JP2012234314A - Receipt analysis technology (examination prevention service) - Google Patents

Abstract

PROBLEM TO BE SOLVED: To support accuracy improvement in receipt inspection at a medical institution.SOLUTION: A medical affairs support device 14 comprises: an examination example DB 22 for holding multiple examination examples that show information about receipts which are sent from a medical institution to a review organization and for which payment of medical service fees as requested is rejected by the review organization; a not-yet-reviewed receipt receiving part 28 for receiving from a user information about a not-yet-reviewed receipt that is a receipt before being sent from the medical institution to the review organization; a retrieval part 32 for identifying an examination example for which a content of medical practice for a patient is consistent with a description in the not-yet-reviewed receipt, among multiple examination examples held by the examination example DB 22; and an examination example provision part for providing the user with information for the examination example identified by the retrieval part 32.

Description

  The present invention relates to a data processing technique, and more particularly to a technique for supporting office work in a medical institution.

  In the insurance treatment for receiving medical care using health insurance, the insured (patient) presents the insured card issued by the insurer (health insurance association, etc.) to the medical institution. Medical insurance fees are set for this insurance medical treatment. Part of the medical fee is paid to the medical institution by the insured who receives the insurance treatment, and the remaining medical fee is paid from the insurer to the medical institution.

  At this time, a document submitted from the medical institution to the insurer is called a receipt. The receipt is a medical fee remuneration statement for the medical institution to charge the insurer a fee that is not borne by the insured when receiving medical care at the medical institution. In general, a receipt is a one-month unit that summarizes the medical treatment contents for each patient according to the format, divided into hospitalization, outpatient, and medical insurance.

  Receipt review is conducted by a pre-determined review body for each prefecture or department. If it is determined by the reviewing organization that the medical treatment described in the receipt is not valid, payment of the medical fee as requested by the receipt may be refused, and points may be deducted or reduced. For this reason, before submitting a receipt to the reviewing institution, it is necessary to check the contents of the receipt in the medical institution. In the following Patent Document 1, a technique for reducing the burden on the inspection work of the receipt is proposed.

JP 2009-193133 A

  By the way, the examiner who examines the receipt in the examination organization is a doctor or the like, and it is left to the examiner's subjective judgment as to whether or not the contents of the receipt are allowed. Therefore, the present inventor has considered that mechanical reception inspection based on predetermined inspection logic may not be sufficient.

  The present invention has been made in view of the above-mentioned idea of the inventor, and an object of the present invention is to provide a technique for supporting improvement in accuracy of receipt inspection in a medical institution.

  In order to solve the above-described problems, a medical office support device according to an aspect of the present invention is a receipt sent from a medical institution to an examination organization, and payment of medical fees as requested is rejected by the examination organization. An assessment case holding unit that holds a plurality of assessment cases using the information of the receipt as an assessment case, and an unexamined receipt reception unit that accepts information on an unexamined receipt that is a receipt before being sent from the medical institution to the assessment organization, , Of the multiple assessment cases, the search section that identifies the assessment cases where the content of the medical practice for the patient matches the description in the unexamined receipt, and the assessment case provision section that provides the user with information on the matching assessment cases And comprising.

  It should be noted that any combination of the above-described constituent elements, and the expression of the present invention converted between a method, a system, a program, a recording medium storing the program, and the like are also effective as an aspect of the present invention.

  ADVANTAGE OF THE INVENTION According to this invention, the improvement of the precision of the receipt check in a medical institution can be supported.

It is a figure showing composition of a medical office work support system of an embodiment. It is a block diagram which shows the function structure of the OA terminal of FIG. It is a figure which shows typically the data item set to a receipt. It is a figure which shows typically the data item stored in a conversion table. It is a figure which shows typically the data item of the anonymized receipt. It is a figure which shows the example of a display of a receipt inspection result. It is a figure which shows typically the template of a reexamination proposal. It is a block diagram which shows the function structure of the medical office work support apparatus of FIG. It is a flowchart which shows operation | movement of the OA terminal of FIG. It is a flowchart which shows operation | movement of the OA terminal of FIG. It is a flowchart which shows operation | movement of the medical office work support apparatus of FIG. It is a flowchart which shows operation | movement of the medical office work support apparatus of FIG.

  FIG. 1 shows a configuration of a medical office support system according to an embodiment. The medical office support system 100 includes an OA terminal 12 installed in a medical institution such as a hospital or a clinic, and a medical office support apparatus 14 installed outside the medical institution. The OA terminal 12 is a general PC in which a web browser and various office software are installed, and is operated by a person in charge of medical office work (including a doctor) in a medical institution. The medical office support device 14 is connected to the OA terminal 12 installed in each of a plurality of medical institutions, and provides the OA terminal 12 with information for supporting the receipt check operation, thereby providing medical office services in each medical institution. It is an information processing device that supports the improvement of the efficiency. The OA terminal 12 and the medical office support apparatus 14 are connected via a communication network 16 including a LAN, a WAN, the Internet, and the like.

