CN106485391A - Medical insurance information sharing total management system - Google Patents
Medical insurance information sharing total management system Download PDFInfo
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- CN106485391A CN106485391A CN201510758007.4A CN201510758007A CN106485391A CN 106485391 A CN106485391 A CN 106485391A CN 201510758007 A CN201510758007 A CN 201510758007A CN 106485391 A CN106485391 A CN 106485391A
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Abstract
The present invention provides a kind of medical insurance information sharing total management system, this management system include operation layer functional module and with management level functional module, operation layer functional module included information acquisition module, cash pledge module, the generation cost model being connected with cash pledge module, freezes module；Management level functional module includes management server and the operation note module being connected with management server, the poor computing module of actual cost, disbursement and sattlement module and expense auditing module；The situation that this system can prevent Medical Insurance Patients arrearage occurs, and is capable of accurately, safely to the cash pledge of patient carrying out the monitoring of whole process it is ensured that patient's cash pledge is sufficient.
Description
Technical field
The invention belongs to medical insurance technical field, particularly to a kind of medical insurance information sharing integrated management
System.
Background technology
With the constantly improve of China's social security system, the crowd that medical insurance covers gets more and more, local
Hospital becomes the main place that patient seeks medical advice.With medical insurance, personnel are on the increase, and medical insurance is settled accounts
Work quantitative change increasing.In order to mitigate administrators of the hospital work load so that
Medical insurance examination ＆ verification settlement process more specification, rationally, medical insurance review efficiency higher, have now been developed
Some hospital's Medical Insurance Patients network management platforms, such as CN104008449 discloses one kind and lives
Institute's Patients with Medical Insurance management system, this system can facilitate doctor, nurse insured insurance kind, signature to patient
Golden information, cost information inquiry and descriptive information mark, have reached the need of real-time upload expense
Ask, improve hospital's medical insurance integrated management level.But this medical insurance management system does not have warning
The not enough function of patient's cash pledge, when the amount of money is more than pre-paying the amount of money at one's own expense, this system is with color
Make a distinction, operator so may be led to forget the meaning represented by each color, thus
Lose the warning function of the cash pledge to cash pledge deficiency patient；And when patient's cash pledge is not enough to do down
During one item inspection, this system does not have corresponding alarm function yet, ultimately results in patient's arrearage
Situation occurs.
Content of the invention
For the problems referred to above, the present invention provide one kind can ensure hospital's capital management accuracy,
Safety, and patient is not in the medical insurance information sharing total management system of the phenomenons such as arrearage.
Concrete technical scheme of the present invention is as follows：
The present invention provides a kind of medical insurance information sharing total management system, and this management system includes industry
Business layer function module and the management level functional module being connected with the communication of operation layer functional module, wherein,
Described operation layer functional module is included information acquisition module, cash pledge module, is connected with cash pledge module
Generation cost model, freeze module；Described information acquisition module is used for counting Medical Insurance Patients
Essential information；Described cash pledge module is used for counting the pre- cash pledge paid of Medical Insurance Patients；Described generation
After cost model is used for the total cost that statistics deduction medical insurance pays, the total of Medical Insurance Patients actual delivery is taken
With；Described blocking module is used for intercepting Medical Insurance Patients inspection project to be carried out or the medicine issued
Relevant information；Described management level functional module includes management server and and management server
Connected operation note module, actual cost difference computing module, disbursement and sattlement module and expense are examined
Core module；Described management server is used for storing the essential information of Medical Insurance Patients, cash pledge, reality
The total cost paying, and for receiving and sending order；Described operation note module is used for recording
Preliminary examination project or medicine that doctor issues for Medical Insurance Patients；Described actual cost difference computing module
For counting the advance payment button of each preliminary examination project that doctor issued or each medicine
Except the actual standard expense after medical insurance payment expense；Described disbursement and sattlement module is used for calculating cash pledge
With the difference of the total cost of Medical Insurance Patients actual delivery, i.e. remaining cash pledge；Described expense auditing mould
Block is used for auditing the size of remaining cash pledge and actual standard expense, is less than if there is remaining cash pledge
Actual standard expense, described management server starts blocking module and is used for will be greater than remaining cash pledge
The inspection project that the corresponding doctor of actual standard expense issues or the relevant information of medicine are blocked
Cut, to limit the corresponding operating to Medical Insurance Patients for the related personnel.
The situation that the system that the present invention provides can prevent Medical Insurance Patients arrearage occurs, and is capable of
Accurately, safely the cash pledge of patient is carried out with the monitoring of whole process it is ensured that patient's cash pledge is sufficient.
