CN114461616A - CHS-DRG data quality management system - Google Patents
CHS-DRG data quality management system Download PDFInfo
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- CN114461616A CN114461616A CN202111593899.9A CN202111593899A CN114461616A CN 114461616 A CN114461616 A CN 114461616A CN 202111593899 A CN202111593899 A CN 202111593899A CN 114461616 A CN114461616 A CN 114461616A
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- 238000003326 Quality management system Methods 0.000 title claims abstract description 13
- 238000003908 quality control method Methods 0.000 claims abstract description 39
- 230000008520 organization Effects 0.000 claims abstract description 5
- 238000005457 optimization Methods 0.000 description 4
- 238000010586 diagram Methods 0.000 description 3
- 230000007246 mechanism Effects 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 2
- 230000004075 alteration Effects 0.000 description 1
- 239000002131 composite material Substances 0.000 description 1
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06F—ELECTRIC DIGITAL DATA PROCESSING
- G06F16/00—Information retrieval; Database structures therefor; File system structures therefor
- G06F16/20—Information retrieval; Database structures therefor; File system structures therefor of structured data, e.g. relational data
- G06F16/21—Design, administration or maintenance of databases
- G06F16/215—Improving data quality; Data cleansing, e.g. de-duplication, removing invalid entries or correcting typographical errors
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06F—ELECTRIC DIGITAL DATA PROCESSING
- G06F16/00—Information retrieval; Database structures therefor; File system structures therefor
- G06F16/20—Information retrieval; Database structures therefor; File system structures therefor of structured data, e.g. relational data
- G06F16/24—Querying
- G06F16/245—Query processing
- G06F16/2455—Query execution
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06F—ELECTRIC DIGITAL DATA PROCESSING
- G06F3/00—Input arrangements for transferring data to be processed into a form capable of being handled by the computer; Output arrangements for transferring data from processing unit to output unit, e.g. interface arrangements
- G06F3/01—Input arrangements or combined input and output arrangements for interaction between user and computer
- G06F3/048—Interaction techniques based on graphical user interfaces [GUI]
- G06F3/0481—Interaction techniques based on graphical user interfaces [GUI] based on specific properties of the displayed interaction object or a metaphor-based environment, e.g. interaction with desktop elements like windows or icons, or assisted by a cursor's changing behaviour or appearance
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- G—PHYSICS
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- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
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Abstract
The invention relates to a CHS-DRG data quality management system, comprising: the medical insurance bill acquisition and management module is used for reporting the information of the payment fee of the patient by swiping a card by each medical insurance business organization and collecting the fee before fund settlement; the medical record home page acquisition management module is used for inquiring the information of the fee for card swiping and settlement of the corresponding patient, uploading the correlation condition of the medical record and checking the fee before fund settlement; the medical record uploading condition analysis module is used for inquiring the summary conditions of the card swiping cost, the card swiping quantity and the uploaded medical records of all medical insurance in the corresponding hospital within a period of time by a user and displaying various dimension analysis results; the data quality control analysis module is used for carrying out statistics and analysis on quality control conditions by taking hospitals in an area as dimensions; the data quality control detail module is used for displaying data quality control analysis details; the problem case inquiry module is used for inquiring the detailed information of the case with the problem of data quality control. The DRG payment pricing is facilitated, so that the regional medical insurance fund payment requirement can be met as soon as possible.
Description
Technical Field
The invention relates to the field of medical management, in particular to a CHS-DRG data quality management system.
Background
In order to ensure that DRG payment reform related projects land, promote the establishment of a DRG payment system, mainly pay DRG under the total budget, combine multiple composite payment modes such as pay by disease, pay by bed day and the like, and carry out quality control on CHS-DRG data quality under the requirements of CHS-DRG unified specification and unified standard, so as to be beneficial to DRG payment pricing.
Disclosure of Invention
The technical problem to be solved by the present invention is to provide a CHS-DRG data quality management system to overcome the above-mentioned deficiencies in the prior art.
The technical scheme for solving the technical problems is as follows:
a CHS-DRG data quality management system, comprising:
the medical insurance bill acquisition and management module is used for reporting the information of the payment fee of the patient by swiping a card by each medical insurance business organization and collecting the fee before fund settlement;
the medical record home page acquisition management module is used for inquiring the information of the fee for card swiping and settlement of the corresponding patient, uploading the correlation condition of the medical record and checking the fee before fund settlement;
the medical record uploading condition analysis module is used for inquiring the summary conditions of the card swiping cost, the card swiping quantity and the uploaded medical records of all medical insurance in the corresponding hospital within a period of time by a user and displaying various dimension analysis results;
the data quality control analysis module is used for carrying out statistics and analysis on quality control conditions by taking hospitals in an area as dimensions;
the data quality control detail module is used for displaying data quality control analysis details;
the problem case inquiry module is used for inquiring the detailed information of the case with the problem of data quality control.
