JP2015087939A - Receipt check device, method, and program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To check accuracy of an electronic receipt for dentistry of a predetermined format created for insurer submission with high accuracy without load increase on a person, and support creation of the electronic receipt for dentistry capable of reducing errors about an insurance institution.SOLUTION: The invention creates data about an identified part based on an order of tooth, in which the part is a target part of respective medical care, from the electronic receipt for dentistry of a predetermined format created for insurer submission. Then, the data about the identified part in which the order of tooth is identified for each medical care is used for checking accuracy of the electronic receipt.

Description

  The present invention relates to a receipt check technique, and more particularly, to a dental receipt computer data check technique.

  When a medical institution such as a hospital or clinic conducts medical treatment for a patient, it creates a medical remuneration statement called a receipt and submits it to a screening organization such as a payment fund or National Health Insurance Federation. Upon receiving the receipt, the reviewing organization checks the contents of the receipt and, if there are no errors in the insurance system, submits the receipt to the appropriate insurer. In response, the insurer pays medical fees to the medical institution.

  The receipt is digitized (electronic receipt), recorded on a recording medium, and submitted. Alternatively, it is transmitted as electronic data. This electronic receipt collects medical records for one month for each patient, and is created in a predetermined format (receipt file: UKE file) with a corresponding receipt computer (computer equipped with receipt creation software).

  In order to prevent the wrong electronic receipt from being sent to the reviewing institution, the medical institution checks the electronic receipt before sending it to the reviewing institution. In order to reduce the burden at this time, there is a technique of automatically checking using master data for checking in which a standard value of the number of medical treatments determined according to the name of a sickness is registered (for example, see Patent Document 1) ).

  However, in dentistry, in order to check the accuracy of the electronic receipt, a site (for example, a tooth number) targeted by a medical practice is required. However, because the data provided by the Ministry of Health, Labor and Welfare and the electronic receipt after making a UKE file cannot identify the tooth number targeted by each medical practice, even if the master data for checking is used, the accuracy is high. Cannot check. For this reason, in order to perform a highly accurate check, the person in charge of the check must identify the tooth number of the medical practice based on the experience from the electronic receipts that are compiled on a monthly basis, for example (for example, Non-patent document 1).

Japanese Patent No. 4903981

Social Insurance Medical Fee Payment Fund “Payment Fund Service Improvement Plan” January 13, 2011

  In such a situation, in order to perform a highly accurate check, the burden on the person in charge is heavy and the check takes time. The accuracy of the check depends on the experience of the person in charge. On the other hand, if an electronic receipt is submitted to the examination body without being checked with high accuracy, the burden on the examination body will increase. In addition, a return occurs, an incorrect electronic receipt is not found, and a legitimate reward is not quickly paid to the medical institution.

  The present invention was made in view of the above circumstances, and without increasing the burden on the person in charge, checks the accuracy of a predetermined format electronic electronic receipt created for insurer submission with high accuracy, It is an object of the present invention to provide a technology that supports the generation of a dental electronic receipt with reduced insurance system errors.

  According to the present invention, in a dental electronic receipt of a predetermined format created for insurer submission, the target site of each medical practice is specified by, for example, a tooth number using predefined master data. Then, the accuracy of the electronic receipt is checked using the medical practice data in which the target part is specified.

  Specifically, from the electronic receipt data created for each patient in a predetermined format, using a target part specifying unit that generates part data in which a medical practice and a part are associated, and the generated part data A check unit that checks the accuracy of the electronic receipt data, and the electronic receipt data records a wound name part record that records a part that has been treated for each wound name and a score and number of times for each medical practice. The target part identifying unit includes, for each medical practice in the medical practice record, identifying a part that is a target of the medical practice using predetermined master data, An electronic receipt check device is provided that generates site data.

  In addition, electronic receipt data created for each patient in a predetermined format, which is a wound name part record for recording a part for which treatment has been performed for each wound name, and a medical record for recording points and the number of times for each medical practice An action record, and for each medical practice of the medical practice record, for each medical practice, specify a site that is a target of the medical practice using predetermined master data, and the medical practice and the site Provided is an electronic receipt check method comprising: a target part specifying step for generating correlated part data; and a check step for checking the accuracy of the electronic receipt data using the generated part data. .

  Furthermore, the computer is electronic receipt data created for each patient in a predetermined format, and records the site of medical treatment for each medical name, and the score and number of times for each medical practice. A medical practice record to be recorded, and for each medical practice of the medical practice record, a site to be targeted for the medical practice is specified using predetermined master data, and the medical practice and the site are recorded And a receipt check program for functioning as a check means for checking the accuracy of the electronic receipt data using the generated part data.