Further improvement, described operation layer functional module also includes intercepting releasing module and cash pledge
Hand in module retroactively；The interception that described management level functional module also includes being connected with management server releases
Anticipation module；Described cash pledge is handed in module retroactively and is handed in cash pledge retroactively for count Medical Insurance Patients；Described block
Cut and release anticipation module for judging to hand in cash pledge and remaining cash pledge sum and the check item being intercepted retroactively
The size of the actual standard expense corresponding to mesh or medicine, is given as security with remaining if there is handing in cash pledge retroactively
Golden sum is more than actual standard expense, and described management server starts interception and releases module, is used for
Release an intercepted inspection project or the relevant information of medicine.
Further improve, described operation layer functional module also include information receive determining module and
Transmission module in information；Described information receives determining module and is used for receiving the relevant information of Medical Insurance Patients,
And confirmed；In described information, transmission module is used for for information receiving the correlation that determining module receives
Information is uploaded to management server；Described relevant information include the name of Medical Insurance Patients, sex,
Age, course of disease brief introduction, whether there are specific disease, allergies, insurance kind, cash pledge, actual delivery
Total cost, take not, doctor and diagnostic message.The present invention is by entering to Medical Insurance Patients relevant information
Row receives and uploads, and can avoid the loss of patient-relevant informa, be diagnosis provides convenient.
Further improve, described operation layer functional module also include Drug catalogue enquiry module and
Transmission module on medical record；Described Drug catalogue enquiry module is used for inquiring about the Drug catalogue of specific disease；
Transmission module on described medical record, for encoding to the medical record diagnostic message of Medical Insurance Patients, and presses
Medical insurance requires to be uploaded to management server.
Further improvement, described operation layer functional module also includes medical insurance reminding module and is used for
The access interface of display medical insurance reminding module relevant information.Preferably, described medical insurance reminding module
Including medical insurance policies reminding module, drug reimbursement classification reminding module, diagnosis and treatment policy reminding module,
Prescription separates reminding module and difference takes other medical insurance political affairs at one's own expense for medical insurance dosage alarm module, medical insurance
Plan difference reminding module.
Further improve, described management level functional module also includes being connected with management server
Auditing module；Preferably, described auditing module includes cash pledge auditing module, expense segmentation examination ＆ verification
Module, medicine indication auditing module and Fei Bie modified module.
Further improve, described management level functional module also includes being connected with management server
Data statistics module；Preferably, described data statistics module is divided into outpatient service statistical module and is in hospital
Statistical module；Described outpatient service statistical module includes each insurance kind medical person-time statistical module, outpatient service expense
With aggregate statistics module, outpatient service per capita expense statistical module, outpatient service at one's own expense than statistical module, door
Consultation fee increases statistical module and expenditure pattern mould is fast；Described statistical module of being in hospital is divided into by section office
Statistics discharged patient's cost model or press patient discharge place section office count cost model；Described
Include each insurance kind by patient discharge place section office statistics cost model to house person-time statistical module, live
Institute's expense aggregate statistics module, be in hospital per capita expense statistical module, be in hospital at one's own expense than statistical module,
Average length of hospitalization statistical module, cost of hospitalization increase statistical module and expenditure pattern module；Described take
Included shared by medicine proportion module, consumptive material proportion module and check fee with composition module
Proportion module.
Further improve, described management level functional module also includes being connected with management server
Returned money reconciliation module and alarm module；Described returned money reconciliation module is used for comparing medical insurance side's expense props up
Whether the detail paid is consistent with the detail of school's reimbursement of expense, if inconsistent, described management clothes
Business device starts alarm module, for being identified to inconsistent detail.
Further improve, described management level functional module also includes being connected with management server
Comprehensive inquiry module and summarizing module, described comprehensive inquiry module is used for the correlation to Medical Insurance Patients
Information is inquired about and is shared；Described summarizing module is used for the relevant information of Medical Insurance Patients is carried out
Statistics, analysis and assessment, and draw out data sheet.
Preferably, described information acquisition module is built by AMR, Memcached and OCR；
Described generation cost model is built by SAS, Seafile and Kalkules.
Medical insurance information sharing total management system provided by the present invention, has advantages below：
1. medical insurance information sharing total management system provided by the present invention can monitor doctor exactly
Protect the cash pledge of patient so as to ensure that the cash pledge paid is sufficient.
2. this medical insurance information sharing total management system can be carried out to the cash pledge of Medical Insurance Patients entirely
Journey, real-time tracking, the department such as section office medical worker, charge department, pharmacy is without constantly monitoring
The cash pledge of patient, when patient basis are frozen, operator cannot be carried out operating, natural
Mean that patient's cash pledge is not enough, reduce Medical Insurance Patients expense dispute and arrearage situation occurs.