On the basis of the technical scheme, the invention can be further improved as follows.
Further, the medical insurance bill collection and management module comprises:
the expense list acquisition unit is used for reporting the condition of all card swiping expenses of the corresponding hospital within a period of time by a user;
and the expense list inquiry unit is used for inquiring the condition of all the card swiping expenses of the corresponding hospital within a period of time by the user.
Further, the expense bill collecting unit mainly collects information of medical insurance settlement kc21\ kc 24.
Further, the medical record home page collection management module comprises:
the system comprises a medical record home page matching detail query unit, a data processing unit and a data processing unit, wherein the medical record home page matching detail query unit is used for a user to query the summary condition of the card swiping cost, the card swiping quantity and the uploaded medical record of all medical insurance in a corresponding hospital within a period of time, and can check the corresponding cost detail and the medical record detail condition;
the medical record home page matching and gathering query unit is used for a user to query all the card swiping expenses of the corresponding hospital within a period of time and upload the gathering condition of the medical records.
Furthermore, the data quality control analysis module displays the result by using the medical record quality control analysis histogram and the medical record quality control detailed table.
The invention has the beneficial effects that: the quality control is carried out on the CHS-DRG data quality, so that the DRG payment pricing is facilitated, and the requirement of regional medical insurance fund payment according to the DRG is met as soon as possible.
Drawings
FIG. 1 is a block diagram of the CHS-DRG data quality management system of the present invention;
FIG. 2 is a block diagram of the medical insurance invoice collecting and managing module according to the present invention;
FIG. 3 is a block diagram of the collection and management module for the first page of the medical records of the present invention.
Detailed Description
The principles and features of this invention are described below in conjunction with the following drawings, the examples of which are set forth to illustrate the invention and are not intended to limit the scope of the invention.
Example 1
As shown in fig. 1, a CHS-DRG data quality management system includes:
the medical insurance bill acquisition and management module is used for reporting the information of the payment settlement cost of the patient by the card of each medical insurance business organization, collecting the cost before the fund settlement, and taking the data as one of important bases of medical insurance pricing;
the medical record home page acquisition management module is used for inquiring the information of the fee for card swiping and settlement of the corresponding patient, uploading the correlation condition of the medical record and checking the fee before fund settlement;
the medical record uploading condition analysis module is used for inquiring the summary conditions of the card swiping cost, the card swiping quantity and the uploaded medical records of all medical insurance in the corresponding hospital within a period of time by a user and displaying various dimension analysis results;
the data quality control analysis module is used for carrying out statistics and analysis on quality control conditions by taking hospitals in an area as dimensions;
the data quality control detail module is used for displaying data quality control analysis details;
the problem case inquiry module is used for inquiring the detailed information of the case with the problem of data quality control.
Example 2
As shown in fig. 2, this embodiment is further optimized based on embodiment 1, and it specifically includes the following steps:
the medical insurance bill collection management module comprises:
the expense list acquisition unit is used for reporting the condition of all card swiping expenses of the corresponding hospital within a period of time by a user;
description of the function: importing according to the requirements of the template;
description of the operation: clicking a navigation bar [ expense list acquisition ] button, entering a query page, inputting query conditions, clicking a button [ upload ], and checking an upload prompt;
the expense list inquiry unit is used for inquiring the condition of all the card swiping expenses of the corresponding hospital within a period of time by a user;
description of the function: querying, viewing and deriving query results;
description of the operation: clicking a navigation bar [ expense list query ] button, entering a query page, inputting query conditions, clicking a button [ query ], and displaying a query result; clicking a page folding button, expanding/hiding advanced inquiry of medical records, and checking detailed medical record information corresponding to the cost;
and (3) query conditions: and inquiring corresponding records according to the institution information, the personnel information, the bed day settlement mark, the admission/discharge time, the settlement time and the like.
Example 3
The present embodiment is further optimized based on embodiment 2, and it specifically includes the following steps:
the expense bill acquisition unit mainly acquires information of medical insurance settlement kc21\ kc 24.
