JP2016218691A - Medical information processing apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve accuracy of calculation of payment for medical services.SOLUTION: A medical information processing apparatus according to an embodiment includes a first storage part, a second storage part, a third storage part, a collation part, and a display control part. The first storage part stores medical activity records of respective patients. The second storage part stores medical service payment information on the respective patients. The third storage part stores relation information in which forms of medical activity records and medical service payment items are related to each other. The collation part collates a form of medical activity records of one patient stored in the first storage part with medical service payment items included in medical service payment information on one patient stored in the second storage part based upon the relation information. The display control part makes display means displays the medical service payment information on the one patient. When the collation part determines that a medical service payment item related to the form of the medical activity records of the one patient is not included in the medical service payment information, the display control part makes the displays means display the medical service payment item together the medical service payment information.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical information processing apparatus.

  Medical institutions handle a wide variety of information. As typical examples, examination order information indicating the contents of the examination order, examination information indicating the contents and results of the examination performed, diagnosis information indicating the contents and results of the diagnosis, surgery information indicating the contents and results of the surgery, There are medication information indicating the type and amount of the administered drug, medical fee information indicating the contents, points, and amount of the medical fee. As a system for managing such information, there are an electronic medical record system, an image management system, an ordering system, a medical accounting system, and the like. Such a system is called a hospital information system (HIS).

  Each medical practice such as examination, diagnosis, surgery, treatment, drug administration, etc. is assigned a medical fee (insurance score) as compensation.

JP 2008-250543 A JP 2010-253189 A JP 2014-216262 A JP 2000-20608 A

  The calculation of the medical fee determines the amount charged to the patient, and its accuracy is questioned, but there are many factors that impair it. For example, in a medical department including an examination department such as ophthalmology, an order such as an examination is not performed in advance, and an order can be entered and a billing cost can be entered simultaneously as an “inspected order” after the examination is performed. is there.

  While this method contributes to the efficiency of medical care, it may be difficult to ensure the accuracy of test content input. For example, when a plurality of tests are performed, it is not easy to accurately input the type of test, the type and amount of medicine used, the type of applied technique, and the like. In ophthalmology, it is also necessary to input whether the subject to be examined is one eye (left eye or right eye) or both eyes. These are the causes of missing or overcharged medical fees. Although it may be possible to rely on manpower to deal with such problems, the work involves a great deal of labor and complexity.

  An object of the present invention is to provide a technique for improving the accuracy of medical fee calculation.

  The medical information processing apparatus according to the embodiment includes a first storage unit, a second storage unit, a third storage unit, a collation unit, and a display control unit. The first storage unit stores a medical practice record of each patient. The second storage unit stores medical fee information for each patient. The third storage unit stores related information in which a medical practice record form and medical fee items are associated with each other. The collating unit associates the form of the medical practice record of one patient stored in the first storage unit with the medical fee item included in the medical fee information of the one patient stored in the second storage unit. Match based on information. The display control unit causes the display means to display the medical fee information of one patient. Furthermore, when the collation unit determines that the medical fee item associated with the medical practice record form of one patient is not included in the medical fee information, the display control unit displays the medical fee item together with the medical fee information. Display.

  According to the embodiment, it is possible to improve the accuracy of medical fee calculation.

It is a schematic diagram showing an example of composition of a medical information processor concerning an embodiment. It is a schematic diagram showing an example of composition of a medical information processor concerning an embodiment. It is a schematic diagram showing an example of composition of a medical information processor concerning an embodiment. It is a flowchart showing an example of the usage pattern of the medical information processing apparatus which concerns on embodiment. It is the schematic for demonstrating the usage type of the medical information processing apparatus which concerns on embodiment.

  An example of a medical information processing apparatus according to an embodiment will be described in detail with reference to the drawings. In addition, the content of the cited reference as described in this specification, and the other well-known technique can be arbitrarily used for embodiment.

  The medical information processing apparatus according to the embodiment includes one apparatus or a combination of two or more apparatuses for processing information (medical information) handled in a medical institution. The medical information processing apparatus includes at least a part of each of one or more information systems provided inside and / or outside the medical institution. A typical example of an information system built inside a medical institution is a hospital information system (HIS) including an electronic medical record system, an image management system, an ordering system, a medical accounting system, and the like. A typical example of an information system provided outside a medical institution is a network system that provides at least a part of the functions of HIS using cloud computing technology. It may include at least a part of an information system constructed to include a plurality of medical institutions, or at least a part of an information system in which an information system in a medical institution and an information system outside the medical institution are linked. . Further, a portable computer such as a tablet terminal or a smartphone, an output device such as a display device or a printing device, and an input device such as an operation device or a reading device may be included.

[Constitution]
An example of the configuration of the medical information processing apparatus is shown in FIG. The medical information processing apparatus 1 may include at least a part of the hospital information system 100.

(Hospital Information System 100)
The hospital information system 100 is generally an information system for processing information handled by a medical institution. The information system included in the hospital information system 100 may be a known one. In this example, an ordering system 110, an electronic medical record system 120, an image management system 130, and a medical accounting system 140 are included in the hospital information system 100. Two or more information systems included in the hospital information system 100 are configured to operate in conjunction with each other.

  The ordering system 110 is a system for transmitting various types of order information such as examination, prescription, and medication. For example, the ordering system 110 receives order information from an information terminal, and transmits this order information to a related department (examination department, radiology department, pharmacy department, etc.) in a medical institution via a network. Examples of the examination include specimen examination, physiological examination, and radiography. These tests are generally performed in a different department from the department to which the ordering physician belongs. On the other hand, there is a case where an examination is performed in a medical department. For example, in ophthalmology, it is common to observe, shoot, and measure a patient's eye in the clinical department. The ordering system 110 includes, for example, a processor (computer, server, etc.) for processing order information, a storage device (database) for storing order information, etc., and a communication device compliant with a communication standard. .