  In the medical institution, a receipt computer (hereinafter also referred to as “reckon 10”) that manages the receipt is installed together with the OA terminal 12. Receipts created by medical institutions are regularly sent to a screening organization such as a health insurance association. When the examination fee is refused in the examination at the examination body, the increase / decrease point and the return notice (hereinafter also referred to as “assessment notice”) are sent from the examination body to the medical institution. The

  FIG. 2 is a block diagram showing a functional configuration of the OA terminal 12 of FIG. The OA terminal 12 includes a logic table 60, a conversion table 62, an unexamined receipt acquisition unit 64, a logic check unit 66, an anonymization unit 68, an unexamined receipt transmission unit 70, a case information acquisition unit 72, A revealing unit 74, a case information display control unit 76, a rejection receipt acquisition unit 78, a rejection receipt transmission unit 80, an offer form acquisition unit 82, and an offer form display control unit 84 are provided.

  Each block shown in the block diagram of the present specification can be realized in terms of hardware by an element such as a CPU of a computer or a mechanical device, and in terms of software, it can be realized by a computer program or the like. The functional block realized by those cooperation is drawn. Therefore, those skilled in the art will understand that these functional blocks can be realized in various forms by a combination of hardware and software. For example, each functional block of FIG. 2 may be stored as a software in a recording medium, installed in the hard disk of the OA terminal 12, and appropriately read into the main memory of the OA terminal 12 and executed by the CPU. The same applies to FIG. 8 described later.

  The unexamined receipt acquisition unit 64 receives a receipt before it is sent from the medical institution to the inspecting institution, in other words, an undecided receipt (hereinafter referred to as “Unexamined Receipt Receipt”). Is also called.). In the present embodiment, a person in charge of medical office writes the unexamined receipt data held in the receptacle 10 to the USB memory, and attaches the USB memory to the OA terminal 12. The unexamined receipt acquisition unit 64 detects an unexamined receipt stored in the USB memory and reads the data.

  FIG. 3 schematically shows data items set in the receipt. Although there are a wide variety of data items set in the actual receipt, only a part of the items are shown in the embodiment for the sake of simplicity of explanation. The data items in FIG. 3A and the data items in FIG. 3B are actually connected as one record, and are set for each patient who received insurance treatment.

  Returning to FIG. 2, the logic table 60 is a storage area for holding check logic for checking whether or not a set value of each data item of a receipt or a combination of set values of a plurality of data items is appropriate. For example, the inspection logic includes data indicating the proper usage / dose of the medicine set in the medicine name field of the receipt. In addition, data indicating combinations in which the names of drugs and their usage / doses are likely to be indicated in combination with the age and disease of patients are included.

  The logic check unit 66 executes a logic check process for checking whether or not the set value of each data item of the unreviewed receipt is appropriate according to the check logic stored in the logic table 60. As a result of the logic check process, the logic check unit 66 outputs a message indicating whether or not the set value of each item of the receipt may be recognized as non-adaptive. A specific example of the result of the logic check process will be described later with reference to FIG.

  The conversion table 62 associates a unique ID, which is identification information for uniquely identifying each record of unexamined receipts (unexamined receipts of each patient) across a plurality of medical institutions, and personal information of each patient. Storage area. FIG. 4 schematically shows data items stored in the conversion table 62. As shown in the figure, each item of the receipt shown in FIG. 3A is associated with a unique ID.

  Returning to FIG. 2, the anonymization unit 68 executes anonymization processing of unexamined receipt data, in other words, processing for deleting or abstracting the patient's personal information to make it difficult to identify the patient. Specifically, first, a unique ID is assigned to each patient record in an unexamined receipt. Then, each item of the receipt shown in FIG. 3A is associated with the unique ID and stored in the conversion table 62.

  Subsequently, the anonymization unit 68 deletes the insured personal identification number / number, the chart number, and the name from the data items of the receipt. In addition, the code other than the prefecture code in the medical institution number is deleted so that only the prefecture code is deleted. Then, the anonymized receipt data is associated with the unique ID and passed to the unexamined receipt transmitter 70.

  FIG. 5 schematically shows anonymized receipt data items. The data item in FIG. 5A and the data item in FIG. 5B are also actually one record. As shown in the figure, each anonymized receipt data is associated with a unique ID. In addition, the result of the logic check by the logic check unit 66 for the unexamined receipt is added.

  Returning to FIG. 2, the unexamined receipt transmitting unit 70 transmits the anonymized unexamined receipt data to the medical office support apparatus 14. Although details will be described later, the medical office work support apparatus 14 according to the present embodiment displays the assessment cases accumulated in the medical office work support apparatus 14 based on the anonymized unexamined receipt data received from the OA terminal 12. Search for. When the search process is completed, the medical office work support apparatus 14 transmits an electronic mail describing the completion to the OA terminal 12. This e-mail may contain a hyperlink to the web page that displays the search results for the assessment case. If the person in charge of the medical office who confirmed the e-mail selects the hyperlink, the case information The acquisition unit 72 may detect an acquisition request for an assessment case search result.

