JP2002183297A - Medical system and recording medium with diagnosis and medical treatment program recorded thereon - Google Patents

Abstract

PROBLEM TO BE SOLVED: To check the contents of diagnosis and medical treatment based on stored invoice data. SOLUTION: A medical system is provided with a receipt database 3 for storing receipt data which are obtained by electronically converting detailed statement for diagnosis and medical treatment fee which are issued for every person insured at every medical institution. The system is also provided with a general inspection check data generating means 20 for generating general inspection check data for every person insured based on receipt data and a diagnosis and medical treatment check means 21 for checking the contents of diagnosis and medical treatment based on general inspection check data.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a system for accumulating and managing receipt data obtained by digitizing a medical institution medical fee statement.

[0002]

2. Description of the Related Art Conventionally, as a technology for accumulating and managing receipt data in which a medical institution medical fee statement is digitized,
There is one described in Japanese Patent Application Laid-Open No. 2000-113062.

[0003] Japanese Patent Application Laid-Open No. 2000-113062 discloses a medical office system in which insurance and accounting data are sequentially accumulated as receipt data. The accumulated receipt data is not processed at the time of load concentration, and the load is not processed. They are processed and accumulated all at once during non-existent time zones.

[0004]

Problems to be Solved by the Invention JP-A-2000-113
Japanese Patent Application Laid-Open No. 062 is a system for processing insurance and accounting data with respect to accumulated receipt data, which aims to use devices and resources effectively in accounting processing. There is an increasing demand for checking medical treatments based on data.

[0005] In the background, in a conventional paper-based medical remuneration statement, a content check for making a payment is appropriately performed by a person having specialized knowledge. However, there are more than 20,000 points of commercially available drugs alone,
It is difficult to remember the names and effects of all drugs. Furthermore, knowledge such as whether or not an essential test is performed on a disease name is required. Many drugs and tests are additionally approved, and it is necessary to acquire knowledge on new names, indications, purposes, and the like.

[0006] In addition to checking the name of the disease and the drug or test, it is necessary to check the erroneous entry of the price and the contents of the treatment performed, which are stipulated by the medical care standard and the drug price standard, and to confirm the limit on the number of billable times. . These standards are revised annually and require the acquisition of new knowledge.

[0007] Further, when treatment is performed over months, such as long-term drug administration, it is necessary to comprehensively check the contents of treatment for the previous month and the contents of treatment for the current month. You have to check while comparing the medical fee statement for this month.

[0008] In the case of consultation at a plurality of medical institutions, such as gynecology and orthopedic surgery, the medicines and the like to be given at each medical institution, the problem of swallowing, the dosage, etc., should be considered. It is necessary to take a comprehensive look at the institution's previous month (including the previous month), taking into account the contents of the previous month's medication, but the previous month's already stored (including the previous month)
It was very troublesome to find the relevant statement from the medical fee statement (including the breakdown).

[0009]

In order to achieve the above object, according to the present invention, there is provided a claim data in which a medical fee statement issued to each insured person for each of a plurality of medical institutions is digitized. And a receipt database that stores
It is characterized by comprising inspection inspection data creating means for creating inspection inspection data summarized for each insured person based on the receipt data, and medical examination inspection means for inspecting medical treatment contents based on the inspection inspection data. .

[0010] According to the above means, inspection inspection data in which receipt data in which medical fee reimbursement statements of a plurality of medical institutions are digitized are prepared for each insured person, inspection of the number of medical treatments at each medical institution, and name of the disease Check the contents of medical treatment to see if the relationship between medical treatment and medical treatment is appropriate. The medical treatment contents indicate medicine, treatment, medical treatment score, and the like. Injury and illness include injury and illness,
This will be described below.

According to a second aspect of the present invention, in the medical system according to the first aspect, the general inspection data creating means creates general inspection data including a consultation date, a medical institution name, a name of a sick and sick, a medical treatment breakdown, and the number of medical treatment points. It is characterized by doing.

According to the above-mentioned means, inspection data including a consultation date, a medical institution name, a name of an injured and illness, a medical treatment breakdown, and the number of medical treatment points are prepared, so that the medical treatment contents of a plurality of medical institutions having overlapping medical treatment periods are inspected. be able to.

According to a third aspect of the present invention, in the medical system according to the second aspect, the medical examination unit examines a contraindicated combination of a medicine prescribed by a plurality of medical institutions based on the medical treatment breakdown and the consultation date. Drug inspection means, injury and disease inspection means for inspecting the injury name and the medical treatment breakdown,
It is characterized by having a calculation check means for checking the medical treatment breakdown and the calculation of the medical treatment score for each medical institution name.

According to the contraindicated combination of drugs prescribed by a plurality of medical institutions based on the date of consultation included in the inspection data, a check is made on drugs that do not exacerbate the condition of the drug or are unsuitable for the purpose. Or, check the contents of medical treatment based on the name of the disease and the medical treatment. Alternatively, it is possible to check the score calculation based on the medical treatment breakdown and the score for each medical institution.

According to a fourth aspect of the present invention, in the medical system according to the second or third aspect, the medical check means finds a medical period based on the number of days included in the medical item and the date of receiving the general inspection data. If the medical treatment period of a specific medical treatment item overlaps with the medical treatment period of another medical treatment item, the medical treatment contents are checked.

According to the above means, the medical treatment period of the medical treatment item is determined based on the consultation date and the number of days indicating the period of using the medicine or the like, and it is checked whether the medicine or treatment does not fall into the contraindicated item. For example, check if a long-term drug is contraindicated with drugs used for other treatments.

According to a fifth aspect of the present invention, in the medical system according to the third or fourth aspect, the medical system includes an inspection information database for storing inspection information of medical treatment contents such as contraindicated combinations of medicines. The inspection information corresponding to the inspection information is extracted from the inspection database from the medical treatment items included in the medical treatment breakdown, and the inspection information is compared with the medical treatment breakdown for inspection.

According to the above means, an inspection information database for storing inspection information of treatment contents, such as a contraindicated combination of medicines, is provided, and the inspection information corresponding to the inspection information included in the medical treatment breakdown is extracted from the inspection database and inspected.

According to a sixth aspect of the present invention, a medical treatment remuneration statement issued to each insured person for each of a plurality of medical institutions is compiled for each insured person from a receipt database storing receipt data in which the receipt data is digitized. A recording medium for creating a general inspection data and recording a medical processing program for inspecting medical treatment contents based on the general inspection data.

According to the above means, there is provided a recording medium storing a program which can read and execute the invention of claim 1 on a computer.

[0021]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments according to the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a configuration of a medical system 1 according to one embodiment of the present invention. The medical system 1 includes an inspection processing unit 2 for inspecting the receipt data, a receipt database 3 for accumulating the receipt data (hereinafter referred to as a receipt DB), and a general inspection for each insured person based on the receipt data. Inspection inspection database 4 (hereinafter referred to as inspection inspection DB) for accumulating data, inspection information database 5 (hereinafter referred to as inspection information DB) for storing inspection information necessary for inspection, and results of inspection of medical treatment contents. Inspection result database 6 stored by
(Hereinafter, referred to as an inspection result DB). Although not shown, the medical system 1 includes a central processing unit (CPU), a memory, and an input / output interface, and has a function of taking in the receipt data from an external storage device or a network via the input / output interface. Alternatively, it has a function of displaying the inspection result on a CRT via an input / output interface or outputting the result to an external storage device or a network.

Further, a receipt DB3, a general inspection DB4,
The inspection information DB 5 and the inspection result DB 6 are databases having a function of searching by key or item as needed. Further, any database may be stored in an external storage device such as a hard disk, or may be stored in the memory of the central processing unit.

Further, the medical system 1 transmits a paper medical fee statement to an OCR (Optical Character R).
and an OCR reading unit 7 that converts the received data into electronic receipt data. The OCR reading unit 7 is connected to the receipt DB 3 and has a function of storing receipt data, which is a digitized paper medical fee statement, in the receipt DB 3.

The receipt data stored in the receipt DB 3 is obtained from a medical institution by retrieving a medical fee statement for each insured on a monthly basis from a medical institution to a medical expense payer (inspection service organization) such as a cooperative or insurance company. Is sent to a medical institution in the form of a paper medical remuneration statement, and is read and digitized by the OCR reading unit 7, for example. Alternatively, the receipt data created by the medical system of the medical institution is sent as an electronic medium to a medical expenses payer (inspection service organization) such as a cooperative or an insurance company.

The inspection processing unit 2 creates inspection inspection data from the receipt data stored in the reception DB 3 and stores the inspection inspection data in the inspection inspection DB 4.
Medical check means 21 for checking the contents of medical treatment based on the inspection data. The medical check means 21 has a function of connecting to the check information DB 5, checking the medical contents based on the check information stored in the check information DB 5, and storing the result of the check of the medical contents in the check result DB 6. .

Further, the medical check means 21 includes a calculation check for checking the calculation of the score based on the medical treatment breakdown for each medical institution and the score corresponding to the medical care item (determined based on the medical standard and the drug price standard). There are provided a means 22, a medicine checking means 23 for checking treatment contents such as a contraindicated combination of medicines from the medical treatment breakdown and consultation date of all medical institutions, and a illness checking means 24 for checking medical treatment contents based on the name of the illness and the medical treatment.

The receipt data is composed of date information, medical institution information, injury / illness name information, and medical treatment breakdown information. As shown in FIG. 2, the receipt DB 3 includes a date information DB 31, a medical institution information DB 32, a disease name information DB 33, and a medical treatment breakdown information DB 34. The record of the date information is in the date information DB 31, and the record of the medical institution information is medical. Institution information D
In B32, the record of the disease name information is a disease name information DB33.
The record of the medical treatment breakdown information is stored in the medical care breakdown information DB 34.

Here, an example of the receipt data will be described with reference to FIGS. As shown in FIGS. 3 to 6, the receipt data includes date information 31 representing the date of consultation.
0, medical institution information 320 taken by the insured person, disease name information 330 indicating the name of the injured or treated during treatment or treatment, medical treatment including medicines required for treatment and medical treatment contents, and medical treatment points including medical treatment points corresponding to the treatment items It consists of a breakdown 340. Also, a date key 310, medical institution information 320, and disease name information 33 are provided by a (uniquely determined) receipt key 301 that enables each receipt data to be distinguished from other receipt data.
0, the medical treatment details 340 are associated. Furthermore, it is associated with the information of the insured person so that the receipt key 301 indicates whether the person is the insured person.

