JP3420720B2 - Disease type selection system, disease type selection method, and machine-readable medium recording program - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention belongs to the technical field of computers for processing medical information, and in particular it is a comprehensive list of disease types that are being considered to be introduced in the medical industry of Japan in place of the current system for paying for medical fees. In the payment method, a new disease type selection that enables the medical insurance organization, which pays the medical fee, and each medical institution, which requests (receives) the medical fee, to appropriately select the disease type for comprehensive payment It belongs to the technical field of system and disease type selection method.
The present invention also belongs to the technical field of a machine-readable medium having a program recorded thereon for causing a computer to function as such a disease type selection system.

[0002]

2. Description of the Related Art At present, in medical insurance such as national health insurance and social insurance in Japan, basically, regardless of the type of illness of the patient, the medical treatment fee is determined depending on what individual medical treatment is actually performed. The method is adopted.
Specifically, for example, every time a specific type of injection is performed or a specific type of test is performed once, the amount of medical treatment fee according to the medical treatment fee points assigned to those medical care actions is It will be paid by the institution. However, in this performance-based payment system, the more medical treatments listed in the medical treatment fee table, or the more medical treatments with higher scores, the higher the income of medical institutions such as hospitals. , The incentive to carry out medical treatment efficiently does not work for medical institutions. As a result, over-medical treatment such as inspection and drug pickling is incurred, and health care costs in Japan continue to increase. On the other hand, in Western countries with the same problem, instead of the pay-as-you-go system, a fixed comprehensive set of treatment processes necessary for one patient, such as one hospitalization unit for one patient, is adopted. A comprehensive payment system for each type of illness, which pays the amount paid as medical fees to each medical institution from the Medical Insurance Agency, is being introduced, and its introduction is being considered in Japan.

[0003] For example, as a disease type for such comprehensive payment, there is a DRG (Diagnosis Related Group), and this DRG is an international disease type (for example, ICD-9).
CM) with more than 10,000 disease names, based on the need for medical resources such as manpower, pharmaceuticals, medical materials, major diagnostic categories (MDC), presence / absence of surgery, major diagnostic names, diagnostic groups, surgical procedure names , Major surgery,
Based on minor surgery, patient information, etc., it is organized and classified into about 500 statistically significant disease types. In principle, DRG / PPS (Prospective Payment System) that pays a certain medical fee to each DRG
According to the m) method, if the patients belong to the same DRG,
It is in the interest of each medical institution to carry out the medical care process as efficiently as possible because the cost is small. Therefore,
Incentives for efficient medical treatment will work for medical institutions, resulting in cost reductions at medical institutions and reductions in insurance medical costs. In this way, DRG / PPS
Comprehensive payment method by disease type such as the method is expected as a very effective means for stopping the increase in health care costs.

However, when the comprehensive payment system for each disease type is introduced, it is difficult to select the disease type.

First, in the medical insurance organization in which medical fees are charged by this comprehensive payment method, information indicating the type of illness which is the basis of medical fees given by each medical institution and information indicating the actual medical treatment process. Although the medical fee will be paid to each medical institution with reference to, there is a problem that it is unclear at this time whether or not an appropriate disease classification is given to each patient. That is, in the case of an actual patient, there are a plurality of symptoms and complications, and one disease type cannot be clearly determined by performing the same medical care process. Therefore, since each medical institution has an incentive to give a disease type with a high medical fee as much as possible to patients who have undergone the same medical care process, the Health Insurance Agency has such an incentive that is too inappropriate. It is expected that there will be a problem in that it is difficult to determine whether the disease type is not assigned, that is, whether it is not fraudulently charged.

[0006] On the other hand, in each medical institution, it is a big problem to make an illegal claim, but at the level where it is not an illegal claim, it is judged as one of two or three or more disease types. If so, it is advantageous (that is,
We would like to judge it as a disease type (of which the medical fee is higher), but it is also expected that there will be a problem that it is difficult to judge whether there is a risk of being judged as a fraudulent claim.