  ADVANTAGE OF THE INVENTION According to this invention, the dental electronic receipt of the predetermined format produced for insurer submission can be checked with high precision, and generation | occurrence | production of the dental electronic receipt which reduced the error in the insurance system as much as possible can be supported.

It is a hardware block diagram of the receipt check apparatus of embodiment of this invention. It is a functional block diagram of the receipt check apparatus of embodiment of this invention. (A) is an electronic reception data of embodiment of this invention, (b) is explanatory drawing for demonstrating a patient unit reception, respectively. (A) is an explanatory drawing for demonstrating the wound name part (HS) record of embodiment of this invention, (b) is a medical treatment act (SS) record, respectively. It is explanatory drawing for demonstrating the treatment disease name master of embodiment of this invention. It is explanatory drawing for demonstrating the calculation requirement master of embodiment of this invention. It is explanatory drawing for demonstrating the site | part data of embodiment of this invention. It is a flowchart of the check process of embodiment of this invention. It is a flowchart of the object part specific process of embodiment of this invention. (A) And (b) is explanatory drawing for demonstrating the site | part candidate data of embodiment of this invention.

  Hereinafter, embodiments to which the present invention is applied will be described. Hereinafter, in all the drawings for explaining the embodiments of the present invention, those having the same function are basically denoted by the same reference numerals, and the repeated explanation thereof is omitted.

<Hardware configuration>
FIG. 1 is a diagram for explaining a hardware configuration of a receipt check apparatus 100 according to the present embodiment. The receipt check device 100 includes a CPU (Central Processing Unit) 102, a main memory 103, a storage device 104, a display memory 105, a controller 107, a network adapter 110, and a system bus 111 that connects these components so that signals can be transmitted and received. With.

  As an input / output interface, a controller 107 is connected to a display device 106 and a mouse 108, and a system bus 111 is connected to a keyboard 109.

  The receipt check apparatus 100 is connected to other information processing apparatuses 130 and the database 140 via a network 120 so as to be able to send and receive signals. Here, “to enable signal transmission / reception” indicates a state in which signals can be transmitted / received to each other or from one to the other, regardless of whether they are electrically or optically wired or wireless.

  The CPU 102 controls the operation of each component. The control is performed according to a predetermined program. The CPU 102 loads a program stored in the storage device 104 and data necessary for program execution into the main memory 103 and executes the program.

  The main memory 103 stores a program executed by the CPU 102 and an intermediate process of arithmetic processing.

  The display memory 105 temporarily stores display data to be displayed on the display device 106 such as a liquid crystal display or a CRT (Cathode Ray Tube).

  The storage device 104 is a device that stores various data necessary for processing, data generated during the processing, and data generated by the processing, and is specifically a hard disk or the like. Further, the storage device 104 may be a device that exchanges data with a portable recording medium such as a flexible disk, an optical (magnetic) disk, a ZIP memory, and a USB memory.

  In the present embodiment, as will be described later, the accuracy of the dental receipt computer data (electronic receipt data) is checked. The electronic receipt data to be checked is also stored in the storage device 104. The electronic receipt data to be checked is stored in another information processing device 130 or database 140 connected to the receipt check device 100 via a network 120 such as a LAN (Local Area Network), and is acquired from there. Also good.

  The mouse 108 and the keyboard 109 are operation devices for an operator to give an operation instruction to the receipt check apparatus 100. The mouse 108 may be another pointing device such as a trackpad or a trackball.

  The controller 107 detects the state of the mouse 108, acquires the position of the mouse pointer on the display device 106, and outputs the acquired position information and the like to the CPU 102.

  The network adapter 110 is an interface for connecting the receipt check apparatus 100 to a network 120 such as a LAN, a telephone line, and the Internet.

<Functional configuration>
As described above, the receipt check apparatus 100 according to the present embodiment checks the accuracy of the dental receipt computer data (electronic receipt data) for errors in the insurance system. In order to realize this, as shown in FIG. 2, the receipt check apparatus 100 according to the present embodiment includes a database unit 210 that holds an electronic receipt data 300 and a data group used for processing, and an electronic receipt data 300, and a medical practice. A target part specifying unit 220 that generates part data 510 that associates parts with each other, a check part 230 that checks the accuracy of the electronic receipt data 300 using the part data 510, and a processing result (check result) of the check part 230 A display processing unit 240 that generates display data from the list 530) and displays the display data on the display device 106.

  As described above, the target part specifying unit 220, the check unit 230, and the display processing unit 240 are realized by the CPU 102 loading the program stored in the storage device 104 into the main memory 103 and executing the program. The database unit 210 is constructed in the storage device 104, for example.

