JP2008305359A - Medical information management system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical information management system capable of facilitating grasp of a medical bill processing. <P>SOLUTION: The medical information management system for performing various inspections of a patient and for managing a plurality of inspection data in the form of electronic data as medical information comprises: a display control means for displaying an electronic medical chart screen to input medical information of the patient and to display the inspection data and inspection items together on a monitor; a storage means for storing the inspection data and the medical information expressed in the electronic medical chart screen; and a determination means for determining if the patient is billed medical cost for inspection items corresponding to the inspection data stored by the storage means, where the display control means highlights the inspection items, whose medical cost the determination means decides not to bill the patient, on the electronic medical chart screen. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a medical information system that manages medical information as electronic data.

A medical information management system for managing electronic medical information such as an electronic medical record on a network is known. In such a medical information management system, information necessary for diagnosis such as medical charts, medical images, interpretation reports, and examination results is digitized and stored in an integrated manner, and necessary information is displayed on a screen by a predetermined operation. . In addition, a technique is known in which a medical fee or the like (medical fee) is billed and accounted for based on medical data described in a medical record or examination data for each patient such as examination results (for example, Patent Document 1). ).
Japanese Patent Laid-Open No. 10-97582

  Such medical charges are billed for each examination based on the medical treatment fee score table. If the medical information management system automatically calculates the medical charges, such charges are charged. The condition is reflected in the automatic calculation. In this way, by handling automatic billing of medical expenses on the system by automatic calculation, the labor of manual labor is reduced, while doctors and medical clerks determine which medical expenses were charged This makes it difficult to grasp easily.

  An object of the present invention is to provide a medical information management system capable of easily grasping a medical billing process in view of the problems of the conventional technology.

In order to solve the above problems, the present invention has the following configuration.
(1) In a medical information management system that conducts various tests on a patient and manages a plurality of acquired test data as medical information in electronic data,
An electronic medical chart screen for inputting medical information of a patient, the display control means for displaying on the monitor an electronic medical chart screen for displaying the examination data together with corresponding examination items, and the electronic chart screen displayed on the electronic medical chart screen A storage means for storing examination data and the medical information; and a judgment means for judging whether or not to charge a medical fee for the examination item corresponding to the examination data stored by the storage means, The display control means highlights and displays on the electronic medical record screen the examination item that the determination means does not charge for medical expenses.
(2) The medical information management system according to (1) further selects a medical expense claim for selecting whether or not to invoice a medical expense for the examination item of the examination data displayed on the electronic medical record screen. And the display control means highlights and displays the examination item that has not been charged for medical expenses on the electronic medical chart screen by the medical cost claim selection means and the determination means. .
(3) In the medical information management system of (1), the medical cost claim selection means is displayed by the display control means in a window different from the electronic medical record screen.
(4) In the medical information management system according to (1) or (2), unclaimed information is provided to give unclaimed information to an examination item that is not charged for medical expenses by the medical cost claim selection means and / or the determination means. Means are provided.
(5) In the medical information management system of (4), the storage unit stores the examination item to which the unclaimed information is attached in association with the medical information.

  According to the present invention, it is easy to grasp the medical billing process.

  Embodiments of the medical information management system of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram showing an outline of a medical information management system. The medical information management system according to the embodiment of the present invention digitizes medical information and collectively manages it by a server, and the system is constructed by a LAN in a hospital. Reference numeral 10 denotes a management server, and 11 denotes a server body. Reference numeral 12 denotes a CPU mounted on the server main body 11, which is responsible for main calculation processing (determination and calculation) of the medical information management system. Reference numeral 13 denotes a hard disk which is a storage means mounted on the server, and stores all system data and all medical information data. All of these data are centrally managed by the management server 10. Each client 20 connected to the management server 10 described later mainly displays various inspection data, inputs data, and the like. A medical information management system program 14 stored in the hard disk 13 is executed by the CPU 12 which is an execution means. By executing this program, the medical information management system is integrated and controlled.

  Reference numeral 20 denotes a client (terminal), which is connected to the management server 10 via the hub 15. The client 20 includes the following. Clients for the reception of patients who visit the hospital, inspection clients for managing patient inspection data, etc., diagnostic clients for recording, managing, and viewing medical records, and medical expenses for patients who have been examined , A client for accounting, to settle or make appointments for the next medical examination. In practice, the reception client and the accounting client may be shared.

  Each client 20 is connected to the management server 10 and has a personal computer (hereinafter abbreviated as PC) for managing and browsing patient information and the like in its main body. Such a generally used PC can be used as a medical information processing apparatus. A monitor 22 is connected to the PC 21 and displays various work screens to be described later. Reference numerals 23 and 24 are input means connected to the PC 21, 23 is a keyboard, and 24 is a mouse. A LAN cable 25 connects the management server 10 and each client 20 via the hub 15. In this way, the management server 10 and each client 20 form a network. A control unit 21a is built in the PC 21 and controls the execution of the client program of this system, various processes (determination, storage, recall, etc.), display, and the like, and includes a CPU, a memory, and the like. A hard disk 21b is built in the PC 21 and stores a client program, data, and the like of this system. The control unit 21a and the hard disk 21b are also prepared in the PC 21 of the other client 20, respectively. The client program of this system cooperates with the management server 10 to construct a server / client system as if the medical information stored in the management server 10 is virtually managed, viewed and changed on the PC 21. Yes.

  In the inspection client, the PC 21 is connected to one or more various inspection devices 30, and patient inspection data (having inspection results for inspection items) obtained by the various inspection devices 30 is stored in the hard disk 21 b. The Examples of the inspection device 30 include a fundus camera, a tonometer, a refractive power measuring device, a corneal shape measuring device, a slit lamp microscope (slit lamp), and the like for photographing the fundus of a subject's eye in the ophthalmic field. . The inspection data obtained by the inspection device 30 is sent to the hard disk 13 of the management server 10 under the control of the control unit 21a of the PC 21.

