JP2001338064A - Nursing insurance reception control system and input slip for the system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a new nursing supporting insurance reception control system capable of facilitating countermeasures to a nursing insurance system introduced from April in 2000. SOLUTION: In this new system, a private slip capable of easily writing the nursing contents of a nursing insurance is developed, and a data slip indicating nursing by a case worker himself or herself is inputted by a reading device such as a scanner so that the office work of the worker himself or herself can be reduced, and a nursing reward bill corresponding to the obtained data is automatically calculated so that the bill can be transmitted to a national insurance union by the Internet communication means.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The present invention relates to a new system for managing nursing care receipts in nursing homes and the like, and a new system that can be used in this system by introducing a nursing care insurance system which was tested in April 2000. It provides an input form for business.

[0002]

2. Description of the Related Art In recent years, as a technique for processing medical-related claims, it has been known to store and edit related data using a computer. As old as
-325056 "Carteres system", medical examination ticket image input to the computer using a magnetic card and a ram card, medical expenses calculation, treatment, medication, etc. at the same time as the creation of medical charts, and input at each location, at the end of the month It discloses a technique that can be used for a receipt, while a huge medical record can be stored on a computer.

[0003] Japanese Patent Application Laid-Open No. 7-160770 "Medical practice check system" comprises a disease name input means, a medical practice input means, a related information storage means, a collation means for collating the contents of a disease name and a medical practice, and a warning for generating a warning. A medical treatment check system is disclosed in which a message output unit is processed by a computer to eliminate a check omission or a check mistake, reduce time, and reduce the number of personnel for the preparation of a receipt.

Further, regarding the processing of medical insurance data,
Japanese Patent Application Laid-Open No. 7-200699 "Medical insurance data processing method, apparatus and processing system" inputs a plurality of types of data corresponding to a receipt and compares the plurality of types of input data with specific types of data However, if it is determined based on this comparison that the correspondence of these data does not meet the predetermined condition, one of the plurality of types of input data is an input error and is inappropriate. A medical insurance data processing method and the like corresponding to a data input / output error that informs the user of an error is disclosed.

Japanese Unexamined Patent Publication No. 2000-113062 "Receipt Data Storage Method and Apparatus" discloses a means for processing health and accounting information data as a receipt data into a receipt accumulation management file and sequentially storing and selecting the same. A medical office system in a hospital that reads and processes these files and collectively accumulates them to add and disperse the receipt data accumulation processing is disclosed.

[0006]

As described above, in the conventional medical-related claim processing, a system for processing a huge amount of receipt data using a computer has been established, but a care insurance system introduced from this year. In the long-term care insurance receipt management system itself, there is a problem that details of health-related items and the like are undecided, and it is difficult to establish software itself such as cost calculation corresponding to the long-term care items.

Another major practical problem is that it is necessary to describe the contents of care provided to a patient by a worker who has taken care of the patient, and to further input the data by the worker or clerk at a computer terminal. Because of this, extra time was required for input errors and input work.

[0008]

According to the present invention, care data described by a worker is OCR-processed using a system input form prepared for each care item prepared in advance, or the data is directly sent to a server using a facsimile. It is a new system that accumulates and sends a nursing care fee request corresponding to a nursing care service to each prefectural branch of the National Health Insurance Federation (hereinafter referred to as the National Health Insurance Federation) using the Internet communication of a computer.

More specifically, a first aspect of the present invention is a care insurance receipt management system comprising a computer for inputting and outputting care insurance related receipt data and a server for storing these various data. In conjunction with a device that reads form data and has a communication function with another computer, the server stores data input to the computer,
This is a long-term care insurance receipt management system that has a function of directly inputting data transmitted via another facsimile.

In a second aspect of the present invention, the input form having the predetermined shape is a form in which a resident number, a service time, a worker number, and a specific service item can be filled in numerically. It is a care insurance receipt management system described.

A third aspect of the present invention is that the reading device reads data of an input form in cooperation with a computer,
3. The care insurance claim management system according to claim 1, wherein the system is an image scanner that performs an OCR process.