First, the date information 310 is a record as shown in FIG. 3 and is composed of a consultation date 311 and the like, and is managed by the receipt key 301 in association with the receipt data.

Next, the medical institution information 320 is a record as shown in FIG. 4 and is composed of a medical institution code 321 and a medical institution name 322, etc., and is managed in association with the receipt data by the receipt key 301.

The wound name information 330 is a record as shown in FIG. 5, and information relating to a wound such as "acute suppurative appendicitis" includes a wound name code 331, a wound name 332, an ICD code 333, a treatment start date 334, and the like. Be composed. Also, it is managed by the receipt key 301 in association with the receipt data.

Further, the medical care breakdown 340 is data as shown in FIG. 6, and is managed by the receipt key 301 in association with the receipt data. Medical treatment breakdown 340 includes drugs, tests,
Alternatively, a medical care category 341 that classifies medical care such as surgery, a code 342 of a medical care item, a medical care name 343, and a quantity 34
4, the number of days 345 and the number of medical treatment points 346. Also,
The code 342 indicates a drug code when the medical treatment section 341 is a drug. The name 343 indicates the name of the medical treatment. The quantity 344 indicates a prescribed dose to be taken daily in the case of a medicine, and represents the number of treatments performed in the case of medical treatment. The number of days 345 indicates the number of days for taking the medicine. The medical care breakdown 340 is a summary of the medical care provided on a date of medical examination at one medical institution by the insured person. One record is a medical care item 350.

The inspection data 400 stored in the inspection inspection DB 4 is obtained by reassembling the receipt data into the insured person by the inspection inspection data creating means 20 and managed by associating with the receipt data by the receipt key 301. It is. The inspection data 400 is, as shown in FIG.
1, a consultation date 311, and a medical treatment breakdown 340. As shown in FIG. 7, the inspection inspection database 400 stores inspection inspection data 400 for each insured person.

In the inspection information DB 5, as shown in FIG.
A drug information database 51 (drug information DB) which is basic information such as a dosage form indicating whether the drug is an injection or an oral medicine, a drug injury / disease name database 52 (drug injury / disease name DB) which manages information on a drug and an applied injury / illness name, Drug contraindication information database 53 (drug contraindication information D) that manages information on contraindications (forbidden to use for injuries and illnesses) for each drug
B) A drug contraindication information database 5 that manages information on drug contraindications (concurrent use of drugs is prohibited)
4 (drug contraindication information DB).

The inspection result is stored as inspection result data 600 in the inspection result DB 6. Inspection result data 60
0, as shown in FIG. 9, a receipt key 301, an inspection category 601, an inspection content 602, and inspection details 603 (inspection details 1,
Inspection details 2, inspection details 3,...), The number of medical treatment points 604, and the like. If there is a non-conformity in the inspection result, the receipt key 301 is transcribed from the record of the inspection inspection data 400, and the inspection result is detailed in the inspection category 601 and the inspection content 6.
02, inspection details 603 (inspection details 1, inspection details 2, inspection details 3,...). Further, if there is a difference in the medical score of the inspection result, it is described in the medical score 604.

Next, the inspection data creation means 20 will be described with reference to the flowchart of FIG. Recept D
The receipt data stored in B3 is retrieved (S1
00), the inspection data 400 is created from the date information 310, the medical institution information 320, and the medical care breakdown 340.

First, the medical care breakdown 340 is taken out, and the inspection date 311 of the date information 310 and the medical institution code 321 of the medical institution information 320 are attached to create inspection inspection data 400 (S101). The created record is added to the inspection check data of the corresponding insured based on the receipt key 301 (S102).

Further, the next receipt data is transferred to the receipt D
B3 (S100), inspection data 400
Is created (S101) and added to the inspection data 400 of the pertinent insured person (S102). The above processing,
It repeats until there is no more receipt data (S103).

Next, the medical check means 21 will be described with reference to the flowchart of FIG. First, in the calculation check processing (calculation check means 22), it is checked whether the calculation of the medical treatment score is properly performed in view of the relation between the outpatient management addition calculation and the guidance management fee and the illness and illness, and further, the duplicate calculation of the first diagnosis fee, etc. Is checked (S110). In addition, the calculation check processing (calculation check means 22) includes inspection inspection data 400 of each insured person.
And check based on the receipt data. Next, a drug inspection process for checking contraindications of the drug (drug inspection means 23).
(S111) and a sickness check process for checking whether the relationship between the sickness and treatment is appropriate (sickness check means 24) (S112)
I do. As described above, the medicine check process and the illness check process are also checked based on the inspection check data 400 and the receipt data of each insured person.

Here, the above-described calculation check processing 22 (S11)
The details of 0) will be described with reference to the flowchart of FIG.

First, the medical treatment category 3 of the inspection data 400
With reference to the inspection list defined by the Minister of Health and Welfare from 41 and the code 342, the check of the outpatient management addition is performed (S12).
0). For example, when the code 342 indicates a trigger point injection, the calculation of the outpatient management addition cannot be claimed.

Next, it is checked whether the guidance fee management fee is appropriate. In checking the guidance fee management fee, the disease name information 330 is extracted from the disease name information DB 33 using the receipt key 301 included in the inspection data 400. It is checked from the medical care classification 341 and the code 342 whether the medical care content corresponds to the extracted disease name information 330 (S12).
1). For example, in the case of “diabetes”, “special diet” can be calculated for inpatients who are deemed necessary by a doctor. In other words, when the code 342 indicates “special diet”, the information of “having a treatment for diabetes” must be included in the name of the disease extracted from the receipt key.

In the other checks, it is checked whether the “initial consultation fee” has been overlapped and added (S122). The medical care breakdown 340 of the same medical institution code 321 in the inspection data 400 is taken out, and it is checked whether there are a plurality of codes 342 indicating the “first consultation fee”. When a plurality is added, it is an overlap addition.

Next, the medicine inspection process 23 (S111) will be described in detail with reference to the flowchart of FIG.
In the medicine inspection process 23, a check is made as to whether the association between the disease name 332 and the medicine (the medical treatment category 341 indicates the medicine) is appropriate (S130), a check is made of the contraindicated medicine from the disease name 332 and the medicine (S131), Check for contraindications for which concomitant use is prohibited (S132), check for long-term administration (S133), check for overdose (S134), check for overlapping applications (S135), check the basis of diagnosis (S136), check other ( S137).

Here, an example of the check (S130) of the association between the disease name 332 and the medicine will be described with reference to the flowchart of FIG. First, the illness name code 331 is extracted from the illness name information DB 33 based on the receipt key 301 included in the medical care breakdown 340 of the inspection data 400 (S14).
0). Injury and disease name code 331 and drug injury and disease name DB
From 52, it is determined whether the medical care division 341 and the code 342 are appropriate (S141). If it is not appropriate (S142), the content indicating improperness is stored in the inspection result data of the corresponding insured person (S143). Further, the next medical care item 350 of the same receipt key is taken out (S144), and the medical care division 34 is selected.
It is determined whether 1 and code 342 are appropriate (S141). The name of the illness and disease 332 for the medical care item 350 of one receipt key
After checking whether the (medical disease name code 331) and the medicine are appropriate (S145), the medical care breakdown 340 of another receipt key 301 is checked. The above processing is repeated until all the inspection data 400 is completed (S146).

As described above, the inspection inspection data 40
0 and the receipt data, referring to the inspection information DB5, referring to the disease name 332 and the medicine (medical treatment section 341 and code 342).
Can be checked for proper use.

Check the name of the illness 332 and the contraindicated drug (S1
An example of 31) will be described based on the flowchart of FIG. First, based on the receipt key 301 of the medical treatment item 350 at the head of the inspection data 400, the name of the disease /
Then, the illness name code 331 is taken out from 3 (S150). The medical care item 350 of the medical care breakdown 340 of the inspection data 400 is extracted (S151), and the code 34 of each medical care item 350 is extracted.
It is determined whether the medicine is appropriate from the medicine injury / disease name DB 52 based on No. 2. The medical treatment item 350 from which the illness name code 331 was taken out, the medical treatment item 350 from which the illness was suffered from the receipt key 301 included in the medical care item 350, and the medical treatment item 3 from which the drug code 342 was taken out
The number of days 34 representing the consultation date 311 for prescribing the drug and the number of days the drug was given from the receipt key 301 included in 50
From 5, when the period of use of the illness and the medicine and the use period of the medicine (the medicine will be described below with the medical treatment period as the use period) overlap, it is checked from the medicine contraindication information DB 53 whether the injury name code 331 and the code 342 of the medicine are contraindicated medicines (S152). . In the case of a contraindicated drug (S153), the contents of the contraindicated drug are stored in the inspection result data 600 of the corresponding insured person (S1).
54). The above processing (S152 to S154) is repeated until all the medical treatment details 340 of the inspection data 400 are completed (S152).
155) Repeat. The inspection and inspection data 4 also applies to the new disease name code 331 of the receipt key (S156).
The contraindicated drug is checked for all the medical treatment items 350 of 00.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, the name of the disease and the contraindications of the medicine can be checked by referring to the check information DB5.

An example of the check for contraindications for drug combination (S132) will be described with reference to the flowchart of FIG. First,
The medicine code 342 of the medical treatment item 350 in the inspection data 400 is taken out as a source code (S160), and the medicine code 342 of the next medical treatment item 350 is taken out as a comparison code (S161). Consultation date 311 of former code 342
And the number of days 345 indicating the number of days when the drug was issued, the date of consultation 311 of the comparison code 342, and the number of days 345 indicating the number of days when the drug was issued check whether the use periods of the drugs overlap. If the use periods overlap, Drug contraindication information DB
From 54, it is checked whether the original code 342 and the comparison code 342 are contraindicated concomitant drugs (S162). In the case of a contraindicated concomitant drug (S163), the content of the contraindicated concomitant drug is stored in the inspection result data 600 of the corresponding insured person (S164).
For all the medical treatment items 350 in the inspection data 400 (S165), the drug code 342 is extracted (S16).
7), Check for contraindicated drugs (S162 to S165)
Is repeated. Further, the next original code 342 is determined (S168), and all combinations of contraindications for other drugs are checked.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, it is possible to check for contraindications to use the medicine by referring to the check information DB5. In addition, 3
In cases where more than one drug is contraindicated for concomitant use, it can be investigated.