  When the case information acquisition unit 72 receives an acquisition request for an assessment case search result from a medical office worker, the case information acquisition unit 72 transmits the acquisition request to the medical office support device 14. In this acquisition request, the unique ID specified in the unexamined receipt transmitted to the medical office support apparatus 14 by the unexamined receipt transmitting unit 70 may be specified. Subsequently, the case information acquisition unit 72 acquires the search result data of the assessment case from the medical office work support apparatus 14. The acquired data here is obtained by adding the search results of the assessment cases to the data of (a) and (b) of FIG. 5, and is hereinafter also referred to as “receipt inspection result”. As will be described later with reference to FIG. 6, the search result of the assessment case in the receipt inspection result includes information indicating the number of assessment cases and the assessment rate in the same case, and the number of assessment cases and the assessment rate in similar cases.

  The revealing unit 74 refers to the conversion table 62 and stores the data associated with the unique ID of the receipt inspection result (insured person's card symbol / number to date of birth in FIG. Personal information) of the patient, and the receipt inspection result is revealed. For example, an insured person ID / number, a medical institution code, a medical record number, a name, and a date of birth associated with the unique ID are added to the receipt check result, or replaced with an abstracted medical institution code or year of birth.

  The case information display control unit 76 causes the display of the receipt inspection result that has been made obvious by the revealing unit 74. In addition, when the data of the receipt inspection result is provided as a web page, the case information display control unit 76 may provide the web page to the web browser and display the reception inspection result on the web browser.

  FIG. 6 shows a display example of the receipt inspection result. Receipt information is displayed in the first area 90 of FIG. In the second area 92, the result of the logic check by the logic check unit 66 is displayed. In the third area 94, the result of the assessment case search by the medical office work support apparatus 14 is displayed. In the present embodiment, as a result of the assessment case search, the same case (ie, the assessment case with the same settings for the birth year of the receipt, the name of the disease, the name of the medical treatment, and the drug name) and the similar case (the above set values are the same) Although it is not, the number of assessment cases for each combination of the whole country / prefecture and all departments / same departments is presented in the number field 96 for each case. Further, the ratio of the number of cases assessed to the total number of unexamined receipts is presented in the ratio field 98.

  Returning to FIG. 2, the rejection receipt acquisition unit 78 includes information entered in the assessment notice entered by the medical clerk and the subject of assessment (hereinafter also referred to as “rejection receipt”). The information described in is accepted. Hereinafter, these pieces of information are also collectively referred to as “assessment information”. When inputting the assessment information, the medical clerk designates the receipt scheduled for reexamination, and the rejection receipt acquisition unit 78 sets a reexamination scheduled flag for the assessment information of the designated receipt.

  The rejection receipt acquisition unit 78 may receive an assessment information input request from a medical clerk and display an assessment information input screen on the display. And the designation | designated of the assessment information and the reexamination petition which the medical office worker entered may be acquired via the input screen.

  The rejection receipt transmission unit 80 transmits the assessment information in which the reexamination schedule flag is appropriately set to the medical office work support apparatus 14. Upon completion of setting the template for the reexamination proposal form, the medical office support apparatus 14 transmits an e-mail describing the completion to the OA terminal 12. This e-mail may contain a hyperlink to the web page for obtaining the template for the reexamination application, and if the person in charge of the medical office who confirmed the e-mail selects the hyperlink The application form acquisition unit 82 may detect a template acquisition request for the reexamination application form.

  When receiving the request for acquiring the reexamination proposal template from the medical office staff, the proposal acquisition unit 82 transmits the acquisition request to the medical office support apparatus 14. In this acquisition request, the medical institution number is specified as the key of the reexamination application. The application form acquisition unit 82 acquires the template data of the reexamination application form from the medical office work support apparatus 14. The template data may be in a data format defined by predetermined word processing software, for example. The application form display control unit 84 displays the template data of the reexamination application form acquired by the application form acquisition unit 82 in an editable state on the display.

  FIG. 7 schematically shows a reexamination application form template. In the first area 200 in the reexamination proposal, the description content of the assessment notice and the description content of the refusal receipt that are associated with each entry item in advance are automatically set. On the other hand, in the second area 202 (that is, the reason for retrial) column in the retrial application form, the result of the assessment case search for the rejection receipt is set.

  FIG. 8 is a block diagram showing a functional configuration of the medical office work support apparatus 14 of FIG. The medical office support apparatus 14 includes an unexamined receipt DB 20, an assessment case DB 22, a search result DB 24, an offer form DB 26, an unexamined receipt reception unit 28, a rejection receipt reception unit 30, a search unit 32, and statistical processing. A unit 40, a search result recording unit 42, a case information providing unit 46, an offer form recording unit 48, and an offer form providing unit 50 are provided.

  The unexamined receipt DB (database) 20 is a storage area for holding an unexamined receipt. The data structure of the unexamined receipt is as already described in FIGS. 5 (a) and 5 (b). The assessment case DB 22 is a storage area for holding a plurality of assessment cases using assessment information including the written contents of the assessment notice and the rejection receipt as assessment cases. The data of the assessment notice includes the reason for the assessment, and the data structure of the rejection receipt is as described above with reference to FIGS. 3 (a) and 3 (b). The search result DB 24 is a storage area that holds data of case search results by the search unit 32. The application form DB 26 is a storage area that holds data of the reexamination application form set by the application form recording unit 48.