A fourth aspect of the present invention is that a resident number, a service time, and a worker number are used as common entry items in a receipt input form, and only specific service items are digitized in accordance with the contents of the service. This is an input form for a care insurance claim management system, which is a form that can be filled out.

[0013]

DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 is a basic configuration diagram showing the entire system of the present invention. FIG. 2 is a drawing showing the overall business process of the system of the present invention.

The basic configuration of the system of the present invention is as follows: scanner input of handwritten forms and OCR processing Insured person registration function Storage function to server Periodical storage function to DVD-RAM Communication).

In order to process these items, a personal computer, a display device, and an external storage device are used as hardware. Scanners and SCSI cards are linked, and software for operating these hardware is as follows: Insured person registration processing Scanner input processing of handwritten forms OCR processing of images Storage processing to server Periodic storage processing to DVD-RAM Processing for nursing care fee Processing Communication (communication to the National Health Insurance Federation) MS SQL Server 7.0 and MS-ACCESS
2000 in the hardware.

In preparation for using these systems,
First, the resident who has entered the facility to receive care insurance is registered. FIG. 3 is a flow sheet for inputting data of an insured person who is a resident. This input is made so that only a pre-designated authorized person can input using his / her own password. This prevents third parties from arbitrarily examining the resident's privacy and falsifying other data.

In this case, an example of a resident list file format used for input is shown in FIG. 4. However, since personal information of the resident is input, sufficient care must be taken for information management as described above. is there.

Next, as a pre-process for reading the nursing care insurance claim, a format of an item to be a nursing care reward is defined and registered in a computer. These items are, as shown in FIG. 5 meal file, FIG. 6 hydration file, FIG. 7 excretion / posture file A, FIG. 8 excretion / posture file B, FIG.・ Position,
If you divide it into other types and divide it into 4 types of forms,
If you write the contents of the worker's actual care in these four types of forms, and read the numbers or symbols with a scanner,
The automatically input data is to be stored in the server.

In addition, software for converting the number, degree, or description of each nursing care item into an official format specified by the National Health Insurance Federation is introduced so that a nursing care fee can be requested.

In this case, as shown in FIG. 10, it is necessary to previously register a unit price table of the nursing care service based on the unit price of the nursing care service issued by the Ministry of Health and Welfare. As a result, the items described by the worker are automatically calculated according to the individual's individual's nursing care rank that has been certified for nursing care, and the compensation amount for each applicable day is issued, and monthly Remuneration for each resident is also issued for each resident.

As shown in FIG. 11, as an example, a system input form used in the present system includes a resident number, a service time, and a worker number as common entry items, and matches only specific service items with the contents of the service. It is a form that can be filled in numerically.

In the present system, the types of input forms for the system are summarized into four types: a care service meal form, a care service hydration form, a care service excretion / posture form, and other forms. After reading these filled out forms with a scanner, OCR processing can be performed as shown in FIG.

In this case, FIG.
The form image input by the scanner as shown in FIG.
It is structured to be converted into an image (or format definition file) in IFF (Tagged Image File Format) format and stored in a specific directory. This TIFF format image is subjected to OCR processing, and the result is displayed on an OCR correction screen. Is done.

Next, the contents corrected on the OCR correction screen are stored in a correction file, and the correction file is further modified by a manager or a clerk.

In this system, since various data are input by many users, a simple input form is prepared for the operation means as shown in FIG. On this operation screen, ordinary workers can proceed to the nursing insurance claim operation screen by entering execution without entering a user code or password, but only the administrator who is an authorized person can use these user codes. And a password, so that a resident list operation screen, a care insurance claim operation screen, or a worker file operation screen can be operated.

FIG. 15 is a resident list input screen displayed when the resident list operation screen is selected. In addition to the following operation items, scanner input and correction / registration status can be selected. And personal photos.