Although a detailed flowchart is omitted below, the check of long-term administration (S133) is for judging whether the number of days 345 given in one prescription is appropriate,
When the medical treatment category 341 of the inspection data 400 is a medicine,
The maximum prescription period is extracted from the medicine information DB 51 based on the medicine code 342, and for example, it is checked whether or not the number of days 345 is 14 or less for a medicine that is determined to be up to 14 days at a time.

In the overdosing check (S134), when the medical treatment category 341 of the inspection data 400 is a medicine, the maximum value of the dose or the number of days 345 is extracted from the medicine information DB 51 based on the medicine code 342 and is equal to or less than the maximum value. Check if it is.

In the same manner as described above, referring to one of the inspection information DB 5 based on the inspection data 400 and the receipt data, a duplication check of application (S135), a check of the diagnosis basis (S136), and other checks ( S13
7) is performed. For example, application overlap check (S13
In case of 5), the one with the higher drug price is assessed. In the case of checking the basis of diagnosis, the medical care item 350 of the same receipt key is used.
Check that there are no tests that can be used as a basis for diagnosis.

Further, the damage inspection process 24 (S112) will be described with reference to the flowchart of FIG. From the receipt key 301 of the inspection inspection data 400, the illness name code 331 is taken out from the illness name information DB 33 of the receipt data (S170), the medical care classification 341 and the code 342 of the record are taken out (S171), and it is checked whether the contents are appropriate (S172). ). The processes of S171 to S172 are repeated for the record of the same receipt key 301.

The items to be checked for proper contents (S172) are, as shown in the flowchart of FIG. 18, a medical contents inspection process (S180) for inspecting medical contents, and an inspection inspection process (S181) for inspecting examination contents. And an image diagnosis inspection process for inspecting image diagnosis (S182), and a rehabilitation inspection process for inspecting rehabilitation (S1)
83) and an admission check process for checking admission is appropriate (S18)
4), a specific health care material inspection process (S185) for checking whether the relationship between the specific health care materials is appropriate.

As described above, inspection inspection data 4
00, various inspections can be performed with reference to the receipt data DB3 and the inspection information DB5.

Although the calculation checking means, the medicine checking means, and the illness checking means have been described as separate processes for convenience, it is also possible to perform a process combining the above checks.

The above-mentioned inspection is only a part, and many other inspections can be performed based on the inspection data 400.

Further, the inspection information DB 5 may store information other than the information related to the medicine.

[0060]

As described above, according to the invention of the present application, the number of claims that can be requested for the erroneous check of the price and the content of the treatment performed, which is determined by the medical care standard and the drug price standard, is accurately confirmed.

In addition, when treatment is performed over months, such as long-term drug administration, the contents of treatment for the previous month and the contents of treatment for the current month can be comprehensively checked.

Further, when a medical examination is conducted at a plurality of medical institutions, regarding the medicines and the like to be given at the respective medical institutions, the problem of swallowing and the dose, etc. at the respective medical institutions in the previous month (that (Including the previous ones), it can be comprehensively checked taking into account the contents of the medication.

Further, by storing inspection information such as medicines in the database, information on new medicines can be immediately reflected in the inspection.

Further, the medical institution concerned can be checked from the inspection result database, and the medical institution can be notified of contraindications of the medicine and errors in the calculation of the number of medical treatments and medical treatments.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a configuration of a medical system 1.

FIG. 2 is a receipt database.

FIG. 3 shows a configuration of date information.

FIG. 4 shows a record configuration of medical institution information.

FIG. 5 shows a record configuration of wound and illness information.

FIG. 6 shows a configuration of a medical treatment breakdown.

FIG. 7 shows a configuration of inspection data.

FIG. 8 shows a configuration of an inspection information database.

FIG. 9 shows inspection result data.

FIG. 10 is a flowchart of inspection data creation means.

FIG. 11 is a flowchart of a medical examination unit.

FIG. 12 is a flowchart of a calculation checking means.

FIG. 13 is a flowchart of a medicine inspection unit.

FIG. 14 is a flowchart for checking the association between the name of a disease and a medicine.

FIG. 15 is a flowchart for checking names of injuries and diseases and contraindications of drugs.

FIG. 16 is a flowchart for checking contraindications for use in combination.

FIG. 17 is a flowchart of the injury / inspection means.

FIG. 18 is a flowchart of inspection items of the injury / inspection means.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Medical system 2 Inspection processing part 3 Reception database 4 Inspection inspection database 5 Inspection information database 6 Inspection result database 7 OCR reading part 20 Inspection inspection data creation means 21 Medical examination means 22 Calculation inspection means 23 Drug inspection means 24 Injury inspection means 31 Date Information database 32 Medical institution information database 33 Injury and disease name information database 34 Medical treatment breakdown information database 51 Drug information database 52 Drug injuries and disease name database 53 Drug contraindication information database 54 Drug contraindication information database 301 Reception key 310 Date information 311 Consultation date 320 Medical institution information 321 Medical institution code 322 Medical institution name 330 Injury and disease name information 331 Injury and disease name code 332 Injury and disease name 333 ICD code 334 Treatment start date 34 Medical Breakdown 341 clinical classification 342 code 343 Name 344 Quantity 345 days 346 medical number 350 medical items 400 inspection inspection data 600 and inspection result data 601 and inspection division 602 Inspection contents 603 Inspection details 604 medical points

[Procedure amendment]

[Submission date] September 12, 2001 (2001.9.1)
2)

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name] Full text

[Correction method] Change

[Correction contents]

[Document Name] Statement

Patent application title: Medical system and recording medium recording medical processing program

[Claims]

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a system for accumulating and managing receipt data obtained by digitizing a medical institution medical fee statement.

[0002]

2. Description of the Related Art Conventionally, as a technology for accumulating and managing receipt data in which a medical institution medical fee statement is digitized,
There is one described in Japanese Patent Application Laid-Open No. 2000-113062.

[0003] Japanese Patent Application Laid-Open No. 2000-113062 discloses a medical office system in which insurance and accounting data are sequentially accumulated as receipt data. The accumulated receipt data is not processed at the time of load concentration, and the load is not processed. They are processed and accumulated all at once during non-existent time zones.

[0004]

Problems to be Solved by the Invention JP-A-2000-113
Japanese Patent Application Laid-Open No. 062 is a system for processing insurance and accounting data with respect to accumulated receipt data, which aims to use devices and resources effectively in accounting processing. There is an increasing demand for checking medical treatments based on data.

[0005] In the background, in a conventional paper-based medical remuneration statement, a content check for making a payment is appropriately performed by a person having specialized knowledge. However, there are more than 20,000 points of commercially available drugs alone,
It is difficult to remember the names and effects of all drugs. Furthermore, knowledge such as whether or not an essential test is performed on a disease name is required. Many drugs and tests are additionally approved, and it is necessary to acquire knowledge on new names, indications, purposes, and the like.

[0006] In addition to checking the name of the disease and the drug or test, it is necessary to check the erroneous entry of the price and the contents of the treatment performed, which are stipulated by the medical care standard and the drug price standard, and to confirm the limit on the number of billable times. . These standards are revised annually and require the acquisition of new knowledge.

[0007] Further, when treatment is performed over months, such as long-term drug administration, it is necessary to comprehensively check the contents of treatment for the previous month and the contents of treatment for the current month. You have to check while comparing the medical fee statement for this month.

[0008] In the case of consultation at a plurality of medical institutions, such as gynecology and orthopedic surgery, the medicines and the like to be given at each medical institution, the problem of swallowing, the dosage, etc., should be considered. It is necessary to take a comprehensive look at the institution's previous month (including the previous month), taking into account the contents of the previous month's medication, but the previous month's already stored (including the previous month)
It was very troublesome to find the relevant statement from the medical fee statement (including the breakdown).

[0009]

In order to achieve the above object, according to the present invention, there is provided a claim data in which a medical fee statement issued to each insured person for each of a plurality of medical institutions is digitized. And a receipt database that stores
It is characterized by comprising inspection inspection data creating means for creating inspection inspection data summarized for each insured person based on the receipt data, and medical examination inspection means for inspecting medical treatment contents based on the inspection inspection data. .

[0010] According to the above means, inspection inspection data in which receipt data in which medical fee reimbursement statements of a plurality of medical institutions are digitized are prepared for each insured person, inspection of the number of medical treatments at each medical institution, and name of the disease Check the contents of medical treatment to see if the relationship between medical treatment and medical treatment is appropriate. The medical treatment contents indicate medicine, treatment, medical treatment score, and the like. Injury and illness include injury and illness,
This will be described below.

According to a second aspect of the present invention, in the medical system according to the first aspect, the general inspection data creating means creates general inspection data including a consultation date, a medical institution name, a name of a sick and sick, a medical treatment breakdown, and the number of medical treatment points. It is characterized by doing.

According to the above-mentioned means, inspection data including a consultation date, a medical institution name, a name of an injured and illness, a medical treatment breakdown, and the number of medical treatment points are prepared, so that the medical treatment contents of a plurality of medical institutions having overlapping medical treatment periods are inspected. be able to.

According to a third aspect of the present invention, in the medical system according to the second aspect, the medical check means checks a contraindicated combination of a medicine prescribed by a plurality of medical institutions based on the medical treatment breakdown and the date of the medical examination. It is characterized by comprising inspection means, injury / illness inspection means for inspecting the name of the disease and the medical treatment breakdown, and calculation inspection means for checking the calculation of the medical treatment breakdown and the number of medical treatment points for each medical institution name.

