CN108389621B - Method and system for detecting data quality of first page of medical record - Google Patents
Method and system for detecting data quality of first page of medical record Download PDFInfo
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Abstract
The embodiment of the invention discloses a method for detecting the quality of first page data of a medical record, which specifically comprises the following steps: importing data into a database; and detecting the imported data. Also discloses a system for detecting the data quality of the first page of the medical record. The error data and the non-standard data of the first page of the medical record can be detected, and the detection result and the detail of the problem can be obtained. The advantages and disadvantages of the quality of the home case home page data of the hospital are also reflected, and the hospital can have visual understanding of the home case home page data of the hospital.
Description
Technical Field
The invention relates to the technical field of medical big data detection, in particular to a method and a system for detecting the quality of first page data of a medical record.
Background
Since the medical record first page data are required to be reported by each hospital by the health care committee, the quality of the medical record first page data is greatly concerned, and the current medical record first page data have the following three problems: the hospital checks the first page data of the medical record in a manual mode, which is low in efficiency and difficult to recognize error data and non-standard data comprehensively; the existing technical conditions of the hospital cannot realize the integral knowledge of the home page data of the medical records of the hospital and cannot know the distribution condition of the wrong data of the hospital; hospitals do not communicate with each other, and medical record data are in an information island and cannot reflect the nationwide level of the hospital data.
Disclosure of Invention
The embodiment of the invention provides a method and a system for detecting the quality of first page data of a medical record, which aim to solve the problems that the efficiency of checking the first page data of the medical record is low, the distribution condition of error data of a hospital cannot be integrally known, and the medical record data cannot be reflected on the level of the national range in the prior art.
In order to solve the technical problem, the embodiment of the invention discloses the following technical scheme:
the invention provides a method for detecting the data quality of a first page of a medical record, which comprises the following steps:
importing data into a database;
and detecting the imported data.
With reference to the first aspect, in a first possible implementation manner of the first aspect, the importing the data into the database specifically includes the following steps:
collecting files reported by a hospital, and converting the files into a uniform format;
storing the converted files in corresponding directories according to a certain classification rule;
generating a database for the hospital according to the imported data file, and importing the information of the data file into a corresponding table;
and creating a temporary table of the hospital and importing the information of the data file into the corresponding temporary table.
With reference to the first aspect, in a second possible implementation manner of the first aspect, the classification rule includes: the method comprises the steps of storing catalogs of all years of a hospital under each type of hospital catalog, storing catalogs of all seasons under each year catalog, storing data files and dictionary table catalogs of the seasons of the hospital under each season catalog, storing dictionary table file catalogs under each dictionary table catalog, and storing dictionary table files under each dictionary table file catalog.
With reference to the first aspect, in a third possible implementation manner of the first aspect, after the data is imported into the database, the method further includes the following steps:
carrying out standardization processing on the data;
and preprocessing the standardized fields.
With reference to the first aspect, in a fourth possible implementation manner of the first aspect, the normalizing the data includes: mapping fields through a standardized dictionary, specifically comprising the following steps:
acquiring the first 232 fields from a field mapping table of a database corresponding to a hospital;
matching the obtained first 232 fields with the standard 232 fields, and converting into capitalization during matching;
if the matching is successful, importing the matched data into a standard template table; if the field does not match, the field is imported into the field mapping table, and the subsequent quality inspection process of the hospital is terminated.
With reference to the first aspect, in a fifth possible implementation manner of the first aspect, the 232 fields of the standard include 232 fields of the satellite system 4-1 standard.
With reference to the first aspect, in a sixth possible implementation manner of the first aspect, the preprocessing the standardized field includes normalizing the code and normalizing the format.
With reference to the first aspect, in a seventh possible implementation manner of the first aspect, the method for normalizing the code specifically includes: converting the yard codes of the corresponding fields into standard codes according to the mapping relation of the code table;
the method for normalizing the format specifically comprises the following steps: acquiring data formats of 232 fields in a database; and converting the fields of the nvarchar data type into the fields of the corresponding type according to the data format, and setting the fields to be null if the conversion fails.
With reference to the first aspect, in an eighth possible implementation manner of the first aspect, the standard code and the home code are in a one-to-many relationship, specifically: the yard code is empty or a plurality of values, and the corresponding standard code is a determined value;
the data format comprises string, double, datetime and int.
With reference to the first aspect, in a ninth possible implementation manner of the first aspect, when the house code of the corresponding field is converted into a standard code, the house code table needs to be read; when reading the yard code table, the yard codes are automatically grouped according to commas.
