CN112256738A - Medical linkage DRG quality control query method, device and system - Google Patents
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Abstract
The application provides a medical linkage DRG quality control query method, a device and a system, wherein the method comprises the following steps: acquiring a medical order from the HIS system and extracting main diseases and main operation code fields in the medical order; associating all charge items generated by the medical advice with the main disease and the main operation code fields; summarizing medical advice provision information under unified diseases according to the main diseases and the main operation code fields, wherein the medical advice provision information comprises: cost use, drug use and consumable use; judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption or not according to the summarized medical advice setting information; performing DRG grouping prejudgment according to information such as diagnosis and operation codes; a database of drug usage information associated with the diagnosis is formed.
Description
Technical Field
The application belongs to the technical field of medical insurance systems, and particularly relates to a medical linkage DRG quality control query method, device and system.
Background
The DRG disease grouping is an important management tool for the current medical management and expense reimbursement, the DRG grouping and quality control in the current medical management system mode are only determined according to the filling result of a set home page, and particularly, manual examination and quality control linkage are lacked in expense reimbursement. The most influential factors in the distribution of DRG groups are the main diagnosis, other diagnoses and main surgical operations on the first page of the medical record. At present, DRG payment requires that the disease with the most medical resources spent for treating the disease is mainly diagnosed, and other diseases which do not interfere in the hospitalization period and do not influence the hospitalization behavior should not be filled. Doctors may cause the filling deviation of related information of the first page of the medical record due to various subjective reasons such as benefit driving or insufficient experience in the context of DRG grouping, so that DRG grouping is wrong, and finally return difference is caused. The existing quality control system can not realize quality control of diagnosis and cost linkage, can not check the correctness of diagnosis selection through cost, and can not objectively judge the correctness of DRG grouping through system functions.
Disclosure of Invention
The application provides a medical linkage DRG quality control query method, device and system, which are used for at least solving the problem that the DRG grouping is wrong and the reimbursement difference is finally caused due to the fact that relevant information filling deviation of a medical record home page is possibly caused by various subjective reasons such as benefit driving or insufficient experience and the like under the DRG grouping background by a doctor at present.
According to one aspect of the application, a medical linkage DRG quality control query method is provided, which comprises the following steps:
acquiring a medical order from the HIS system and extracting main diseases and main operation code fields in the medical order;
associating all charge items generated by the medical advice with the main disease and the main operation code fields;
summarizing the medical order placing associated information under the unified diseases according to the main diseases and the main operation code fields, wherein the medical order placing associated information comprises the following steps: cost use, drug use and consumable use;
and judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption or not according to the summarized medical order information.
In one embodiment, the medical linkage DRG quality control query method further includes:
and acquiring a main treatment disease code, and acquiring the main treatment disease code and the main operation code when the medical order sets the operation and operation. And matching expense consumption categories according to the main treatment disease codes and the main operation codes, and related medicine use and consumable use information, including medicine universal name codes, medicine classification codes and consumable codes, universal names, materials, specifications and medical insurance classification information, and storing the information into a database. According to another aspect of the present application, there is also provided a medical linkage DRG quality control query device, including:
the main disease code field extraction unit is used for acquiring the medical advice from the HIS system and extracting main diseases and main operation code fields in the medical advice;
the association unit is used for associating all the charge items generated by the medical advice with the main diseases and the main operation code fields;
the summarizing unit is used for summarizing the associated information of medical advice provision under the unified diseases according to the main diseases and the main operation code fields, and the associated information of medical advice provision comprises: cost use, drug use and consumable use;
and the judging unit is used for judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption according to the summarized medical advice setting information.
In one embodiment, the medical linkage DRG quality control query device further comprises:
and the matching storage unit is used for acquiring the main treatment disease codes, matching the corresponding medicine universal name codes, medicine classification codes and medical insurance classification information according to the main treatment disease codes and storing the medicine universal name codes, the medicine classification codes and the medical insurance classification information into the database. And the system is used for acquiring the main operation codes, matching corresponding general names of consumables, consumable codes, consumable specifications and medical insurance classification information according to the main operation codes and storing the consumable codes, the consumable specifications and the medical insurance classification information into a database.