  The electronic medical record system 120 is an information system (filing system) for storing and managing an electronic medical record created for each patient. The electronic medical record is data obtained by electronically recording medical record information. The electronic medical chart system 120 receives an electronic medical chart created by a computer such as a doctor terminal and stores it. The electronic medical record system 120 receives a request from a computer such as a doctor terminal, and provides information recorded in the electronic medical record to the computer via a network. The electronic medical record system 120 receives the electronic medical record edited by a computer such as a doctor terminal, and updates the contents of the electronic medical record of the patient. The electronic medical record system 120 may include at least a part of a system used in a single medical institution, and may include at least a part of a system that is interoperated in a plurality of facilities. The electronic medical record system 120 includes, for example, a processor (computer, server, etc.) for processing electronic medical record information, a storage device (database) for storing electronic medical record information, etc., and a communication device compliant with a communication standard Including.

  The image management system 130 is an information system for storing and managing medical images of each patient. The image management system 130 is called PACS (Picture Archiving and Communication System) or the like. The PACS receives medical images such as X-ray images, X-ray CT images, and MRI images from the modality device, and stores and manages them. An image management system specialized for a specific medical department is also widely used. For example, ophthalmology is provided with an examination room (photographing room) in which a modality device such as a fundus camera, a slit lamp, an optical coherence tomography (OCT) device, and a scanning laser ophthalmoscope (SLO) is installed. Medical images relating to all departments are integrated and linked by a standard called DICOM (Digital Imaging and Communications in Medicine). The image management system 130 receives a request from a computer such as a doctor terminal, a viewer, or an analysis device, and provides a medical image to the computer via a network. When diagnosis, analysis, and interpretation are performed using medical images, the results are sent to the image management system 130 and the electronic medical record system 120 for storage and management. The image management system 130 includes, for example, a processor (computer, server, etc.) for performing processing related to medical images, a storage device (database) for storing medical images, and a communication device that complies with communication standards. Including.

  The medical accounting system 140 creates a medical remuneration statement based on information stored and managed by the hospital information system 100. Further, the medical accounting system 140 has a function for inputting medical treatment contents, a function for calculating window accounting (patient payment), a function for issuing a prescription, a function for managing a medication usage fee, and a function for issuing drug information. , A function of issuing a receipt may be provided. The medical accounting system 140 includes, for example, a processor (computer, server, etc.) for processing accounting related information, a storage device (database) for storing accounting related information, etc., and a communication device compliant with a communication standard Including.

  The hospital information system (which may include a cloud computing system) according to the embodiment may not include any of the order management function, electronic medical record management function, image management function, and medical accounting processing function described above. . The hospital information system according to the embodiment may include other functions related to the processing of medical information. Examples of other functions include surgery management function, rehabilitation management function, hospitalization management function, nutrition management function, ward comprehensive management function, outpatient comprehensive management function, medical office comprehensive management function, pathology management function, examination management function, clinical laboratory management function Radiology management function (RIS), diagnostic imaging management function, dialysis management function, regional medical cooperation function, patient information management function, business improvement management function, article management function, personnel management function, and the like.

(Medical information processing device 1)
The medical information processing apparatus 1 of this example includes a control processor 10, a storage device 20, a data processor 30, and a communication unit 40.

  The display device 50 and / or the operation device 60 may be included in the medical information processing apparatus 1. Alternatively, the display device 50 and / or the operation device 60 may be configured as a device (external device) connected to the medical information processing device 1. The display device 50 includes, for example, a flat panel display such as a liquid crystal display and has a function of displaying information. The operation device 60 includes, for example, a pointing device such as a mouse, a keyboard, and the like, and is used for operation of the medical information processing device 1 and information input. It is also possible to use a device such as a touch screen in which the display device 50 and the operation device 60 are integrated.

(Control processor 10)
The control processor 10 can execute control of each unit of the medical information processing apparatus 1 and control of devices connected to the medical information processing apparatus 1. The control processor 10 includes at least a processor and may further include a storage device such as a RAM, a ROM, a hard disk drive, and a solid state drive.

  The control processor 10 includes a display control unit 11 and may additionally include a storage control unit 12. The display control unit 11 controls the display device 50 to display information. The storage control unit 12 executes control for storing information in the hospital information system 100. Processing executed by the display control unit 11 and the storage control unit 12 will be described later.

(Storage device 20)
The storage device 20 stores various information processed by the medical information processing apparatus 1. The storage device 20 includes, for example, a RAM, a ROM, a hard disk drive, a solid state drive, and the like. The storage device 20 can store related information 21, order information 22, medical practice records 23, and medical fee information 24.

  The related information 21 is created in advance and stored in the storage device 20. Alternatively, the related information 21 is created in advance and stored in the hospital information system 100, and is referred to by the medical information processing apparatus 1 as necessary.

  The order information 22, the medical practice record 23, and the medical fee information 24 are read from the hospital information system 100 in response to a request from the medical information processing apparatus 1. The request for reading out the information is performed by designating a patient by patient identification information (patient ID or the like), for example. When the medical information processing apparatus 1 designates a patient (and designation of information type), the hospital information system 100 retrieves information (designated type information) related to the designated patient and medical information processing apparatus 1 to send. The order information 22 is acquired from the ordering system 110, for example. The medical practice record 23 is acquired from the electronic medical chart system 120 and / or the image management system 130, for example. The medical fee remuneration information 24 is acquired from the medical accounting system 140, for example. Alternatively, the order information 22, the medical practice record 23, and / or the medical fee information 24 may include content input (created, edited, etc.) by the medical information processing apparatus 1.

  The order information 22 includes one patient's order information acquired from the ordering system 110 and one patient's order information input (created, edited, etc.) by the medical information processing apparatus 1.

  The medical practice record is a record of a medical practice performed on a patient, and is created for each patient (and for each type). Examples of types of medical practice records include medical records (electronic medical records), medical images, surgical records (surgical findings), treatment records, medication records, nursing records, and the like. The medical practice record 23 stored in the storage device 20 includes, for example, one patient's electronic medical record, surgical record, treatment record, medication record, and the like acquired from the electronic medical record system 120 or the like. In addition, or instead of this, the medical practice record 23 includes, for example, a medical image of one patient, an interpretation report, an image analysis report, and the like acquired from the image management system 130 or the like.

  The medical fee information is information related to the medical fee that is a consideration for the medical practice performed on the patient, and includes at least the description items of the medical fee description. The medical fee information may further include items described in a billing statement for a patient, items described in a receipt, and the like. The medical fee information 24 includes one patient's medical fee information acquired from the medical accounting system 140 and the like, and one patient's medical fee information input (created, edited, etc.) by the medical information processing apparatus 1.