According to the contraindicated combination of drugs prescribed by a plurality of medical institutions based on the date of consultation included in the inspection data, a check is made on drugs that do not exacerbate the condition of the drug or are unsuitable for the purpose. Or, check the contents of medical treatment based on the name of the disease and the medical treatment. Alternatively, it is possible to check the score calculation based on the medical treatment breakdown and the score for each medical institution.

According to a fourth aspect of the present invention, in the medical system according to the second or third aspect, the medical check means finds a medical period based on the number of days included in the medical item and the date of receiving the general inspection data. If the medical treatment period of a specific medical treatment item overlaps with the medical treatment period of another medical treatment item, the medical treatment contents are checked.

According to the above means, the medical treatment period of the medical treatment item is determined based on the consultation date and the number of days indicating the period of using the medicine or the like, and it is checked whether the medicine or treatment does not fall into the contraindicated item. For example, check if a long-term drug is contraindicated with drugs used for other treatments.

According to a fifth aspect of the present invention, in the medical system according to the third or fourth aspect, the medical system includes an inspection information database for storing inspection information of medical treatment contents such as contraindicated combinations of medicines. The inspection information corresponding to the inspection information is extracted from the inspection database from the medical treatment items included in the medical treatment breakdown, and the inspection information is compared with the medical treatment breakdown for inspection.

According to the above means, an inspection information database for storing inspection information of treatment contents, such as a contraindicated combination of medicines, is provided, and the inspection information corresponding to the inspection information included in the medical treatment breakdown is extracted from the inspection database and inspected.

According to a sixth aspect of the present invention, a medical treatment remuneration statement issued to each insured person for each of a plurality of medical institutions is compiled for each insured person from a receipt database storing receipt data in which the receipt data is digitized. A recording medium for creating a general inspection data and recording a medical processing program for inspecting medical treatment contents based on the general inspection data.

According to the above means, there is provided a recording medium storing a program which can read and execute the invention of claim 1 on a computer.

[0021]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments according to the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a configuration of a medical system 1 according to one embodiment of the present invention. The medical system 1 includes an inspection processing unit 2 for inspecting the receipt data, a receipt database 3 for accumulating the receipt data (hereinafter referred to as a receipt DB), and a general inspection for each insured person based on the receipt data. Inspection inspection database 4 (hereinafter referred to as inspection inspection DB) for accumulating data, inspection information database 5 (hereinafter referred to as inspection information DB) for storing inspection information necessary for inspection, and results of inspection of medical treatment contents. Inspection result database 6 stored by
(Hereinafter, referred to as an inspection result DB). Although not shown, the medical system 1 includes a central processing unit (CPU), a memory, and an input / output interface, and has a function of receiving receipt data from an external storage device or a network via the input / output interface. Alternatively, it has a function of displaying the inspection result on a CRT via an input / output interface or outputting the result to an external storage device or a network.

Further, a receipt DB3, a general inspection DB4,
The inspection information DB 5 and the inspection result DB 6 are databases having a function of searching by key or item as needed. Further, any database may be stored in an external storage device such as a hard disk, or may be stored in the memory of the central processing unit.

Further, the medical system 1 transmits a paper medical fee statement to an OCR (Optical Character R).
and an OCR reading unit 7 that converts the received data into electronic receipt data. The OCR reading unit 7 is connected to the receipt DB 3 and has a function of storing receipt data, which is a digitized paper medical fee statement, in the receipt DB 3.

The receipt data stored in the receipt DB 3 is obtained by sending a medical fee statement for each insured person from a medical institution to a medical payer (inspection service institution) such as an association or an insurance company on a monthly basis. And stored
For example, when sent from a medical institution in the form of a paper medical fee statement, it is read by the OCR reading unit 7 and digitized. Alternatively, the receipt data created by the medical system of the medical institution is sent as an electronic medium to a medical expenses payer (inspection service organization) such as a cooperative or an insurance company.

The inspection processing unit 2 creates inspection inspection data from the receipt data stored in the reception DB 3 and stores the inspection inspection data in the inspection inspection DB 4.
Medical check means 21 for checking the contents of medical treatment based on the inspection data. The medical check means 21 has a function of connecting to the check information DB 5, checking the medical contents based on the check information stored in the check information DB 5, and storing the result of the check of the medical contents in the check result DB 6. .

Further, the medical check means 21 includes a calculation check for checking the calculation of the score based on the medical treatment breakdown for each medical institution and the score corresponding to the medical care item (determined based on the medical standard and the drug price standard). There are provided a means 22, a medicine checking means 23 for checking treatment contents such as a contraindicated combination of medicines based on the medical treatment breakdown and consultation date of all medical institutions, and a illness checking means 24 for checking medical treatment contents based on the name of the illness and the medical treatment.

The receipt data is composed of date information, medical institution information, injury / illness name information, and medical treatment breakdown information. As shown in FIG. 2, the receipt DB 3 includes a date information DB 31, a medical institution information DB 32, a disease name information DB 33, and a medical treatment breakdown information DB 34. The record of the date information 310 is stored in the date information DB 31, and the record of the medical institution information 320 is stored. Is stored in the medical institution information DB 32, the record of the disease name information 330 is stored in the disease name information DB 33, and the record of the medical treatment breakdown information 340 is stored in the medical care breakdown information DB 34.

Here, an example of the receipt data will be described with reference to FIGS. As shown in FIGS. 3 to 6, the receipt data includes date information 31 representing the date of consultation.
0, medical institution information 320 taken by the insured person, disease / injury name information 330 indicating the name of the injured or treated during treatment or treatment, medical treatment including medicines required for the treatment and medical treatment contents, and medical treatment points corresponding to the treatment items It consists of a breakdown 340. Also, a date key 310, medical institution information 320, and disease name information 33 are provided by a (uniquely determined) receipt key 301 that enables each receipt data to be distinguished from other receipt data.
0, the medical treatment details 340 are associated. Furthermore, it is associated with the information of the insured person so that the receipt key 301 indicates whether the person is the insured person.

First, the date information 310 is a record as shown in FIG. 3 and is composed of a consultation date 311 and the like, and is managed by the receipt key 301 in association with the receipt data.

Next, the medical institution information 320 is a record as shown in FIG. 4 and is composed of a medical institution code 321 and a medical institution name 322, etc., and is managed in association with the receipt data by the receipt key 301.

The wound name information 330 is a record as shown in FIG. 5, and information relating to a wound such as "acute suppurative appendicitis" includes a wound name code 331, a wound name 332, an ICD code 333, a treatment start date 334, and the like. Be composed. Also, it is managed by the receipt key 301 in association with the receipt data.

Further, the medical care breakdown 340 is data as shown in FIG. 6, and is managed by the receipt key 301 in association with the receipt data. Medical treatment breakdown 340 includes drugs, tests,
Alternatively, a medical care category 341 that classifies medical care such as surgery, a code 342 of a medical care item, a medical care name 343, and a quantity 34
4, the number of days 345 and the number of medical treatment points 346. Also,
The code 342 indicates a drug code when the medical treatment section 341 is a drug. The name 343 indicates the name of the medical treatment. The quantity 344 indicates a prescribed dose to be taken daily in the case of a medicine, and represents the number of treatments performed in the case of medical treatment. The number of days 345 indicates the number of days for taking the medicine. The medical care breakdown 340 is a summary of the medical care provided on a date of medical examination at one medical institution by the insured person. One record is a medical care item 350.

The inspection inspection data 400 stored in the inspection inspection DB 4 is obtained by reassembling the receipt data into the insured person by the inspection inspection data creating means 20 and is managed in association with the receipt data by the receipt key 301. It is. The inspection data 400 is, as shown in FIG.
1, a consultation date 311, and a medical treatment breakdown 340. As shown in FIG. 7, the inspection inspection database 400 stores inspection inspection data 400 for each insured person.

In the inspection information DB 5, as shown in FIG.
A drug information database 51 (drug information DB) which is basic information such as a dosage form indicating whether the drug is an injection or an oral medicine, a drug injury / disease name database 52 (drug injury / disease name DB) which manages information on a drug and an applied injury / illness name, Drug contraindication information database 53 (drug contraindication information D) that manages information on contraindications (forbidden to use for injuries and illnesses) for each drug
B) A drug contraindication information database 5 that manages information on drug contraindications (concurrent use of drugs is prohibited)
4 (drug contraindication information DB).

The inspection result is stored as inspection result data 600 in the inspection result DB 6. Inspection result data 60
0, as shown in FIG. 9, a receipt key 301, an inspection category 601, an inspection content 602, and inspection details 603 (inspection details 1,
Inspection details 2, inspection details 3,...), The number of medical treatment points 604, and the like. If there is a non-conformity in the inspection result, the receipt key 301 is transcribed from the record of the inspection inspection data 400, and the inspection result is detailed in the inspection category 601 and the inspection content 6.
02, inspection details 603 (inspection details 1, inspection details 2, inspection details 3,...). Further, if there is a difference in the medical score of the inspection result, it is described in the medical score 604.

Next, the inspection data creation means 20 will be described with reference to the flowchart of FIG. Recept D
The receipt data stored in B3 is retrieved (S1
00), the inspection data 400 is created from the date information 310, the medical institution information 320, and the medical care breakdown 340.

First, the medical care breakdown 340 is taken out, and the inspection date 311 of the date information 310 and the medical institution code 321 of the medical institution information 320 are attached to create inspection inspection data 400 (S101). The created record is added to the inspection check data of the corresponding insured based on the receipt key 301 (S102).

Further, the next receipt data is transferred to the receipt D
B3 (S100), inspection data 400
Is created (S101) and added to the inspection data 400 of the pertinent insured person (S102). The above processing,
It repeats until there is no more receipt data (S103).

Next, the medical check means 21 will be described with reference to the flowchart of FIG. First, in the calculation check processing (calculation check means 22), it is checked whether the calculation of the medical treatment score is properly performed in view of the relation between the outpatient management addition calculation and the guidance management fee and the illness and illness, and further, the duplicate calculation of the first diagnosis fee, etc. Is checked (S110). In addition, the calculation check processing (calculation check means 22) includes inspection inspection data 400 of each insured person.
And check based on the receipt data. Next, a drug inspection process for checking contraindications of the drug (drug inspection means 23).
(S111) and a sickness check process for checking whether the relationship between the sickness and treatment is appropriate (sickness check means 24) (S112)
I do. As described above, the medicine check process and the illness check process are also checked based on the inspection check data 400 and the receipt data of each insured person.