According to another aspect of the present application, there is also provided a medical linkage DRG quality control query system, including: the system comprises a database management module, an information input module, an information prompt module, an information output module and an information storage module;
the information input module is used for inputting the use categories of the information associated with the medical advice and the charge, and the use categories include and not only the main treatment disease codes and the medicine universal name codes, the medicine classification codes and the medical insurance classification information which are matched and correspond to the main treatment disease codes; the operation code of the main operation and the corresponding information such as the general name of the consumable, the code of the consumable, the specification of the consumable, the medical insurance classification and the like are input.
The information prompting module is used for prompting whether the diagnosis of the main diseases and the selection of the main operations accord with the consumption of main medical resources; and prompting the diagnosis of main diseases, the diagnosis of other diseases and whether the main operation conforms to the basic filling rules or not according to the coding rules.
The database management module is used for managing the stored main treatment disease and operation codes and the corresponding expense consumption classification matched with the codes, wherein the expense consumption classification comprises information such as medicine names, common names, medicine classifications and codes, medical insurance classifications and the like; and information such as general names of consumables, consumable codes, consumable specifications, medical insurance classifications and the like.
The information output module is used for outputting the query result;
the information storage module is used for storing the main treatment disease codes and corresponding medicine universal name codes, medicine classification codes and medical insurance classification information matched with the main treatment disease codes.
In one embodiment, the medical linkage DRG quality control query system further comprises: and the DRG grouping inquiry terminal is used for carrying out grouping result inquiry on the basis of a charge payment grouping principle and giving diagnosis and operation selection prompts according to the use principle of the main disease treatment codes.
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In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the drawings without creative efforts.
Fig. 1 is a flowchart of a medical linkage DRG quality control query method provided by the present application.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Under the current HIS system (medical advice and charging system), according to the current DRG payment scheme, the medical record home page management system and the HIS system are connected together, the medical advice is connected with various diseases and operation, under the condition of charging, the main diagnosis and operation filled in the first page of the quality control medical record are selected to be the disease and operation which are the most main treatment for the greatest medical resource consumption, and judges whether the related diagnosis generates medical resource consumption in the medical process, and carries out DRG prejudgment and basic rule check of the payment rule, meanwhile, the quality control can be carried out reversely under the condition of the established diagnosis, the use of the cost comprises whether the use of the medicine and the consumable material meets the standard or not, meanwhile, under the support of the database, the medicine use information of the same disease can be pushed to the doctor, and the doctor can inquire the case information related to the same diagnosis and medicine use information by taking the information as a clue.
The conventional electronic medical record system can not realize DRG synchronous grouping, the conventional DRG pre-judging system adopts a DRG grouping judgment result of a previous medical record code to perform similar medical record grouping information reference judgment, a DRG grouping scheme rule is not embedded, and particularly DRG grouping without a DRG payment scheme rule is realized. Moreover, the existing DRG pre-judging system does not comprise diagnosis and expense information linkage judgment, and does not have linkage between a diagnosis code and a medicine and consumable material use library.
In order to solve the above problem, the present application provides a medical linkage DRG quality control query method, as shown in fig. 1, including:
s101: acquiring a medical order from the HIS system and extracting main diseases and operation coding fields in the medical order;
s102: associating all charge items generated by the medical order with the main disease and operation code fields and the related operation code fields;
s103: summarizing medical advice provision information under unified diseases according to the main diseases and the main operation code fields, wherein the medical advice provision information comprises: cost use, drug use and consumable use;
s104: and judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption or not according to the summarized medical order information. And performing DRG grouping prejudgment and rule verification according to the established diagnosis and operation codes.
S105: and classifying and controlling whether medical consumption under set diagnosis meets use specifications according to the information related to the cost, and pushing the frequency and related information of the use condition of various medicines under the same disease to a doctor according to the previous medicine use information.