  The related information 21 will be described. In the related information 21, the association between the medical practice record form and the medical fee item is recorded.

  The medical practice record form indicates a form in which a medical practice is recorded. The form of medical practice record includes, for example, any of the following: type (format) of template in which medical practice record is input; type of character string input to template; type of image associated with template; template The type of image pasted on the template; the type of input area provided in the template.

  The template will be described. The medical practice record is input to a template prepared in advance according to the examination type, disease name, operation type, drug type, and the like. The method of using these templates is arbitrary, and for example, each template is used alone or in combination of two or more (association, embedding, etc.). As specific examples of template types, the following templates are prepared in ophthalmology: a commonly used electronic medical record template; a template for inputting an anterior segment schema; a fundus (for posterior segment) Template for inputting a schema; template provided for each of a plurality of types of ophthalmic examinations; template provided for each of a plurality of methods related to a single type of ophthalmic examination (eg, non-contact type eye relating to tonometry) A template for pressure examination and a template for contact tonometry; a template provided for each of a plurality of types of modalities; a template provided for each of a plurality of imaging methods for a single type of modality (eg, fundus camera) Contrast imaging templates and non-related Shadow imaging (normal imaging) template, mydriatic imaging template and non-mydriatic imaging template); analysis results of data obtained by inspection of one or more types (and one or more techniques) A template to which an analysis result of an image obtained by imaging one or more modalities (and one or more imaging methods) is input; a template provided for each of a plurality of ophthalmic operations; a single type A template provided for each of a plurality of procedures for ophthalmic surgery; a template for medication records. Identification information (template identification information) is given in advance to each template.

  One or more input areas are provided in the template. The input area is a partial area in the template into which information related to a predetermined medical practice is input. There is a template provided with a plurality of input areas. For example, a typical example of a template generally used as an electronic medical chart for ophthalmology includes an area for inputting information about a patient (patient ID, name, sex, age, etc.), an input area for a disease name, An input area for chief complaints, an input area for findings, an input area for visual acuity values / intraocular pressure values, an input area for schemas, an input area for examination contents, an area for presenting an image list, and the like. Identification information (input area identification information) is given in advance to each input area in each template. Therefore, each input area is specified by a combination of template identification information and input area identification information. Alternatively, by including information for identifying the template type in the input area identification information, the input area may be specified only by the input area identification information.

  A character string input to the template will be described. In medical records such as electronic medical records, interpretation reports, and surgical records, findings, diagnosis results, interpretation results, and surgical contents are entered in text. There is a characteristic character string to be input. Examples of characteristic character strings include a character string indicating a disease name, a character string indicating a body part, a character string indicating a drug name, and a character string indicating a surgical technique. Some specific examples in ophthalmology will be described below. Specific examples of body parts include the left eye, right eye, one eye, both eyes, cornea, corner, pupil, iris, conjunctiva, retina (name of the layer tissue that composes it), optic disc, macula, fovea, choroid Strings such as sclera and meibomian glands are used. Specific examples of drug names include names of various contrast agents, names of various anesthetics, names of various therapeutic drugs, and the like. Specific examples of surgical procedures include: Lens reconstruction for cataractous eyes (monofocal intraocular lens, multifocal intraocular lens, adjustable intraocular lens, toric intraocular lens, phakic intraocular lens); glaucomatous eye Trabeculectomy, trabeculotomy, etc .; laser photocoagulation for diabetic retinopathy, retinal vein occlusion, retinal detachment. The medical information processing apparatus 1 or the hospital information system 100 may store a library of characteristic character strings.

  An image associated with the template and an image pasted on the template will be described. These may be collectively referred to as “images input to the template”. The association between the template and the image is performed, for example, by inputting information (storage address) indicating the storage location of the image stored in a location different from the template into the template. On the other hand, an image is pasted on the template by inputting the image itself or an image (thumbnail or the like) obtained by processing the image into the template. Each image may be preliminarily provided with identification information (image identification information) indicating the type of modality used to acquire the image.

  The medical fee items associated with the form of the medical practice record as described above will be described. The medical fee item includes any item related to the medical fee. Specific examples of medical fee items include items (target items) that indicate medical practices (tests, treatments, drugs, etc.) that are the targets of medical fees, and items (body part items) that indicate the body part where the medical action was performed. is there. Further, the medical fee item may include items other than these, for example, an item (number item) indicating the number of times medical practice has been performed.

  As described above, the association information 21 records the association between the medical practice record form and the medical fee item. Two examples of association modes are described below.

  The first example of the association mode is master data (master registration). The master data is a set of basic data used for collating the medical practice record of one patient with the medical fee information. In the master data, a predetermined medical practice record form and a predetermined medical fee item are associated in advance.

  A specific example of the master data is shown in FIG. 2A. Master data 21 a shown in FIG. 2A is included in the related information 21. The master data 21a is table information in which items recorded in the “recording form” column are associated with items recorded in the “medical fee item” column. In the “record form” column, pre-selected forms of medical practice records are listed. In the “medical fee item” column, items inputted as the medical fee item are recorded for each of these recording forms.

  In the example shown in FIG. 2A, the recording forms are classified into a plurality of groups including “template type”, “character string”, and “image type”. The group of “template type” includes “anterior segment finding (mydriatic) schema”. This shows a template for recording, as a schema, findings of anterior ocular segment observation performed by administering a mydriatic agent. The template “anterior segment finding (mydriatic) schema” is associated with “mydriatic agent” as a medical fee item. A similar association is provided for the group of “character strings”. The “character string” group further includes “fundus photographing (fluorescence)”. This is a character string indicating angiographic imaging of the fundus using a fluorescent agent. This character string “fundus photographing (fluorescence)” is associated with “fluorescent agent” as a medical fee item. A similar association is provided for the “fundus type” group. The “fundus type” group further includes “fundus OCT”. This shows an image obtained by optical coherence tomography of the fundus (and / or a result of analysis based on the image). This image type “fundus OCT” is associated with “fundus three-dimensional image analysis” as a medical fee item.