3. this medical insurance information sharing total management system is by the comprehensive pipe to Medical Insurance Patients cash pledge
Reason, ensures accuracy and the safety of hospital's capital management, by medical worker from heavy medical insurance
Policy implementation and expense are refused to pay in pressure and are freed, and have larger promotional value in hospital.
4. this medical insurance information sharing total management system application effect is notable, and range of application extends
To other medical insurance insurance kinds such as industrial injury medical insurance, civil servant's series medical insurances, can be fitted according to the change of policy
Shi Tuozhan adjusts function.
5. this medical insurance information sharing total management system can build the doctor of different aspects and dynamics
Protect information networking shared platform；By the isomeric data effective connection of each for medical insurance information island, with
Reach information fully shared；Mitigate the pressure of medical worker's medical insurance policies management.
6. this medical insurance information sharing total management system application data digging technology, to medical insurance disease
People's relevant information carries out statistics, analysis and the assessment of various dimensions, stage construction and many granularities, is duty
Energy administration section's effective control expense and formulation management strategy provide strong data supporting.
7. this medical insurance information sharing total management system General Promotion all departments management efficiency, promotees
Enter medical insurance pay for first the quick of fund and full-amount steam again, ensure hospital's capital management accuracy and
When property and safety, effectively reduce the cost of hospital itself every medical insurance management work, improve doctor
Institute adapts to local medical reform.
Brief description
Fig. 1 is the structural representation of the medical insurance information sharing total management system of embodiment 1；
Fig. 2 is the structural representation of the medical insurance information sharing total management system of embodiment 2；
Fig. 3 is the structural representation of the medical insurance information sharing total management system of embodiment 3；
Fig. 4 is the structural representation of the medical insurance information sharing total management system of embodiment 4；
Fig. 5 is the structural representation of the medical insurance information sharing total management system of embodiment 5.
Specific embodiment
Embodiment 1
The present invention provides a kind of medical insurance information sharing total management system, as shown in figure 1, this pipe
Reason system includes operation layer functional module 1 and the management being connected with operation layer functional module 1 communication
Layer function module 2, wherein, described operation layer functional module 1 include information acquisition module 11,
Cash pledge module 12, the generation cost model 13 being connected with cash pledge module 12 and blocking module 14；
Described information acquisition module 11 is used for counting the essential information of Medical Insurance Patients；Described cash pledge module 12
For counting the pre- cash pledge paid of Medical Insurance Patients；Described generation cost model 13 is used for statistics deduction
The total cost of Medical Insurance Patients actual delivery after the total cost that medical insurance pays；Described blocking module 14 is used
In the relevant information intercepting Medical Insurance Patients inspection project to be carried out or the medicine issued；Described pipe
Reason layer function module 2 includes management server 21 and the operation note being connected with management server 21
Record module 22, actual cost difference computing module 23, disbursement and sattlement module 24 and expense auditing mould
Block 25；Described management server 21 is used for storing the essential information of Medical Insurance Patients, cash pledge, reality
The total cost paying, and for receiving and sending order；Described operation note module 22 is used for remembering
Preliminary examination project or medicine that record doctor issues for Medical Insurance Patients；Described actual cost difference calculates mould
Block 23 is for counting the advnace money on a contract of each preliminary examination project that doctor is issued or each medicine
Volume deducts the actual standard expense after medical insurance payment expense；Described disbursement and sattlement module 24 by based on
Calculate the difference of the total cost of cash pledge and Medical Insurance Patients actual delivery, i.e. remaining cash pledge；Described expense
Auditing module 25 is used for auditing the size of remaining cash pledge and actual standard expense, if there is residue
Cash pledge is less than actual standard expense, and described management server 21 startup blocking module 14 is used for will
The inspection project issued more than the corresponding doctor of actual standard expense of remaining cash pledge or the phase of medicine
Pass information is intercepted, to limit the corresponding operating to Medical Insurance Patients for the related personnel.The present invention is led to
The management level functional module crossing setting can achieve the monitoring to operation layer functional module and management, carries
The accuracy of high medical insurance capital management and safety；This system can be to the cash pledge of Inpatients with Medical Insurance
Carry out whole process, real-time tracking；And implement to monitor the cash pledge of patient whether enough to do next
The inspection of item or the corresponding medicine of purchase, if this cash pledge is not enough, patient cannot be carried out
The next item down checks or drug purchase, so avoids patient's arrearage situation and occurs.