Similarly, FIG. 16 shows a nursing care remuneration request screen which can be operated only by the administrator. In addition to displaying remuneration details for a designated period, software for enabling calculation, transmission, and cancellation operations on this screen can be displayed. Is becoming

In the care insurance claim input operation, as shown in FIG. 17, a worker or clerk other than the manager can input a scanner, and can confirm the total result of the input.

In this operation, when the “work end Q” and “compensation calculation / printing E” buttons are pressed on the screen, the application is not terminated, the compensation calculation is started, and the software is printed so that the compensation is printed. Is becoming

In the present system, the form described by the worker is read by the scanner and subjected to the OCR processing. However, if there is no scanner near the worker, Fa
It is also possible to store the data directly transmitted by x transmission in an SQL server and check the transmitted data by a manager or a clerk at a computer terminal.

Hereinafter, the present invention will be described in detail with reference to examples.

[0032]

[Example 1] At A nursing home for the elderly under Tokyo, 50 residents receiving nursing care insurance were accepted and started nursing care. Therefore, a new system has been developed in which case workers or clerks can easily input nursing care data and set a fee for the nursing care.

As the hardware of the system, as shown in FIG. 1, a personal computer, a display device, an external storage device, a scanner, and a SCSI card are connected as hardware, and an Internet communication function is provided so that the obtained data can be reported to the National Health Insurance Federation. I had it.

As software for operating these hardware, an insured person registration process, a scanner input process of a handwritten form, an OCR process of an image, a process of storing in a server, a periodic storage process of a DVD-RAM, a process of requesting a nursing care fee, Communication to) MS SQL Server 7.0 and MS-ACCESS
2000 in the hardware.

In preparation for using these systems,
First, in order to register an insured person of a resident who has entered a facility to receive long-term care insurance, only data of the insured person who is a resident according to the flow sheet shown in FIG. Was entered using the password.

In this case, since the data to be input is based on personal privacy information as shown in FIG. 4, only the authorized person can input using his own password. This prevented a third party from arbitrarily examining the resident's privacy and falsifying other data.

Next, as a pre-process for reading the nursing care insurance claim, a format of an item to be a nursing care reward was defined and registered in a computer. These items are shown in FIGS.
As shown in the table, items can be classified into four categories: meal, hydration, excretion / posture, and others.

In addition, software has been introduced to convert the number, degree, or description of nuclear care items to conform to the official format specified by the National Health Insurance Federation so that nursing care compensation can be requested.

In this case, based on the nursing care unit price issued by the Ministry of Health and Welfare, a nursing care unit price table was previously registered in a computer as shown in FIG. As a result, the items described by the worker are automatically calculated according to the individual's individual's nursing care rank that has been certified for nursing care, and the compensation amount for each applicable day is issued, and monthly There is also a system in which the remuneration amount for each resident is issued for each resident.

As the system input form used in the present system, as shown in FIG. 11, the resident number, the service time, and the worker number are used as common entry items, and only specific service items are matched to the contents of the service. The caseworker who actually performed the nursing care uses a form that can be filled in numerically and filled in.

When the case worker takes care of the resident, the case worker enters the number or the number in the corresponding item according to the care service meal, care service hydration, care service excretion / position, and other services in the input form for these systems. The sign is described, and a terminal arranged nearby is operated to designate a care insurance claim operation screen from the operation screen shown in FIG.

The terminal screen is changed to the screen shown in FIG. 17. After the user has specified "scanner input" and made the form read by the scanner, the OCR screen is displayed as shown in FIG.
Processed. Next, after the reading procedure was completed, the "correction / registration status" was re-designated and the data subjected to the OCR processing was checked.

The contents corrected on this OCR correction screen are as follows:
The correction file is stored in a correction file. The correction file is further checked by an administrator and a clerk, and is corrected in the case of an input error or the like.

On the other hand, the administrator who is an authorized person operates the present system from his / her own terminal based on the data input by the worker, and inputs a user code and a password to call a nursing care remuneration request screen. The care insurance claim operation screen shown in FIG. 16 was exhibited.