  A second example of the association mode is related pattern information indicating an association pattern (association tendency) in past data. This related pattern information is created by analyzing past medical practice records and medical fee information. More specifically, by analyzing a combination of medical practice records and medical fee information of a plurality of patients created in the past, an association pattern between the medical practice record form and the medical fee items can be obtained. For example, when there are a predetermined number (for example, 10) or more of patients (or cases, etc.) corresponding to one medical practice record form and one medical fee item, the recording form and the medical fee item are associated with each other. It is done. By assembling such associations, the related pattern information of this example is created.

  A specific example of the related pattern information is shown in FIG. 2B. The related pattern information 21 b illustrated in FIG. 2B is included in the related information 21. The related pattern information 21b is table information in which items recorded in the “recording form” column are associated with items recorded in the “medical fee item” column. In the “record form” column, record forms extracted from past medical practice records are listed. In the “medical fee item” column, the medical fee item extracted from the past medical fee information related to each of these recording forms is recorded.

  The recording form of the example shown in FIG. 2B includes a group of “character strings”. Other groups such as “template type” and “image type” may be included. The “character string” group includes “intraocular lenses”. This means that an intraocular lens has been used. This character string “intraocular lens” is associated with “crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” as a medical fee item. The “lens reconstruction (when an intraocular lens is inserted) (insertion of a sewn lens)” indicates an intraocular lens sewing (a lens reconstruction) as a cataract operation. This related pattern is recorded, for example, as medical fee information recorded as “Crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” in the medical fee item and “Intraocular lens” as the equipment used. It is created when there are 10 or more combinations with the recorded medical practice records.

  The group of “character strings” further includes “respiration heart rate monitoring”. This represents a medical practice that monitors the patient's breathing and heartbeat status. Respiratory heart rate monitoring is recorded in surgical records. The character string “breathing heartbeat monitoring” is associated with “breathing heartbeat monitoring” as a medical fee item. In addition, the medical treatment reward score for respiratory heartbeat monitoring changes with time. In order to cope with the medical practice in which the medical reward score changes according to such time, the “character string” group is provided with “(X) time”. Here, “X” is, for example, a positive integer. This character string “(X) time” is associated with “frequency item = (X) time equivalent” as a medical fee item. This indicates that the frequency item in the medical fee item is “(X) time equivalent”. Here, “(X) time equivalent” may be “(X) time” itself, or may be information different from “(X) time”. As an example of the latter, there is a time division to which “(X) time” belongs among the time divisions of the medical fee points.

(Data processor 30)
The data processor 30 executes various data processing. The data processor 30 may include at least a collation unit 31 and may additionally include a related pattern information creation unit 32.

(Verification unit 31)
The collation unit 31 collates the form of the medical practice record (23) of one patient with the medical fee item included in the medical fee information (24) of the patient based on the related information 21. Several examples of processing executed by the collation unit 31 will be described below.

  As a first example of collation processing, collation between a template type and a medical fee item will be described. The collation unit 31 identifies the type of template used for medical treatment records (electronic medical records, medical images, surgical records) of one patient. The template type is specified using the template identification information described above. The matching unit 31 searches the related information 21 for the identified template type. For example, the collation unit 31 determines whether the identified template type is included in the “recording form” column of the master data 21a or the “recording form” column of the related pattern information 21b. When the template type is included in the related information 21, the collation unit 31 acquires the medical fee item associated with the template type from the related information 21.

  Further, the collation unit 31 determines whether the medical fee item acquired from the related information 21 is included in the medical fee information of the patient. When the medical fee item is included in the medical fee information, it is determined that the template type and the medical fee item have been successfully verified. This means that it has been confirmed that the medical fee is charged correctly for the medical practice recorded in the template. On the other hand, if this medical fee item is not included in the medical fee information, the collation is determined to have failed. This means that the medical fee charge for the medical practice recorded in the template is missing.

  The collation unit 31 can perform collation between the template type and the medical fee item as described above for each template included in the medical practice record of the patient.

  As a second example of collation processing, collation between an input area in a template and a medical fee item will be described. Similar to the first example, the collation unit 31 identifies the type of template used for medical treatment records (electronic medical records, surgical records) of one patient. Furthermore, the collation unit 31 specifies the type of the input area in this template. The specification of the type of the input area includes, for example, a process of specifying an input area in which information is input by comparison with a template, and a process of specifying the type of the input area specified thereby based on the input area identification information.

  The matching unit 31 searches the related information 21 for the specified input area type. This search process can be executed by a method similar to the first example. Thereby, for example, the type of medical practice performed on the patient is specified. This is based on a correspondence between a medical practice (eg, visual acuity test) and an input area (eg, visual acuity value input area). In addition, the body part on which the medical practice has been performed is specified. For example, it is specified whether a medical practice was performed on both eyes, or whether a medical practice was performed only on one eye (left eye or right eye).

  When the identified input area type is included in the related information 21, the collation unit 31 acquires the medical fee item (target item, body part item, etc.) associated with the input area type from the related information 21. Further, the collation unit 31 determines whether the medical fee item acquired from the related information 21 is included in the medical fee information of the patient. When this medical fee item is included in the medical fee information, it is determined that the matching between the input area type and the medical fee item is successful. This means that it has been confirmed that the medical fee for the medical practice recorded in the input area is correctly charged. On the other hand, if this medical fee item is not included in the medical fee information, the collation is determined to have failed. This means that there is no charge for medical fees for medical practices recorded in the input area.

  The collation unit 31 can perform the collation between the input area type and the medical fee item as described above for each input area of each template included in the medical practice record of the patient.

  As a third example of collation processing, collation between a character string included in a medical practice record and a medical fee item will be described. The collation unit 31 searches the medical practice record using a character string included in the related information 21 as a search query. For example, the collation unit 31 retrieves the character string “anterior segment findings (mydriasis)” included in the master data 21a and the character string “intraocular lens” included in the related pattern information 21b from the electronic medical record and the surgical record. To do. When the character string is searched, that is, when the character string is included in the medical practice record, the collation unit 31 acquires the medical fee item associated with the character string from the related information 21.

  Further, the collation unit 31 determines whether the medical fee item acquired from the related information 21 is included in the medical fee information of the patient. When this medical fee item is included in the medical fee information, it is determined that the matching between the character string and the medical fee item is successful. This means that it has been confirmed that the medical fee for the medical practice related to the character string has been correctly charged. On the other hand, if this medical fee item is not included in the medical fee information, the collation is determined to have failed. This means that the medical fee charge for the medical practice related to the character string is missing.