  Such an inspection device 30 is connected to each of a plurality of input ports (not shown) prepared on the PC 21 side. The PC 21 discriminates the inspection result sent from each inspection device 30 by port, and the control unit 21a identifies identification information (object ID), inspection date information and inspection for identifying the inspection item corresponding to the inspection result. Test data (including test items, test results, etc.) is sent to the server 10 side with the time, patient identification information (patient ID), and the like attached. Thereby, it is possible to determine which inspection item the inspection data corresponds to. When the test data is manually input to the test client 20 (PC 21), the control unit 21a identifies the patient in the test result by designating the patient, the test item, etc. on the screen. Information, inspection date information, object ID, etc. are given. The object ID includes information for identifying an examination item and identifying information on which medical department the examination belongs to by an alphanumeric character string. Note that the object ID may be assigned by the examination device 30. In such a case, the control unit 21a of the client 20 adds the patient ID or the like to the examination data to which the object ID sent from the examination device 30 is given. Grant and perform the process as listed above.

  Thus, the object ID is given to the inspection data by the control unit 21a and the control unit (not shown) of the inspection device 30. Further, after the object ID is given to the examination result, the examination date information, the patient ID, and the like may be given, and the examination data and the identification information of the examination item may be associated with each other.

  In the above description, the server 10 and the client 20 are connected by the LAN cable 25 and the medical information management system is constructed by the LAN. However, the present invention is not limited to this. You may build by WAN. For example, hospitals may be connected via an internet line and used for centralized medical information management and telemedicine between hospitals. Further, the network construction need not be limited to the connection of the LAN cable 25. A wireless LAN using radio waves that do not affect medical devices, for example, a wireless LAN using PHS may be constructed and used.

  Next, the screen configuration of the medical information management system according to the embodiment of the present invention will be described in order. The operation of the medical information management system described below is performed by moving the cursor displayed on each work screen with a pointing device such as the mouse 24 and selecting (clicking) a button or icon on the screen. Similarly, the cursor is moved, an input field is selected, and characters and codes are input and operated by a character input device such as a keyboard. A reader device may be used for inputting characters and codes. Examples thereof include an acquisition device (reader) such as a card, an IC chip, and a barcode, a biometric device for biometric authentication, and the like.

  FIG. 2 is a diagram showing a setting screen (maintenance screen) for setting a large number of users using the medical information management system. The setting screen is displayed on the monitor 22 by starting the setting program of the medical information management system. In FIG. 2A, 100 is a master maintenance window for performing maintenance of the medical information management system of this embodiment. Each department (clinical department), user group, individual authority level and display settings, and authentication information of each user (User name (login name), password, etc.) are set using this window. As shown in the figure, setting items such as departments are suspended in the tree display 101 in the window 100. For example, when it is desired to newly register a department from the tree display 101, the department can be set by operating the mouse 24 to move the cursor displayed on the screen and selecting “department”. A possible department setting window 120 can be opened on the screen. At this time, the department setting window 120 displays an input field for setting the user ID and password.

  In the department setting window 120, various departments in hospitals such as various departments such as ophthalmology, internal medicine, otolaryngology, medical affairs (reception and accounting), and pharmacies are prepared in advance. Use the various button icons (add, update, delete, etc.) to register the necessary departments. Also, by setting user IDs and passwords, authentication information is set in association with departments such as medical department information required for each user.

  Next, for each user who has set authentication information, settings relating to a list display of inspection data (inspection items) on an inspection screen to be described later are performed. Similar to the setting method described above, when “Examination list display setting” is selected from the tree display 101, an examination list display setting window 130 is displayed (see FIG. 2B). This window 130 displays examination items belonging to another medical department in addition to the medical department column 131 that displays the medical department (department) to which the user belongs, and the medical department displayed in the medical department column 131. When you want to display relevant examination data, add a department to add another department 132, and a test frequently used in other departments in addition to the department displayed in the department section 131 A preset menu 133 capable of setting the data list display and a custom setting button 134 for setting the list display of each inspection data in detail are provided. The preset menu 133 includes a pull-down menu that allows each department to be selected from the pull-down menu. The preset menu 133 indicates that all the examination data corresponding to the examination items of the clinical department to which the user (doctor) belongs and the examination items of other medical departments that are necessary (or reference) for the examination of the medical department to which the user (doctor) belongs. The inspection data corresponding to the inspection item to be performed can be selected and set so as to be displayed in a list. For example, even in medical departments other than ophthalmology, “ophthalmology in general” or the like that is set to display examination data related to ophthalmology, for example, examination of diabetes in internal medicine, fundus photographs used in medical care, etc. . Here, the setting of the medical department is ophthalmology. Such preset setting information is managed in a table and stored in the hard disk 13.

  The custom setting button 134 is a button for individually setting all the inspection data that the user wants to display. When the custom setting button 134 is clicked with the cursor, the custom setting window 140 shown in FIG. 2C is displayed. Is done. The custom setting window 140 is provided with a select box 141 for individually setting display / non-display of each inspection data. The select box 141 is provided with a pull-down menu for selecting each department by pull-down and a window for displaying a list of examination items of the selected department. Each of the examination items (examination names) displayed in this window is provided with a check box, and when the check box is checked with a cursor, a list of examination data of patients specified by the user, which will be described later, is displayed. The selected inspection data is displayed on the monitor. Further, each examination item is provided with an attribute display column indicating to which medical department the examination belongs. Attributes include “ophthalmology”, “internal medicine”, “common” common to all medical departments, and the like. Note that the list of examination items in the select box 141 is not limited to that displayed for each department. It is good also as a structure by which the examination item of all the medical departments which the system handles is displayed as a list. In such a case, the user can select a check box from a list of all clinical departments without switching the pull-down menu.

  As described above, after setting the user and examination list display in each setting window, the user sets the user by the CPU 12 by clicking the OK button (confirmation button) of the button icon provided in the window with the cursor. Is reflected in the management server 10 and setting information for displaying the inspection data is stored in the hard disk 13 in a state of being associated with the user authentication information. The setting information corresponding to the authentication information is a table in which object IDs corresponding to the inspection items selected to be displayed in a list are stored for each user. At the time of list display to be described later, the control unit 21a selects the object IDs in this table. The inspection data is displayed as a list on the screen. The above setting is performed for each user.