<Electronic receipt data>
The electronic receipt data 300 is electronic data of a medical remuneration statement in which medical records (medical records) for a predetermined period (for example, one month) for each patient are aggregated, and is created in a predetermined format. As the predetermined format, for example, the UKE format defined by the Ministry of Health, Labor and Welfare is used. The predetermined period is an interval of submission to the insurance claimee, for example, one month. Hereinafter, in this embodiment, one patient's electronic receipt data is referred to as a patient unit receipt 310. The electronic receipt data 300 is a set of patient unit receipts 310 as shown in FIG.

  As shown in FIG. 3B, the patient unit receipt 310 includes a wound name part record (HS record) 320 and a dental practice record (SS record) 330 as data related to the check process of the present embodiment. .

  The HS record 320 is a record part that records the name and part of the wound for the treatment performed on the patient. As shown in FIG. 4A, in the HS record 320, a site 323 where medical care is performed is recorded for each wound name code (wound name CD) 322 for specifying the wound name 321. The wound name code 322 is predetermined for each wound name 321. The site | part 323 registers the location which performed the treatment regarding the said wound in the tooth number format. In addition, the abbreviated name of the wound name may be registered for each wound name 321.

  In the example of FIG. 4A, the part 323 “[upper right] 7, 4” is associated with the wound name 321 “caries”, and the part 323 “[lower left] 1” is associated with the wound name 321 “dental pulpitis”. be registered.

  The SS record 330 is a record part for recording a medical practice performed for the patient and its score and number of times. As shown in FIG. 4B, for each medical practice code (medical practice CD) 332 that identifies the medical practice name 331, an addition code (addition CD) 333, a score 334, and a number 335 of the medical practice Is recorded. The medical practice code 332 is determined in advance for each medical practice.

  Note that the SS record 330 holds information (date data) related to the date. In the present embodiment, the SS record 330 includes a medical practice group (identical calculation unit data) having the same calculation unit. The addition code 333 indicates the parent-child relationship of each medical practice within the same calculation unit data. However, in this embodiment, the same calculation unit data is divided into calculation date units in advance. That is, even in the medical practice group having the same calculation unit data, those having different calculation dates are not set as the same calculation unit.

  In the example of FIG. 4B, for the clinical practice name 331 “first visit”, the score 334 “218” and the number of times 335 “1” are displayed, and “228” and “1” are displayed in the “extraction (single root canal)”. Each is registered. The medical practice name 331 “metal crown restoration (inlay simple)” and “(material) gold para (molar)” are in a parent-child relationship and have the same calculation unit (same calculation unit data). Accordingly, “316” is registered as the score 334 and “1” is registered as the number of times 335. Similarly, “metal crown restoration (inlay simple)” and “(material) gold para (molar and anterior teeth)” are in a parent-child relationship, “276” is registered in the score 334, and “1” is registered in the number of times 335. The

  The patient unit receipt 310 further includes a pharmaceutical record (IY record), a specific equipment record (TO record), a symptom detail record (SJ record), a comment record (CO record), and a medical practice record (SI record). It may be.

  Among these records, the TO record has the same structure as the SS record 330. The SI record and the IY record have a structure in which the addition code 333 is removed from the SS record 330. On the other hand, a code, a part, and contents are recorded in the CO record. In addition, the code and contents are recorded in the SJ record.

<Target site identification part>
The target part specifying unit 220 generates part data 510 by specifying and associating each part of the medical practice recorded in the SS record 330 with the part that is the target of the medical part. The part is selected from the parts recorded in the HS record 320. For specifying the region, master data prepared in advance such as a treatment disease name master 410 and a calculation requirement master 420 are used. The treatment disease name master 410 and the calculation requirement master 420 are registered in the database unit 310 in advance.

  The target part specifying unit 220 of the present embodiment also includes an oral information generating unit 221 that generates the oral information file 520 from the generated part data 510.

  The treatment disease name master 410 is a database in which a medical practice and an injury and disease name are associated with each other. As shown in FIG. Specifically, for each medical practice code (medical practice CD) 412 that identifies the medical practice name 411, a wound name and disease name code (wound and disease name CD) 413 that identifies the wound name 414 is registered. In addition, the abbreviated name of the wound name may be registered.

  The calculation requirement master 420 is a database associating the medical practice with the calculation requirement. As shown in FIG. 6, the calculation requirement 424 is registered for each medical practice code 422 associated with the medical practice name 421. In the calculation requirement 424, the type of tooth that is the subject of the medical practice is registered. In the calculation requirement master 420, an addition code (addition CD) 423 for each medical practice, a calculation unit 425, and an upper limit number of times (upper limit number) 426 that can be treated within the calculation unit are registered. Also good.