The management system of the present invention is realized by the following method, first information acquisition module,
Cash pledge module counts to the essential information of patient and cash pledge, and is stored in management server,
Occur cost model calculate deduction medical insurance pay total cost after Medical Insurance Patients actual delivery total
Expense；Expense computing module calculates remaining cash pledge, if remaining cash pledge is 200 yuan, existing
Have in technology if the cash pledge of patient is not 0 yuan or negative, then each system of hospital will be given
Medical Insurance Patients carry out the inspection of respective item or issue medicine, and that is, patient will do one next time
Individual ultrasound diagnosis, the expense after deduction medical insurance payment expense is 220 yuan, because patient's is surplus
Remaining cash pledge also has 200 yuan, and ultrasound diagnosis can be done to patient by hospital, so leads to patient to owe hospital
20 yuan of expense；And the medical insurance information sharing total management system of the present invention is passed through to add operation note
After record module, actual cost difference computing module, expense auditing module and blocking module, Ke Yiyou
The situation preventing Medical Insurance Patients arrearage of effect occurs.Operation note module in this system is by doctor
For patient, the preliminary examination project issued or medicine are recorded, afterwards actual cost difference computing module
The preliminary examination project issued according to doctor or medicine, calculate each preliminary examination project or each
Plant the actual standard expense of medicine, after this actual standard expense is deduction medical insurance payment expense
Each inspection or the expense of each medicine, then after, expense auditing module compares remaining cash pledge
With the size of actual standard expense, if the inspection issued for patient of doctor and medicine include following 5
?：It is respectively ultrasound diagnosis, blood routine examination, amoxicillin, somedon, imatinib,
Actual cost difference computing module calculates the actual standard expense of each in above-mentioned 5 contents afterwards
With, respectively 220 yuan of ultrasound diagnosis, 180 yuan of blood routine examination, 30 yuan of amoxicillin, go
10 yuan of pain piece, 210 yuan of imatinib, are less than actual standard due to there is 200 yuan of residue cash pledge
The situation that 220 yuan and 210 yuan of expense, described management server starts blocking module, by B ultrasonic
Check and the relevant information of imatinib is intercepted, after information is intercepted, ultrasound diagnosis portion
Door and pharmacy can not receive related information, and then limit this two contents；Given as security due to remaining
200 yuan of gold is more than 10 yuan, 180 yuan and 30 yuan, so patient can select according to the wish of oneself
Select and first carry out which project, if patient have selected blood routine examination and is 180 yuan, then patient
After carrying out blood routine examination, expense computing module calculates the remaining cash pledge of patient automatically, remaining
Cash pledge is 20 yuan, due to there are remaining 20 yuan of situations less than 30 yuan of actual standard expense of cash pledge,
So management server also needs to start blocking module, the information of amoxicillin is intercepted,
After information is intercepted, pharmacy does not receive the relevant information issuing amoxicillin for patient,
And then limit this content, and patient can go by somedon, remaining cash pledge is 10 yuan；As
It is 30 yuan of expense computing modules that fruit patient have selected by medicine amoxicillin according to the wish of oneself
Automatically calculate the remaining cash pledge of patient, remaining cash pledge is 170 yuan, due to there is remaining cash pledge
170 yuan of situations being less than 180 yuan of actual standard expense, so management server also needs to startup and blocks
Cut module, the information of blood routine examination is intercepted, after information is intercepted, inspection portion
Door does not receive the relevant information carrying out blood routine examination for patient, and then limits this content,
And patient can go by somedon, now remaining cash pledge is 160 yuan.