With reference to the first aspect, in a tenth possible implementation manner of the first aspect, the detecting the imported data includes data detection and quality detection.
With reference to the first aspect, in an eleventh possible implementation manner of the first aspect, the data detection specifically includes the following steps:
separating the diagnosis information and the operation and operation information from the first page label data of the medical record into a separate table;
updating data in the diagnosis information, the operation and operation information and the medical record attribute table, and preparing for later statistics;
counting the number of records in each month;
and matching the hospital disease dictionary table and the operation and operation dictionary table with the standard dictionary table, and counting the matching rate.
With reference to the first aspect, in a twelfth possible implementation manner of the first aspect, the quality detection includes detecting a data field of a first page of a medical record according to a quality inspection rule, and storing a detection result in a database, and specifically includes the following steps:
traversing all quality inspection rules;
extracting the contents of the first page of the medical record from the data table according to the contents of the first page of the medical record related to each quality inspection rule;
and judging whether the content of the first page of the medical record is legal or not according to the quality inspection rule.
With reference to the first aspect, in a thirteenth possible implementation manner of the first aspect, the detecting, according to the quality inspection rule, the data field of the first page of the medical record specifically includes detecting integrity of data, detecting standard of data, and detecting normalization of data;
the integrity detection comprises detecting the integrity rate of the data filling of the first page of the medical record, including detecting the integrity of the mandatory field, detecting the integrity of the unnecessary field and detecting the integrity of the combined field;
the detection standard comprises the detection of the utilization rate of each code, the matching condition of a standard diagnosis and treatment subject directory and codes of a department discharged from the home, the matching condition of the version of a disease dictionary table of the home and the matching condition of the version of an operation dictionary table of the home;
the detection normalization comprises detection of single field normalization, detection of qualified field encoding logic, detection of combined field cost logic, and detection of combined field time logic.
With reference to the first aspect, in a fourteenth possible implementation manner of the first aspect, the detection result includes a detection result report and a question list;
the quality detection result is reported as an integral quality detection result, and comprises all indexes of a quality detection rule and a corresponding problem chain; the question link can be linked to a corresponding question list;
the problem detail tables are distributed according to quality inspection result items, and each problem detail table comprises problem data recorded by one result item; the question list is stored according to the case number, the birth date, the admission time and the question field; the case number, date of birth and time of admission are used to locate the case home page data, and the question field is the data of the question field.
The second aspect of the invention provides a system for detecting the quality of the data of the first page of the medical record, which comprises a data import module, a data analysis module and a data analysis module, wherein the data import module is used for converting hospital data into a uniform format and importing the uniform format into a database according to classification rules; and the combination of (a) and (b),
and the detection module is used for carrying out data detection and quality detection on the home page data of the hospital medical records.
With reference to the second aspect, in a first possible implementation manner of the second aspect, the system further includes a normalization module, configured to perform normalization processing on the imported data according to a normalization dictionary, where the normalization processing includes code normalization and format normalization; identifying the content of the data file, and stopping quality inspection of the first page of the medical record of the hospital if an nonstandard file is identified; and the combination of (a) and (b),
and the data statistical analysis module is used for performing statistical analysis on the data according to the quality inspection rule, analyzing the overall situation of the first page data of all hospital medical records in a certain period of time, obtaining a quality detection result report and giving a corresponding problem detailed list.
The system for detecting the quality of the first page data of the medical record of the second aspect of the invention can realize the methods of the first aspect and the implementation manners of the first aspect, and achieve the same effects.
According to the technical scheme, the method can detect the error data and the non-standard data of the first page of the medical record, and obtain the detection result and the detail of the problem.
According to the detection result and the detail of the problem, the advantages and disadvantages of the quality of the home medical record home page data can be reflected, and the hospital can have visual understanding on the home medical record home page data.
Drawings
FIG. 1 is a schematic flow chart of a method for detecting the quality of the first page data of a medical record according to the present invention;
FIG. 2 is a flow chart illustrating a method for importing data into a database according to an embodiment of the present invention;
FIG. 3 is a flowchart illustrating a method for normalizing data according to an embodiment of the invention;
FIG. 4 is a flow chart of a method for data detection according to an embodiment of the present invention;
FIG. 5 is a schematic flow chart of a method for quality inspection according to an embodiment of the present invention;
FIG. 6 is a schematic diagram of a system for detecting the quality of the first page data of the medical records of the present invention.
Detailed Description
In order to more clearly illustrate the embodiments or technical solutions in the prior art of the present invention, the drawings used in the description of the embodiments or prior art will be briefly described below, and it is obvious for those skilled in the art that other drawings can be obtained based on these drawings without creative efforts.