  The unexamined receipt receiving unit 28 receives unexamined receipt data transmitted from the OA terminal 12 of the medical institution and stores it in the unexamined receipt DB 20. The rejection receipt acceptance unit 30 accepts the assessment information transmitted from the OA terminal 12 of the medical institution and stores it in the assessment case DB 22.

  When the unexamined receipt is accepted by the unexamined receipt accepting unit 28, the retrieval unit 32 retrieves an assessment case using the contents of the medical practice described in the unexamined receipt as a search key. In addition, when the assessment information is accepted by the rejection receipt acceptance unit 30 and the reexamination schedule flag is set in the assessment information, the retrieval unit 32 assesses the content of the medical practice described in the assessment information as a search key. The search unit 32 that searches for cases includes the same case search unit 34, a similar condition table 36, and a similar case search unit 38. Hereinafter, an unexamined receipt and a rejection receipt that are subject to case search are also referred to as “search condition receipt” as appropriate.

  The same case search unit 34 matches the patient's birth year, gender, disease name, medical practice name, and drug name (including usage and dose) described in the search condition receipt among the assessment cases stored in the assessment case DB 22 The assessment case of the description content to be specified is identified as the same assessment case. As a modification, an assessment case that matches a part of the combination, for example, an assessment case that matches a combination of a disease name, a medical practice name, and a medicine name may be specified as the same assessment case. In addition, the same case search unit 34, among the unexamined receipts stored in the unexamined receipt DB 20, has entered unexamined in which the description content (contents of the above-mentioned data items as in the case of identifying the same assessed case) matches the search condition receipt. Identify the receipt as the same unreviewed receipt.

  Even if the description content of the search condition receipt and the description content of the assessment case are different, the similar condition table 36 is a condition (hereinafter also referred to as “similarity determination condition”) for determining that both of the description contents are similar. .). As the similarity determination condition, an age range presumed to be similar and a range of usage / dose of a medicine are set. For example, when the year of birth in the search condition receipt is 1975, the years of birth 1970 to 1974 and 1976 to 1980 may be set as similar ranges. As another similarity determination condition, a correspondence relationship between an original drug (also referred to as an original drug or a new drug) and a generic drug (also referred to as a generic drug) is set.

  The similar case search unit 38 identifies an assessment case that matches the similarity determination condition stored in the similar condition table 36 as a similar assessment case among assessment cases in which the content of the medical practice is different from the search condition receipt. For example, when a generic drug is described in the drug name field of the search condition receipt, the assessment example in which the generic drug corresponding to the generic drug is described in the drug name field is identified as a similar assessment example. The same applies to the reverse case. In addition, the similar case search unit 38 selects unreviewed receipts stored in the unreviewed receipt DB 20 as unreviewed receipts whose medical action content is different from the search condition receipt and whose difference matches the similar determination condition. Identified as an audit receipt.

  The statistical processing unit 40 performs statistical processing on the same assessed case specified by the identical case searching unit 34 based on the examination attribute. In the present embodiment, on the premise that the subject review subject is different for each prefecture and medical department, the number of the same assessment cases for each prefecture and medical subject, which are the attributes of the subject subject, is tabulated.

  Specifically, the statistical processing unit 40 counts the total number of the same assessed cases as the number of the same assessed cases nationwide and all courses. In addition, the number of cases of the same assessment where the prefecture code in the medical institution code matches the description in the search condition receipt is counted as the number of cases of the same assessment in the prefecture and all departments. In addition, the number of cases of the same assessment that the clinical department matches with the description in the search condition receipt is counted as the number of cases of the same assessment in the same department. In addition, both the prefecture code and the medical department in the medical institution code count the number of the same assessed cases that match the description contents of the search condition receipt as the number of the same assessed cases in the prefecture and the same department.

  The statistical processing unit 40 also executes statistical processing based on the examination attribute for the similar assessment cases specified by the similar case search unit 38 as in the case of the same assessment cases. That is, the total number of similar assessment cases is counted as the number of similar assessment cases nationwide and in all courses. In addition, the number of similar assessment cases where the prefecture code in the medical institution code matches the description in the search condition receipt is counted as the number of similar assessment cases in the prefecture and in all departments. In addition, the number of similar assessment cases that the clinical department matches with the description content of the search condition receipt is counted as the number of similar assessment cases in the same department. In addition, the prefecture code and medical department in the medical institution code count the number of similar assessment cases that match the description contents of the search condition receipt as the number of similar assessment cases in the prefecture and the same department.