In one embodiment, the medical linkage DRG quality control query method further includes:
acquiring main treatment disease and operation codes, matching corresponding medicine universal name codes, medicine classification codes and medical insurance classification information according to the main treatment disease codes, and storing the medicine universal name codes, the medicine classification codes and the medical insurance classification information in a database
In a specific embodiment, under the existing HIS system and the medical record homepage filling system, a new field is added under the medical record field of the HIS system, each next medical record related to treatment needs to follow the main treatment purpose, the purpose is embodied in the form of disease code (disease classification code uniformly used by the country), and when the operation is related, the main treatment purpose is followed, and meanwhile, the operation classification code is attached to the prepared medical record, and the operation code can be fixedly matched with the medical record according to the established operation name. Under the HIS charging system, the charge is classified and divided, and meanwhile, a medicine universal name and consumable universal name classification database is embedded. When the medical advice charge is generated, the system can summarize according to the classification generated by the charge, judge the medical resource consumption of various diseases, and push the main treatment diseases with the maximum medical resource consumption to doctors when the patients are discharged, so that the doctors can conveniently select main diagnosis when filling in the home pages of the main medical records. Meanwhile, when the patient is settled, the settlement party can reversely control the rationality of main diagnosis selection of doctors and whether diagnosis and treatment behaviors are standard. Under the condition of long-term use, the system can also form a continuously perfect database to enrich the condition that various medicines are mainly used for treating diseases.
Based on the same inventive concept, the embodiment of the present application further provides a medical linkage DRG quality control query device, which can be used to implement the method described in the above embodiments, as described in the following embodiments. The principle of solving the problems of the medical linkage DRG quality control inquiry device is similar to that of the medical linkage DRG quality control inquiry method, so the implementation of the medical linkage DRG quality control inquiry device can refer to the implementation of the medical linkage DRG quality control inquiry method, and repeated parts are not repeated. As used hereinafter, the term "unit" or "module" may be a combination of software and/or hardware that implements a predetermined function. While the system described in the embodiments below is preferably implemented in software, implementations in hardware, or a combination of software and hardware are also possible and contemplated.
The application provides a medical treatment linkage DRG matter accuse inquiry unit includes:
the main disease code field extraction unit is used for acquiring the medical advice from the HIS system and extracting code fields related to main diseases in the medical advice;
the association unit is used for associating all the charge items generated by the medical advice with the main diseases and the main operation code fields;
the summarizing unit is used for summarizing the medical advice provision information under the unified diseases according to the main diseases and the main operation code fields, and the medical advice provision information comprises: cost use, drug use and consumable use;
and the judging unit is used for judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption according to the summarized medical advice setting information.
In one embodiment, the medical linkage DRG quality control query device further comprises:
and the matching storage unit is used for acquiring the main treatment disease codes, matching the corresponding medicine universal name codes, medicine classification codes and medical insurance classification information according to the main treatment disease codes and storing the medicine universal name codes, the medicine classification codes and the medical insurance classification information into the database.
In one embodiment, the application further provides a medical linkage DRG quality control query system, which comprises a database management module, an information input module, an information prompt module, an information output module and an information storage module. The method is characterized in that: through the input of information and the database information embedded in the system, under the condition of being linked with the expense classification, the diagnosis and the operation of the main medical resource consumption of the system are prompted. And when the DRG grouping information is output, the DRG grouping result of the electronic medical record diagnosis result can be synchronously inquired, and whether the current main diagnosis is the main disease of main medical resource consumption treatment or not and whether the treatment function of the main medicine consumption is related to the main disease or not can be controlled in quality. Meanwhile, a manual entry query end of a mobile phone is arranged, the filling rules of diagnosis and operation under the payment principle are embedded through information entry rule processing, the hidden transmission of the current mainstream coding library is embedded, and the DRG query result output under the hidden transmission condition of various coding libraries can be realized. The information storage module can collect the classification of the medicines mainly used for diagnosing diseases in the using process of the system, can continuously perfect the database related to the diseases and the medicines, can realize the prompt reference of the use of the previous medicines under the same diagnosis, and can control the medicine use normalization of the previous medicines in a quality control manner.
As will be appreciated by one skilled in the art, embodiments of the present invention may be provided as a method, system, or computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product embodied on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, and the like) having computer-usable program code embodied therein.