  Next, each work screen configuration used in the medical information male management system of the present embodiment will be described. FIG. 3 shows a login screen. Using this login screen, each user enters a login name (user name, user ID or account) and password, and logs in to use the system functions. Login user authentication is performed by cooperation between the control unit 21a and the CPU 12. FIG. 3 shows a login screen. Reference numeral 200 denotes a login window. Reference numeral 201 denotes an input field for inputting a login name and a password. Reference numeral 202 denotes a selection field for selecting a department from a pull-down menu. In the selection column 202, only preset departments are displayed so as to be selectable. In other words, only users registered in advance by the system settings described above can log in. As shown in FIG. 3, when a registered login name and password are entered in the input field 201, the department set previously for each user can be selected from the pull-down menu. Here, by selecting a department and pressing the OK button of the button icon, the user can log in to the system, and the user logs in to the system with the authority of a predetermined department (clinical department).

  First, when a user whose department is “reception” logs in to the system using the reception client 20, a reception window (not shown) is activated. In the reception window, a patient list in which patients who have been subjected to reception processing are registered in order, a patient status indicating a patient state (advancing degree of medical treatment such as examination, medical examination, treatment) is displayed.

  Similarly, if the department is a user of “Examination (Ophthalmology)”, “Diagnosis (Ophthalmology)”, or “Accounting”, each window is activated. Here, examination and examination will be described with reference to the drawings.

  When a user whose department is “examination (medical department: ophthalmology)” logs in with the examination client 20, an examination window 400 shown in FIG. 4 is activated. At this time, when the control unit 21a displays various inspection data on the monitor screen, the control unit 21a is based on the above-described user authentication information and the setting information for inspection data list display stored correspondingly. Control is performed so that only necessary inspection data is displayed.

  In FIG. 4, reference numeral 401 denotes a navigator button, which is a common launcher that is displayed in common with the medical information management system and that changes functions provided for each screen such as reception, examination, examination, and accounting. Reference numeral 410 denotes a patient list that displays a list of patients waiting for examinations and examinations, and reference numeral 800 denotes a patient information display unit that displays information on the patient selected by the examiner. Reference numeral 440 denotes an examination list, which displays examination information received by the patient designated by the cursor or the like from the patient list 410. In the inspection list 440, inspection items (inspection names) and their quantities are displayed. Here, the patient designated by the cursor is surrounded and displayed on the patient list 410.

  When a patient is specified by a cursor or the like in the patient list 410, the control unit 21a reads patient information in the hard disk 13 based on the patient identification information. Here, examinations received by the patient are displayed in examination list 440. As described above, the patient is designated by a series of display control by the control unit 21a, access to the server 10, or the like. The designation of this patient is similarly performed in examinations, examinations, accounting, and the like, which will be described below.

  Next, fetching of inspection data will be described. When a patient is selected in the examination window 400, the control unit 21a reads patient information from the hard disk 13. In this state, when examination data is captured (sent) to the examination client 20, a patient ID is given to the examination data in the examination data import operation of the examination window 400. Here, an operation of taking examination data using a fundus camera will be described. FIG. 5 shows an imaging window 450 for capturing an image that is activated when the “imaging” button of the navigator button 401 in the examination window 400 is selected. The imaging window 450 is provided with a window for displaying a fundus image taken by the inspection device 30 (fundus camera), and a tool icon for performing an operation for saving inspection data. When the examination result obtained by photographing the fundus of the patient with the fundus camera is sent to the examination client 20 by an operation such as a transmission button (not shown) of the fundus camera, the fundus image of the patient is displayed in the imaging window 450. In the case of a fundus camera, an object ID is assigned when a fundus photograph is taken and stored by the fundus camera.

  When the fundus photograph acquired as the examination result is taken into the PC 21 (hard disk 21b) by the operation of “save” of the tool icon, the control unit 21a displays the examination data in the current examination window 450 when the examination data is stored in the hard disk 13. The patient identification information, date, examination conditions, etc. of the designated patient are given to the examination data. In this way, the examination data is given the object ID for identifying the examination item, patient-specific patient identification information (patient ID), date (examination date), examination conditions, etc., and is sent to the server 10 (CPU 12). Managed. In addition, the chart data of the inspection data is transferred with the operation of clicking “Save” on the tool icon as a trigger (described later).

  In the above description, the case where the inspection data is image data (image) has been described. However, the processing procedure is the same even for inspection data (measurement data) having a numerical value. For example, although illustration is omitted, by operating the navigator button 401, a numerical value input window is activated, and inspection data having numerical values can be manually input. An automatic numerical value input from the inspection device may be used. By the same operation as described above, the patient identification information and the like are added to the examination data and stored in the hard disk 13.

  Next, a list display of inspection data will be described. When “inspection list” provided in the navigator button 401 of the inspection window 400 is selected, an inspection list window 420 shown in FIG. 6 is activated. In the examination list window 420, the examination data of the patient specified in the examination window 400 is displayed in a tree as if a symbol 421 is added for each examination date. In this tree display 421, each inspection item suspended with “Date” as the top node (or root) is an inspection item displayed by setting information set for each user as described in the inspection list display setting. Is different. The top node or root used here indicates the highest level in the tree display of each inspection item to be displayed as a list, the root in the structure, the vertex portion, or the hierarchy of each inspection data.

  For example, when only the department is “ophthalmology” in the above-described examination list display setting, the tree display 421 shows fundus photographs (fundus camera photography), intraocular pressure values (precision eye pressure measurements), refractions related to ophthalmology. Only the value (refraction test) etc. is displayed. By clicking each examination item with the cursor, the examination result of the patient is displayed in the window. The inspection data (inspection result) may be displayed as a list in a thumbnail format, and detailed information may be displayed by clicking each thumbnail.

  Although illustration is omitted, when another medical department (for example, internal medicine) is set with the medical department addition button 132 in addition to the medical department displayed in the medical department column 131, the tree display 421 displays the ophthalmology and Inspection items related to internal medicine are displayed. Furthermore, when “General Ophthalmology” is set in the preset menu 133, ophthalmic examination data and examination items related to ophthalmology of other medical departments, for example, fundus photographs acquired in internal medicine and diabetes-related examinations Items etc. are displayed. Furthermore, when display / non-display of each inspection item is individually set in the custom setting window 140, the inspection data desired by the user is displayed in the tree display 421.