  The part data 510 obtained as a result of associating by the target part specifying unit 220 is obtained by associating the target part with each medical practice name 331 of the SS record 330. As shown in FIG. 7, similarly to the SS record 330, the part data 510 stores a score 513 and a count 514 for each medical practice code (medical practice CD) 512 that identifies the medical practice name 511, , The target region 515 is recorded.

  The oral cavity information generation unit 221 uses the part data 510 to create missing tooth information. Information about the missing tooth to be created is registered in the database unit 210 as the oral cavity information file 520. For example, a part (tooth number) 515 associated with a medical practice name 511 such as tooth extraction is a missing tooth.

<Check section>
The check unit 230 includes a pre-check unit 231 that performs syntax check and office check of the patient unit receptor 310 to be checked, and a score that determines the appropriateness of the score and number of times of the patient unit receptor 310 using the part data 510. The frequency check unit 233 and a validity check unit 234 that determines the validity of the medical practice of the patient unit receipt 310 are provided.

  The pre-check unit 231 checks whether or not essential items to be recorded are recorded in the patient unit receipt 310 to be processed, item length, mode, code, and consistency between items of each item. Do. The check result is recorded in the check result list 530, for example, in the form of a message or the like indicating the location where there was a failure and the content of the failure. This check result list 530 is generated for each patient unit receipt 310.

  The score count checking unit 233 performs score count check processing for checking the validity of the patient unit receipt 310 from the score plane, using the site data 510 in which the target site of each medical practice is specified. The check uses a dental electronic score table 430 provided by the Ministry of Health, Labor and Welfare and an oral information file 520 including a calculation number master in which a calculation unit and an upper limit number are registered for each medical practice. The check result is recorded in the check result list 530 in the same manner as the check result by the pre-check unit 231.

  In addition, when said calculation requirement master 420 is provided with the calculation unit 425 and the upper limit frequency | count 426 for every medical practice 421, you may use this calculation requirement master 420 as a calculation frequency master.

The score count check unit 233 checks suitability for the following items, for example.
1: Hospitalization / outpatient check for medical practice 2: Medical check for the elderly in the late stage of medical care 3: Check of hospital / clinical clinic for medical practice 4: Checking the number of beds for medical practice 5: Medical practice and reporting check 6: Medical practice and future Hospital check 7: Medical practice and special item check 8: Facility standard check of medical practice 9: Unreported subtraction check of medical practice 10: Dental calculation check of medical practice 11: General addition check 12: Basic addition check 13: Note addition Check 14: Material addition check 15: Kick quantity check 16: Age restriction check 17: Actual days related check 18: Comprehensive / included (same day) check 19: Comprehensive / included (same month) check 20: Comprehensive / included (same) (Part) check 21: check against the relationship (same day) 22: check against the relationship (same month) 23: check against the relationship (Same part) Check 24: Check the number of calculations

  Among these, the score count check unit 233 performs “24: calculation count check” as the calculation count for each patient unit receipt 310 for calculation requirements (dental type, etc.) and calculation units (tooth, day, etc.) of dental practice. Check if is appropriate. For example, with reference to the calculation number master, it is checked whether the number 335 of each medical practice name 331 in the SS record 330 of the patient unit receipt 310 is equal to or less than the upper limit number.

  For example, in dental practice, there is a medical practice that can be performed only once on the same site, such as “pulvation (single root canal)”. It is checked whether or not such a medical practice is performed several times for the same part.

  In addition, the oral information file 520 is used to check whether or not a medical practice has been performed on a tooth registered as a missing tooth in the file.

  The validity checking unit 234 performs validity checking processing for checking the validity of the medical practice registered in the patient unit receipt 310 using the part data 510 in which the target part of each medical practice is specified. For the check, the basic check master 440 and the oral cavity information file 520 are used. The basic check master 440 is obtained by converting the interpretation in dental calculation into data for checking, and the check items, check conditions, and the like that the electronic medical record creation system generally has are registered. The check result is recorded in the check result list 530 in the same manner as the check result by the pre-check unit 231.