The present invention is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each flow and/or block of the flow diagrams and/or block diagrams, and combinations of flows and/or blocks in the flow diagrams and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
The principle and the implementation mode of the invention are explained by applying specific embodiments in the invention, and the description of the embodiments is only used for helping to understand the method and the core idea of the invention; meanwhile, for a person skilled in the art, according to the idea of the present invention, there may be variations in the specific embodiments and the application scope, and in summary, the content of the present specification should not be construed as a limitation to the present invention.
An embodiment of the present application further provides a specific implementation manner of an electronic device, which is capable of implementing all steps in the method in the foregoing embodiment, where the electronic device specifically includes the following contents:
a processor (processor), a memory (memory), a communication Interface (Communications Interface), and a bus;
the processor, the memory and the communication interface complete mutual communication through the bus;
the processor is configured to call the computer program in the memory, and the processor implements all the steps of the method in the above embodiments when executing the computer program, for example, implements steps S101-S105 when executing the computer program.
Embodiments of the present application also provide a computer-readable storage medium capable of implementing all the steps of the method in the above embodiments, and the computer-readable storage medium stores thereon a computer program, which when executed by a processor implements all the steps of the method in the above embodiments, for example, the processor implements the steps S101-S104 when executing the computer program.
The embodiments in the present specification are described in a progressive manner, and the same and similar parts among the embodiments are referred to each other, and each embodiment focuses on the differences from the other embodiments. In particular, for the hardware + program class embodiment, since it is substantially similar to the method embodiment, the description is simple, and the relevant points can be referred to the partial description of the method embodiment. Although embodiments of the present description provide method steps as described in embodiments or flowcharts, more or fewer steps may be included based on conventional or non-inventive means. The order of steps recited in the embodiments is merely one manner of performing the steps in a multitude of orders and does not represent the only order of execution. When an actual apparatus or end product executes, it may execute sequentially or in parallel (e.g., parallel processors or multi-threaded environments, or even distributed data processing environments) according to the method shown in the embodiment or the figures. The terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. Without further limitation, the presence of additional identical or equivalent elements in a process, method, article, or apparatus that comprises the recited elements is not excluded. For convenience of description, the above devices are described as being divided into various modules by functions, and are described separately. Of course, in implementing the embodiments of the present description, the functions of each module may be implemented in one or more software and/or hardware, or a module implementing the same function may be implemented by a combination of multiple sub-modules or sub-units, and the like. The above-described embodiments of the apparatus are merely illustrative, and for example, the division of the units is only one logical division, and other divisions may be realized in practice, for example, a plurality of units or components may be combined or integrated into another system, or some features may be omitted, or not executed. In addition, the shown or discussed mutual coupling or direct coupling or communication connection may be an indirect coupling or communication connection through some interfaces, devices or units, and may be in an electrical, mechanical or other form. The present invention is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each flow and/or block of the flow diagrams and/or block diagrams, and combinations of flows and/or blocks in the flow diagrams and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
As will be appreciated by one skilled in the art, embodiments of the present description may be provided as a method, system, or computer program product. Accordingly, embodiments of the present description may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, embodiments of the present description may take the form of a computer program product embodied on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, and so forth) having computer-usable program code embodied therein. The embodiments in the present specification are described in a progressive manner, and the same and similar parts among the embodiments are referred to each other, and each embodiment focuses on the differences from the other embodiments. In particular, for the system embodiment, since it is substantially similar to the method embodiment, the description is simple, and for the relevant points, reference may be made to the partial description of the method embodiment. In the description herein, references to the description of the term "one embodiment," "some embodiments," "an example," "a specific example," or "some examples," etc., mean that a particular feature, structure, material, or characteristic described in connection with the embodiment or example is included in at least one embodiment or example of an embodiment of the specification.