Example 4
As shown in fig. 3, this embodiment is further optimized based on embodiment 1, and it specifically includes the following steps:
the medical record home page collection management module comprises:
the system comprises a medical record home page matching detail query unit, a data processing unit and a data processing unit, wherein the medical record home page matching detail query unit is used for a user to query the summary condition of the card swiping cost, the card swiping quantity and the uploaded medical record of all medical insurance in a corresponding hospital within a period of time, and can check the corresponding cost detail and the medical record detail condition;
description of the function: querying, viewing and deriving query results;
and (3) query conditions: settlement time (month), pool category, institution information, institution level.
Description of the operation: clicking a navigation bar [ medical record home page matching query (summary) ] button, entering a query page, inputting query conditions, clicking the button [ query ], and displaying a query result;
clicking a page folding button to expand/hide advanced inquiry of medical records;
the detail button can be clicked to operate, a expense detail checking interface is opened, and detailed expense information corresponding to expenses is checked;
clicking an interface to view a medical record button, and continuing to open an interface for viewing detailed information of the medical record to view details of the medical record;
the medical record home page matching and gathering query unit is used for a user to query the gathering conditions of all the card swiping expenses of the corresponding hospital within a period of time and uploading medical records;
description of the function: querying, viewing and deriving query results;
and (3) query conditions: settlement time, overall category, institution information, institution grade, admission time, discharge time, medical record uploading mark, remote medical service sign, identification number and transaction type;
description of the operation: clicking a navigation bar [ medical record home page matching query (detail) ] button, entering a query page, inputting a query condition, clicking the button [ query ], and displaying a query result;
clicking a page folding button to expand/hide advanced inquiry of medical records;
clicking an operation detail button, opening a medical record viewing interface, and viewing detailed medical record information corresponding to the expense.
Example 5
This example is a further optimization performed on the basis of example 1, and specifically includes the following:
the medical record uploading condition analysis module has the following functional description: querying, viewing and deriving query results;
and (3) query conditions: settlement time (month), overall category, institution information, institution level;
description of the operation: clicking a navigation bar (medical record uploading condition analysis) button, entering a query page, inputting query conditions, clicking the button (query), and displaying a query result.
Example 6
This example is a further optimization performed on the basis of example 1, and specifically includes the following:
functional specification of a data quality control analysis module: querying, viewing and exporting analysis results;
description of the operation: clicking a navigation bar [ quality control analysis ] button, entering an analysis query page, inputting a query condition, clicking the button [ query ], and displaying a query result;
clicking a page folding button, and expanding/hiding the advanced query;
and (3) query conditions: selecting organization mechanisms in user permissions according to the date of discharge and year, quarter and month, and selecting a mechanism type and a mechanism grade through high-level screening;
and (5) inquiring results: a problem case quality control analysis histogram and a case quality control detail table;
the data quality control analysis module displays the result by the case quality control analysis histogram and the case quality control detail table, and can display the case quality control condition of the hospital represented by the column by clicking the analysis histogram;
in the distribution detail module, selecting the name of the hospital to be inquired, and displaying the quality control distribution details of the medical records of the inquired hospital in a lower list display area; clicking a [ viewing ] button to enter a viewing page, and viewing the ranking condition of each department in the hospital; clicking a [ export ] button to export the content of the list displayed in the current list display area; dragging the side sliding bar to view the hidden form field; clicking the fold button may expand/hide the distribution details module.
Example 7
This example is a further optimization performed on the basis of example 1, and specifically includes the following steps:
functional description of the data quality control detail module: querying, viewing and deriving query results;
and (3) query conditions: settlement time (month), overall category, institution information, institution level;
description of the operation: clicking a navigation bar [ data quality control details ] button, entering a query page, inputting query conditions, clicking the button [ query ], and displaying a query result.
And clicking the viewing details to view the detailed information of the corresponding record.
Example 8
This example is a further optimization performed on the basis of example 1, and specifically includes the following:
question and medical record query module
Description of the function: querying, viewing and deriving query results;
and (3) query conditions: upload time (month), institution information, institution level.
Description of the operation: clicking a navigation bar [ problem and medical record inquiry ] button, entering an inquiry page, inputting inquiry conditions, clicking the button [ inquiry ], and displaying an inquiry result;
clicking the viewing details to view the detailed information of the corresponding record;
and clicking the settlement list in the pop-up box to check the settlement expense information of the corresponding record.
Although embodiments of the present invention have been shown and described above, it should be understood that the above embodiments are exemplary and not to be construed as limiting the invention, and that changes, modifications, substitutions and alterations can be made to the above embodiments by those of ordinary skill in the art within the scope of the invention.