  The list display of the inspection data as described above is controlled by the management server 10. With the activation of the examination list window 420 as a trigger, the CPU 12 calls from the hard disk 13 setting information related to the examination data list display associated with the authentication information of the currently logged-in (operating) user. The CPU 12 accesses the patient examination data stored in the hard disk 13 based on the patient identification information specified on the client 20 side, refers to the called setting information, and displays the examination list. Is sent to the inspection client 20 (control unit 21a, hard disk 21b). In the inspection client 20, the control unit 21 a causes the monitor 22 to display a list of inspection items set by the user in a tree display in accordance with the command from the CPU 12 and the transmitted data.

  In this way, by configuring only the inspection items required by the user to be displayed in a list, while suppressing the load on the system side that handles a large amount of data, there is no display of unnecessary inspection data on the user side, It becomes easy to confirm the examination data of the patient. Thereby, medical treatment, medical examination, etc. can be performed efficiently.

  When the user clicks on the inspection item, the control unit 21a causes the monitor 22 to display detailed information on the inspection data in the hard disk 21b. At this time, since the date is given to the inspection data, the inspection items acquired for each date are displayed as a tree with “Date” as the top node. Note that the list of inspections is not limited to the configuration having “date” as the top node as in the tree display 421, and each inspection item is suspended below each inspection item by date as the “inspection item” top node. It is good also as a structure to be made. With such a configuration, it is easy to grasp specific inspection data in time series. This setting is performed using an icon or the like not shown in the examination list window 420.

  In addition, although illustration is abbreviate | omitted, it is good also as a structure which sets the setting of a test | inspection list display with the icon etc. of the test | inspection window 400. FIG. In this case, the setting in the window is associated with the authentication information of the currently logged-in user. In this way, a list display of inspection data can be set on the inspection window, and the setting is saved for each user.

  Next, the configuration of a medical examination screen (electronic medical record screen) for creating a medical chart will be described. When a user who is authorized to perform a diagnosis in the department “Ophthalmology” logs in to the diagnosis client 20, a diagnosis window 600 shown in FIG. 7 is activated. Reference numeral 601 denotes a navigator button for examination, 800 is a patient information display unit, 640 is a medical record, and is composed of three screens denoted by reference numerals 641 to 643. 641 is a new chart display, which describes and browses patient information on the day of examination and SOAP (main complaint, physical findings, evaluation, plan). Reference numeral 642 denotes a past medical chart display, which can refer to a patient's past medical chart. Reference numeral 643 denotes a medical history, which displays a date, a finding at that time, a disease name, and the like extracted from a past medical record as a list. The new chart display 641, the past chart display 642, and the medical history 643 can be used to view past information by scrolling.

  Data transfer for pasting patient examination data on the chart 640 is performed by data transfer from the examination client 20. Although the description of the approval system for writing the medical record accompanying the transfer is omitted, the transfer approval window displayed on the monitor 22 of the medical client 20 is triggered by the storage of the inspection data in the inspection client 20 (inspection window 400). This is done by deciding whether or not to transfer the test data to the medical chart. When the inspection data is transferred to the medical record, inspection items and inspection results of the inspection data are displayed (pasted) on the medical record.

  In the past medical chart display 642, the display is divided for each medical treatment date (examination date). The displays 650 and 660 are an example of the display of inspection data transcribed for each inspection date, and the display 650 is past information from the display 660. The display of the inspection data is expressed by combining at least three types of display of “inspection title”, “inspection item”, and “inspection result” for one inspection. For example, in the display 650, four <ophthalmic examinations> are displayed as "subjects of examination". <Refraction examination>, <Cornea curvature radius measurement>, <Precision intraocular pressure measurement>, <Slit lamp examination> are displayed as each "inspection item", and each "inspection result" is <1.0D>, <7.8 mm>, <19 mmHg (intraocular pressure value)> and the like are displayed. As for the inspection result acquired by the image, for example, <slit lamp inspection>, the inspection data is enlarged and displayed by clicking the display. Also, in the display 660, five <ophthalmic examinations> are displayed as "examination subjects", and the difference from the display 650 is that <precision tonometry> is displayed as "examination items", and "examination results" Is indicated by <21 mmHg>. Further, <fundus camera photography> is displayed as the “examination item”, and a thumbnail of the fundus photo of the patient's eye is displayed as the “examination result”. Clicking on this thumbnail enlarges the fundus photo (actual data is displayed).

  In the display 660, the fact that the inspection data is an abnormal value is highlighted as 661. Along with the above-mentioned medical record transcription, test data with numerical values, such as intraocular pressure value, axial length, corneal thickness, etc., are significantly different from standard values or abnormal values at first glance. So as to be distinguished from the inspection data, the highlighted data is highlighted on the chart (abnormal value highlighted display) as in the highlighted display 661.

  In addition, in the display 650, even when the medical fee is not charged for the examination (medical practice), the medical fee is not charged, and the highlighted display is shown as 651 so that it can be distinguished from the requested examination item. To be made. In the display 651, the fact that the medical cost of the examination data has not been charged is highlighted (unclaimed highlighted) (details will be described later).

  The abnormal value highlighting is performed in the following procedure. As the inspection data is transferred to the medical record, the CPU 12 identifies the inspection item by the object ID, and the numerical value of the inspection data is extracted. The CPU 12 stores in advance a predetermined reference value (threshold value) for each inspection item as reference data in the hard disk 13. The CPU 12 corresponds to the numerical value of the inspection data to be transferred to the medical record and the inspection data. Compare with the reference value prepared for the inspection item. The CPU 12 determines whether the inspection data exceeds or falls below the prepared reference value, and when it is determined as an abnormal value, sends a command signal to the control unit 21a of the examination client, and the inspection posted in the medical chart The data “inspection result” (numerical value) is highlighted as shown in a display 661.

  Note that the highlighting may be a configuration that draws attention to the doctor who conducts the diagnosis and diagnosis based on the medical record information. The highlighted display, the color display that changes the color with other characters on the medical record, the font display that changes the font, and bold , Underline, shaded display, marker display, blinking characters, symbols such as asterisks, etc. may be added. In this embodiment, the color of the portion surrounded by the diagonal line of the display 661 is displayed in bold while being displayed in red (for convenience of illustration, it is displayed as a box). Note that the display of unclaimed information only requires that the user be informed that the examination indentation has not been billed for medical expenses. Instead of highlighting on the medical chart, the cursor is placed on the examination item. The billing information may be displayed in a pop-up.