  The collation when the character string “(X) time” is included will be described. As an example, the collation unit 31 searches the surgical record or the like for the character string “breathing heart rate monitoring” included in the related pattern information 21b and the character string “(X) time” recorded corresponding thereto. Here, it is assumed that the character string “breathing heart rate monitoring” and the character string “3 hours” are searched. The collation unit 31 includes a medical fee item (target item) “respiratory heart rate monitoring” associated with the character string “breathing heart rate monitoring” and a medical fee item (frequency item) “3 hours” associated with the character string “3 hours”. "Is included in the medical fee information of the patient. When this medical fee item is included in the medical fee information, it is determined that the matching between the character string and the medical fee item is successful. On the other hand, when at least one of these medical fee items is not included in the medical fee information, the collation is determined to have failed.

  The collation unit 31 can perform collation between the character string and the medical fee item as described above for each character string included in the related information 21. The set of character strings included in the related information 21 is an example of the character string library described above.

  As a fourth example of collation processing, collation between an image included in a medical practice record and a medical fee item will be described. The collation unit 31 identifies the type of image included in the medical practice record. The identification of the type of image is executed based on, for example, image identification information. As a specific example, it is possible to apply a configuration in which image identification information is recorded in the DICOM tag at the time of photographing or image storage, and the collation unit 31 refers to this. As another specific example, a configuration in which the collation unit 31 analyzes an image to specify an image type (modality, imaging method, etc.) from the form (pixel value, pixel value distribution, etc.) of the image can be applied.

  The collation unit 31 acquires the medical fee item associated with the specified image type (image identification information or the like) from the related information 21. Further, the collation unit 31 determines whether the medical fee item acquired from the related information 21 is included in the medical fee information of the patient. When the medical fee item is included in the medical fee information, it is determined that the matching between the image type and the medical fee item is successful. This means that it has been confirmed that a medical fee for medical treatment (such as photographing) for acquiring the image is correctly charged. On the other hand, if this medical fee item is not included in the medical fee information, the collation is determined to have failed. This means that the medical fee for medical treatment (such as photographing) for obtaining the image is not charged.

  In this example, the collation part 31 can specify the body part represented by the image. This processing may include arbitrary image processing such as pixel value analysis and image matching, for example. As a specific example, when an image region corresponding to a pupil, iris, eyelid, or eyelash is specified, the image is determined to be an anterior segment image. Furthermore, it is possible to determine whether the object of the anterior segment image is the left eye or the right eye by specifying an image area corresponding to the eye and / or the corner of the eye.

  As another specific example, when an image region corresponding to an optic disc, macular, or blood vessel is specified, the image is determined to be a fundus image. Furthermore, it is possible to determine whether the fundus image is the left eye or the right eye based on the arrangement of these characteristic parts. In addition, by analyzing the image quality and the pixel value, the modality (fundus camera, SLO, OCT front image, etc.) used for acquiring the fundus image can be specified.

  As a further specific example, when the image represents a cross section of the eye, the modality can be specified as OCT. In addition, it is possible to determine whether the image is an anterior ocular segment OCT image or a fundus OCT image based on the shape of the cross section represented by the image (such as the shape of a characteristic part). For example, when an image region corresponding to a corner where the cornea and the iris intersect is specified, it can be determined that the OCT image is an anterior segment OCT image. Further, when an image region corresponding to a concave portion corresponding to the optic nerve head or the macula is specified, it can be determined that the OCT image is a fundus OCT image.

  In addition, when only one of the left-eye image and the right-eye image is specified for one image type (or when only one image is included), the target of medical practice (such as photographing) is “one eye” Can be determined. On the other hand, when both the left-eye image and the right-eye image are specified for one image type, it can be determined that the target of the medical action (such as photographing) is “binocular”.

  Instead of or in addition to the above configuration, it is possible to employ a configuration in which information indicating the target body part is attached to the image by using, for example, a DICOM tag.

(Related pattern information creation unit 32)
The related pattern information creation unit 32 generates related pattern information (21b) based on a plurality of medical practice records stored in the electronic medical chart system 120 or the like and a plurality of medical fee information stored in the medical accounting system 140 or the like. ). This process includes a process of newly creating related pattern information and a process of updating the content of related pattern information that already exists.

  A plurality of medical practice records and a plurality of medical fee information are associated with each other. Specifically, each medical fee information is created from information recorded in any one of a plurality of medical practice records. For example, one piece of medical fee information is created as a price for a medical practice given to one patient.

  The related pattern information creating unit 32 creates related pattern information by executing a process of comparing pairs of medical action records and medical fee information corresponding to each other over a plurality of sets. More specifically, when the correspondence between one recording form and one medical fee item is included in a set of a predetermined number or more, the related pattern information creation unit 32 includes the recording form and the medical fee item. It is determined that they are related, and the combination of the recording form and the medical fee item is recorded in the related pattern information. Specific examples of such processing have been described above.

  In this specification, the “processor” is, for example, a CPU (Central Processing Unit), a GPU (Graphics Processing Unit), an ASIC (Application Specific Integrated Circuit), a programmable logic device (for example, SPLD (Simple LD). It means a circuit such as (Complex Programmable Logic Device) or FPGA (Field Programmable Gate Array). For example, the processor implements the functions according to the embodiment by reading and executing a program stored in a storage circuit or a storage device. At least a part of the memory circuit or the memory device may be included in the processor.

  The medical information processing apparatus 1 stores various programs. Alternatively, the medical information processing apparatus 1 can read and execute a program stored in an external device (such as a server). As programs executed by the medical information processing apparatus 1, there are an operating system and application software. The application software includes, for example, the following: an application for an order (for example, an application that can be linked with the ordering system 110); an application for viewing and editing an electronic medical record (for example, that can be linked with the electronic medical chart system 120) Application); Image browsing / interpretation application (eg, application that can be linked with the image management system 130); Medical fee information browsing / input / editing application (eg, application that can be linked with the medical accounting system 140) An application for executing processing according to the embodiment (collation processing, related pattern information creation processing, display control, storage control, etc.); and other application for processing medical information. Note that an application for executing the processing according to the embodiment may be incorporated in another application (for example, an application for medical fee information).