[0007] Therefore, after introducing the comprehensive payment system for each disease type, the international disease type diagnosed by the doctor in charge at each medical institution, the main diagnosis category, the presence or absence of surgery, the main diagnosis name, Diagnostic group,
It is conceivable that a technology for determining this will be constructed by using the basic information for determining the disease type for comprehensive payment such as the surgical procedure name, major surgery, minor surgery, and patient information as input information.

[0008]

However, by using the above-mentioned computer, the basic information for defining the disease type (that is, the international disease type diagnosed by the doctor in charge at each medical institution, the main diagnosis category, the surgery) is used. Presence / absence, major diagnosis name, diagnosis group, surgical procedure name, major surgery,
With a technique that uses minor surgery, patient information, etc.) as input information, for example, it is necessary to attach not only the disease type and the medical treatment process for each patient but also these complicated basic information to the medical treatment fee bill in some form. Or, in addition to the disease type and medical care process for each patient, it is necessary to attach information such as the medical examination result, test result, main diagnosis name, etc. of each patient entered in the electronic medical record to the medical treatment fee bill in some form. . It is extremely difficult in practice for a medical insurance organization, which has to deal with a large number of medical fee bills at one time, to sort out and process such complicated information for each medical fee bills. There is a problem that the number of unchecked bills may increase.

The present invention has been made in view of the above-mentioned problems, and even if there is no information on the disease name, it is possible to select an appropriate disease type for each patient from the information on the medical treatment process, or at least to an appropriate candidate. An object of the present invention is to provide a narrowed down disease type selection system, a disease type selection method, and a machine-readable medium in which a program that allows a computer to function as such a disease type selection system is recorded.

[0010]

[Means for Solving the Problems] In order to solve the above-mentioned problems, the first disease type selection system of the present invention is a medical insurance machine.
The disease that is assigned to each patient by the medical institution.
Disease type selection used to judge the validity of disease type
It is a fixed system, with multiple disease types as a population
(a) A first file that stores in advance the probability that each of a plurality of medical care actions in a series of medical care processes performed for one patient belonging to one disease type and (b) the one disease type corresponds means and an input means for inputting the medical care action information indicating the intervention respective kinds to be performed on each patient in the medical institution, for the intervention each type indicated by medical treatment information the input Based on the probability stored in the first file means, one or a plurality of disease types having a higher probability of being a disease type for each patient among the plurality of disease types than a predetermined reference value,
Selecting means for selecting as a disease type candidate, and the selecting means
One disease type is selected as the disease type candidate by
In the case of
The first determining means for determining the type and the selecting means
Multiple disease types were selected as candidate disease types
In this case, a predetermined association with the selected multiple disease types
A predetermined screen that prompts the user to input the relevant information
Is displayed by the display means, and the related information is displayed by the input means.
When the information is input, the information is input according to the input related information.
Determining one of multiple disease types selected
Second determining means and the medical institution for each patient
The disease type assigned by the first or second determining means.
Whether or not it matches the determined disease type candidate
And a classification suitability determination means .

