepared for the nurse following the same operations. .

  To prevent the nurse from going to her professional office 4 to load these electronic care sheets on her portable terminal 12, the program 40 commands the sending of the care sheets stored in the memory 16 and concerning this nurse, to the private home 5 of it. To do this, the electronic care sheets are sent by the program 40 of the memory 16 to the connection means 22 (arrows e and f) and sent via the network 2 to the connection means 30 of the station 10 ( arrows g and h).

  The sending of the encrypted data on the public network 2 of the Internet type is effected for example in the form of an electronic mail whose destination address corresponds to the station 10.

  At home 5, the nurse controls the computer station 10 by means of a program 41 implanted in the subunit 24 so that the memory 25 retrieves the encrypted electronic care sheets (arrows i and j). At this time, the encrypted data contained in the memory 25 are identical to the encrypted data of the memory 16 with respect to the nurse in question.

  When the nurse is at home 5, she connects via the serial link 34 the exchange means 26 to her portable terminal 12. She then controls the computer station 10 by the program 41 so as to successively extract the electronic care sheets stored in 25 (arrow k), decrypt them at 28 (arrows 1 and m) and load them into the memory 32 of its portable terminal 12 (arrows n and o). The nurse then goes to where the patient is, by example in the home of the latter, in the hospital or in a retirement home, to carry out the series of planned care. She then asks her to certify her identity, the reality of the care practiced, as well as their billing by electronically signing the care sheet stored at 32, which corresponds to the second phase of implementation of the system 1, shown in FIG. To this end, it introduces an identification medium, such as its vital card V in France, in the identification interface 36. The flow of data is shown schematically by an arrow p. The corresponding electronic care sheet stored in the memory 32 is then certified, the corresponding information being stored in this memory.

  When the nurse is back at home 5, she implements the third phase of use of the system 1, shown in Figure 4 in which the flow of data is shown schematically by arrows q to ae. For this purpose, it connects again its portable terminal 12 to the station 10 and orders by means of the program 41 the unloading of the sheets of certified care (arrows q and r), their encryption (arrows s and t) then their storage in the memory working 25 (arrow u). The discharged data are then erased from the memory 32.

  At a later time, she also orders the transmission of these certified care sheets to her cabinet 4. To do this, the certified and encrypted care sheets contained in the memory 25 are sent to the connection means 30 (arrows v and w) from where they are sent to the connection means 22 of the central unit 8 via the network 2 (arrows x and y), for example in the form of an electronic mail.

  On receipt of these encrypted care sheets, a second program 42, associated with the program 40 within the processing sub-unit 14, controls their storage in 17 (arrows z and aa). At this time, the encrypted data stored at 17 are identical to those present in the memory 25 of the station 5.

  Then, at the request of a user present in the cabinet 4, the program 42 controls the means 18 so as to decrypt the data stored in 17 (arrows ab and ac) and imports them into the database 6 (arrows ad and ae).

  Subsequently, during a fourth implementation phase of the system 1 shown in FIG. 5, a third program 43 implemented in the processing sub-unit 14 returns the essential of the decrypted information to the administrative center 3 following the data flow. schematized by the arrows ba to bd. More specifically, the program 43 successively controls their recovery in the database 6 (arrow ba), their formatting according to a predetermined format adapted to the center 3 and their dispatch, via the network 2, by the means 22 (arrows bb, bc and bd).

  The system 1 thus enables the nurse to manage the loading and unloading of her portable terminal 12 at her home 5, therefore without having to regularly go to her professional office. 4. No major computer processing, particularly formatting or access. to a database, is made in the home of the nurse so that a personal computer consumer is sufficient for the fixed station 10. In addition, the data exchanged between the cabinet 4 and the home 5 of the nurse are small compared to those exchanged between the central unit 8 and the database 6 during the formatting of the raw data, so that a modem with a low transmission rate is sufficient for the connection means 30. , this solution is more economical and above all much more easily achievable than the establishment of a local communication network. For example, a rate modem of less than or equal to 128 kbit / s is possible, for example a 56 kbit / s modem.