  Next, a description will be given of the configuration of reference data that serves as a determination criterion (reference value, threshold value) when an abnormal value is highlighted and data change. FIG. 8 is a diagram showing a reference data setting window 700. The reference data setting window 700 is activated from the master maintenance window 100. Reference numeral 701 denotes a medical department menu for calling up an examination item for which a reference value in each department can be set by pull-down, and a list of examination items is displayed in the examination item column 702. Note that each inspection item displayed in the reference data setting window 700 is assigned an object ID in the same manner as described above, and the inspection data that has been transferred is triggered by the operation that the inspection data is transferred to the chart 640. The CPU 12 compares this numerical value with the reference value of the inspection item of the reference data corresponding thereto. Numerals 703 and 704 are numerical value setting fields for setting numerical values for the upper limit value and the lower limit value that are normal values (reference values) in the respective inspection items by pull-down. Numerical value setting fields 703 and 704 are provided for each inspection item. Reference numeral 705 denotes a display switching field, which is a field for setting whether or not to highlight an abnormal value on the chart. The numerical value may be changed by inputting a numerical value using a keyboard or the like. Here, the upper limit value and the lower limit value in precision intraocular pressure measurement (intraocular pressure value) are set to 20 mmHg and 5 mmHg, for example.

  In this embodiment, in order to determine the normal value (abnormal value) for the inspection data, upper and lower reference values (threshold values) are provided. However, the present invention is not limited to this, and the upper limit value or lower limit value is not limited thereto. It is also possible to set only one of the values as a reference value.

  In this way, the user can set reference values (upper limit value, lower limit value) for discriminating between normal values and abnormal values for each inspection item.

  The setting of the reference data is confirmed by pressing the OK button and stored in the hard disk 13 by the CPU 12. The reference data may be one for the entire system, or may be prepared for each user (doctor). The reference data may be stored in the hard disk 21b of the inspection client 20. In this way, the reference data is set by the control unit 21a and the CPU 12.

  In the above description, the presence / absence of the abnormal value is determined by determining whether the measured value obtained by inspecting the reference value in the reference data is higher or lower. However, the present invention is not limited to this. The CPU 12 may perform a comparison operation between the measured value and the reference value, and an abnormal value difference (amount of displacement from the reference value) may be highlighted on the chart based on the calculation result. Moreover, it is good also as a structure which highlights in steps according to the difference from a reference value. For example, in the case of precise intraocular pressure measurement, blue is displayed when +1 to 3 from the reference value (upper limit value), red is displayed when +4 to 6, and bold and red is displayed when +7 or more. Thereby, it becomes easy for the user to grasp the degree in addition to the abnormal value.

  As described above, the examination data is transferred to the chart 640, and diagnosis and diagnosis are advanced based on the information of the chart 640. When the doctor closes (saves) the medical chart screen, the patient's examination is terminated. The control unit 21a and the CPU 12 cooperate with each other to activate the billing selection window 750 using the saving operation of the medical chart 640 as a trigger, and whether or not medical expenses (medical expenses) such as examinations posted on the medical chart 640 are charged / unclaimed. The doctor is prompted to decide whether or not to send the transaction to the accounting client. In the present embodiment, the CPU 12 displays a billing selection window 750 on the monitor 22 with a click of “close” or “end of examination” on the navigator button 601 as a trigger (see FIG. 9).

  A billing selection window 750 serving as a medical cost billing selection unit is activated in a window different from the electronic medical record 640 by the control unit 21a, and is superimposed on the electronic medical record screen (or displayed on a separate screen). The size of the bill selection window 750 is a size that does not cover the past chart display 642 of the chart 640, and is displayed at a position that does not cover the past chart display 642 (about 1/6 to 1/2). The Further, the bill selection window 750 is always displayed in front of the electronic medical chart 640 by the control unit 21a even when the window is in an inactive state. Even if the bill selection window 750 is always displayed on the front, the display is controlled by the control unit 21a so that the chart 640 can be scrolled.

  In the bill selection window 750, the inspection items inspected on the day and transferred to the medical chart are displayed in a list in the inspection item column 751, and each check item is provided with a check box that can be checked with a cursor. By clicking the check box with the cursor and checking with a check mark, the checked inspection items are sent to the accounting client 20 as medical expenses charged, and the unchecked inspection items are not charged as medical expenses. At this time, in each check box, the medical cost is billed / unbilled based on the medical cost billing combination calculation data (created from the medical treatment fee score table etc.) stored in the hard disk 13 in each check box. The determined result is reflected. The combined use calculation data is a table that defines criteria for whether or not medical expenses can be requested based on combinations of examinations, the number of examinations within a month, and the like.

  In this embodiment, after receiving a medical billing / unbilled check (judgment) for each examination item described in the medical chart by the CPU 12, a doctor who is a user makes a billing / unbilled judgment and confirmation (approval). I do. At this time, the doctor can always see past information that cannot be displayed on the chart 640 while looking at the bill selection window 750 displayed on the front.

  After the doctor selects billing / unbilled for medical costs for each examination in the billing selection window 750, by clicking on the confirmation button in the billing selection window 750 with the cursor, billing / unsettled for the medical costs for each examination item. Billing information is finalized. The CPU 12 uses the confirmation in the billing selection window 750 as a trigger, and gives unbilled information to the unbilled examination items in the patient combined calculation data stored in the hard disk 13. The addition of unclaimed information is, for example, flag processing. The CPU 12 sends to the accounting client 20 the examination items to which the unbilled information is given and the examination items to which the unbilled information is not given. In addition, the CPU 12 stores the inspection item to which unclaimed information is added in the hard disk 13. At this time, the examination item to which unclaimed information is assigned and the medical information on the medical chart 640 are stored in association with each other. The control unit 21a triggers the addition of the unbilled information to the inspection item, and highlights the display of the inspection item on the chart like a display 651. This prompts the doctor at the next and subsequent examinations to pay attention to the examination items that have not been requested by the CPU 12 or the doctor's determination. When the patient's chart is called after the next time, the CPU 12 reads the patient information stored in the hard disk 13 and examines the examination item to which the unclaimed information is given. If there is an examination item to which unclaimed information is added, the CPU 12 issues a display control command to the control unit 21a, and when the control unit 21a displays past patient information on the medical chart, the examination item that has been unclaimed is displayed. Highlight it. As a result, the user (doctor) knows when and which examination is unclaimed. Conventionally, the billing / unbilled information does not remain in the medical record and the unbilled information does not remain in the accounting (accounting client). In the present embodiment, both the medical record and the accounting are charged for the inspection item. / Unbilled history is saved.