Embodiment 2
As shown in Fig. 2 the present invention provides a kind of medical insurance information sharing total management system, this doctor
Protect information sharing total management system as different from Example 1, described operation layer functional module 1
Also include intercepting releasing module 15 and cash pledge hands in module 16 retroactively；Described management level functional module 2
The interception also including being connected with management server 21 releases anticipation module 26；Described cash pledge hands in mould retroactively
What block 16 was used for counting Medical Insurance Patients hands in cash pledge retroactively；The described releasing anticipation module 26 that intercepts is used for
Judge to hand in cash pledge and remaining cash pledge sum and the reality corresponding to intercepted inspection project or medicine retroactively
The size of border Standard Rate, is more than actual standard if there is handing in cash pledge retroactively with remaining cash pledge sum
Expense, described management server 21 starts interception and releases module 15, is intercepted for releasing one
Inspection project or medicine relevant information.What this system can supervise patient constantly hands in cash pledge retroactively
Number, and related intercepted project is released, so that patient does corresponding inspection or takes medicine
Product；This system operation procedures is as follows：In conjunction with the embodiments 1, if patient select blood routine examination and
After have purchased somedon, the remaining cash pledge of patient is 10 yuan, then the packet that patient is intercepted
Include 220 yuan of ultrasound diagnosis, 30 yuan of amoxicillin and 210 yuan of imatinib, if cash pledge is handed in retroactively
The cash pledge of handing in retroactively of module statistics is 50 yuan, then hands in cash pledge retroactively and is 60 yuan with remaining cash pledge sum,
Intercept releasing anticipation module and judged that handing in cash pledge retroactively is more than actual standard for 60 yuan with residue cash pledge sum
30 yuan of expense amoxicillin, so management server starts to intercept releases module, for releasing
The relevant information of intercepted amoxicillin, after Medical Insurance Patients take amoxicillin away, remaining cash pledge
It is 30 yuan with handing in cash pledge sum retroactively, no more than 220 yuan and 210 yuan of actual standard expense, intercept
Release module can not be activated；If patient hands in cash pledge retroactively is 260 yuan, remaining cash pledge and handing in retroactively
Cash pledge sum is 270 yuan, exists more than 220 yuan of actual standard expense, 210 yuan and 30 yuan
Situation, then intercept and release a module releasing content therein, if relieving intercepted B
Super relevant information, then remaining cash pledge and hand in cash pledge sum retroactively and become 50 yuan, also exists big
In 30 yuan of situation, intercept and release the relevant information that module releases amoxicillin, and can not release
The relevant information of imatinib.
Embodiment 3
As shown in figure 3, the present invention provides a kind of medical insurance information sharing total management system, this doctor
Protect information sharing total management system as different from Example 2, this medical insurance information sharing is comprehensive
Management system can achieve DRGs-based payment system management, improves the accuracy of medical insurance quality inspection management further
And safety.
As shown in figure 3, the present invention limits described operation layer functional module 1 further also includes letter
Breath receives transmission module 18 in determining module 17 and information；Described information receives determining module 17 and uses
In the relevant information receiving Medical Insurance Patients, and confirmed；In described information, transmission module 18 is used for
The relevant information that information reception determining module 17 is received is uploaded to management server 21；Described phase
Pass information include the name of Medical Insurance Patients, sex, age, course of disease brief introduction, whether have specific disease,
Allergies, insurance kind, cash pledge, the total cost of actual delivery, take not, doctor and diagnostic message.
By to the reception of Medical Insurance Patients relevant information and upload, preventing losing of Medical Insurance Patients related data
Lose.
As shown in figure 3, the operation layer functional module 1 of the present invention also includes Drug catalogue inquiry mould
Transmission module 110 on block 19 and medical record；Described Drug catalogue enquiry module 19 is used for inquiring about specific disease
Drug catalogue；Transmission module 110 on described medical record, for the medical record diagnostic message to Medical Insurance Patients
Encoded, and be uploaded to management server 21 by medical insurance requirement.Upload mould by arranging medical record
Block can achieve that the diagnostic message of patient is included the every terms of informations such as symptom, medicine, detection is compiled
Code, after upload onto the server, consult being easy to after, and be capable of according to disease pay manage
Reason.Facilitate patient that related medicine is inquired about by arranging Drug catalogue enquiry module, enter one
Step improves the medication accuracy of special patient.
As shown in figure 3, this system can achieve being served as theme with patient assessment's flow process, with other with regard to consultation fee
It is that foundation realizes information system and local medical insurance information system interlinks, realize medical insurance information altogether
Enjoy, realize convenience and the accuracy of medical insurance management system.The present invention limits described industry further
Business layer terminal 1 also including medical insurance reminding module 111 and is used for showing medical insurance reminding module 111
The access interface 112 of relevant information；Described medical insurance reminding module 11 is used for medical insurance policies, medicine
Product reimbursement classification, medical insurance dosage, medical insurance at one's own expense prescription separately etc. information is pointed out；Described
Medical insurance reminding module 111 include medical insurance policies reminding module, drug reimbursement classification reminding module,
Mould separately pointed out by prescription at one's own expense for diagnosis and treatment policy reminding module, medical insurance dosage alarm module, medical insurance
Block and difference take other medical insurance policies difference reminding module；The wherein medical insurance reminding module of addition and visit
Ask interface can hospital each doctor station (containing be in hospital and Emergency call) embed necessary medical insurance policies letter
Breath prompt facility, to reach medical insurance regulation and to require, prevents trouble before it happens.Described medical insurance policies carry
Show that module is used for pointing out the related medical insurance policies information of diagnosis and treatment and pharmaceutical item etc.；Described medicine report
Pin classification reminding module is used for pointing out the classification of pharmaceutical item reimbursement；Diagnosis and treatment policy reminding module is used
Relevant information in prompting doctor's website diagnosis and treatment policy；Medical insurance dosage alarm module is used for
Emergency call doctor station setting medical insurance dosage information warning；Medical insurance prescription separately reminding module at one's own expense
Point out the medical insurance automatically separate information of prescription at one's own expense for standing in doctor；Difference takes other medical insurance policies
Difference reminding module is used for taking not in each work station according to different insurance kinds setting difference, according to setting
Different expenses do not show different Content of policies.