For example, the validity check unit 234 checks validity of the following items.
1: Checking the consistency of the name of the medical care injury and illness 2: Checking the medical care 1/3 amount calculation count 3: Checking the medical checkup tooth condition calculation (including cross-month)
4: Medical practice tooth number range check 5: Medical practice designated tooth number check 6: Molar side artificial tooth check 7: Medical practice calculation omission check 8: Missing part disease name check 9: Guidance fee omission check 10: Insurance medical bridge check 11: Item search check 12: Checking for non-calculation of medical practice and medical practice (monthly straddle)
13: Drug dosage check

  For example, in the master data of the tooth condition calculation check performed in “3: medical practice tooth condition calculation check (including cross-month)”, the types of teeth that can be calculated for each medical action are registered. For example, it is assumed that only “molar teeth” and “wisdom teeth” are set as the types of teeth that can be calculated for the medical practice “metal crown restoration (inlay simple)” in the master data. On the other hand, it is assumed that the target part 515 [upper right] 4 [lower left] 1 is registered as the part data 510 for the medical practice name 331 “metal crown restoration (inlay simple)”. Since tooth number 4 is a premolar and 1 is an anterior tooth, the obtained part data 510 cannot be calculated in this tooth calculation check and is a check target. Such a check can be performed by having the part data 510 in which the part specified by the tooth number is associated with the medical practice.

<Display processing unit>
As described above, the display processing unit 240 generates display data from the check result list 530 that is the processing result of the check unit 230 and displays the display data on the display device 106. Specifically, for example, the check result by the pre-check unit 231, the check result of each check item by the score number check unit 233, and the check result of each check item by the validity check unit 234 are displayed. Further, the site data 510 generated by the target site specifying unit 220 may be displayed. Further, the oral information file 520 generated by the oral information generator 221 may be displayed.

<Check process flow>
Next, the flow of the check process of the electronic receipt data 300 by the target part specifying unit 220 and the check unit 230 of the present embodiment will be described. FIG. 8 is a processing flow of the check processing of this embodiment. The check process is performed for each patient unit receipt 310 constituting the electronic receipt data 300. Further, this process is started by receiving a start instruction from the user.

  First, the check unit 230 reads the entire electronic receipt data 300 to be checked (step S1001). Next, selection of a patient unit receptor 310 to be checked is accepted (step S1002). For example, all patient unit receptors 310 constituting the read electronic receipt data 300 are displayed as a list, and the selection of one or more patient unit receptors 310 to be processed is received. This is processing that assumes a case where processing is performed for each dentist in charge at a dental clinic where there are a plurality of dentists, for example. At this time, the display processing unit 240 may be configured to display the selected patient unit receipt 310.

  Thereafter, for each patient unit receptor 310 selected in step S1002, the check unit 230 performs the following processing from step S1003 to step S1007.

  First, the pre-check unit 231 performs a pre-check on the patient unit receipt 310 (step S1003). The precheck result is registered in the check result list 530 in association with the patient unit receipt 310 to be checked.

  Next, the target part specifying unit 220 performs target part specifying processing on the patient unit receipt 310 after the precheck, and generates part data 510 (step S1004). As described above, the site 323 registered in the HS record 320 is associated with each medical practice name 331 registered in the SS record 330 of the patient unit receipt 310.

  The oral cavity information generation unit 221 generates the oral cavity information file 520 using the generated part data 510 (step S1005).

  Thereafter, the score count check unit 233 performs the score count check process using the site data 510, the dental electronic score table 430 including the calculation count master, and the oral cavity information file 520 (step S1006). The check result is additionally registered in the check result list 530 associated with the patient unit receipt 310.

  Finally, the validity check unit 234 performs validity check processing using the part data 510, the basic check master 440, and the oral cavity information file 520 (step S1007). Also in this case, the check result is additionally registered in the check result list 530 associated with the patient unit receipt 310.

  When the process is completed for all the patient unit receptors 310 selected in step S1002 (step S1008), the display processing unit 240 uses the check result list 530 created for each patient unit receptor 310 as display data, and displays the display device. 106 (step S1009).

  Thereafter, the check unit 230 returns to step S1002 and waits for selection of a patient unit receptor 310 to be processed by the user until an end instruction is received from the user (step S1010). On the other hand, when an end instruction is received, the process ends.

<Target site identification process flow>
Next, the flow of the target part specifying process by the target part specifying unit 220 will be described. FIG. 9 is a processing flow of the target part specifying process of the present embodiment. Here, a case where the symmetrical part specifying process is performed on the patient unit receptor 310 including the HS record 320 illustrated in FIG. 4A and the SS record 330 illustrated in FIG. 4B will be described as an example. Further, the treatment disease name master 410 to be used is exemplified in FIG. 5, and the calculation requirement master 420 is exemplified in FIG.

  The target part specifying unit 220 first refers to the treatment disease name master 410 and performs part candidate extraction processing for extracting part candidates for each medical practice name 331 of the record (step S1101) (step S1102). 540 is generated (step S1103).

  Here, the medical practice name 331 (medical practice code 332) in the SS record 330 is collated with the medical practice name 411 (clinical practice code 412) in the treatment disease name master 410, and further, the wound disease name 414 (in the treatment disease name master 410). A candidate for a part is extracted by collating the name of the sick and sick 413) with the name of the sick and sick 321 (sick and sick name code 322) of the HS record 320.