  In addition, the statistical processing unit 40 performs statistical processing similar to the statistical processing for the same assessed case for the same unexamined receipt specified by the same case searching unit 34,・ Count the same number of unreviewed receipts for all departments, the same number of unreviewed receipts for the whole country / same department, and the same number of unreviewed receipts for the prefecture / same department. And the ratio of the number of cases of the same unreviewed cases in the whole country and all departments in the number of the same unreviewed cases in the whole country and all departments, the ratio of the number of cases of the same assessed cases in the prefecture and all departments in the same number of unreviewed cases in the prefecture and all departments Percentage of the same number of unidentified cases in the same department / country in the same number of cases received in the same department / in the same department, and percentage of the same number of cases in the same department / in the same department in the same unreviewed cases in the same department / division. Count.

  The statistical processing unit 40 also executes statistical processing similar to the statistical processing for similar assessed cases for the similar unexamined receipts identified by the similar case search unit 38, Count the number of similar unexamined receipts within the prefecture and all departments, the number of similar unexamined receipts across the country and the same department, and the number of similar unexamined receipts within the prefecture and the same department. And the ratio of the number of similar assessed cases in the national and all departments in the number of similar unexamined cases in the national and all departments, the ratio of the number of similar assessed cases in the prefecture and all departments in the number of similar unexamined receipts in the prefecture and all departments, The ratio of the number of similar assessed cases in the country and the same department to the number of similar unreviewed cases in the country and the same department, and the ratio of the number of similar assessed cases in the prefecture and the same department in the number of similar unexamined receipts in the prefecture and the same department, respectively. Count.

  When the search result recording unit 42 receives an unexamined receipt at the unexamined receipt receiving unit 28 and the search unit 32 executes a case search process for the unexamined receipt, the result of the statistical processing at the statistical processing unit 40 is The data is stored in the search result DB 24 in association with the unexamined receipt data. At that time, the search result recording unit 42 transmits to the OA terminal 12 an electronic mail stating that the inspection result of the unexamined receipt can be referred to (downloadable).

  The case information providing unit 46 receives an acquisition request for an assessment case search result from the OA terminal 12. And it is the data of the unexamined receipt specified by the unique ID specified in the acquisition request, and the data including the result of the statistical processing in the statistical processing unit 40 is acquired from the search result recording unit 42, and OA is obtained as the receipt check result. Transmit to the terminal 12. That is, the unchecked receipt data to be displayed in the first area 90, the logic check result data to be displayed in the second area 92, and the assessment example to be displayed in the third area 94 of the receipt check result shown in FIG. The search result data is provided to the OA terminal 12.

  When the assessment information is received by the rejection receipt acceptance unit 30 and the case retrieval process for the assessment information is executed by the retrieval unit 32, the proposal record recording unit 48 includes a reexamination application including the result of the statistical processing by the statistical processing unit 40 The document data of the certificate is stored in the proposal document DB 26. At that time, the application form recording unit 48 transmits to the OA terminal 12 an electronic mail stating that the reexamination application form can be referred to (downloadable).

  Specifically, the application form recording unit 48 correlates each entry item of the first area 200 in the reexamination application form shown in FIG. 7 with each entry content of the assessment notification form and the rejection receipt included in the assessment information. Preserve relationships. When the reexamination proposal is set, the correspondence is referred to, and the description contents of the assessment notice and the rejection receipt are set for each description item in the first area 200.

  The proposal recording unit 48 sets the result of statistical processing in the statistical processing unit 40 for the second area 202 in the reviewer application. As shown in FIG. 7, in this embodiment, the same number of unreviewed receipts in the whole country and all departments, the same number of unreviewed receipts in the whole prefecture and all departments, the same number of unreviewed receipts in the whole country and the same department, Are set in the second area 202 with the same number of unexamined receipts and the same number of cases assessed. As a modification, the rate of assessment may be set in the same manner as the assessment case search result, or the number of similar unexamined receipts and the number of similar assessment cases may be further set.

  The offer form providing unit 50 receives a request for obtaining a reexamination offer form template from the OA terminal 12. Then, the reexamination proposal specified by the medical institution number specified in the acquisition request, in other words, the document data of the reexamination proposal with the medical institution number specified in the acquisition request is acquired from the application DB 26. And sent to the OA terminal 12 as a template for the reexamination application.

The operation of the above configuration will be described below.
FIG. 9 is a flowchart showing the operation of the OA terminal 12 of FIG. When the unexamined receipt acquisition unit 64 of the OA terminal 12 detects that an unexamined receipt is stored in the connected USB memory (Y in S10), the unexamined receipt is read. The logic checking unit 66 executes a logic checking process for the unexamined receipt (S12). The anonymization unit 68 executes anonymization processing on a predetermined data item related to the patient's personal information in the unexamined receipt (S14). The unexamined receipt transmitter 70 uploads the anonymized unexamined receipt data to the medical office work support apparatus 14 (S16). If an unexamined receipt is not detected (N in S10), S12 to S16 are skipped.

  When the case information acquisition unit 72 detects a display request for the inspection result of the unexamined receipt input from the medical clerk (Y in S18), the case information acquisition unit 72 indicates the inspection result of the unexamined receipt (logic inspection result and case search result). Data is acquired from the medical office work support apparatus 14 (S20). The revealing unit 74 reads the patient's personal information from the conversion table 62, and executes the revealing process of the inspection result data (S22). The case information display control unit 76 displays the inspection result of the unrecognized unexamined receipt on the display (S24). If the display request for the inspection result of the unexamined receipt has not been detected (N in S18), S20 to S24 are skipped.