(Communication unit 40)
The communication unit 40 performs data communication with an external device. The method of data communication is arbitrary. For example, the communication unit 40 includes a communication interface compliant with LAN, a communication interface compliant with the Internet, and the like. The communication unit 40 performs data communication with the hospital information system 100 via a communication line. Data transmitted and received by the communication unit 40 may be encrypted. In this case, the medical information processing apparatus 1 includes an encryption processing unit that encrypts transmission data and decrypts reception data.

[Usage form]
A usage pattern of the medical information processing apparatus 1 will be described. An example of usage is shown in FIG. Hereinafter, application to ophthalmology will be described as a main example.

(S1: Input electronic medical record)
The doctor activates an electronic medical record application and inputs the electronic medical record of one patient. Some of the information that is input will be used to calculate the medical fee. For example, the schema and findings input by the doctor, the contents and results of the examination already performed, the contents and results of the examination performed in parallel with the input of the electronic medical record, and the like are used as calculation materials for the medical fee. In ophthalmology, part information indicating whether a schema, findings, or examination target is one eye (left eye / right eye) or both eyes is also input.

(S2: Start up the medical fee information input screen)
The doctor activates an application for inputting medical fee information. Thereby, a medical fee information input screen is displayed on the display device 50. In ophthalmology, a screen for inputting medical fee information and a screen for inputting an order may be common.

(S3: Display medical fee information based on electronic medical record)
The data processor 30 identifies the medical fee item corresponding to the information input to the electronic medical record in step S1 by executing the medical fee information application, and displays it on the medical fee information input screen.

  The processing from step S1 to S3 is executed in the same manner as in the prior art. At this stage, the medical fee information input screen is automatically input to the electronic medical record or the like by the medical fee item corresponding to some of the information input by the doctor to the electronic medical record and the hospital information system 100 (such as the electronic medical record system 120). Only the medical fee items corresponding to the received information are presented. In addition, the doctor can manually input medical fee items (target items, body part items, frequency items, etc.) on the medical fee information input screen. Therefore, when there is an input omission on the electronic medical record or the medical fee information input screen, the medical fee item corresponding to the medical action that has not been input is not presented. Then, this medical fee item will be leaked from the bill. In order to prevent such a situation, the following processing is executed in this example.

(S4: Perform verification based on master data)
The collation unit 31 collates the form of the electronic medical record (medical practice record) with the medical fee item currently included in the medical fee information based on the master data 21a included in the related information 21. This process is executed as described above.

(S5: Is collation successful?)
If the verification is successful (S5: Yes), that is, if all the relationships registered in the master data 21a are satisfied, the process proceeds to step S6. On the other hand, if the verification fails (S5: No), that is, if any of the relationships registered in the master data 21a is not satisfied, the process proceeds to step S8.

(S6: collation based on related pattern information)
The collation unit 31 collates the form of the electronic medical record (medical practice record) with the medical fee item currently included in the medical fee information based on the related pattern information 21b included in the related information 21. This process is executed as described above.

(S7: Is collation successful?)
If the verification is successful (S7: Yes), that is, if all the relationships registered in the master data 21a are satisfied and all the relationships included in the related pattern information 21b are satisfied, the process proceeds to step S11. Transition. On the other hand, if the verification fails (S5: No), that is, if any of the relationships included in the related pattern information 21b is not satisfied, the process proceeds to step S8.

(S8: Display medical fee items that do not match)
When collation in step S4 and / or collation in step S6 fails (S5: No, S7: No), that is, items and medical fee information entered in the electronic medical record (medical practice record) with the related information 21 as a criterion If the medical fee item included in the item does not match, the process proceeds to step S8. The medical fee items that do not match the items described in the electronic medical record are specified by the matching unit 31, and information indicating the items is sent to the control processor 10.

  The display control unit 11 displays the inconsistent medical fee item specified by the matching unit 31 on the medical fee information input screen together with the medical fee information displayed in Step S3. At this time, the display control unit 11 can display inconsistent medical fee items in a manner different from the medical fee information displayed in step S3. For example, the medical fee information displayed in step S3 and the inconsistent medical fee item can be distinguished by the display color, font type, font size, background color, presence / absence of an underline, and the like. It is also possible to display inconsistent medical fee items identified by matching based on the master data 21a and non-matched medical fee items identified by matching based on the related pattern information 21b in different modes. is there. Note that the conventional technique cannot present such inconsistent medical fee items.

  An example of the display mode of the medical fee information input screen (order input screen) used in ophthalmology is shown in FIG. FIG. 4 shows a medical fee information presentation area (order information presentation area) 70 which is a part of the medical fee information input screen. The medical remuneration information input screen further includes an area where patient information (patient ID, name, date of birth, age, etc.) is presented, an area where date / time information (examination date, etc.) is presented, and the currently entered medical care There are provided an area where the total value of medical remuneration points corresponding to the remuneration item is presented, an area where information related to injuries and diseases is presented, an area where information concerning administered drugs is presented (medicine presentation area), various software keys, etc. . The software key includes a button for confirming and saving the input content, a button for canceling the input content, a button for inputting the same medical fee item (order information) as the previous time, and the input medical fee item ( A button for selectively deleting (order information), a button for collectively inputting medical fee items (order information) corresponding to a predetermined group of medical practices, and the like are provided.

  In the medical fee information presentation area 70, medical fee information corresponding to a medical practice performed on a patient is presented. The medical remuneration information presentation area 70 is provided with a plurality of columns including a target item column 71, a body part item column 72, a frequency item column 73, and a score column 74. In the target item column 71, a medical practice that is a target of medical fee is presented. In the target item column 71, for example, a character string indicating the classification name of the medical practice described in the medical fee score table is presented. In the body part item column 72, information indicating the body part where the corresponding medical practice is performed is presented. In ophthalmology, for example, “both” indicating both eyes, “single” indicating one eye, “left” indicating the left eye, “right” indicating the right eye, and “(none)” that does not require input of a body part. Is presented in the body part item field 72. In the number-of-times item column 73, a numerical value indicating the number of times and the time when the corresponding medical practice is performed is presented. In the score column 74, the medical treatment reward score of the corresponding medical practice is presented.