As shown in fig. 1, the method for detecting the quality of the data of the first page of the medical record specifically comprises the following steps:
s1, importing the data into a database;
s2, carrying out standardization processing on the data;
s3, preprocessing the standardized fields;
and S4, detecting the imported data.
As shown in fig. 2, importing data into the database in S1 specifically includes the following steps:
s11, collecting files reported by hospitals, and converting the files into a uniform format; the file formats comprise four formats of xls, xlsx, csv and dbf, and the data files are uniformly converted into the xlsx format through a third-party tool.
S12, storing the converted files in corresponding directories according to a certain classification rule; the classification rules include: the hospital classification catalog is divided into individual hospitals, relieved hospital associations, civil hospital associations, and Tianjin hospital associations.
S13, generating a database for the hospital according to the imported data file, and importing the information of the data file into a corresponding table;
and S14, creating a temporary table of the hospital, and importing the information of the data file into the corresponding temporary table. A total of six dictionary tables including: the medical record comprises a patient record head page code table of the hospital, a patient record head page dictionary table of the patient record head page of the patient record of the hospital, a patient classification and code (ICD-10), a patient record head page dictionary table of the patient record head page of the patient record, an operation classification and code (ICD-9-CM3), a patient record head page dictionary table of the patient record head page of the patient record, a morphological code and a patient record head page dictionary table of the patient record head page of the patient record, an operation grading.
The classification rules in S12 include: the method comprises the steps of storing catalogs of all years of a hospital under each type of hospital catalog, storing catalogs of all seasons under each year catalog, storing data files and dictionary table catalogs of the seasons of the hospital under each season catalog, storing dictionary table file catalogs under each dictionary table catalog, and storing dictionary table files under each dictionary table file catalog.
As shown in fig. 3, the normalization processing of data in S2 includes: mapping fields through a standardized dictionary, specifically comprising the following steps:
s21, obtaining the first 232 fields from the field mapping table of the database corresponding to the hospital.
And S22, matching the obtained first 232 fields with the standard 232 fields, and converting into capitalization during matching.
S23, judging whether the matching is successful; if the matching is successful, S24 is executed; otherwise, S25 is executed.
And S24, importing the matched data into a standard template table.
And S25, importing the field into the field mapping table and terminating the subsequent quality inspection process of the hospital. The matching is unsuccessful as long as there are fields that do not match.
The 232 fields of the standard include 232 fields of the satellite 4-1 standard.
Preprocessing the standardized fields in S3 includes standardizing the code and normalizing the format.
The method for standardizing the code specifically comprises the following steps: and converting the home code of the corresponding field into a standard code according to the mapping relation of the code table. When the yard code of the corresponding field is converted into the standard code, the yard code table is read; when reading the yard code table, the yard codes are automatically grouped according to commas. An example of a standard code is shown in table 1.
| Corresponding field | Standard code name | Standard code |
| YLFKFS | Basic medical insurance for town staff | 1 |
| YLFKFS | Basic medical insurance for urban residents | 2 |
| YLFKFS | Novel rural cooperative medical treatment | 3 |
| YLFKFS | Poverty relief | 4 |
| YLFKFS | Commercial medical insurance | 5 |
| YLFKFS | Full public fee | 6 |
| YLFKFS | All self-fee | 7 |
| YLFKFS | Other social insurance | 8 |
| YLFKFS | Others | 9 |
| XB | Unknown sex | 0 |
| XB | Male sex | 1 |
| XB | Female with a view to preventing the formation of wrinkles | 2 |
| XB | Unspecified sex | 9 |
TABLE 1 Standard code example table
The method for normalizing the format specifically comprises the following steps: acquiring data formats of 232 fields in a database; and converting the fields of the nvarchar data type into the fields of the corresponding type according to the data format, and setting the fields to be null if the conversion fails.
The standard code and the home code are in one-to-many relationship, specifically: the yard code is empty or a plurality of values, and the corresponding standard code is a determined value;
the data format includes string, double, datetime, int.
The detection of the imported data in S4 includes data detection and quality detection.
As shown in fig. 4, the data detection specifically includes the following steps:
s411, separating the diagnosis information and the operation information from the first page label data of the medical record into a separate table;
s412, updating data in the diagnosis information, the operation and operation information and the medical record attribute table, and preparing for later-stage statistics;
s413, counting the number of records in each month;
and S414, matching the disease dictionary table and the operation and operation dictionary table with the standard dictionary table, and counting the matching rate.