Claims (5)
1. A CHS-DRG data quality management system, comprising:
the medical insurance bill acquisition and management module is used for reporting the information of the payment fee of the patient by swiping a card by each medical insurance business organization and collecting the fee before fund settlement;
the medical record home page acquisition management module is used for inquiring the information of the fee for card swiping and settlement of the corresponding patient, uploading the correlation condition of the medical record and checking the fee before fund settlement;
the medical record uploading condition analysis module is used for inquiring the summary conditions of the card swiping cost, the card swiping quantity and the uploaded medical records of all medical insurance in the corresponding hospital within a period of time by a user and displaying various dimension analysis results;
the data quality control analysis module is used for carrying out statistics and analysis on quality control conditions by taking hospitals in an area as dimensions;
the data quality control detail module is used for displaying data quality control analysis details;
the problem case inquiry module is used for inquiring the detailed information of the case with the problem of data quality control.
2. The CHS-DRG data quality management system according to claim 1, wherein the medical insurance invoice collection management module comprises:
the expense list acquisition unit is used for reporting the condition of all card swiping expenses of the corresponding hospital within a period of time by a user;
and the expense list inquiry unit is used for inquiring the condition of all the card swiping expenses of the corresponding hospital within a period of time by the user.
3. The CHS-DRG data quality management system as claimed in claim 1 or 2, wherein the invoice collecting unit mainly collects information of medical insurance settlement kc21\ kc 24.
4. The CHS-DRG data quality management system according to claim 1, 2 or 3, wherein the medical record homepage collection management module comprises:
the system comprises a medical record home page matching detail query unit, a data processing unit and a data processing unit, wherein the medical record home page matching detail query unit is used for a user to query the summary condition of the card swiping cost, the card swiping quantity and the uploaded medical record of all medical insurance in a corresponding hospital within a period of time, and can check the corresponding cost detail and the medical record detail condition;
the medical record home page matching and gathering query unit is used for a user to query all the card swiping expenses of the corresponding hospital within a period of time and upload the gathering condition of the medical records.
5. The CHS-DRG data quality management system according to claim 1, wherein the data quality control analysis module displays the results by using a case quality control analysis histogram and a case quality control detail table.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202111593899.9A CN114461616A (en) | 2021-12-23 | 2021-12-23 | CHS-DRG data quality management system |
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| CN202111593899.9A CN114461616A (en) | 2021-12-23 | 2021-12-23 | CHS-DRG data quality management system |
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| CN114461616A true CN114461616A (en) | 2022-05-10 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN117632920A (en) * | 2023-11-21 | 2024-03-01 | 上海金仕达卫宁软件科技有限公司 | Quality analysis method and system based on medical insurance settlement data |
Citations (5)
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| CN201853236U (en) * | 2010-08-11 | 2011-06-01 | 上海宝景信息技术发展有限公司 | Highly-efficient medical service system |
| CN102156818A (en) * | 2011-04-12 | 2011-08-17 | 成都中医药大学 | Hospital information system and terminal thereof |
| CN105844566A (en) * | 2016-03-25 | 2016-08-10 | 东华软件股份公司 | Electronic medical record filing management system and electronic medical record filing management method |
| CN107800755A (en) * | 2016-09-12 | 2018-03-13 | 平安科技（深圳）有限公司 | Medical information processing method and device |
| CN112686684A (en) * | 2020-12-08 | 2021-04-20 | 望海康信(北京)科技股份公司 | Medical expense management system and corresponding equipment and storage medium |
-
2021
- 2021-12-23 CN CN202111593899.9A patent/CN114461616A/en active Pending
Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN201853236U (en) * | 2010-08-11 | 2011-06-01 | 上海宝景信息技术发展有限公司 | Highly-efficient medical service system |
| CN102156818A (en) * | 2011-04-12 | 2011-08-17 | 成都中医药大学 | Hospital information system and terminal thereof |
| CN105844566A (en) * | 2016-03-25 | 2016-08-10 | 东华软件股份公司 | Electronic medical record filing management system and electronic medical record filing management method |
| CN107800755A (en) * | 2016-09-12 | 2018-03-13 | 平安科技（深圳）有限公司 | Medical information processing method and device |
| CN112686684A (en) * | 2020-12-08 | 2021-04-20 | 望海康信(北京)科技股份公司 | Medical expense management system and corresponding equipment and storage medium |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN117632920A (en) * | 2023-11-21 | 2024-03-01 | 上海金仕达卫宁软件科技有限公司 | Quality analysis method and system based on medical insurance settlement data |
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Application publication date: 20220510 |