Embodiment 4
As shown in figure 4, the present invention provides a kind of medical insurance information sharing total management system, this doctor
Protect information sharing total management system as different from Example 3, by this medical insurance information sharing
Total management system carries out in advance examination ＆ verification monitoring in good time in institute's Patients with Medical Insurance expense, to discharge doctor
Protect patients ' expenses and carry out post audit, whether expense of checking is split correctly, medicine consumptive material etc. is each to be taken
Whether business project indication meets the requirements.The present invention further defines described management layer function mould
Block 2 also includes the auditing module 28 being connected with management server 21；It is right that described auditing module is used for
Whether patient pays cash pledge, expense is not split the whether information such as correct, medicine indication and audited；
Described auditing module 28 includes cash pledge auditing module, expense segmentation auditing module, medicine indication
Auditing module and Fei Bie modified module.Whether Medical Insurance Patients cash pledge is audited by cash pledge auditing module
Press number to pay on time；Expense segmentation auditing module audits cash pledge and at one's own expense whether according to corresponding
Expense correctly do not split；Whether the medicine that medicine indication auditing module examination ＆ verification doctor issues is pin
Disease to patient；Take other auditing module for not correcting to the incorrect expense of segmentation.
As shown in figure 4, for the ease of the statistics and analysis of data, the present invention is further improved
In scheme, management level functional module 2 also includes the data statisticss mould being connected with management server 21
Block 29；Described data statistics module 29 is used for the information of outpatient service department and department in hospital is united
Meter；Described information include medical person-time information, expense aggregate information, per capita cost information, from
Take than information, expense aggregate information etc.；Described data statistics module 29 is divided into outpatient service statistical module
Statistical module in hospital；Described outpatient service statistical module include each insurance kind go to a doctor person-time statistical module,
Ambulatory expenses aggregate statistics module, outpatient service per capita expense statistical module, outpatient service at one's own expense ratio statistics mould
Block, ambulatory expenses increase statistical module and expenditure pattern mould is fast；Described statistical module of being in hospital is divided into
By section office statistics discharged patient's cost model or press patient discharge place section office count expense mould
Block；Described include each insurance kind by patient discharge place section office statistics cost model and house a person-time statistics
Module, hospitalization cost aggregate statistics module, be in hospital per capita expense statistical module, be in hospital at one's own expense than
Statistical module, average length of hospitalization statistical module, cost of hospitalization increase statistical module and expenditure pattern mould
Block；Described expenditure pattern module include medicine proportion module, consumptive material proportion module and
Check fee proportion module.Data statistics module of the present invention can divide outpatient service and number of being in hospital
According to statistics, can be counted the unrestricted choice beginning and ending time, can arbitrarily be selected insurance kind expense not.Wherein
Outpatient Department data statistics includes that each insurance kind is gone to a doctor person-time and expense is total, the equal expense of outpatient service flow, a door
Examine and constitute situation than, ambulatory expenses growth pattern and ambulatory expenses at one's own expense, that is, medicine proportion,
Consumptive material proportion, Laboratory Fee proportion etc.；Hospitalization data statistics both can be by responsibility section office
(patient that transfers from one department to another is counted on statistics discharged patient's expense situation by expense with actually occurring respectively
Corresponding section office), also can count expense by patient discharge place section office, concrete data includes each insurance kind
House person-time and expense add up to, be in hospital person-time all an expense, be in hospital at one's own expense than, average length of hospitalization,
Cost of hospitalization growth pattern and hospitalization cost constitute situation, i.e. medicine proportion, consumptive material institute accounting
Weight, Laboratory Fee proportion etc..