  As described above, information indicating which medical cost is charged for which examination is displayed on the chart screen, so that the user can easily understand the medical cost claim process. In addition, since the medical billing / unbilled information is stored in the medical chart, it is easy to grasp the history of medical treatment related to medical billing.

  Furthermore, in addition to the medical billing / unclaimed determination of the CPU 12, the medical fee that is not easily calculated automatically only by the CPU is determined by the configuration in which the medical billing / unbilling is determined by the selection (determination) of the doctor. In this point calculation, it is possible to reflect the judgment of the doctor who is familiar with the request for medical expenses. As a result, the reliability of medical billing is improved and the billing process can be performed smoothly. In addition, the burden of confirmation of billing / unbilled in accounting (medical office work) is reduced.

  Furthermore, in the conventional electronic medical chart system, since the information about whether or not the inspection item described in the medical chart is charged for medical expenses is not given, the inspection is performed by the billing / unbilled determination process based on the combined calculation data of the CPU 12. In many cases, the items are unchecked. However, in this embodiment, since the history of unbilled information for each examination item can be reflected in automatic calculation, omission of billing for medical expenses can be reduced.

  In the present embodiment, the check items that do not charge medical expenses are unchecked, but the present invention is not limited to this. When the request selection window is opened, the check item is cleared in the sense that the medical fee is charged for all the test items, and the check item is unchecked by the doctor checking if necessary. May be configured to charge for medical expenses.

  In addition, in this embodiment, although it was set as the structure which highlights the test | inspection item which does not charge medical expenses, it is good also as a structure which pops up by a comment as the additional information on the reason which was not requested. In the above-mentioned determination by the CPU 12 and the doctor's determination in the claim selection window 750, if the CPU 12 makes an unclaimed process, the agreement in the combined calculation data (medical medical fee table, etc.) is used as a comment. In the case of unclaimed processing by a doctor, it is added as a comment to the patient's medical record information. In addition to the above-mentioned unclaimed highlighting display, the control unit 21a is configured to display a pop-up comment when the cursor is positioned at the highlighted display location. Thereby, the doctor can easily understand the highlighted comment of the unclaimed examination (reason for unclaimed).

  In FIG. 7, a display 651 represents that the medical expenses for the examination performed in the previous medical care were not charged. The highlighting of the display 651 is to display <corneal curvature radius measurement> of “inspection item (examination name)” in blue, and performs a different highlighting from the display 661 in which abnormal values are highlighted (here, For convenience of illustration, a box is displayed.) This indicates that the doctor is not charged for the inspection item. In addition, it is possible to display two emphasized displays for one inspection item by changing the abnormal value emphasis display to the color display switching of the inspection result and the unclaimed emphasis display to the color display switching of the inspection item.

  Next, accounting will be described. When the department is an accounting user and logs in to the accounting client 20, an accounting window (not shown) is activated. This accounting window is substantially the same as the reception window. The accounting window has a patient list, a navigator button, a patient information display section, etc., as in the other windows. In accounting, the medical expenses are calculated after the examination is completed. Based on the insurance score attached to each of the examination items for which the process of claiming the medical expenses is confirmed by the examination in the medical chart described on the day of the medical treatment, with the confirmation of the above-described billing selection window 750 as a trigger. The result is calculated, and the result (the amount of medical expenses billed to the patient) is displayed on the accounting client 20. When the medical fee is paid by the patient, the patient's medical care is terminated and the patient is deleted from the patient list 410.

  At this time, the billed / unbilled items are also displayed, and the medical doctor confirms this display and checks the final medical billing request. In medical practice, when a billing / unclaimed mistake for each item (examination item or medical treatment item) is found, a comment is sent from the accounting client to the examination client to prompt the doctor to review it. Also, depending on the level of mistakes, it can be corrected by medical practice. If the billing / unclaimed processing is corrected by medical practice, the doctor is contacted later and the doctor requests the doctor to correct the billing / unbilled billing. As a result, the medical staff can grasp and correct the status of billing / unbilled processing by accounting without changing the description content of the medical chart. In this way, the accounting client can know the billing / non-billing status of each item, thereby facilitating medical checkup.

  Next, the operation of the medical information management system according to the embodiment of the present invention will be described for each item based on the configuration described above. In the following description, a case where a patient receives medical care twice a month will be described. It is assumed that the inspections indicated by the displays 650 and 660 are performed.

  First, login for using each client 20 of the medical information management system will be described. The login window 200 of FIG. 3 is displayed as the same on each client 20. The user who logs in inputs a preset user name (login name) and password in the input field 201 in the login window 200. The CPU 12 authenticates whether the input is a user name and password registered in advance. If the authentication conforms, the department selection field 202 is activated (selectable), and if the authentication fails, an error dialog (not shown) is displayed. The user selects a department to log in from the selection column 202 and clicks an OK button on the login window 200 to log in to the medical information management system.

  When a user whose department is medical (reception) logs in, a reception window (not shown) is activated. At the reception desk, patients who visit the hospital are registered in the medical information management system, and procedures for receiving medical care such as examinations and medical examinations are taken. The patient is additionally registered in the patient list, and the medical care received by the patient is registered. On this day, a refraction examination, a corneal curvature radius measurement, a precise intraocular pressure measurement (NCT), and a slit lamp examination are performed (see examination list 440 in FIG. 4). In the case of examination at a later date, fundus camera photography is added to the examination items.

  The patient is then advanced to the examination. When a user whose department is an examination (an examination engineer, a nurse, or a doctor belonging to an ophthalmologist) logs into the system, an examination window 400 is activated. An inspector who is a user designates a patient to be inspected from the patient list 410 of the inspection window 400 with a cursor, so that the inspection items received by the patient can be known from the inspection list 440.