  Other functions, known per se, of the portable terminal 12 are compatible with the system 1. For example, the identification cell 36 collects in the memory 32 raw data corresponding to the identification of a new patient. This raw data is stored in a part referenced 32A of the memory 32. The system 1 allows the nurse to send the raw data to his office 4 via the network 2, these raw data being routed to the central unit 8 in the same way as certified electronic care sheets, as explained above. Similarly, the input means 38 allow the nurse on the move to a new patient to establish, in the home of this patient, an electronic care sheet corresponding to an isolated act. More specifically, the nurse groups in the memory 32 the information necessary for the establishment of a minimum electronic care sheet which is then certified by the social insured identified at the level of the cell 36. The certified electronic care sheet is then forwarded to the firm 4 in the same way as previously explained.

  In Figure 6 is shown a variant of the system 1, the elements common with the system of the 2859298 14 Figure 1 bears the same references. In this variant, the system comprises two computer stations 10 and 10 'respectively located in two separate buildings of the building 4. The station 10 corresponds for example to the personal computer of a first nurse belonging to the professional office 4, located at his home 5, while the station 10 'corresponds to the personal computer of a second nurse of the cabinet 4, located at his home 5'. Each of these stations 10 and 10 'is equipped with own means 26 and 26' for exchanging data with the portable terminal 12, 12 'of the corresponding nurse.

  At the level of the professional cabinet 4, several computer stations, two of which are represented and referenced 52 and 54, are interconnected by a local area network 50 so as to exchange data with each other and with the database. known per se, these stations 52 and 54 are each adapted to allow the exchange and formatting, within the cabinet, of data between the base 6 and portable terminals similar to the terminal 12, for example for nurses cabinet 4 do not have a personal computer at home and therefore have to regularly go to the office to charge and unload their terminal. For this purpose, each of the stations 52 and 54 is equipped with respective means 56 for exchanging data with the portable terminal of a nurse, substantially similar to the means 26 for the station 10.

  In addition, according to the invention, at least one of the positions of the cabinet 4, for example the station 52, is provided with the processing sub-unit 14, in which the programs 40 and 42 are implemented, as well as memories associated work 16, 17, encryption and decryption means 18 and connection means 22, so as to exchange data with the stations 10 and 10 'through the network 2 remote communication. Station 52 thus constitutes a central unit similar to central unit 8 for the system of FIG.

  In the same way as for the system of FIG. 1, the station 52 and the stations 10 and 10 'of the system of FIG. 6 are able to exchange data via the remote communication network 2 whereas stations 52 and 54 exchange information with each other through the local network 50.

  Various arrangements and alternatives to the data processing and data exchange systems and methods described above are furthermore conceivable.

  For example, to ensure better tracking of the data sent from the cabinet 4 to the home 5, it can be expected that an electronic control message is sent via the network 2, the computer station 10 to the sub-office. processing unit 14 to warn of the proper loading of the electronic care sheets in the portable terminal 12. Another control message can be sent from the central unit 8 to the station 10 when certified care sheets are correctly received and processed by the program 42.

  Similarly, integrity control means (not shown) may be associated with the encryption and decryption means 18 and 28 so as to control that the decrypted information is correct. By way of example, these integrity control means comprise an algorithm known under the name SHA-1 applied to the file to be transmitted, not yet encrypted. This algorithm calculates a key based on the contents of the file, which is sent with the encrypted file. The integrity of the message is verified by applying the same algorithm to the received and decrypted file, the key obtained on this decrypted file having to be of the same value as the first key.

  Moreover, alternatively, the computer station 10 is not a fixed station, but a laptop used in any building other than the cabinet 4 and connected to the remote communication network 2.