As shown in fig. 5, the quality inspection includes inspecting the data field of the first page of the medical record according to the quality inspection rule, and storing the inspection result in the database, and specifically includes the following steps:
s421, traversing all quality inspection rules;
s422, extracting the contents of the first page of the medical record from the data table according to the contents of the first page of the medical record related to each quality inspection rule;
and S423, judging whether the content of the first page of the medical record is legal or not according to the quality inspection rule.
The detection of the data field of the first page of the medical record according to the quality inspection rule specifically comprises the integrity of detection data, the standard of the detection data and the normalization of the detection data.
The integrity detection comprises detecting the integrity rate of the filling of the data of the first page of the medical record, including detecting the integrity of a mandatory field, detecting the integrity of an unnecessary field and detecting the integrity of a combined field, wherein the mandatory field comprises 29 fields including USERNAME, Y L FKFS, ZYCS, BAH, XM, XB, CSRQ, N L YFS, SFZZYJH and ZFY, the other fields except the mandatory field are unnecessary fields, and the combined field mainly comprises three diagnosis items (disease name, ICD-10 code and admission condition) and three operation items (operation and operation name, ICD-9-CM-3 code and operation date).
The detection of the standard property comprises the detection of the utilization rate of each code, the matching condition of a standard diagnosis and treatment subject directory and the codes of the department discharged from the home, the matching condition of the version of the disease dictionary table of the home and the matching condition of the version of the operation dictionary table of the home. The method mainly comprises the utilization rate of codes of 17 code tables, the matching condition of standard diagnosis and treatment subject name lists and codes of department discharged from the home, the matching condition of the version of a disease dictionary table of the home and the matching condition of the version of an operation dictionary table of the home. The 17 code tables include: medical payment mode, gender, occupation category, marital, admission route, admission condition, drug allergy, dead patient autopsy, blood type, RhD blood type, case quality, operation level, operation incision grade, operation incision healing category, anesthesia mode, leaving mode, and whether there is a plan of re-hospitalization within 31 days of discharge.
Detecting the normativity comprises detecting single field normativity, detecting closed field encoding logic, detecting combined field cost logic, and detecting combined field time logic.
The detection result comprises a detection result report and a question list.
The quality detection result is reported as an integral quality detection result, and comprises all indexes of the quality detection rule and a corresponding problem chain; the question link may be linked to a corresponding question list.
The problem detail tables are distributed according to the quality inspection result items, and each problem detail table comprises problem data recorded by one result item; the question list is stored according to the case number, the birth date, the admission time and the question field; the medical record number, the birth date and the admission time are used for positioning the data of the first page of the medical record, and the problem field is the data of the problem field, so that a user can conveniently and quickly position and modify the data of the first page of the medical record.
As shown in fig. 6, the system for detecting the quality of the data of the first page of the medical record comprises a data import module, which converts hospital data into a uniform format and imports the data into a database according to classification rules; the detection module is used for carrying out data detection and quality detection on the home page data of the hospital medical records; the standardization module is used for carrying out standardization processing on the imported data according to the standardization dictionary, and comprises code standardization and format standardization; identifying the content of the data file, and stopping quality inspection of the first page of the medical record of the hospital if an nonstandard file is identified; and the data statistical analysis module is used for performing statistical analysis on the data according to the quality inspection rule, analyzing the overall situation of the data of the first page of all hospital medical records in a certain period of time, obtaining a quality detection result report and giving a corresponding problem list.
The foregoing are merely exemplary embodiments of the present invention, which enable those skilled in the art to understand or practice the present invention. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments without departing from the spirit or scope of the invention. Thus, the present invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.