Here, the above-described calculation check processing 22 (S11)
The details of 0) will be described with reference to the flowchart of FIG.

First, the medical treatment category 3 of the inspection data 400
With reference to the inspection list determined by the Minister of Health and Welfare from 41 and the code 342, the check for outpatient management addition is performed (S12).
0). For example, when the code 342 indicates a trigger point injection, the calculation of the outpatient management addition cannot be claimed.

Next, it is checked whether the guidance fee management fee is appropriate. In checking the guidance fee management fee, the disease name information 330 is extracted from the disease name information DB 33 using the receipt key 301 included in the inspection data 400. It is checked from the medical care classification 341 and the code 342 whether the medical care content corresponds to the extracted disease name information 330 (S12).
1). For example, in the case of “diabetes”, “special diet” can be calculated for inpatients who are deemed necessary by a doctor. In other words, when the code 342 indicates “special diet”, the information of “having a treatment for diabetes” must be included in the name of the disease extracted from the receipt key.

In the other checks, it is checked whether the “initial consultation fee” has been overlapped and added (S122). The medical care breakdown 340 of the same medical institution code 321 in the inspection data 400 is taken out, and it is checked whether there are a plurality of codes 342 indicating the “first consultation fee”. When a plurality is added, it is an overlap addition.

Next, the medicine inspection process 23 (S111) will be described in detail with reference to the flowchart of FIG.
In the medicine inspection process 23, a check is made as to whether the association between the disease name 332 and the medicine (the medical treatment category 341 indicates the medicine) is appropriate (S130), a check is made of the contraindicated medicine from the disease name 332 and the medicine (S131), Check for contraindications for which concomitant use is prohibited (S132), check for long-term administration (S133), check for overdose (S134), check for overlapping applications (S135), check the basis of diagnosis (S136), check other ( S137).

Here, an example of the check (S130) of the association between the disease name 332 and the medicine will be described with reference to the flowchart of FIG. First, the illness name code 331 is extracted from the illness name information DB 33 based on the receipt key 301 included in the medical care breakdown 340 of the inspection data 400 (S14).
0). Injury and disease name code 331 and drug injury and disease name DB
From 52, it is determined whether the medical care division 341 and the code 342 are appropriate (S141). If it is not appropriate (S142), the content indicating improperness is stored in the inspection result data of the corresponding insured person (S143). Further, the next medical care item 350 of the same receipt key is taken out (S144), and the medical care division 34 is selected.
It is determined whether 1 and code 342 are appropriate (S141). The name of the illness and disease 332 for the medical care item 350 of one receipt key
After checking whether the (medical disease name code 331) and the medicine are appropriate (S145), the medical care breakdown 340 of another receipt key 301 is checked. The above processing is repeated until all of the inspection data 400 is completed (S146).

As described above, the inspection inspection data 40
0 and the receipt data, referring to the inspection information DB5, referring to the disease name 332 and the medicine (medical treatment section 341 and code 342).
Can be checked for proper use.

Check the name of the disease 332 and the contraindicated drug (S1
An example of 31) will be described based on the flowchart of FIG. First, based on the receipt key 301 of the medical treatment item 350 at the head of the inspection data 400, the name of the disease /
Then, the illness name code 331 is taken out from Step 3 (S150). The medical care item 350 of the medical care breakdown 340 of the inspection data 400 is extracted (S151), and the code 34 of each medical care item 350 is extracted.
It is determined whether the medicine is appropriate from the medicine injury / disease name DB 52 based on No. 2. The medical treatment item 350 from which the illness name code 331 was extracted, the receipt key 301 included in the receipt key 301 included in the medical treatment item 350, and the medical treatment item 3 from which the drug code 342 was extracted.
The number of days 34 representing the consultation date 311 at which the drug was prescribed from the receipt key 301 included in 50 and the number of days the drug was issued.
From 5, when the use period of the illness and the medicine and the use period of the medicine (the medicine will be described below with the medical treatment period as the use period) overlap, it is checked from the medicine contraindication information DB 53 whether the injury name code 331 and the code 342 of the medicine are contraindicated medicines (S 152). . In the case of a contraindicated drug (S153), the contents of the contraindicated drug are stored in the inspection result data 600 of the corresponding insured person (S1).
54). The above processing (S152 to S154) is performed until all the medical treatment details 340 of the inspection data 400 are completed (S152).
155) Repeat. Inspection data 4 for the new name 331 of the disease name of the receipt key (S156).
The contraindicated drug is checked for all the medical treatment items 350 of 00.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, the name of the disease and the contraindications of the medicine can be checked by referring to the check information DB5.

An example of the check for contraindications for drug combination (S132) will be described with reference to the flowchart of FIG. First,
The medicine code 342 of the medical treatment item 350 in the inspection data 400 is taken out as a source code (S160), and the medicine code 342 of the next medical treatment item 350 is taken out as a comparison code (S161). Consultation date 311 of former code 342
And the number of days 345 indicating the number of days when the medicine was issued, the date of examination 311 of the comparison code 342, and the number of days 345 indicating the number of days when the medicine was issued are checked to determine whether the use periods of the drugs overlap. If the use periods overlap, Drug contraindication information DB
From 54, it is checked whether the original code 342 and the comparison code 342 are contraindicated concomitant drugs (S162). In the case of a contraindicated concomitant drug (S163), the content of the contraindicated concomitant drug is stored in the inspection result data 600 of the corresponding insured person (S164).
For all the medical treatment items 350 in the inspection data 400 (S165), the drug code 342 is extracted (S16).
7), Check for contraindicated drugs (S162 to S165)
Is repeated. Further, the next original code 342 is determined (S168), and all combinations of contraindications for other drugs are checked.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, it is possible to check for contraindications to use the medicine by referring to the check information DB5. In addition, 3
In cases where more than one drug is contraindicated for concomitant use, it can be investigated.

Although a detailed flowchart is omitted below, the check of long-term administration (S133) is for judging whether the number of days 345 given in one prescription is appropriate,
When the medical treatment category 341 of the inspection data 400 is a medicine,
The maximum prescription period is extracted from the medicine information DB 51 based on the medicine code 342, and for example, it is checked whether or not the number of days 345 is 14 or less for a medicine that is determined to be up to 14 days at a time.

In the overdosing check (S134), when the medical treatment category 341 of the inspection data 400 is a medicine, the maximum value of the dose or the number of days 345 is extracted from the medicine information DB 51 based on the medicine code 342 and is equal to or less than the maximum value. Check if it is.

In the same manner as described above, referring to one of the inspection information DB 5 based on the inspection data 400 and the receipt data, a duplication check of application (S135), a check of the diagnosis basis (S136), and other checks ( S13
7) is performed. For example, application overlap check (S13
In case of 5), the one with the higher drug price is assessed. In the case of checking the basis of diagnosis, the medical care item 350 of the same receipt key is used.
Check that there are no tests that can be used as a basis for diagnosis.

Further, the damage inspection process 24 (S112) will be described with reference to the flowchart of FIG. From the receipt key 301 of the inspection inspection data 400, the illness name code 331 is taken out from the illness name information DB 33 of the receipt data (S170), the medical care classification 341 and the code 342 of the record are taken out (S171), and it is checked whether the contents are appropriate (S172). ). The processes of S171 to S172 are repeated for the record of the same receipt key 301.

The items to be checked for proper contents (S172) are, as shown in the flowchart of FIG. 18, a medical contents inspection process (S180) for inspecting medical contents, and an inspection inspection process (S181) for inspecting examination contents. And an image diagnosis inspection process for inspecting image diagnosis (S182), and a rehabilitation inspection process for inspecting rehabilitation (S1)
83) and an admission check process for checking admission is appropriate (S18)
4), a specific health care material inspection process (S185) for checking whether the relationship between the specific health care materials is appropriate.

As described above, inspection inspection data 4
00, various inspections can be performed with reference to the receipt data DB3 and the inspection information DB5.

Although the calculation checking means, the medicine checking means, and the illness checking means have been described as separate processes for convenience, it is also possible to perform a process combining the above checks.

The above-mentioned inspection is only a part, and many other inspections can be performed based on the inspection data 400.

Further, the inspection information DB 5 may store information other than the information related to the medicine.

[0060]

As described above, according to the invention of the present application, the number of claims that can be requested for the erroneous check of the price and the content of the treatment performed, which is determined by the medical care standard and the drug price standard, is accurately confirmed.

In addition, when treatment is performed over months, such as long-term drug administration, the contents of treatment for the previous month and the contents of treatment for the current month can be comprehensively checked.

Further, when a medical examination is conducted at a plurality of medical institutions, regarding the medicines and the like to be given at the respective medical institutions, the problem of swallowing and the dose, etc. at the respective medical institutions in the previous month (that (Including the previous ones), it can be comprehensively checked taking into account the contents of the medication.

Further, by storing inspection information such as medicines in the database, information on new medicines can be immediately reflected in the inspection.

Further, the medical institution concerned can be checked from the inspection result database, and the medical institution can be notified of contraindications of the medicine and errors in the calculation of the number of medical treatments and medical treatments.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a configuration of a medical system 1.

FIG. 2 is a receipt database.

FIG. 3 shows a configuration of date information.

FIG. 4 shows a record configuration of medical institution information.

FIG. 5 shows a record configuration of injury / illness information.

FIG. 6 shows a configuration of a medical treatment breakdown.

FIG. 7 shows a configuration of inspection data.

FIG. 8 shows a configuration of an inspection information database.

FIG. 9 shows inspection result data.

FIG. 10 is a flowchart of inspection data creation means.

FIG. 11 is a flowchart of a medical examination unit.

FIG. 12 is a flowchart of a calculation checking means.

FIG. 13 is a flowchart of a medicine inspection unit.

FIG. 14 is a flowchart for checking the association between the name of a disease and a medicine.

FIG. 15 is a flowchart for checking names of injuries and diseases and contraindications of drugs.