  Furthermore, rather than using as a connection means 30 of the computer door 10, a modem directly connected to the remote communication network 2, these means can be at least partly formed of a cellular telephone or the like, which sends and / or receives data via a cellular telephone system, such as one of the GPRS or GSM low-speed systems or the UMTS higher-speed system. The data transmitted through one of these networks is then supported on the Internet-type remote communication network 2 to the building 4 where the central unit 8 is located. This possibility is particularly advantageous when the station 10 is a laptop.

  The invention is not obviously limited to its use by a nurse, but by any health professional.

Claims (1)

17 CLAIMS   1. System (1) for processing and exchanging data relating to medical services, comprising: a permanent database (6) of raw data relating to medical services, in particular medical procedures, to insured social patients and to healthcare professionals users of the system (1), - a central unit (8; 52) located in a first building (4) and equipped with both means (14, 16, 40) for processing and formatting the data raw data extracted from the permanent base (6) and means (22) for connection to a remote communication network (2), and - a portable terminal (12) for identifying a social insured, equipped with a memory (32) storage data formatted by the central unit (8) and adapted to collect certification by the social insured, including in the form of an electronic signature, stored data, characterized in that it further comprises at least one computer station (10, 10 ') located in a second building (5, 5 ') distinct from the first building (4) and equipped at the same time with means (26) for data exchange, in particular formatted and possibly certified, with the memory (32) of the terminal port (12), means (30) for connection to the remote communication network (2) and control means (24, 41) adapted to control the transfer, between the exchange means (26) and the communication means. connection (30) of the computer station (10, 10 '), on the one hand data to be loaded into the portable terminal after receiving them from the central unit (8) via the remote communication network and, on the other hand, on the other hand, of data discharged from the portable terminal before sending them to the central unit (8) via the remote communication network.   2. System according to claim 1, characterized in that the computer station (10) comprises a working memory (25) associated with the control means (24, 41) and adapted to temporarily store the data transferred between the exchange means (26) and the connection means (30) of the computer station.   3. System according to claim 1 or 2, characterized in that the central unit (8) and the computer station (10) are respectively equipped with means (18, 28) for encrypting and decrypting the data sent to or coming from their respective means (22, 30) for connection to the remote communication network (2).   4. System according to any one of the preceding claims, characterized in that the central unit (8) and the computer station (10) are respectively equipped with data integrity control means sent to or from their respective means. (18, 28) encryption and decryption.   5. System according to any one of the preceding claims, characterized in that the portable terminal (12) is provided with an interface (36) for identifying a social insured, in particular in the form of a reading cell. an electronic or magnetic medium specific to the social insured, and a memory part (32A) adapted to store raw data relating to this social insured made available by the identification interface (36), the post computer (10) being adapted to transfer the raw data stored in the memory portion (32A) of the portable terminal (12) to the central unit (8) via the remote communication network (2) while the central unit (8) is adapted to store, in the permanent database (6), the raw data received from the computer station.   6. System according to any one of the preceding claims, characterized in that the connection means (30) of the computer station (10) consist of a low transmission rate modem.   7. System according to claim 6, characterized in that the transmission rate of said modem is less than or equal to 128 kbit / s.   8. System according to any one of the preceding claims, characterized in that the remote communication network is a public communication network (2) of the Internet type.   9. A method for processing and exchanging data relating to medical services, in which: - raw data relating to medical services, in particular medical procedures, social insured patients and healthcare professionals are stored permanently; user health of a system (1) for implementing the method, - at a first building (4), the raw data extracted from the permanent base (6) are processed and computerized and communicated with a center (3) for centralized management of medical services, and - a portable terminal (12) for identifying a social insured, equipped with a memory (32) for storing data formatted and adapted to collect certification by the social insured, in particular in the form of an electronic signature, of the data stored in said memory, characterized in that at a second building (5, 5 ') distinct from the first building (4), data is exchanged with the memory (32) of the portable terminal (12), in particular formatted and optionally certified, which, via a remote communication network (2), have been received from or will be sent at the first building (4).   10. A method according to claim 9, characterized in that the data is transmitted between the first (4) and the second (5) buildings through a network type Internet (2), particularly in the form of e-mails.