  FIG. 10 is also a flowchart showing the operation of the OA terminal 12 of FIG. The rejection receipt acquisition unit 78 of the OA terminal 12 detects the assessment information input from the medical clerk (Y in S30), and assesses the reexamination schedule flag when a reexamination is designated (Y in S32). Information data is set (S34). If re-examination is not designated (N in S32), S34 is skipped. The rejection receipt transmitter 80 transmits the assessment information to the medical office support apparatus 14 (S36). If the input of the assessment information is not detected (N in S30), S32 to S36 are skipped. When the application form acquisition unit 82 detects a display request for the reexamination application form input from the medical clerk (Y in S38), the application form acquisition unit 82 obtains the document data of the reexamination application form as the medical office support device 14 (S40), the application form display control unit 84 displays the data on the display as an editable reexamination application form template (S42). If the re-examination application display request is not detected (N in S38), S40 and S42 are skipped.

  FIG. 11 is a flowchart showing the operation of the medical office support apparatus 14 of FIG. When receiving the unexamined receipt from the OA terminal 12 (Y in S50), the unexamined receipt receiving unit 28 of the medical office support apparatus 14 stores the data of the unexamined receipt in the unexamined receipt DB 20 (S52). The search unit 32 searches for an assessment case in the assessment case DB 22 using the content of the medical practice for the patient described in the unexamined receipt as a search key, and identifies an assessment case that matches or is similar to the description content of the unexamined receipt (S54). The statistical processing unit 40 aggregates the results of the assessment case search (by examination attribute units (specifically, by region and department)) (S56), and the search result recording unit 42 stores the aggregation results in the search result DB 24 ( S58). If an unexamined receipt is not accepted (N in S50), S52 to S58 are skipped.

  Subsequently, when the case information providing unit 46 receives from the OA terminal 12 a request for acquiring the inspection result of the unexamined receipt (Y in S60), the inspection result data including the logic inspection result and the case search result is acquired from the search result DB 24. Then, it transmits to the OA terminal 12 (S62). If the request for acquiring the inspection result of the unexamined receipt is not accepted (N in S60), S62 is skipped.

  FIG. 12 is also a flowchart showing the operation of the medical office support apparatus 14 of FIG. Upon receipt of the assessment information from the OA terminal 12 (Y in S70), the rejection receipt acceptance unit 30 of the medical office support apparatus 14 stores the assessment information in the assessment case DB 22 (S72). When the reexamination schedule flag is set in the assessment information (Y in S74), the search unit 32 uses the content of the medical practice for the patient described in the rejection receipt in the assessment information as the search key, and the assessment case in the assessment case DB 22 And an assessment case that matches or resembles the description of the rejection receipt is specified (S76). The statistical processing unit 40 tabulates the results of the assessment case search in units of examination attributes (specifically, by region and by department) (S78). The application form recording unit 48 stores the document data of the reexamination application form in which the totaling result is set in the reexamination reason column in the application form DB 26 (S80). If the reexamination schedule flag is not set (N in S74), S76 to S80 are skipped, and if no assessment information is accepted (N in S70), S72 to S80 are skipped.

  Subsequently, when receiving the request for obtaining the reexamination application form from the OA terminal 12 (Y in S82), the offer form providing unit 50 obtains the data of the reexamination application form from the application form DB 26 and transmits it to the OA terminal 12 ( S84). If the acquisition request for the reexamination proposal is not accepted (N in S82), S84 is skipped.

  According to the medical office support system 100 of the present embodiment, the medical office support apparatus 14 accumulates the assessment cases of the receipts, and the number of cases and the number of unexamined receipts for the assessment cases that are the same as or similar to the unexamined receipts. The ratio of the number of assessments to the total is presented to medical staff. This suggests whether or not the current description of the receipt is likely to be assessed, and the medical clerk will show the past cases of the degree of risk that the description of the unexamined receipt will be rejected by the review. Judgment can be made based on this, and the contents can be modified as appropriate. The examination result of the receipt depends on the subjectivity of the examiner. According to the medical office support system 100, not only the static check based on the inspection logic but also the assessment situation with the description content that matches or is similar. By presenting it to the person in charge of medical office work, it is possible to support the improvement of accuracy in the inspection work of unexamined receipts.

  In the present embodiment, it is possible to further improve the accuracy in the inspection work of the unexamined receipt by searching not only the same as the unexamined receipt but also similar assessment cases and providing the search results. . For example, the second record of the search result of FIG. 6 shows that there are a large number of similar assessment cases although there are 0 cases of the same assessment, and the current description content of the unexamined receipt is recognized as non-conforming. Medical clerks know that there is a high risk that More specifically, when a generic drug name is described in an unexamined receipt, it is possible to grasp an assessment case in which a generic drug name that can be identified with the generic drug is described.