  In the conventional technique, only information relating to “slit M (anterior / posterior eye part)” and information relating to “precision fundus (both)” are presented. On the other hand, according to the present embodiment, the medical fee information represented in bold is further presented. Specifically, “Crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” is presented in the target item column 71, “piece” is presented in the body part item column 72, and the frequency item column 73 is presented as “1”, and the score column 74 is presented as “17440”. Furthermore, “respiratory heart rate monitoring” is presented in the target item column 71, “(none)” is presented in the body part item column 72, “3” is presented in the frequency item column 73, and “150” is presented in the score column 74. Is presented.

  The process of presenting medical fee information related to “crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” is performed, for example, as follows. As a premise, there have been more than 10 cases (patients) in which lens reconstruction has been performed in the past, and they are described as “intraocular lenses” in their medical records (electronic medical records, surgical records, etc.), and their medical fees It is assumed that “lens reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” is described in the information item of information. The related pattern information creation unit 32 created the related pattern information 21b based on ten or more combinations of such medical practice records and medical fee information. In addition, the doctor performed the lens reconstruction for this patient and entered “intraocular lens” as the equipment to be used in the medical practice record. However, “the lens reconstruction (when inserting an intraocular lens) (sewing) Suppose that the user forgets to enter the medical fee information on the “medical lens insertion”) on the medical fee information input screen. The collation unit 31 refers to the related pattern information 21b to specify that the medical fee information corresponding to the intraocular lens described in the medical practice record is not included. The display control unit 11 treats medical remuneration information (target items, region items, frequency items, and points) related to “crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” corresponding to the intraocular lens. It is displayed in the reward information presentation area 70. Here, the calculation of the medical fee score is performed based on, for example, a medical fee score table stored in advance in the storage device 20 (or the medical accounting system 140). This calculation process is executed by the data processor 30, for example.

  The process of presenting medical fee remuneration information related to “breathing heartbeat monitoring” is performed as follows, for example. As a premise, there have been more than 10 surgeries that have been monitored for respiratory heart rate, and those medical action records (electronic medical records, surgical records, etc.) are described as “respiratory heart rate monitoring” and are subject to medical fee information It is assumed that “Respiratory heart rate monitoring” is described in the item. The related pattern information creation unit 32 created the related pattern information 21b based on ten or more combinations of such medical practice records and medical fee information. Furthermore, the doctor performed respiratory heart rate monitoring in this patient's operation and entered “respiratory heart rate monitoring 3 hours” in the medical practice record, but the medical fee information related to “respiratory heart rate monitoring” was displayed on the medical fee information input screen. Suppose you forgot to enter it. The collation unit 31 refers to the related pattern information 21b to identify that the medical fee information corresponding to the respiratory heartbeat monitoring described in the medical practice record is not included. The display control unit 11 causes the medical fee information presentation area 70 to display medical fee information (target item, part item, frequency item, and score) related to “respiratory heart rate monitoring” corresponding to respiratory heart rate monitoring. The calculation of the medical remuneration score is performed in the same manner as in the case of “crystal reconstruction (inserting an intraocular lens) (inserting a sewn lens)”.

  Although illustration is omitted, it is also possible to perform the following automatic presentation. As a premise, it is assumed that the master data 21a includes an association between a schema template of “anterior segment findings (mydriasis)” and “mydriatic A”. The doctor performed an anterior segment observation using mydriatic A for this patient and entered the findings in the “Anterior segment findings (mydriasis)” schema template. Suppose you have forgotten to enter "Pupil A". The collation unit 31 refers to the master data 21a to specify that the medical fee information corresponding to the schema template of “anterior segment finding (mydriasis)” included in the medical practice record is not included. Or the collation part 31 detects the character string "anterior eye part finding (mydriasis)" described in the finding column of medical practice record (electronic medical record), and the medical fee information corresponding to this is not included Is identified. The display control unit 11 displays “mydriatic agent A” corresponding to the schema template of “anterior segment finding (mydriasis)” in the medication presentation area (described above) of the medical remuneration information input screen. Further, the display control unit 11 can display medical fee information (medical fee points etc.) related to mydriatic A in the medical fee information presentation area 70. The calculation of the medical remuneration score is executed in the same manner as described above.

  In the mode shown in FIG. 4, the display control unit 11 displays the medical fee information regarding “slit M (anterior / posterior eye region)” and the medical fee information regarding “precision fundus (both)” in the first mode. In addition, the medical fee information related to “crystal reconstruction (when an intraocular lens is inserted) (inserting a sewn lens)” and the medical fee information related to “respiratory heartbeat monitoring” are different from the first display mode. It is possible to display in the mode.

(S9: Is there additional input for medical fee information?)
The doctor confirms the information displayed on the medical fee information input screen. At this time, by applying the control of the display mode as described above, it is possible to confirm whether or not to forget to input the medical fee information and the content that the user forgot to input. The doctor additionally inputs medical fee information as necessary. Moreover, it is possible to confirm an erroneous input or an excessive charge, and it is possible to correct it appropriately. If additional input or the like is not required (S9: No), the process proceeds to step S11. On the other hand, if additional input or the like is necessary (S9: Yes), the process proceeds to step S10.

(S10: Add medical fee item)
When additional input or the like is necessary (S9: Yes), the doctor uses the operation device 60 (keyboard or the like) to perform additional input, correction, or deletion of the medical fee item. The process proceeds to step S11.

(S11: Store medical fee information)
The doctor uses the operation device 60 (such as a mouse) to click a button (described above) for confirming and saving the input content. In response to this operation, the storage control unit 12 collects the medical fee information input on the medical fee information input screen and associates it with the identification information (patient ID, etc.) of the patient. Further, the storage control unit 12 controls the communication unit 40 to transmit patient identification information and medical fee information to the medical accounting system 140. The medical accounting system 140 stores the medical fee information in an account corresponding to the patient identification information.

[Action / Effect]
The operation and effect of the medical information processing apparatus according to the embodiment will be described.

  The medical information processing apparatus according to the embodiment includes a first storage unit, a second storage unit, a third storage unit, a collation unit, and a display control unit. The first storage unit stores a medical practice record of each patient. The second storage unit stores medical fee information for each patient. A 3rd storage part stores the relevant information (21) with which the form of the medical practice record and the medical fee item were linked | related. One of the first to third storage units corresponds to the storage device 20, for example. In the above embodiment, the third storage unit corresponds to the storage device 20. Any one of the first to third storage units may correspond to a storage device provided in the hospital information system 100. For example, the first storage unit corresponds to the storage device (database) of the electronic medical record system 120 and / or the storage device (database) of the image management system 130, and the second storage unit corresponds to the storage device (database) of the medical accounting system 140. Equivalent to.