Embodiment 5
As shown in figure 5, the present invention provides a kind of medical insurance information sharing total management system, this doctor
Protect information sharing total management system as different from Example 1, by this medical insurance information sharing
Total management system reports detail to contrast one by one with medical insurance side's reimbursement of expense detail to school's expense,
Comprehensive management is carried out to the expense returned money situation of Patients with Medical Insurance, prevents bad credit, bad accounts, stagnant
Receive gold, ensure accuracy, promptness and the safety of hospital's capital management.Further improvement
In scheme, described management level functional module 2 also includes the returned money pair being connected with management server 21
Account module 210 and alarm module 211；Described returned money reconciliation module 210 is used for comparing medical insurance side's expense
Whether consistent with the detail of school reimbursement of expense with the detail that pays, if inconsistent, described pipe
Reason server 21 starts alarm module 211, for being identified to inconsistent detail.
As shown in figure 5, in the further improved scheme of the present invention, described management level functional module 2
Also include comprehensive inquiry module 212 and the summarizing module 213 being connected with management server 21, institute
State comprehensive inquiry module 212 to be used for the relevant information of Medical Insurance Patients being inquired about and sharing；Institute
State summarizing module 213 to be used for the relevant information of Medical Insurance Patients is counted, analyzed and assessed,
And draw out data sheet.By arranging comprehensive inquiry module and summarizing module, by different aspects
Become networking service system platform with the medical insurance information architecture of granularity；Each for medical insurance data of information system is had
Effect connection, fully shared to reach information；Application data digging technology is according to policy guidance simultaneously
Patients with Medical Insurance relevant information is counted, analyzed and assessed, is that functional management department effectively manages
Reason expense, control cost and formulation management strategy provide strong data supporting.
As shown in figure 5, further improve, the information acquisition module 11 in the present invention by AMR,
Memcached and OCR builds；Described generation cost model 13 is by SAS, Seafile
Building with Kalkules, thus realizing accurately and quickly gathering to relevant information, making
Cost model must be occurred to realize quick computing, improve accuracy and the speed that whole system is run.
Claims (10)
1. a kind of medical insurance information sharing total management system, described management system includes business layer function mould
Block (1) and the management level functional module (2) being connected with operation layer functional module (1) communication,
It is characterized in that, described operation layer functional module (1) includes information acquisition module (11), gives as security
Generation cost model (13) and interception that golden module (12) is connected with cash pledge module (12)
Module (14)；Described information acquisition module (11) is used for counting the essential information of Medical Insurance Patients；
Described cash pledge module (12) is used for counting the pre- cash pledge paid of Medical Insurance Patients；Described generation expense
After the total cost that module (13) pays for statistics deduction medical insurance, Medical Insurance Patients actual delivery is total
Expense；Described blocking module (14) is used for intercepting Medical Insurance Patients inspection project to be carried out or opening
The relevant information of the medicine of tool；Described management level functional module (2) inclusion management server (21),
And be connected with management server (21) operation note module (22), actual cost is poor calculates mould
Block (23), disbursement and sattlement module (24) and expense auditing module (25)；Described management service
Device (21) is used for storing the essential information of Medical Insurance Patients, cash pledge, the total cost of actual delivery,
And for receiving and sending order；It is doctor that described operation note module (22) is used for recording doctor
Protect preliminary examination project or the medicine that patient issues；Described actual cost difference computing module (23) is used
Advance payment deduction in statistics each preliminary examination project being issued of doctor or each medicine
Actual standard expense after medical insurance payment expense；Described disbursement and sattlement module (24) is used for calculating
The difference of the total cost of cash pledge and Medical Insurance Patients actual delivery, i.e. remaining cash pledge；Described expense is examined
Core module (25) is used for auditing the size of remaining cash pledge and actual standard expense, if there is surplus
Remaining cash pledge is less than actual standard expense, and described management server (21) starts blocking module (14)
For will be greater than inspection project or the medicine that the corresponding doctor of actual standard expense of remaining cash pledge issues
The relevant information of product is intercepted, to limit the corresponding operating to Medical Insurance Patients for the related personnel.
2. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State operation layer functional module (1) also include intercept release module (15) and cash pledge hand in module (16) retroactively；
The interception that described management level functional module (2) also includes being connected with management server (21) releases
Anticipation module (26)；Described cash pledge is handed in module (16) retroactively and is handed in signature retroactively for count Medical Insurance Patients
Gold；Described interception releases anticipation module (26) and hands in cash pledge and remaining cash pledge sum retroactively for judgement
With the size of the actual standard expense corresponding to intercepted inspection project or medicine, if there is
Hand in cash pledge retroactively and be more than actual standard expense, described management server (21) with remaining cash pledge sum
Start to intercept and release module (15), for releasing the phase of an intercepted inspection project or medicine
Pass information.
3. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State operation layer functional module (1) and also include information reception determining module (17) and information upload mould
Block (18)；Described information receives determining module (17) and is used for receiving the relevant information of Medical Insurance Patients,
And confirmed；In described information, transmission module (18) is used for for information receiving determining module (17)
The relevant information receiving is uploaded to management server (21)；Described relevant information includes Medical Insurance Patients
Name, sex, age, course of disease brief introduction, whether have specific disease, allergies, insurance kind, signature
Gold, the total cost of actual delivery, take not, doctor and diagnostic message.
4. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State operation layer functional module (1) and also include Drug catalogue enquiry module (19) and medical record upload mould
Block (110)；Described Drug catalogue enquiry module (19) is used for inquiring about the Drug catalogue of specific disease；
Transmission module (110) on described medical record, for encoding to the medical record diagnostic message of Medical Insurance Patients,
And it is uploaded to management server (21) by medical insurance requirement.
5. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State operation layer functional module (1) also to include medical insurance reminding module (111) and be used for showing medical insurance
The access interface (112) of reminding module (111) relevant information；Preferably, described medical insurance prompting
Module (111) includes medical insurance policies reminding module, drug reimbursement classification reminding module, diagnosis and treatment political affairs
Plan reminding module, medical insurance dosage alarm module, medical insurance prescription separately reminding module and not at one's own expense
Take other medical insurance policies difference reminding module together.
6. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State the auditing module (28) that management level functional module (2) also includes being connected with management server (21)；
Preferably, described auditing module (28) includes cash pledge auditing module, expense splits auditing module,
Medicine indication auditing module and Fei Bie modified module.
7. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State the data statisticss mould that management level functional module (2) also includes being connected with management server (21)
Block (29)；Preferably, described data statistics module (29) is divided into outpatient service statistical module and is in hospital
Statistical module；Described outpatient service statistical module includes each insurance kind medical person-time statistical module, outpatient service expense
With aggregate statistics module, outpatient service per capita expense statistical module, outpatient service at one's own expense than statistical module, door
Consultation fee increases statistical module and expenditure pattern mould is fast；Described statistical module of being in hospital is divided into by section office
Statistics discharged patient's cost model or press patient discharge place section office count cost model；Described
Include each insurance kind by patient discharge place section office statistics cost model to house person-time statistical module, live
Institute's expense aggregate statistics module, be in hospital per capita expense statistical module, be in hospital at one's own expense than statistical module,
Average length of hospitalization statistical module, cost of hospitalization increase statistical module and expenditure pattern module；Described take
Included shared by medicine proportion module, consumptive material proportion module and check fee with composition module
Proportion module.
8. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State the returned money reconciliation mould that management level functional module (2) also includes being connected with management server (21)
Block (210) and alarm module (211)；Described returned money reconciliation module (210) is used for comparing doctor
Whether the detail of guarantor side's reimbursement of expense is consistent with the detail of school's reimbursement of expense, if inconsistent,
Described management server (21) starts alarm module (211), for entering to inconsistent detail
Line identifier.
9. medical insurance information sharing total management system as claimed in claim 1 is it is characterised in that institute
State the comprehensive inquiry mould that management level functional module (2) also includes being connected with management server (21)
Block (212) and summarizing module (213), described comprehensive inquiry module (212) is used for medical insurance
The relevant information of patient is inquired about and is shared；Described summarizing module (213) is used for medical insurance is suffered from
The relevant information of person is counted, analyzed and is assessed, and draws out data sheet.
10. medical insurance information sharing total management system as claimed in claim 1 it is characterised in that
Described information acquisition module (11) is built by AMR, Memcached and OCR；Described
Raw cost model (13) is built by SAS, Seafile and Kalkules.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201510758007.4A CN106485391A (en) | 2015-11-09 | 2015-11-09 | Medical insurance information sharing total management system |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510758007.4A CN106485391A (en) | 2015-11-09 | 2015-11-09 | Medical insurance information sharing total management system |
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| CN201510758007.4A Pending CN106485391A (en) | 2015-11-09 | 2015-11-09 | Medical insurance information sharing total management system |
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| CN108154443A (en) * | 2017-07-18 | 2018-06-12 | 邹鑫洋 | A kind of medical treatment medical insurance data processing equipment and method |
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| CN111563193A (en) * | 2020-04-29 | 2020-08-21 | 安徽靓马信息科技有限公司 | Medical insurance fixed-point management system based on information technology |
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| CN112508710A (en) * | 2020-10-29 | 2021-03-16 | 望海康信(北京)科技股份公司 | Account checking system and corresponding computer equipment |
| CN112508710B (en) * | 2020-10-29 | 2021-11-12 | 望海康信(北京)科技股份公司 | Account checking system and corresponding computer equipment |
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