  Further, according to the medical office support system 100, the assessment cases that match the examination attribute (region or department) of the search condition receipt in the medical office support device 14 are aggregated separately from other assessment cases, and the number of assessment cases and assessments are counted. Present the percentage to the medical clerk. Thereby, it becomes easy for the medical staff to grasp the examination tendency for each region or department, and it is possible to support the appropriate correction according to the tendency. For example, if the medical clerk confirms the first record of the receipt check result in FIG. 6, the current description of the receipt has a high risk of being assessed nationwide, but the risk of being assessed within the prefecture is low. Thus, it can be determined that the current description may be maintained.

  Further, according to the medical office support system 100, each item in the first area 200 in the reexamination proposal shown in FIG. 7 includes the description content of the assessment notice associated with each item and the description content of the rejection receipt. Is set automatically. On the other hand, in the second area 202 in the retrial application form, that is, in the retrial reason column, the result of the assessment case search for the rejection receipt is set. For example, a doctor can determine the presence / absence of a retrial in consideration of the number of cases evaluated in the retrial reasons column, and can easily cite the number of cases evaluated as one of the reasons for retrial. In addition, since many of the items to be described in the first area 200 are automatically set, it is possible to reduce the burden of creating a reexamination proposal.

  Further, according to the medical office support system 100, the personal information of the patient described in the unexamined receipt is held in the OA terminal 12, and the unexamined receipt passed to the medical office support apparatus 14 is anonymized. . Thereby, diffusion of patient personal information can be avoided and the risk of leakage can be reduced.

  The present invention has been described based on the embodiments. This embodiment is an exemplification, and it will be understood by those skilled in the art that various modifications can be made to combinations of the respective constituent elements and processing processes, and such modifications are also within the scope of the present invention. is there.

  A first modification will be described. In the above embodiment, the number of the same assessment cases and the number of similar assessment cases are displayed on the inspection result screen of the unexamined receipt. As a modification, when the medical clerk selects a predetermined object (may be a display character string of the number of cases) provided in the display field of the same assessment case, the content of the same assessment case is displayed on the display of the OA terminal 12 You may let them. Similarly, when the medical clerk selects a predetermined object provided in the display field of the similar assessment case, the content of the similar assessment case may be displayed on the display of the OA terminal 12.

Here, although the structural example in the case of showing the description content of the similar assessment example is shown, it is needless to say that the same configuration can be realized when the description content of the same assessment case is presented.
The search result recording unit 42 of the medical office support device 14 has data of similar assessment cases that are subject to aggregation with respect to character strings indicating the number of similar assessment cases (by region / clinical department) that have been aggregated by the statistical processing unit 40. A hyperlink specifying the identification information (URL or the like) may be set. When detecting that the hyperlink is selected by the medical office worker, the case information providing unit 46 designates the identification information of the similar assessment case and transmits the acquisition request to the medical office support device 14 to obtain the similarity. You may acquire and display the data which show the description content of the assessment example.

  According to this modification, the actual contents of the same assessment case or similar assessment case can be presented to a medical office worker, and further improvement in accuracy in the inspection work of unexamined receipts can be further supported. In particular, similar assessment cases are different from unexamined receipts, and it is a preferable aspect to present the description to medical staff.

  A second modification will be described. In the above embodiment, as the similarity determination condition, the range of the set value of each data item of the receipt and the correspondence relationship between the original drug and the generic drug are mentioned. As a modified example, when there are a plurality of elements for assessment (deduction points, etc.), a combination of elements that show a strong positive correlation (for example, correlation coefficient = 0.7 to 1), in particular, is a similarity determination condition. May be determined in advance.

  For example, statistical data that there is a high probability that a combination of disease name A and drug B is present in the receipt, such as the reason for assessment that “This patient is 65 years old and drug B is not suitable for disease name A” Consider the case. In this case, the similarity condition table 36 of the medical office work support apparatus 14 may hold a combination of the disease name A and the medicine B as a similarity determination condition. The similar case search unit 38 may specify all the receipts having a combination of the disease name A and the medicine B as similar assessment cases regardless of differences in other description contents.

  A third modification will be described. In the above embodiment, the OA terminal 12 reads the unreviewed receipt data in the receptacle 10 via a predetermined recording medium (USB memory). However, the receptacle 10 and the OA terminal 12 are connected online. Of course it is good. In the notification of the assessment information from the medical institution to the medical office support apparatus 14, the assessment notification form and the rejection receipt document are sent from the medical institution to the administrator (system management company, etc.) of the medical office support apparatus 14. Also good. In this case, the administrator may read the assessment notice and the contents of the rejection receipt with an OCR (Optical Character Reader) device, and the rejection data reception unit 30 of the medical office support device 14 may receive the character data.

  A fourth modification will be described. In the above embodiment, the logic check process for the unexamined receipt is executed by the OA terminal 12, but it goes without saying that this logic check process may be executed by the medical office support apparatus 14. In this case, the medical office support apparatus 14 further includes the logic table 60 and the logic checking unit 66 described in FIG. 2, and the logic checking unit 66 is not anonymized at the OA terminal 12 before or after the case search. Execute logic check process for audit receipt.