  The collation unit (31) includes the form of the medical practice record of one patient stored in the first storage unit and the medical fee item included in the medical fee information of the patient stored in the second storage unit. , Matching based on related information. The display control unit (11) displays the medical fee information of the patient on the display means. Further, if the collation unit determines that the medical fee item associated with the medical practice record form of the patient is not included in the medical fee information, the display control unit displays the medical fee item together with the medical fee information. Display. The display means (display device 50) may or may not be included in the medical information processing apparatus.

  According to such an embodiment, even if there is an omission of input of medical fee information, etc., the consistency between the medical practice record (electronic medical record, surgical record, etc.) and the medical fee information is automatically confirmed, and inconsistent medical care is performed. Reward items can be displayed. Therefore, it is possible to improve the accuracy of the medical fee calculation.

  In the embodiment, the medical fee item may include a body part item indicating the type of the body part. When the collation unit determines that the body part item associated with the form of the medical practice record of one patient is not included in the medical fee information, the display control unit displays the body part item together with the medical fee information be able to.

  In application to ophthalmology, the body part item may include a target eye item for distinguishing between a medical action for one eye and a medical action for both eyes (see FIG. 4 and the like). The display control unit displays, as target eye items, information indicating that the medical action target is one eye (or the left eye or the right eye) and information indicating that the medical action target is both eyes Is possible.

  Conventionally, body part items have been manually input by a doctor. However, according to this configuration, the body part item can be automatically input based on the medical practice record and the related information. Therefore, it is possible to reduce the input effort while improving the accuracy of the medical fee calculation.

  In the embodiment, the form of the medical practice record may include any of the following: the type of the input template in which the content and / or result of the medical practice is input; the type of the character string input to the input template and / or Image type: Type of input area in the input template.

  In the embodiment, the related information may include master data (21a) in which a predetermined medical fee item is associated with a predetermined medical practice record form. Further, the related information includes related pattern information (21b) representing a related pattern between the form of the medical practice record and the medical fee item created based on the past medical practice record and the past medical fee information. Good.

  The medical information processing apparatus according to the embodiment may include a creation unit (related pattern information creation unit 32). The creation unit creates the related pattern information (21b) based on the plurality of medical practice records stored in the first storage unit and the plurality of medical fee information stored in the second storage unit.

  In the embodiment, the display control unit can display medical fee items determined to be not included in the medical fee information in a manner different from other medical fee items. Thereby, it is possible to easily identify and confirm a medical fee item determined not to be included in the medical fee information.

  The medical information processing apparatus according to the embodiment may include an operation unit and a storage control unit. The operation unit (operation device 60) is used for confirming or correcting the medical fee information displayed on the display means. The storage control unit (12) associates the medical fee information with the identification information of one patient when an operation for determining the medical fee information displayed on the display unit is performed via the operation unit. Store in the second storage. The second storage unit corresponds to the storage device (database) or the storage device 20 of the medical accounting system 140, for example.

  The configuration described above is merely an example of an embodiment. The present invention can be arbitrarily modified (omitted, substituted, added, etc.) within the scope of the gist of the present invention.

DESCRIPTION OF SYMBOLS 1 Medical information processing apparatus 10 Control processor 11 Display control part 12 Storage control part 20 Storage apparatus 21 Related information 21a Master data 21b Related pattern information 30 Data processor 31 Collation part 32 Related pattern information creation part 40 Communication part 50 Display apparatus 60 Operation apparatus

Claims (9)

A first storage for storing a medical practice record of each patient;
A second storage for storing medical fee information for each patient;
A third storage unit for storing related information in which a medical practice record form and medical fee items are associated;
The form of the medical practice record of one patient stored in the first storage unit and the medical fee item included in the medical fee information of the one patient stored in the second storage unit are related to A collation unit that collates based on information;
A display control unit for displaying the medical fee information of the one patient on a display means,
When the collation unit determines that the medical fee item associated with the medical practice record form of the one patient is not included in the medical fee information, the display control unit displays the medical fee item as the medical fee item. A medical information processing apparatus characterized by being displayed together with reward information. The medical fee item includes a body part item indicating a type of body part,
When the collation unit determines that the body part item associated with the medical practice record form of the one patient is not included in the medical fee information, the display control unit displays the body part item as the medical treatment item. The medical information processing apparatus according to claim 1, wherein the medical information processing apparatus is displayed together with reward information. The body part item includes a target eye item for distinguishing between a medical action for one eye and a medical action for both eyes,
The display control unit can display, as the target eye item, information indicating that a medical practice target is one eye and information indicating that the medical practice target is binocular. The medical information processing apparatus according to claim 2. The form of the medical practice record includes the type of the input template into which the content and / or result of the medical practice is input, the type of the character string and / or the type of the image input to the input template, and the input template The medical information processing apparatus according to any one of claims 1 to 3, wherein the medical information processing apparatus includes at least one of types of input areas. The medical information according to any one of claims 1 to 4, wherein the related information includes master data in which a predetermined medical fee item is associated with a form of a predetermined medical practice record. Processing equipment. The related information includes related pattern information representing a related pattern between a form of medical practice records and medical fee items, which is created based on past medical practice records and past medical fee information. The medical information processing apparatus according to any one of claims 1 to 5. Including a creation unit that creates the related pattern information based on a plurality of medical practice records stored in the first storage unit and a plurality of medical fee information stored in the second storage unit. The medical information processing apparatus according to claim 6. The display control unit displays the medical fee item determined to be not included in the medical fee information in a mode different from other medical fee items. The medical information processing apparatus according to claim 1. An operation unit for confirming or correcting medical fee remuneration information displayed on the display means;
The second storage unit associates the medical fee information with the identification information of the one patient when an operation for determining the medical fee information displayed on the display means is performed via the operation unit. The medical information processing apparatus according to claim 1, further comprising: a storage control unit that stores the medical information in the medical information processing apparatus.

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