  Specifically, in the part candidate extraction process, the target part specifying unit 220 sequentially reads records from the SS record 330, and the medical practice name 411 that matches the registered medical practice name 331 is registered in the treatment disease name master 410. It is determined whether or not. The discrimination is performed using the medical practice code 332 of the SS record 330 and the medical practice code 412 of the treatment disease name master 410.

  If registered, there is a name corresponding to the medical practice name 411 that matches the name of the disease 321 registered in the HS record 320 among the names of diseases 414 registered in the treatment disease name master 410. To determine. The discrimination is performed using the wound name code 413 of the treatment disease name master 410 and the wound name code 322 of the HS record 320.

  Then, if there is a match, a part 323 associated with the wound name 321 is extracted from the HS record 320 and is recorded in the part candidate data as a target part candidate in association with the medical practice. When a plurality of matches, a logical sum (OR) of all matching parts 323 is recorded as a target part candidate.

  If there is no match, no target site candidate is recorded in the site candidate data 540.

  When the medical practice name 411 that matches the medical practice name 331 is not registered in the treatment disease name master 410, all the parts 323 registered in the HS record 320 for the medical practice name 331 are set as candidate target parts. Record in site candidate data. If it is not registered, the medical practice is a medical practice not related to the disease name. For example, a comment field may be provided in the part candidate data 540 and described so.

  In addition, when there exists a site | part of the uncoded wound disease name in the HS record 320 part, it records in the site | part candidate data 540 as an object site | part candidate unconditionally about all the medical treatment actions.

  A specific example of the part candidate data 540 created by the processing of the target part specifying unit 220 is shown in FIG. As shown in this figure, the part candidate data 540 includes a medical practice code 542 that identifies a medical practice name 541, a target part candidate 543, and a comment 544.

  As shown in the figure, for the medical practice name 331 “first medical examination” of the SS record 330, the corresponding medical practice name 411 is not registered in the treatment disease name master 410. Therefore, the target part specifying unit 220 records all parts 323 registered in the HS record 320 as target part candidates 543.

  Regarding the medical practice name 331 “pulmonary cord (single root canal)” of the SS record 330, the treatment disease name master 410 is associated with the clinical practice name 411 and includes “dental crown fracture”, “total pulpitis”, Four names of wounds and diseases 414 of “dental pulpitis” and “dental dislocation” are registered. Among these, only “dental pulpitis” matches the wound name 321 registered in the HS record 320. Accordingly, the target part specifying unit 220 records, as the target part candidate 543, the part 323 "[lower left] 1" that is registered in association with the injury / illness name 321 "dental pulpitis" among the parts 323 registered in the HS record 320. To do.

  Regarding the medical practice name 331 “metal crown restoration (inlay simple)”, the treatment disease name master 410 is associated with the clinical practice name 411 in accordance with the dental practice fracture 411, “total pulpitis”, “dental pulp”. Five names of wounds 414 of “flame”, “tooth dislocation”, and “tooth decay” are registered. Among these, “dental pulpitis” and “dental tooth” match the injury / illness name 321 registered in the 320 record of the HS record. Accordingly, the target part specifying unit 220 includes a part 323 “[lower left] 1” registered in association with the wound name 321 “pulisitis” and “dental teeth” among the parts 323 registered in the HS record 320 parts. “[Upper right] 74” is recorded as the target region candidate 543.

  Similarly, for the medical practice name 331 “(material) gold para (molar)” and “(material) gold para (premolar / anterior tooth)”, the target site specifying unit 220 similarly sets the site 323 “[lower left]”. “1” and “[Upper right] 74”, and “[Lower left] 1” and “[Upper right] 74” are recorded as the target region candidates 543.

  When the part candidate extraction processing is completed for all the records registered in the SS record 330 (step S1104), the target part specifying unit 220 uses the calculation requirement master 420 for each part candidate data (step S1005). The target part candidate narrowing-down process is performed (step S1106), and the part candidate data is updated.

  Here, the target part specifying unit 220 extracts, from the calculation requirement master 420, the calculation requirement 424 registered in association with the medical practice name 421 that matches the medical practice name 541 for each medical practice of the candidate site data 540. To do. For the extraction, a medical practice code 542 and a medical practice code 422 are used.

  Then, it narrows down to the tooth type that matches the target part candidate 543 and updates the part candidate data 540. An example of the updated part candidate data 540 is shown in FIG.