  A fifth modification will be described. Accumulation of assessment cases is indispensable to improve the accuracy of the assessment case search results for unexamined receipts, but it is assumed that some medical institutions would like to inspect unexamined receipts but do not want to provide assessment information. The This is not a desirable situation because it reduces the accuracy of the assessment case search result of the medical office support apparatus 14. Therefore, although not mentioned in the above embodiment, a kind of restriction in checking unreviewed receipts may be imposed on medical institutions that do not provide assessment information. Specifically, the medical office support apparatus 14 holds the date (January, February, 2011, etc.) when the assessment information was provided from the medical institution, and the search unit 32 determines the assessment information before the provided date. May be the search target population. As a result, medical institutions that have stopped providing assessment information will be provided with search results for assessment cases that do not reflect new assessment cases, and can encourage medical institutions to provide active assessment cases. .

  Any combination of the above-described embodiments and modifications is also useful as an embodiment of the present invention. The new embodiment generated by the combination has the effects of the combined embodiment and modification.

  It should also be understood by those skilled in the art that the functions to be fulfilled by the constituent elements recited in the claims are realized by the individual constituent elements shown in the embodiments and the modified examples or by their linkage.

  In addition, the content of Claim 3 can also be actualized as follows. That is, the similar condition holding unit holds the correspondence relationship between the original drug and the generic drug, and the search unit does not match the description of the medical action to the patient among the plurality of assessed cases with the contents described in the unexamined receipt. Although there is an assessment case in which the content of the discrepancy is the difference between the original drug and the generic drug defined in the correspondence relationship, the similar case may be specified.

  10 Rececon, 12 OA terminal, 14 Medical office support device, 20 Unexamined receipt DB, 22 Assessment case DB, 24 Search result DB, 26 Proposal DB, 28 Unexamined receipt reception, 30 Rejection reception, 32 Search , 34 Same case search section, 36 Similar condition table, 38 Similar case search section, 40 Statistical processing section, 42 Search result recording section, 46 Case information providing section, 48 Application form recording section, 50 Application form providing section, 100 Medical office work Support system.

Claims (6)

An assessment case holding section that holds a plurality of assessment cases by using the information of a receipt sent from a medical institution to the examination body and the payment of the medical fee as requested is rejected by the assessment body ,
An unexamined receipt reception unit that receives information on an unexamined receipt, which is a receipt before being sent from a medical institution to an examination organization, from a user;
Among the plurality of assessment cases, a search unit for identifying an assessment case in which the content of the medical action to the patient matches the description content in the unexamined receipt;
An assessment case providing unit for providing information of the matching assessment case to the user;
A medical office work support apparatus comprising: Each of the plurality of assessment cases includes examination attribute information indicating an examination attribute,
The unexamined receipt also includes the examination attribute information,
The search unit further identifies an assessment case including examination attribute information described in the unexamined receipt among the matching assessment cases,
The assessment case providing unit, when providing information of the matching assessment case to a user, provides the assessment case including the examination attribute information described in the unexamined receipt in an identifiable manner. Item 2. The medical office work support apparatus according to Item 1. A similar condition holding unit that holds information indicating a predetermined condition that should be determined as similar even if the description content in the unexamined receipt differs from the description content in the assessment case;
The search unit includes, as a similar case, an assessment case in which the content of the medical action on the patient is inconsistent with the content described in the unexamined receipt among the plurality of assessed cases, but the content of the mismatch is consistent with the condition. More specific,
The medical office work support apparatus according to claim 1, wherein the assessment case providing unit further provides the user with information on the similar case. Further comprising an unexamined receipt holding unit for accumulating and holding information on the unexamined receipt;
When a new unexamined receipt is received by the unexamined receipt receiving unit, the search unit includes the unexamined receipt stored in the unexamined receipt holding unit and the content of the medical practice for the patient is the new To further identify unreviewed receipts that match what is stated in the unreviewed receipts,
The said assessment example provision part further provides the user with the information which shows the ratio of the number of the said matching case examples to the number of the said matching unexamined receipts, The Claim 1 characterized by the above-mentioned. Medical office support equipment. A rejection receipt accepting unit that accepts information on a receipt that is rejected by the examination body and is to be filed for reexamination from the user;
A document provider,
Further comprising
The search unit identifies an assessment case in which the content of the medical practice for a patient matches the content described in the rejected reception among the plurality of assessment cases,
The document providing unit sets the information on the matching assessment case in the input area of the reason for retrial in the document data of the reexamination proposal form, and provides the user with the document data of the reexamination proposal form. The medical office work support apparatus according to any one of claims 1 to 3, wherein A function of holding a plurality of assessment cases by using the information sent from the medical institution to the assessment institution and receiving information on the receipt for which the payment of medical fees as requested was rejected by the assessment organization,
A function for accepting information from an unexamined receipt, which is a receipt before being sent from a medical institution to an examination organization,
Among the plurality of assessment cases, the function of identifying an assessment case in which the content of the medical practice for the patient matches the description content in the unexamined receipt;
A function of providing the user with information on the matching assessment case;
A computer program for realizing a computer.

Images