FIG. 16 is a flowchart for checking contraindications for use in combination.

FIG. 17 is a flowchart of the injury / inspection means.

FIG. 18 is a flowchart of inspection items of the injury / inspection means.

[Description of Signs] 1 Medical system 2 Inspection processing unit 3 Reception database 4 Inspection inspection database 5 Inspection information database 6 Inspection result database 7 OCR reading unit 20 Inspection inspection data creation means 21 Medical examination means 22 Calculation and inspection means 23 Pharmaceutical inspection means 24 Injury and disease inspection means 31 Date information database 32 Medical institution information database 33 Injury and disease name information database 34 Medical treatment breakdown information database 51 Drug information database 52 Drug and disease name database 53 Drug contraindication information database 54 Drug contraindication information database 301 Reception key 310 Date information 311 Consultation Date 320 Medical Institution Information 321 Medical Institution Code 322 Medical Institution Name 330 Injury Name Information 331 Injury Name Code 332 Injury Name 333 ICD Code 334 Care start date 340 medical Breakdown 341 clinical classification 342 code 343 Name 344 Quantity 345 days 346 medical number 350 medical items 400 inspection inspection data 600 and inspection result data 601 and inspection division 602 Inspection contents 603 Inspection details 604 medical points

[Procedure amendment 2]

[Document name to be amended] Drawing

[Correction target item name] Figure 3

[Correction method] Change

[Correction contents]

FIG. 3

[Procedure amendment 3]

[Document name to be amended] Drawing

[Correction target item name] Fig. 4

[Correction method] Change

[Correction contents]

FIG. 4

[Procedure amendment 4]

[Document name to be amended] Drawing

[Correction target item name] FIG.

[Correction method] Change

[Correction contents]

FIG. 16 ────────────────────────────────────────────────── ───

[Procedure amendment]

[Submission date] December 7, 2001 (2001.12.
7)

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name] Full text

[Correction method] Change

[Correction contents]

[Document Name] Statement

Patent application title: Medical system and recording medium recording medical processing program

[Claims]

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a system for accumulating and managing receipt data obtained by digitizing a medical institution medical fee statement.

[0002]

2. Description of the Related Art Conventionally, as a technology for accumulating and managing receipt data in which a medical institution medical fee statement is digitized,
There is one described in Japanese Patent Application Laid-Open No. 2000-113062.

[0003] Japanese Patent Application Laid-Open No. 2000-113062 discloses a medical office system in which insurance and accounting data are sequentially accumulated as receipt data. The accumulated receipt data is not processed at the time of load concentration, and the load is not processed. They are processed and accumulated all at once during non-existent time zones.

[0004]

Problems to be Solved by the Invention JP-A-2000-113
Japanese Patent Application Laid-Open No. 062 is a system for processing insurance and accounting data with respect to accumulated receipt data, which aims to use devices and resources effectively in accounting processing. There is an increasing demand for checking medical treatments based on data.

[0005] In the background, in a conventional paper-based medical remuneration statement, a content check for making a payment is appropriately performed by a person having specialized knowledge. However, there are more than 20,000 points of commercially available drugs alone,
It is difficult to remember the names and effects of all drugs. Furthermore, knowledge such as whether or not an essential test is performed on a disease name is required. Many drugs and tests are additionally approved, and it is necessary to acquire knowledge on new names, indications, purposes, and the like.

[0006] In addition to checking the name of the disease and the drug or test, it is necessary to check the erroneous entry of the price and the contents of the treatment performed, which are stipulated by the medical care standard and the drug price standard, and to confirm the limit on the number of billable times. . These standards are revised annually and require the acquisition of new knowledge.

[0007] Further, when treatment is performed over months, such as long-term drug administration, it is necessary to comprehensively check the contents of treatment for the previous month and the contents of treatment for the current month. You have to check while comparing the medical fee statement for this month.

[0008] In the case of consultation at a plurality of medical institutions, such as gynecology and orthopedic surgery, the medicines and the like to be given at each medical institution, the problem of swallowing, the dosage, etc., should be considered. It is necessary to take a comprehensive look at the institution's previous month (including the previous month), taking into account the contents of the previous month's medication, but the previous month's already stored (including the previous month)
It was very troublesome to find the relevant statement from the medical fee statement (including the breakdown).

[0009]

In order to achieve the above object, according to the first aspect of the present invention, a medical remuneration statement provided at an inspection service organization and issued to each insured person for each of a plurality of medical institutions. A receipt database that stores the receipt data in electronic form, and the inspection data that includes the receipt data issued by the plurality of medical institutions for each insured person, including the date of medical examination, the name of the medical institution, the name of the illness, the breakdown of the medical treatment, and the number of medical treatments. Inspection inspection data creating means for creating data, an inspection information database for storing inspection information of medical treatment contents such as contraindications for drugs, a prescription at a plurality of medical institutions based on the medical treatment breakdown of the inspection inspection data and the consultation date. The combination of drug contraindications is checked out from the check database by extracting the corresponding check information from the check database from the specified drug use period. It comprises medical inspection means having a material inspection means.

[0010] According to the above-mentioned means, a general inspection including the date of medical treatment, the name of the medical institution, the name of the injured and sick, the medical treatment breakdown, and the number of medical treatments, which is obtained by summarizing receipt data obtained by digitizing the medical remuneration statements of a plurality of medical institutions for each insured person. Inspection data can be created to check medical treatment contents where the medical treatment periods of multiple medical institutions overlap. In this way, a check is made of a drug that worsens the condition or is unsuitable for the purpose, such as a contraindicated combination of drugs prescribed by a plurality of medical institutions. The medical treatment contents indicate medicine, treatment, medical treatment score, and the like. In the following, the injury and illness include injury and illness.

According to a second aspect of the present invention, there is provided a receipt database provided in the inspection service institution, the receipt database storing electronic receipt data of a medical remuneration statement issued to each insured person for each of a plurality of medical institutions. A general inspection data creating means for summarizing receipt data issued by the plurality of medical institutions for each insured person to create general inspection data including a date of medical examination, medical institution name, name of illness, medical treatment breakdown, number of medical treatment points, Based on the inspection information database storing the inspection information of the medical treatment contents such as contraindications, and the breakdown of the inspection data and the date of the medical examination, the names of the diseases and injuries at a plurality of medical institutions are determined based on the date of the medical examination and the period of use of the medicine. A drug check means for checking the combination of the contraindicated drug and the corresponding check information by taking out the check information from the check database. Equipped with a medical inspection means.

[0012] According to the above-mentioned means, a general inspection including the date of receipt, the name of the medical institution, the name of the injured and sick, the breakdown of the medical treatment, the number of medical treatments, and the receipt data obtained by digitizing the medical remuneration statements of a plurality of medical institutions for each insured person. Inspection data can be created to check medical treatment contents where the medical treatment periods of multiple medical institutions overlap. In this way, a check is made on a drug that worsens the condition or is unsuitable for the purpose, such as a contraindicated combination of a drug and a disease prescribed by a plurality of medical institutions.

According to a third aspect of the present invention, in the medical system according to the first or second aspect, the medical check means is configured to check the name of the disease and the details of the medical treatment; It is characterized by having a medical treatment breakdown and calculation check means for checking the calculation of the medical treatment score.

Based on the inspection data, the contents of the medical treatment are checked based on the names of the injuries and diseases and the medical treatment breakdown. Alternatively, it is possible to check the score calculation based on the medical treatment breakdown and the score for each medical institution.

According to a fourth aspect of the present invention, a plurality of medical institutions are provided by a receipt database storing receipt data in which medical treatment statement statements issued to each insured person for each of the plurality of medical institutions are digitized. The receipt data issued at the insured person is collected for each insured person, and the inspection date, medical institution name, illness name, medical treatment breakdown, and the inspection inspection data including the number of medical treatment points are created, and the inspection breakdown and the consultation date of the inspection inspection data are created. A recording medium on which a combination of drug contraindications is taken out from the inspection database based on the use period of the drug prescribed by a plurality of medical institutions and the corresponding inspection information is taken out from the inspection database.

According to the above means, there is provided a recording medium storing a program which can read and execute the invention of claim 1 on a computer.

According to a fifth aspect of the present invention, a plurality of medical institutions are provided by a receipt database which stores receipt data in which medical treatment remuneration statements issued to each insured person are digitized. The receipt data issued at the insured person are collected for each insured person, and the inspection date, medical institution name, illness / illness name, medical treatment breakdown, and the inspection inspection data including the number of medical treatment points are created, and the inspection breakdown and the consultation date of the inspection inspection data are created. Based on a plurality of medical institutions, a combination of a disease name and a contraindicated drug based on the date of consultation of the name of the disease and the period of use of the drug at a plurality of medical institutions, and a recording medium that records an inspection medical processing program that retrieves the relevant inspection information from the inspection database and performs inspection. .

According to the above means, there is provided a recording medium storing a program capable of reading and executing the invention of claim 2 on a computer.

[0019]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments according to the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a configuration of a medical system 1 according to one embodiment of the present invention. The medical system 1 includes an inspection processing unit 2 for inspecting the receipt data, a receipt database 3 for accumulating the receipt data (hereinafter referred to as a receipt DB), and a general inspection for each insured person based on the receipt data. Inspection inspection database 4 (hereinafter referred to as inspection inspection DB) for accumulating data, inspection information database 5 (hereinafter referred to as inspection information DB) for storing inspection information necessary for inspection, and results of inspection of medical treatment contents. Inspection result database 6 stored by
(Hereinafter, referred to as an inspection result DB). Although not shown, the medical system 1 includes a central processing unit (CPU), a memory, and an input / output interface, and has a function of receiving receipt data from an external storage device or a network via the input / output interface. Alternatively, it has a function of displaying the inspection result on a CRT via an input / output interface or outputting the result to an external storage device or a network.

Also, a receipt DB3, a general inspection DB4,
The inspection information DB 5 and the inspection result DB 6 are databases having a function of searching by key or item as needed. Further, any database may be stored in an external storage device such as a hard disk, or may be stored in the memory of the central processing unit.