  For example, in the calculation requirement master 420, a molar is registered as being associated with the medical practice name 421 “(material) gold para (molar)”. Therefore, as shown in FIG. 10B, the target part candidate 543 “[lower left] 1” registered in association with the medical practice name 541 “(material) gold para (molar tooth)” of the part candidate data 540 and “[Upper right] 74” is narrowed down to “Upper right” 7 corresponding to the molar. Similarly, in the calculation requirement master 420, an anterior tooth and a premolar are registered in association with a medical practice name 421 “(material) gold para (molar and anterior teeth)”. Therefore, the medical practice name 541 “(material) gold para (premolar / anterior tooth)” of the part candidate data 540 is narrowed down to [upper right] 4 and [lower left] 1 corresponding to the premolar.

  Finally, the target part specifying unit 220 performs the intra-calculation unit consistency process for taking consistency within the calculation unit (step S1110). In the intra-calculation unit consistency processing, the part candidate data 540 is aggregated with the same calculation unit data (parent-child data) having the same calculation of the score and the number of medical treatments, and the part data 510 shown in FIG. 7 is generated. Specifically, the logical product (AND) of the target part candidates 543 between parent and child data having the same calculation unit is calculated.

  For example, in the SS record 330, a medical practice name 331 “metal crown restoration (inlay simple)” and “(material) gold para (molar teeth)” are parent-child data that are the same calculation unit. Therefore, the AND of the target part candidate 543 [upper right] 74 [lower left] 1 and [upper right] 7 of the corresponding medical practice name 541 in the part candidate data 540 is taken, and the target part 515 of the part data 510 of this calculation unit. Is [upper right] 7.

  Further, in the SS record 330, the medical practice name 331 “metal crown restoration (inlay simple)” and “(material) gold para (premolars / anterior teeth)” are parent-child data serving as the same calculation unit. Therefore, the AND of the target part candidate 543 [upper right] 74 [lower left] 1 and [upper right] 4 [lower left] 1 of the corresponding medical practice name 541 in the part candidate data 540 is obtained, and the part data 510 of this calculation unit. The target region 515 of the above is defined as [upper right] 4 [lower left] 1.

  In the part candidate data 540, for the remaining data that does not have the same calculation unit data, the part registered in the target part candidate 543 is set as the target part 515 as it is.

  As described above, the target part specifying unit 220 associates the target part of the HS record 320 with each medical practice of the SS record 330 by the part candidate extraction process, the narrowing process, and the calculation unit consistency process. 510 is generated. Note that the processing order of the part candidate extraction process, the narrowing process, and the intra-calculation unit consistency process by the target part specifying unit 220 does not matter. Further, in the above example, the target part candidate narrowing process is performed after the part candidate data of all records is generated. However, the target part extraction process and the narrowing process may be performed continuously for each record.

  As described above, the electronic receipt check device 100 according to the present embodiment generates the part data 510 that associates the medical practice with the part from the electronic receipt data 300 created for each patient in a predetermined format. A target part specifying unit 220, and a check part 230 that checks the accuracy of the electronic receipt data using the generated part data 510, and the electronic receipt data 300 is a part that has been treated for each wound name And a medical practice record 330 for recording the score and the number of times for each medical practice, and the target part specifying unit 220 performs the medical treatment for each medical practice in the medical practice record 330. By specifying the part to be acted using predetermined master data, the part data Generated.

  As described above, according to the present embodiment, in a dental electronic receipt in a predetermined format created for insurer submission, the target site of each medical practice is, for example, a tooth using a predefined master data. Specify by number. Then, the accuracy of the electronic receipt is checked using the medical practice data in which the target part is specified.

  Therefore, according to this embodiment, in order to check the accuracy of the electronic receipt, even in dentistry that requires a site targeted for medical practice, the burden on the person in charge does not increase, and it is for insurer submission. It is possible to check the created dental electronic receipt of a predetermined format with high accuracy, and to generate a dental electronic receipt with the smallest possible insurance system error.

  Particularly, in a medical institution where a medical department and a dentistry are provided side by side, an electronic receipt that is a dental UKE file is created using a medical receipt request system even in dentistry. In this medical receipt claim system, since the association information between the performed medical practice and the tooth number is insufficient, it is difficult to check in advance. Even in such a medical institution, prior checks can be performed with high accuracy without increasing the burden on the person in charge in the existing system.

  In the above embodiment, the case where one information processing apparatus realizes all the functions of the receipt check apparatus 100 has been described as an example. However, the present invention is not limited to this. For example, each function of the receipt check apparatus 100 may be realized on an information processing apparatus which is a different information processing apparatus and can transmit and receive data to and from each other.