  Here, for ease of explanation, fundus camera photography and precise intraocular pressure measurement will be described as examples. In the inspection client 20, a fundus photograph as inspection data is taken into the inspection client 20 by an operation on the imaging window 450 as described above. Further, the examiner acquires the intraocular pressure value of the patient with the non-contact tonometer, operates the examination window 400, and inputs the intraocular pressure value (may be automatic input by the tonometer connected to the PC 21). In this way, examination data such as an intraocular pressure value is stored in the hard disk 21b, and an object ID is assigned to each examination data by the control unit 21a and stored in the hard disk 13 of the server 10. Further, the fundus image obtained by the fundus camera is given an object ID by the fundus camera, and when this examination data is “saved” by a tool icon or the like of the imaging window 450, an object ID is given as described above. The examination data is given patient information, date, examination conditions, etc., and stored in the hard disk 13. Furthermore, the transfer processing of each inspection data to the chart 640 is performed by using the inspection data saving operation as a trigger, and when the transfer is approved, the chart information to which the inspection data is transferred is stored in the hard disk 13. Similarly, the refractive value obtained by the refraction examination, the corneal curvature obtained by the corneal curvature radius measurement, the slit images of the anterior and posterior eye obtained by the slit lamp examination, etc. are appropriately selected by the doctor. Posted to 640.

  Next, the patient who has completed the examination enters the examination room. When a user (physician) having the right of examination logs into the examination client 20, the examination window 600 is activated. When the doctor selects a patient to be examined from a patient list (not shown) and clicks the SOAP button of the navigator button 601, a medical chart 640 is displayed.

  When the user opens the chart 640, the previously acquired inspection data is transferred by a transfer approval dialog (not shown). At this time, the CPU 12 compares the intraocular pressure value, which is numerical data, of the examination data to be transferred to the medical chart 640 with the reference data in the hard disk 13 and determines whether the examination data is an abnormal value. This time, since it was not an abnormal value, it is not highlighted. Here, the refractive value, the corneal curvature, and the like are not determined to be abnormal values.

  Here, when it is desired to see a list of patient examination data on the examination client 20, as described above, the navigator button 601 is operated to switch the display to the navigator button 401 used in the examination client 20. The control unit 21 a activates the examination list window 420 when the user clicks the “inspection list” on the navigator button 401. As described in the above configuration, the CPU 12 reads the setting information of the user, issues a command to the control unit 21a, and displays a list of inspection items in the setting information. At this time, in the tree display 421, only a list of examination items set in advance by a user who has logged into the diagnosis client 20 is displayed (see FIG. 6). In order to view detailed data and images from the inspection list, the control unit 21a displays the actual data and images on the inspection window 400 by selecting the displayed inspection items with a cursor or the like.

  As a result, the user can extract data necessary for the user from the patient examination data and view the list. In addition, since data unnecessary for the user is not displayed in the examination list, the processing load of the CPU 12 and the control unit 21a can be reduced, and a smooth examination can be performed. In the list display of examination data, examination data belonging to the clinical department displayed in the clinical department column 131 is displayed on the examination window 400 (monitor 22). Further, by performing detailed settings in the custom setting window 140, in addition to displaying examination data for each department, it is possible to set display / non-display of examination data necessary and unnecessary for the user.

  Furthermore, since the examination data required by the user is displayed in a list, it is possible to save the trouble of switching the screen display of the examination screen of the specific medical department that is currently used when browsing examination data of different medical departments. In the case of such a list display setting, since each examination item is displayed without displaying each medical department on the top node, it is easy for the user to view examination data. In addition, since nodes of medical departments (ophthalmology, internal medicine, common department, etc.) are unnecessary, the load of reading the tree display and the load of display are reduced.

  The doctor diagnoses and treats the patient's disease name based on the examination data. Here, it is assumed that a diagnosis of “suspected glaucoma” is made in the examination on the display 650. This patient will receive “fundus camera photography” at the next medical examination.

  The patient is examined by the procedure as described above, and finally the medical record is saved, and the examination is completed. Triggered by the medical chart storage by the “end of examination” of the navigator button 601, the billing selection window 750 is activated after the CPU 12 determines whether or not the medical cost of the examination is billed. The doctor selects billing / unbilling of examination costs for each examination. Here, precise intraocular pressure measurement, slit lamp examination, and refraction examination are claimed, and corneal curvature radius measurement is not claimed. This is based on a rule prescribed by this hospital, in which a refraction test and a corneal curvature radius measurement are performed on the same day, and if a patient's disease name is not confirmed, only one medical fee can be charged once a month. However, once the disease name is confirmed, the medical expenses for the other test can be charged even within the month. In addition, precise intraocular pressure measurement is a rule that can only be billed for medical expenses once a month unless the disease name is confirmed.

  With the confirmation in the doctor's request selection window 750, the CPU 12 sends each examination item to be billed and unbilled to the accounting client 20, and further calculates the medical cost billed to the patient. At this time, the control unit 21a highlights the unclaimed examination items displayed on the medical chart, and causes the user (doctor) to show unclaimed information at the next medical examination (display 651).

  In accounting, a user whose department is medical (accounting) logs in to the accounting client 20 and performs an accounting process by looking at the patient's medical expenses calculated based on the examination, medical practice, etc. charged to the patient. When the patient pays medical expenses, the patient's series of medical care is completed.

  Next, a case where the same patient comes to receive medical care in the same month will be described. This time, in addition to the previous examination, “fundus camera photography” shall be performed. Here, the same description as above is omitted.

  Each inspection data is acquired as in the previous time, and the inspection data is transferred to the chart. At this time, the CPU 12 compares the intraocular pressure value, which is numerical data, among the inspection data to be transferred to the medical chart, and determines that the inspection data is an abnormal value. Since the abnormal value (21 mmHg) is obtained this time, the CPU 12 instructs the control unit 21a to highlight the display on the chart 640 (past chart display 642) as a display 661.

  As described above, the examination data (numerical value) is highlighted so that the doctor can easily recognize the abnormal value, so that the diagnosis and diagnosis can be performed smoothly and the oversight of the examination data is reduced. In addition, since the user can set a value that is a criterion for the inspection data to be highlighted, it is possible to deal with users having various criteria. The conventional electronic medical chart system has a configuration in which a doctor manually inputs a finding or the like to a SOAP and confirms it with a marker or the like while checking examination data. If the system is configured as in the present embodiment, the examination data can be transferred to the medical chart without manual input by the doctor, and further, highlighting for caution can be performed.