Further, the medical system 1 converts the paper medical fee statement into an OCR (Optical Character R).
and an OCR reading unit 7 that converts the received data into electronic receipt data. The OCR reading unit 7 is connected to the receipt DB 3 and has a function of storing receipt data, which is a digitized paper medical fee statement, in the receipt DB 3.

The receipt data stored in the receipt DB 3 is obtained by sending a medical fee statement for each insured person from a medical institution to a medical payer (inspection service institution) such as an association or an insurance company on a monthly basis. And stored
For example, when sent from a medical institution in the form of a paper medical fee statement, it is read by the OCR reading unit 7 and digitized. Alternatively, the receipt data created by the medical system of the medical institution is sent as an electronic medium to a medical expenses payer (inspection service organization) such as a cooperative or an insurance company.

The inspection processing unit 2 generates inspection inspection data from the receipt data stored in the reception DB 3 and stores the inspection inspection data in the inspection inspection DB 4.
Medical check means 21 for checking the contents of medical treatment based on the inspection data. The medical check means 21 has a function of connecting to the check information DB 5, checking the medical contents based on the check information stored in the check information DB 5, and storing the result of the check of the medical contents in the check result DB 6. .

Further, the medical check means 21 includes a calculation check for checking the calculation of the score based on the medical treatment breakdown for each medical institution and the score corresponding to the medical care item (determined based on the medical standard and the drug price standard). There are provided a means 22, a medicine checking means 23 for checking treatment contents such as a contraindicated combination of medicines from the medical treatment breakdown and consultation date of all medical institutions, and a illness checking means 24 for checking medical treatment contents based on the name of the illness and the medical treatment.

The receipt data is composed of date information, medical institution information, injury and disease name information, and medical treatment breakdown information. As shown in FIG. 2, the receipt DB 3 includes a date information DB 31, a medical institution information DB 32, a disease name information DB 33, and a medical treatment breakdown information DB 34. The record of the date information 310 is stored in the date information DB 31, and the record of the medical institution information 320 is stored. Is stored in the medical institution information DB 32, the record of the disease name information 330 is stored in the disease name information DB 33, and the record of the medical treatment breakdown information 340 is stored in the medical care breakdown information DB 34.

Here, an example of the receipt data will be described with reference to FIGS. As shown in FIGS. 3 to 6, the receipt data includes date information 31 representing the date of consultation.
0, medical institution information 320 taken by the insured person, disease name information 330 indicating the name of the injured or treated during treatment or treatment, medical treatment including medicines required for treatment and medical treatment contents, and medical treatment points including medical treatment points corresponding to the treatment items It consists of a breakdown 340. Also, a date key 310, medical institution information 320, and disease name information 33 are provided by a (uniquely determined) receipt key 301 that enables each receipt data to be distinguished from other receipt data.
0, the medical treatment details 340 are associated. Furthermore, it is associated with the information of the insured person so that the receipt key 301 indicates whether the person is the insured person.

First, the date information 310 is a record as shown in FIG. 3, and is composed of a consultation date 311 and the like, and is managed by the receipt key 301 in association with the receipt data.

Next, the medical institution information 320 is a record as shown in FIG. 4 and is composed of a medical institution code 321 and a medical institution name 322, etc., and is managed by the receipt key 301 in association with the receipt data.

The wound name information 330 is a record as shown in FIG. 5, and information on wounds such as "acute suppurative appendicitis" includes a wound name code 331, a wound name 332, an ICD code 333, a treatment start date 334, and the like. Be composed. Also, it is managed by the receipt key 301 in association with the receipt data.

Further, the medical care breakdown 340 is data as shown in FIG. 6 and is managed by the receipt key 301 in association with the receipt data. Medical treatment breakdown 340 includes drugs, tests,
Alternatively, a medical care category 341 that classifies medical care such as surgery, a code 342 of a medical care item, a medical care name 343, and a quantity 34
4, the number of days 345 and the number of medical treatment points 346. Also,
The code 342 indicates a drug code when the medical treatment section 341 is a drug. The name 343 indicates the name of the medical treatment. The quantity 344 indicates a prescribed dose to be taken daily in the case of a medicine, and represents the number of treatments performed in the case of medical treatment. The number of days 345 indicates the number of days for taking the medicine. The medical care breakdown 340 is a summary of the medical care provided on a date of medical examination at one medical institution by the insured person. One record is a medical care item 350.

The inspection inspection data 400 stored in the inspection inspection DB 4 is obtained by reassembling the receipt data into the insured person by the inspection inspection data creating means 20 and is managed in association with the reception data by the receipt key 301. It is. The inspection data 400 is, as shown in FIG.
1, a consultation date 311, and a medical treatment breakdown 340. As shown in FIG. 7, the inspection inspection database 400 stores inspection inspection data 400 for each insured person.

In the inspection information DB 5, as shown in FIG.
A drug information database 51 (drug information DB) which is basic information such as a dosage form indicating whether the drug is an injection or an oral medicine, a drug injury / disease name database 52 (drug injury / disease name DB) which manages information on a drug and an applied injury / illness name, Drug contraindication information database 53 (drug contraindication information D) that manages information on contraindications (forbidden to use for injuries and illnesses) for each drug
B) A drug contraindication information database 5 that manages information on drug contraindications (concurrent use of drugs is prohibited)
4 (drug contraindication information DB).

The inspection result is stored in the inspection result DB 6 as inspection result data 600. Inspection result data 60
0, as shown in FIG. 9, a receipt key 301, an inspection category 601, an inspection content 602, and inspection details 603 (inspection details 1,
Inspection details 2, inspection details 3,...), The number of medical treatment points 604, and the like. If there is a non-conformity in the inspection result, the receipt key 301 is transcribed from the record of the inspection inspection data 400, and the inspection result is detailed in the inspection category 601 and the inspection content 6.
02, inspection details 603 (inspection details 1, inspection details 2, inspection details 3,...). Further, if there is a difference in the medical score of the inspection result, it is described in the medical score 604.

Next, the inspection data creation means 20 will be described with reference to the flowchart of FIG. Recept D
The receipt data stored in B3 is retrieved (S1
00), the inspection data 400 is created from the date information 310, the medical institution information 320, and the medical care breakdown 340.

First, the medical treatment details 340 are taken out, and the inspection date 311 of the date information 310 and the medical institution code 321 of the medical institution information 320 are attached to create inspection inspection data 400 (S101). The created record is added to the inspection check data of the corresponding insured based on the receipt key 301 (S102).

Further, the next receipt data is transferred to the receipt D
B3 (S100), inspection data 400
Is created (S101) and added to the inspection data 400 of the pertinent insured person (S102). The above processing,
It repeats until there is no more receipt data (S103).

Next, the medical examination means 21 will be described with reference to the flowchart of FIG. First, in the calculation check processing (calculation check means 22), it is checked whether the calculation of the medical treatment score is properly performed in view of the relation between the outpatient management addition calculation and the guidance management fee and the illness and illness, and further, the duplicate calculation of the first diagnosis fee, etc. Is checked (S110). In addition, the calculation check processing (calculation check means 22) includes inspection inspection data 400 of each insured person.
And check based on the receipt data. Next, a drug inspection process for checking contraindications of the drug (drug inspection means 23).
(S111) and a sickness check process for checking whether the relationship between the sickness and treatment is appropriate (sickness check means 24) (S112)
I do. As described above, the medicine check process and the illness check process are also checked based on the inspection check data 400 and the receipt data of each insured person.

Here, the above-described calculation check processing 22 (S11)
The details of 0) will be described with reference to the flowchart of FIG.

First, the medical treatment category 3 of the inspection data 400
With reference to the inspection list determined by the Minister of Health and Welfare from 41 and the code 342, the check for outpatient management addition is performed (S12).
0). For example, when the code 342 indicates a trigger point injection, the calculation of the outpatient management addition cannot be claimed.

Next, it is checked whether the guidance fee management fee is appropriate. In checking the guidance fee management fee, the disease name information 330 is extracted from the disease name information DB 33 using the receipt key 301 included in the inspection data 400. It is checked from the medical care classification 341 and the code 342 whether the medical care content corresponds to the extracted disease name information 330 (S12).
1). For example, in the case of “diabetes”, “special diet” can be calculated for inpatients who are deemed necessary by a doctor. In other words, when the code 342 indicates “special diet”, the information of “having a treatment for diabetes” must be included in the name of the disease extracted from the receipt key.

In the other checks, it is checked whether the “initial consultation fee” is overlapped and added (S122). The medical care breakdown 340 of the same medical institution code 321 in the inspection data 400 is taken out, and it is checked whether there are a plurality of codes 342 indicating the “first consultation fee”. When a plurality is added, it is an overlap addition.

Next, the medicine inspection process 23 (S111) will be described in detail with reference to the flowchart of FIG.
In the medicine inspection process 23, a check is made as to whether the association between the disease name 332 and the medicine (the medical treatment category 341 indicates the medicine) is appropriate (S130), a check is made of the contraindicated medicine from the disease name 332 and the medicine (S131), Check for contraindications for which concomitant use is prohibited (S132), check for long-term administration (S133), check for overdose (S134), check for overlapping applications (S135), check the basis of diagnosis (S136), check other ( S137).

Here, an example of the check (S130) of the association between the disease name 332 and the medicine will be described with reference to the flowchart of FIG. First, the illness name code 331 is extracted from the illness name information DB 33 based on the receipt key 301 included in the medical care breakdown 340 of the inspection data 400 (S14).
0). Injury and disease name code 331 and drug injury and disease name DB
From 52, it is determined whether the medical care division 341 and the code 342 are appropriate (S141). If it is not appropriate (S142), the content indicating improperness is stored in the inspection result data of the corresponding insured person (S143). Further, the next medical care item 350 of the same receipt key is taken out (S144), and the medical care division 34 is selected.
It is determined whether 1 and code 342 are appropriate (S141). The name of the illness and disease 332 for the medical care item 350 of one receipt key
After checking whether the (medical disease name code 331) and the medicine are appropriate (S145), the medical care breakdown 340 of another receipt key 301 is checked. The above processing is repeated until all the inspection data 400 is completed (S146).

As described above, the inspection inspection data 40
0 and the receipt data, referring to the inspection information DB5, referring to the disease name 332 and the medicine (medical treatment section 341 and code 342).
Can be checked for proper use.