Then, it was checked that the details of the nursing care for the insured person were issued according to the contents of the nursing care for each designated period, and the monthly nursing care remuneration was collectively transmitted to the National Health Insurance Federation via the Internet.

[0046]

According to the system of the present invention, the care data described by a case worker in a unified report is read by a scanner and managed by a computer, and the care-reward amount of the insured person is automatically adjusted according to the care content. And send the obtained monthly remuneration directly to the National Health Insurance Agency over the Internet. Therefore, the system has the greatest effect that the case worker can concentrate on the original nursing care service without taking the processing time.

In addition, after the form written by the case worker is read by a scanner in the care insurance claim management, the image is subjected to OCR processing and the care items and the number of cares and the care work data such as the degree of care are stored on the hard disk. Since these nursing care data can be stored, these nursing care data are converted into nursing care remuneration based on the nursing care remuneration table, and can be printed out as nursing care remuneration on the day, which has an effect of easily checking management data and nursing work for each day. I have.

Since the form read by the scanner can be stored as evidence as it is, it has the effect of preventing fraudulent claims.

Personal information relating to privacy, such as resident's entry, medical care, health or pension information, is a system that can be managed and edited only by a manager with a password. Have.

By processing the data input from the manager or the case worker, the care manager or the care manager can easily display and print the management summary report and the care performance report, and determine the cause of the difference in the care plan care performance. It can summarize the analyzed reports.

Further, the managers of these facilities and home care service companies can obtain the information of the total information from the various data described above, which has the effect that the future management policy can be easily set.

[Brief description of the drawings]

FIG. 1 is a configuration diagram showing the overall configuration of a system of the present invention.

FIG. 2 is a configuration diagram showing a business process of a care insurance receipt reading system.

FIG. 3 is a flowchart showing an insured person registration procedure using a resident list.

FIG. 4 is a diagram showing an example of a file format of a resident list.

FIG. 5 is a drawing showing a format definition of a meal file for reading a long-term care insurance claim.

FIG. 6 is a diagram showing a format definition of a hydration file for reading a long-term care insurance claim.

FIG. 7 is a drawing showing a format definition of an excretion / posture file A for reading a nursing care insurance claim.

FIG. 8 is a diagram showing a format definition of an excretion / posture file B for reading a nursing care insurance claim.

FIG. 9 is a drawing showing a format definition of another file for reading a long-term care insurance claim.

FIG. 10 is a drawing showing a care service unit price table.

FIG. 11 is a drawing showing a care service meal form in the input form for the care insurance claim management system.

FIG. 12 is a flowchart showing a procedure for reading a long-term care insurance claim.

FIG. 13 is a flowchart showing a procedure of an OCR process.

FIG. 14 is a diagram showing an input screen in terminal operation.

FIG. 15 is a diagram showing an input screen of a resident list among terminal operations.

FIG. 16 is a drawing showing an input screen for requesting a care fee among terminal operations.

FIG. 17 is a drawing showing an input screen of a care insurance claim among terminal operations.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Scanner 2 ... Printer 3 ... Computer terminal 4 ... SQL server

Claims (4)

[Claims] 1. A care insurance claim management system comprising a computer for inputting and outputting care insurance-related receipt data and a server for storing these various data.
The computer is interlocked with a device that reads data of an input form in a predetermined shape and has a communication function with another computer.The server stores data input to the computer, and also transmits the data via another facsimile. Long-term care insurance claim management system that has the function of directly inputting transmitted data. 2. The nursing care insurance claim according to claim 1, wherein the input form having the predetermined shape is a form in which a resident number, a service time, a worker number and a specific service item can be filled in numerically. Management system. 3. The care insurance claim management system according to claim 1, wherein said reading device is an image scanner which reads data of an input form in conjunction with a computer and performs an OCR process. 4. In the input form for a receipt, the resident number, service time, and worker number are used as common entry items, and only specific service items can be digitized and filled in according to the contents of the service. An input form for a care insurance receipt management system, which is a form.