  In the past medical chart display 642, since the patient was not charged for the medical cost for measuring the corneal curvature radius in the previous medical examination, the CPU 12 instructs the control unit 21a to send the information to the past medical chart as shown in the display 651. Display above. As described above, the abnormal value emphasis display and the unclaimed emphasis display are realized by the cooperation of the CPU 12 and the control unit 21a.

  The doctor proceeds with the examination by referring to the examination data, diagnoses the patient's disease name as “glaucoma”, and finishes the examination. By “saving” the chart 640, a billing selection window 750 is activated, and the items that have been checked for billing / unbilled by the CPU 12 are displayed in the window 750 (different from the case of FIG. 9). Here, refraction examination, corneal curvature radius measurement, and precise intraocular pressure measurement have not been claimed yet, and slit lamp examination and fundus camera photography have been claimed. In the billing / unbilled processing, the CPU 12 makes a billing / unbilled determination by associating each examination item (medical item) with the medical treatment fee score table without referring to the patient's disease name.

  Since the name of the patient's disease was confirmed as “glaucoma” at this examination, the doctor checks the corneal curvature radius measurement and the precise intraocular pressure measurement according to the above-mentioned rules (the billing process). At this time, doctors can claim accurate intraocular pressure measurement regardless of past examination within the month if the disease name is confirmed, but in the billing process of corneal curvature radius measurement, the refraction examination is performed in the past examination within the moon. Or information on whether a corneal curvature radius measurement was requested. The doctor confirms the past medical chart display 642 displayed on the back of the billing selection window 750, and based on the display 651, it can be understood that the medical cost for measuring the corneal curvature radius can be billed this time. As described above, the medical examination is completed, the CPU 12 calculates the medical expenses charged to the patient, and the patient pays the medical expenses by accounting, thereby completing a series of medical treatments.

As described above, since the examination for which the examination cost has not been previously charged is highlighted on the medical chart, the doctor who is the user can know at a glance whether the previous medical expense has been requested or not. Thereby, duplication of medical costs and omission of bills can be reduced. In particular, if there are items that can be billed or cannot be billed depending on the combination of examinations in a plurality of medical treatments performed within the month, unbilled information on past examination items (medical treatment items) is displayed in the examination window. Since it can be grasped by 600 (past chart display 640), it is not necessary to browse data in which another billed / unbilled information is recorded.
Further, when the request selection window 750 is displayed on the chart 640, the display size and position of the window 750 are not affected by the past chart display 642. This makes it easier to check and makes a smooth decision on the choice of medical expenses. In addition, the CPU 12 does not take into account detailed medical information of the patient such as a disease name, and makes a determination of whether each item is charged or not based on the correspondence between the examination item and the medical treatment fee score table. As a result, it is not necessary to prepare a huge database for billing / unbilling judgment in the server 10, and the calculation load of the CPU 12 and the data capacity of the hard disk 12 can be suppressed.

  In the present embodiment described above, in the billing / unbilled processing of medical expenses, the doctor 12 receives the determination by the CPU 12 and checks the billing selection window 750 to confirm the billing / unbilled processing. This is not a limitation. Only the CPU 12 may be judged. Even in this case, information indicating that the medical expenses for the examination on a certain day have not been requested is displayed on the medical chart, so that the doctor can easily grasp the medical condition of the patient.

  In the above-described embodiment, the object ID assigned to each examination data (examination item) includes information on the medical department, but is not limited thereto. It is good also as a structure which does not include medical department information and is given object ID by a serial number. Since the object ID is stored in the setting information (examination item table), the setting desired by the user can be associated with the examination data even if the department information is not added to the examination data.

  In addition, although the unclaimed highlight display of this embodiment demonstrated above was set as the structure which highlights an inspection item, it is not restricted to this. If it falls under a medical practice, that is, if it falls under a medical treatment item, it may be an object of highlighting that is unclaimed during medical treatment. For example, surgery, treatment, and the like are included in the medical care items.

It is a figure which shows the outline | summary of the medical information management system of this invention. It is a figure which shows the screen which performs medical information management system setting. It is a figure which shows the login screen for logging in to a medical information management system. It is a figure which shows an inspection window. It is a figure which shows an imaging window. It is a figure which shows the list display of test | inspection data. It is a figure which shows an examination window. It is a figure which shows a reference data setting window. It is a figure which shows a claim selection window.

Explanation of symbols

10 management server 12 CPU
13 Hard disk 20 Client 21 PC
21a control unit 21b hard disk 30 inspection device 100 master maintenance window 130 inspection list display setting window 140 custom setting window 200 login window 401, 601 navigator button 400 inspection window 450 imaging window 600 diagnosis window 640 chart 642 past chart display 750 claim selection window 800 patient Information display section

Claims (5)

In a medical information management system that performs various tests on patients and manages the acquired multiple test data as medical information in electronic data,
An electronic medical chart screen for inputting medical information of a patient, the display control means for displaying on the monitor an electronic medical chart screen for displaying the examination data together with corresponding examination items, and the electronic chart screen displayed on the electronic medical chart screen A storage means for storing examination data and the medical information; and a judgment means for judging whether or not to charge a medical fee for the examination item corresponding to the examination data stored by the storage means, The medical information management system, wherein the display control means highlights and displays on the electronic medical record screen the examination item which is not charged by the determination means. The medical information management system according to claim 1 further includes medical cost claim selection means for selecting whether or not to charge a medical fee for the examination item of the examination data displayed on the electronic medical record screen. And the display control means highlights and displays the examination items that have not been charged for medical expenses on the electronic medical record screen by the medical cost claim selection means and the determination means. system. 3. The medical information management system according to claim 2, wherein the medical cost claim selection means is displayed in a window different from the electronic medical record screen by the display control means. 3. The medical information management system according to claim 1 or 2, further comprising unclaimed information adding means for adding unclaimed information to an examination item that is not charged for medical expenses by the medical charge request selecting means and / or the determining means. A featured medical information management system. 5. The medical information management system according to claim 4, wherein the storage unit stores the examination item to which the unclaimed information is attached in association with the medical information.

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