Check the name of the disease 332 and the contraindicated drug (S1
An example of 31) will be described based on the flowchart of FIG. First, based on the receipt key 301 of the medical treatment item 350 at the head of the inspection data 400, the name of the disease /
Then, the illness name code 331 is taken out from 3 (S150). The medical care item 350 of the medical care breakdown 340 of the inspection data 400 is extracted (S151), and the code 34 of each medical care item 350 is extracted.
It is determined whether the medicine is appropriate from the medicine injury / disease name DB 52 based on No. 2. The medical treatment item 350 from which the illness name code 331 was taken out, the medical treatment item 350 from which the illness was suffered from the receipt key 301 included in the medical care item 350, and the medical treatment item 3 from which the drug code 342 was taken out
The number of days 34 representing the consultation date 311 for prescribing the drug and the number of days the drug was given from the receipt key 301 included in 50
From 5, when the period of use of the illness and the medicine and the use period of the medicine (the medicine will be described below with the medical treatment period as the use period) overlap, it is checked from the medicine contraindication information DB 53 whether the injury name code 331 and the code 342 of the medicine are contraindicated medicines (S152). . In the case of a contraindicated drug (S153), the contents of the contraindicated drug are stored in the inspection result data 600 of the corresponding insured person (S1).
54). The above processing (S152 to S154) is repeated until all the medical treatment details 340 of the inspection data 400 are completed (S152).
155) Repeat. The inspection and inspection data 4 also applies to the new disease name code 331 of the receipt key (S156).
The contraindicated drug is checked for all the medical treatment items 350 of 00.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, the name of the disease and the contraindications of the medicine can be checked by referring to the check information DB5.

An example of the check for contraindications for drug combination (S132) will be described with reference to the flowchart of FIG. First,
The medicine code 342 of the medical treatment item 350 in the inspection data 400 is taken out as a source code (S160), and the medicine code 342 of the next medical treatment item 350 is taken out as a comparison code (S161). Consultation date 311 of former code 342
And the number of days 345 indicating the number of days when the drug was issued, the date of consultation 311 of the comparison code 342, and the number of days 345 indicating the number of days when the drug was issued check whether the use periods of the drugs overlap. If the use periods overlap, Drug contraindication information DB
From 54, it is checked whether the original code 342 and the comparison code 342 are contraindicated concomitant drugs (S162). In the case of a contraindicated concomitant drug (S163), the content of the contraindicated concomitant drug is stored in the inspection result data 600 of the corresponding insured person (S164).
For all the medical treatment items 350 in the inspection data 400 (S165), the drug code 342 is extracted (S16).
7), Check for contraindicated drugs (S162 to S165)
Is repeated. Further, the next original code 342 is determined (S168), and all combinations of contraindications for other drugs are checked.

As described above, the inspection inspection data 40
Based on 0 and the receipt data, it is possible to check for contraindications to use the medicine by referring to the check information DB5. In addition, 3
In cases where more than one drug is contraindicated for concomitant use, it can be investigated.

Although the detailed flowchart is omitted below, the check of long-term administration (S133) is for judging whether the number of days 345 given in one prescription is appropriate,
When the medical treatment category 341 of the inspection data 400 is a medicine,
The maximum prescription period is extracted from the medicine information DB 51 based on the medicine code 342, and for example, it is checked whether or not the number of days 345 is 14 or less for a medicine that is determined to be up to 14 days at a time.

In the overdosing check (S134), when the medical care category 341 of the inspection data 400 is a medicine, the maximum value of the dose or the number of days 345 is extracted from the medicine information DB 51 based on the medicine code 342 and is equal to or less than the maximum value. Check if it is.

As described above, referring to one of the inspection information DBs 5 based on the inspection data 400 and the receipt data, a duplication check of application (S135), a check of the diagnosis basis (S136), and other checks (Similar to the method described above) S13
7) is performed. For example, application overlap check (S13
In case of 5), the one with the higher drug price is assessed. In the case of checking the basis of diagnosis, the medical care item 350 of the same receipt key is used.
Check that there are no tests that can be used as a basis for diagnosis.

Further, the damage inspection process 24 (S112) will be described with reference to the flowchart of FIG. From the receipt key 301 of the inspection inspection data 400, the illness name code 331 is taken out from the illness name information DB 33 of the receipt data (S170), the medical care classification 341 and the code 342 of the record are taken out (S171), and it is checked whether the contents are appropriate (S172). ). The processes of S171 to S172 are repeated for the record of the same receipt key 301.

The items to be checked for proper contents (S172) are, as shown in the flowchart of FIG. 18, a medical contents inspection process (S180) for inspecting medical contents, and an inspection inspection process (S181) for inspecting examination contents. And an image diagnosis inspection process for inspecting image diagnosis (S182), and a rehabilitation inspection process for inspecting rehabilitation (S1)
83) and an admission check process for checking admission is appropriate (S18)
4), a specific health care material inspection process (S185) for checking whether the relationship between the specific health care materials is appropriate.

As described above, inspection inspection data 4
00, various inspections can be performed with reference to the receipt data DB3 and the inspection information DB5.

Although the calculation checking means, the medicine checking means, and the illness checking means have been described as separate processes for convenience, it is also possible to perform a process combining the above checks.

The above-mentioned inspection is only a part, and many other inspections can be performed based on the inspection data 400.

The inspection information DB 5 may store information other than the information related to the medicine.

[0058]

As described above, according to the present invention, when a plurality of medical institutions receive medical examinations, the medicines and the like issued at each medical institution also include problems of swallowing and doses. In addition, it is possible to comprehensively check the contents of the previous month (including before) at each medical institution. In addition, when treatment is performed across months such as long-term drug administration, the contents of treatment for the previous month and the contents of treatment for the current month can be comprehensively checked. further,
By storing inspection information such as medicines in the database, information on new medicines can be immediately reflected in the inspection.

With regard to the erroneous inspection of the price and the details of the treatment performed, which are determined by the medical standard and the drug price standard, the number of billable times is confirmed accurately.

Further, the corresponding medical institution can be checked from the check result database, and the medical institution can be notified of the contraindications of the medicine and the error in the calculation of the number of medical treatments.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a configuration of a medical system 1.

FIG. 2 is a receipt database.

FIG. 3 shows a configuration of date information.

FIG. 4 shows a record configuration of medical institution information.

FIG. 5 shows a record configuration of wound and illness information.

FIG. 6 shows a configuration of a medical treatment breakdown.

FIG. 7 shows a configuration of inspection data.

FIG. 8 shows a configuration of an inspection information database.

FIG. 9 shows inspection result data.

FIG. 10 is a flowchart of inspection data creation means.

FIG. 11 is a flowchart of a medical examination unit.

FIG. 12 is a flowchart of a calculation checking means.

FIG. 13 is a flowchart of a medicine inspection unit.

FIG. 14 is a flowchart for checking the association between the name of a disease and a medicine.

FIG. 15 is a flowchart for checking names of injuries and diseases and contraindications of drugs.

FIG. 16 is a flowchart for checking contraindications for use in combination.

FIG. 17 is a flowchart of the injury / inspection means.

FIG. 18 is a flowchart of inspection items of the injury / inspection means.

[Description of Signs] 1 Medical system 2 Inspection processing unit 3 Reception database 4 Inspection inspection database 5 Inspection information database 6 Inspection result database 7 OCR reading unit 20 Inspection inspection data creation means 21 Medical examination means 22 Calculation and inspection means 23 Pharmaceutical inspection means 24 Injury and disease inspection means 31 Date information database 32 Medical institution information database 33 Injury and disease name information database 34 Medical treatment breakdown information database 51 Drug information database 52 Drug and disease name database 53 Drug contraindication information database 54 Drug contraindication information database 301 Reception key 310 Date information 311 Consultation Date 320 Medical Institution Information 321 Medical Institution Code 322 Medical Institution Name 330 Injury Name Information 331 Injury Name Code 332 Injury Name 333 ICD Code 334 Care start date 340 medical Breakdown 341 clinical classification 342 code 343 Name 344 Quantity 345 days 346 medical number 350 medical items 400 inspection inspection data 600 and inspection result data 601 and inspection division 602 Inspection contents 603 Inspection details 604 medical points

Claims (6)

[Claims] Claims: 1. A receipt database for storing receipt data obtained by digitizing a medical remuneration statement issued to each insured person for each of a plurality of medical institutions, and for each insured person based on the receipt data. A medical system comprising: a general inspection data creating unit configured to generate summarized inspection inspection data; and a medical check unit configured to check medical treatment contents based on the general inspection data. 2. The medical inspection system according to claim 1, wherein the inspection inspection data creating means creates inspection inspection data including a date of consultation, a medical institution name, a name of an illness, a medical treatment breakdown, and the number of medical treatment points. Medical system. 3. The medical system according to claim 2, wherein the medical check means is configured to check a breakdown of the medical treatment and a contraindicated combination of drugs prescribed by a plurality of medical institutions from the date of the medical examination, and the medical checkup means. A medical system comprising: a morbidity check means for checking the name and the medical treatment breakdown; and a calculation check means for checking the calculation of the medical care breakdown and the number of medical treatments for each medical institution name. 4. The medical system according to claim 2, wherein the medical check unit obtains a medical treatment period based on the number of days included in the medical check item and the date of reception of the general inspection check data, and determines a specific medical check item. A medical system characterized by checking medical treatment contents when a medical treatment period overlaps with a medical treatment period of another medical treatment item. 5. The medical system according to claim 3, wherein the medical system includes an inspection information database that stores inspection information of medical treatment contents such as contraindications for medicines, and the medical inspection unit includes the inspection information in the medical treatment breakdown. A medical system, wherein the inspection information corresponding to the inspection database is taken out from the inspection database from a medical treatment item, and the inspection information is compared with the medical treatment breakdown for inspection. 6. Inspection inspection data compiled for each insured person is created from a receipt database that stores receipt data in which medical fee statements issued to each insured person for each of a plurality of medical institutions are digitized. And a medical recording program for recording a medical processing program for inspecting medical treatment contents based on the inspection data.