Claims (10)
1. The method for detecting the data quality of the first page of the medical record is characterized by comprising the following steps:
importing data into a database;
importing data into a database specifically comprises the following steps:
collecting files reported by a hospital, and converting the files into a uniform format;
storing the converted files in corresponding directories according to a certain classification rule; the classification rules include: storing the directories of each year of the hospital under each type of hospital directory, storing the directories of each quarter under each year directory, storing the data files and dictionary table directories of the quarter of the hospital under each quarter directory, storing each dictionary table file directory under each dictionary table directory, and storing each dictionary table file under each dictionary table file directory;
generating a database for the hospital according to the imported data file, and importing the information of the data file into a corresponding table;
creating a temporary table of the hospital and importing the information of the data file into the corresponding temporary table;
detecting the data imported into the temporary table, wherein the detection of the data imported into the temporary table comprises data detection and quality detection;
the data detection specifically comprises the following steps:
separating the diagnosis information and the operation and operation information from the first page data of the medical record into a separate table;
updating data in the diagnosis information, the operation and operation information and the medical record attribute table, and preparing for later statistics;
counting the number of records in each month;
matching the hospital disease dictionary table and the operation and operation dictionary table with the standard dictionary table, and counting the matching rate;
the quality detection comprises detecting the fields of the first page data of the medical records according to quality detection rules and storing the detection results in a database, and specifically comprises the following steps:
traversing all quality inspection rules;
extracting the related content of the first page of the medical record from the data table according to the related content of the first page of the medical record related to each quality inspection rule;
judging whether the related content of the first page of the medical record is legal or not according to the quality inspection rule;
detecting fields of the first page data of the medical records according to quality inspection rules, wherein the fields specifically comprise integrity of detection data, standard property of the detection data and normalization of the detection data;
the integrity of the detection data comprises the integrity rate of the data filling of the first page of the detection case, including the integrity of the detection mandatory field, the integrity of the detection unnecessary field and the integrity of the detection combined field;
the standard of the detection data comprises the usage rate of each code, the matching condition of a standard diagnosis and treatment subject directory and the codes of the department discharged from the home, the matching condition of the version of the disease dictionary table of the home and the matching condition of the version of the operation dictionary table of the home;
the normalization of the detection data comprises the normalization of a single detection field, the coding logic of a combined detection field, the cost logic of a combined detection field and the time logic of a combined detection field;
the detection result comprises a detection result report and a question list; the detection result is reported as an integral quality detection result, and comprises all indexes of a quality detection rule and a corresponding problem chain; the question chain can be linked to a corresponding question list; the problem detail tables are distributed according to quality inspection result items, and each problem detail table comprises problem data recorded by one result item; the question list is stored according to the case number, the birth date, the admission time and the question field; the case number, date of birth and time of admission are used to locate the case home page data, and the question field is the data of the question field.
2. The method of claim 1, further comprising, after importing the data into the database, the steps of:
carrying out standardization processing on the data;
and preprocessing the standardized fields.
3. The method of claim 2, wherein normalizing the data comprises: mapping fields through a standardized dictionary, specifically comprising the following steps:
acquiring the first 232 fields from a field mapping table of a database corresponding to a hospital;
matching the obtained first 232 fields with the standard 232 fields, and converting into capitalization during matching;
if the matching is successful, importing the matched data into a standard template table; if the field does not match, the field is imported into the field mapping table, and the subsequent quality inspection process of the hospital is terminated.
4. The method of claim 3, wherein the standard 232 fields comprise satellite 4-1 standard 232 fields.
5. The method of claim 2, wherein preprocessing the normalized fields comprises normalizing the code and normalizing the format.
6. The method of claim 5, wherein the step of normalizing the code comprises:
converting the yard codes of the corresponding fields into standard codes according to the mapping relation of the code table;
the method for normalizing the format specifically comprises the following steps: acquiring data formats of 232 fields in a database;
and converting the fields of the nvarchar data type into the fields of the corresponding type according to the data format, and setting the fields to be null if the conversion fails.
7. The method as claimed in claim 6, wherein the standard code and the home code are in one-to-many relationship, specifically:
the yard code is empty or a plurality of values, and the corresponding standard code is a determined value;
the data format comprises string, double, datetime and int.
8. The method as claimed in claim 6, wherein the house code table is read when converting the house code of the corresponding field into the standard code; when reading the yard code table, the yard codes are automatically grouped according to commas.
9. A medical record homepage data quality detection system using the method of any one of claims 1 to 8, comprising a data import module for converting hospital data into a uniform format and importing the uniform format into a database according to classification rules; and the combination of (a) and (b),
and the detection module is used for carrying out data detection and quality detection on the home page data of the hospital medical records.
10. The system of claim 9, further comprising a normalization module for normalizing the imported data according to a normalization dictionary, including code normalization and format normalization; identifying the content of the data file, and stopping quality inspection of the first page of the medical record of the hospital if an nonstandard file is identified; and the combination of (a) and (b),
and the data statistical analysis module is used for performing statistical analysis on the data according to the quality inspection rule, analyzing the overall situation of the first page data of all hospital medical records in a certain period of time, obtaining a quality detection result report and giving a corresponding problem detailed list.
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| CN109446192B (en) * | 2018-11-09 | 2021-06-29 | 贵州医渡云技术有限公司 | Data testing method and device |
| CN109659034A (en) * | 2018-11-30 | 2019-04-19 | 平安医疗健康管理股份有限公司 | Data Quality Assessment Methodology, device, equipment and the storage medium of first page of illness case |
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