In this specification, the schematic representations of the terms used above are not necessarily intended to refer to the same embodiment or example. Furthermore, various embodiments or examples and features of different embodiments or examples described in this specification can be combined and combined by one skilled in the art without contradiction. The above description is only an example of the embodiments of the present disclosure, and is not intended to limit the embodiments of the present disclosure. Various modifications and variations to the embodiments described herein will be apparent to those skilled in the art. Any modification, equivalent replacement, improvement, etc. made within the spirit and principle of the embodiments of the present specification should be included in the scope of the claims of the embodiments of the present specification.
Claims (8)
1. A medical treatment linkage DRG quality control query method is characterized by comprising the following steps:
acquiring a medical order from the HIS system and extracting main diseases and main operation code fields in the medical order;
associating all billing items resulting from the order with the primary disease and primary procedure code fields;
summarizing medical advice provision associated information under unified diseases according to the main diseases and the main operation code fields, wherein the medical advice provision associated information comprises: cost use, drug use and consumable use;
and judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption or not according to the summarized medical order information.
2. The medical linkage DRG quality control query method according to claim 1, further comprising:
acquiring a main treatment disease code, matching a corresponding medicine universal name code, a medicine classification code and medical insurance classification information according to the main treatment disease code, and storing the medicine universal name code, the medicine classification code and the medical insurance classification information into a database.
3. A medical treatment linkage DRG quality control inquiry unit is characterized by comprising:
the main disease and main operation code field extraction unit is used for acquiring the medical advice from the HIS system and extracting the main disease and main operation code field in the medical advice;
an association unit for associating all charge items generated by the order with the main disease and main surgery code fields;
the summarizing unit is used for summarizing medical advice provision information under unified diseases according to the main diseases and the main operation code fields, and the medical advice provision information comprises: cost and drug use;
and the judging unit is used for judging whether the diagnosis of the main diseases and the selection of the main operations accord with the main medical resource consumption according to the summarized medical advice setting information.
4. The medical linkage DRG quality control inquiry device of claim 3, further comprising:
and the matching storage unit is used for acquiring the main treatment disease codes, matching the corresponding medicine universal name codes, medicine classification codes and medical insurance classification information according to the main treatment disease codes and storing the medicine universal name codes, the medicine classification codes and the medical insurance classification information into a database.
5. An electronic device comprising a memory, a processor and a computer program stored on the memory and executable on the processor, wherein the processor implements the method of quality control inquiry of medical linked DRG according to any of claims 1 to 2 when executing the program.
6. A computer-readable storage medium, on which a computer program is stored, wherein the computer program, when executed by a processor, implements the method for quality control inquiry of medical linked DRG according to any of claims 1 to 2.
7. A medical treatment linkage DRG quality control inquiry system is characterized by comprising: the system comprises a database management module, an information input module, an information prompt module, an information output module and an information storage module;
the information input module is used for inputting the main treatment disease codes and the medicine universal name codes, the medicine classification codes and the medical insurance classification information which are matched and correspond to the main treatment disease codes;
the information prompting module is used for prompting whether the diagnosis of the main diseases and the selection of the main operations meet the main medical resource consumption;
the database management module is used for managing the stored main treatment disease codes and corresponding medicine universal name codes, medicine classification codes and medical insurance classification information matched with the main treatment disease codes;
the information output module is used for outputting the query result;
the information storage module is used for storing the main treatment disease codes and corresponding medicine universal name codes, medicine classification codes and medical insurance classification information matched with the main treatment disease codes.
8. The medical linkage DRG quality control query system of claim 7, further comprising: and the DRG grouping inquiry terminal is used for inquiring the grouping result on the basis of a charge payment grouping principle and giving diagnosis and operation selection prompts according to the use principle of the main treatment disease codes.
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Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN113593686A (en) * | 2021-08-05 | 2021-11-02 | 南方医科大学珠江医院 | Medical insurance comprehensive management system and management method based on DRG/DIP full-flow medical quality supervision |
| CN114153871A (en) * | 2021-12-07 | 2022-03-08 | 上海柯林布瑞信息技术有限公司 | Data query optimization method and device based on DIP grouping |
| CN116563039A (en) * | 2023-07-06 | 2023-08-08 | 山东贝森医院管理咨询有限公司 | Medical insurance management method and system based on DRG/DIP |
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