  In addition, a user such as a medical institution may be configured to use a function realized by the receipt check apparatus 100 via a web browser installed in its own server. As this web browser, it is used as an application for browsing the website, and HTML (Hyper Text Markup Language), CGI (Common Gateway Interface), XML (extensible Markup Language), Java (registered trademark), etc. A general browser can be used.

  100: Receipt check device, 102: CPU, 103: Main memory, 104: Storage device, 105: Display memory, 106: Display device, 107: Controller, 108: Mouse, 109: Keyboard, 110: Network adapter, 111: System Bus: 120: Network, 130: Information processing device, 140: Database, 200: Server, 202: Server, 210: Database unit, 220: Target site specifying unit, 221: Oral information generation unit, 230: Check unit, 231: Pre-check unit, 233: Number of times check unit, 234: Validity check unit, 240: Display processing unit, 300: Electronic receipt data, 310: Database unit, 310: Patient unit receipt, 320: HS record, 321: Injury name 322: Injury name code, 323: Part , 330: SS record, 331: medical practice name, 332: medical practice code, 333: addition code, 334: score, 335: number of times, 410: treatment disease name master, 411: medical practice name, 412: medical practice code, 413 : Wound name code, 414: wound name, 420: calculation requirement master, 421: treatment action name, 422: treatment action code, 423: addition code, 424: calculation requirement, 425: calculation unit, 426: upper limit number of times, 430: Dental electronic score table, 440: basic check master, 510: site data, 511: clinical practice name, 512: clinical practice code, 513: score, 514: frequency, 515: target site, 520: oral cavity information file, 530: check Result list, 540: site candidate data, 541: medical practice name, 542: medical practice code, 543: target site Complement, 544: Comments

Claims (10)

A target part specifying unit that generates part data in which a medical practice and a part are associated from electronic receipt data created for each patient in a predetermined format;
A check unit that checks the accuracy of the electronic receipt data using the generated site data, and
The electronic receipt data is
Wound and disease name site record that records the site of medical treatment for each wound name,
A medical practice record that records the score and number of times for each medical practice,
The target part specifying unit generates the part data for each medical practice in the medical practice record by specifying a part that is a target of the medical practice using predetermined master data. Electronic receipt check device. The electronic receipt check device according to claim 1,
The target part specifying unit specifies a part to be a target of each medical practice using a pre-defined treatment disease name master in which a medical practice and a wound name are associated with each other. apparatus. An electronic receipt check device according to claim 1 or 2,
The target part specifying unit uses a calculation condition master for registering a tooth type for each medical practice, which is defined in advance, to specify the part that is a target of each medical practice. . An electronic receipt check device according to any one of claims 1 to 3,
The medical practice record includes the same calculation unit data associated with a medical practice group having the same calculation unit,
The target part specifying unit sets the part of the part data as the same part for the same calculation unit data. An electronic receipt check device according to any one of claims 1 to 4,
The check unit
Using the part data and an electronic score table including a calculation number master for registering a predetermined calculation unit and an upper limit number for each medical practice, the score of the electronic receipt data and the appropriateness of the number of times of the medical practice calculation A score count check section for judging
A validity check unit that determines the validity of the medical practice of the electronic receipt data using the part data and a basic check master that is converted into data for checking the interpretation in dental calculation. Electronic receipt check device. The electronic receipt check device according to claim 5,
The target part specifying unit further includes an oral information generating unit that generates oral information for specifying a missing tooth using the part data.
The electronic receipt check device, wherein the score count check unit and the validity check unit determine the suitability and the validity, respectively, by taking the oral cavity information into consideration. The electronic receipt check device according to any one of claims 1 to 6,
An electronic receipt check device, further comprising: a display processing generation unit that generates display data to be displayed on a display device from a check result by the check unit. The electronic receipt check device according to any one of claims 1 to 7,
The electronic receipt data is for dentistry,
The said part is represented by a tooth number. The electronic receipt check apparatus characterized by the above-mentioned. Electronic receipt data created for each patient in a predetermined format, which is a wound name record that records the site of treatment for each wound name, and a medical practice record that records the number and number of times for each medical practice For each medical practice of the medical practice record, the site that is the target of the medical practice is identified using predetermined master data, and the medical practice and the site are associated with each other A target part specifying step for generating the target part data;
A check step of checking the accuracy of the electronic receipt data using the generated site data. An electronic receipt check method comprising: Computer
Electronic receipt data created for each patient in a predetermined format, which is a wound name record that records the site of treatment for each wound name, and a medical practice record that records the number and number of times for each medical practice For each medical practice of the medical practice record, using a predetermined master data, the medical practice and the part are associated with each other Target part specifying means for generating part data,
The receipt check program for functioning as a check means which checks the accuracy of the electronic receipt data using the generated part data.

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