The first disease type selection system of the present invention is
Used by the medical insurance organization . That is, according to the illness type selection system of the present invention, the first file means includes, for example, comprehensive payments classified based on the necessity of medical resources necessary for one patient treated by a series of medical care processes. A plurality of types of medical care actions in a series of medical care processes and the one type of the disease, with a plurality of disease types for comprehensive payment such as DRG as a population or a disease type generally called a disease name as a population. The probabilities that and correspond to each other are stored in advance. The monitoring disease types that each medical institution is granted in the medical insurance mechanism (inspection) to place
In this case, the medical treatment action information indicating the type of each medical treatment action to be performed on each patient is input by the input means . Then, on the basis of the probability stored in the first file means for each type of medical care action indicated by the input medical care action information, the possibility that the disease type for each patient among the plurality of disease types is a predetermined criterion. One or a plurality of disease types higher than the value are selected by the selection means as disease type candidates. This is because, if the types of a plurality of medical care actions that compose a series of medical care processes that are complicated and sophisticated and are executed systematically are known, for example, there are several hundred types of disease types represented by DRG. If so, in most cases,
This is based on the enthusiastic research and study by the inventor of the present invention that the disease type can be accurately identified (estimated) or can be narrowed down to at least a practically sufficiently small number of candidates. More specifically, a single medical practice that constitutes a series of medical care processes often corresponds to a large number of disease types, for example, hundreds or thousands, so without the information on the disease name and symptoms, etc. Cannot be specified or cannot be narrowed down practically. However, when two or three types of medical treatment are performed, the probability that the plurality of medical treatments correspond to the disease type will decrease at an accelerating rate. For example, if the probability that one type of medical treatment, such as a specific type of injection, corresponds to a disease type is 10 to 20%, if the disease type is about hundreds or thousands, then this one medical treatment is performed. There are still several tens to several hundreds of disease types that can be imparted as a result, but this has little or no practical use for identifying the disease type. However, even if there is more than one piece of information related to each medical practice that seems to be of no use in identifying a disease type, the number of disease types and disease names commonly associated with both medical practices may be significantly limited. It is known (for example, when two types of medical treatment are performed on one patient, the number of disease types for the one patient is (10 to 20%) of all disease types).
X (10 to 20%) = narrowed down to about 1% to 4%), and since the number of medical treatments performed for each patient is diverse, there is a lack of information on disease names and symptoms. However, based on the probability that each type of a plurality of medical care actions that constitutes a series of medical care process originally performed with the purpose of treating one patient and the disease type for the patient correspond to each other, Disease type and disease name (especially main disease name)
Can be specified (estimated). At this time, instead of simply selecting the one with the highest probability, the selection result is output by comparing it with the predetermined reference value, so it is not necessary to mix the uncertain estimation result into the certain estimation result, which is advantageous. is there. That
In the present invention, in particular, as a disease type candidate by the selection means
When one disease type is selected, the first determining means
Therefore, the one disease type is the disease type for this patient.
Then it is decided as it is. On the other hand, by selecting means, diseases
If multiple disease types are selected as type candidates,
First, the display means displays a plurality of selected disease types and predetermined relationships.
Relationship, such as sex of the patient, age, length of hospital stay, etc.
A predetermined screen is displayed prompting you to enter information using the input means.
It Next, the input hand operated by the user who saw this predetermined screen
When the relevant information is input by the stage, the second determining means
A plurality of programs selected according to the input related information.
One of the disease types is determined. Next, classification suitability judgment
Granted to each patient by the medical institution by means
The disease type is the disease determined by the first or second determining means.
It is determined whether or not it matches the disease type candidate. Where the doctor
The disease type given to each patient by the medical institution is
The one or more cases determined by the first or second determining means.
If it matches any of the disease types, the disease type will not be assigned.
It can be judged to be suitable. Conversely, depending on the medical institution, each patient
The disease type assigned to the first or second determining means
One of one or more disease types determined by
If you have not done so, it is not appropriate to assign the disease type or
Can be determined to be fraudulent. Therefore, for medical insurance organizations who are particularly charged for medical fees and cannot expect to obtain information such as disease names and symptoms of each patient, the types of diseases that are granted by each medical institution and are the basis of medical fees are It is very convenient from the viewpoint of efficiently inspecting or monitoring suitability.

The second disease type selection system of the present invention is as follows.
In order to solve the problem
The validity of the disease type given to each patient by Seki
It is a disease type selection system that is used to judge
Then, using multiple disease types as a population (a)
A series of clinical processes for one patient
Types of multiple medical treatment activities in (b) the disease
First file means for storing in advance the probability that the types correspond
And the procedure performed for each patient at the medical institution
Input to input medical care information indicating each type of medical care
Means and the information indicated by the input medical practice information
In the first file means for each type of medical treatment
Of the multiple disease types based on the stored probabilities
Predetermined reference value that may be the disease type for each patient
One or more disease types that are higher than
Selection means for selecting and selecting, and a classification suitability determination means for determining whether or not the disease type given to each patient by the medical institution is included in one or more disease types selected as the disease type candidate With .

The second disease type selection system of the present invention is
It is preferably used by the medical insurance organization that pays medical fees. That is, although the medical institution that requests the medical fee gives the disease type to each patient, for example, due to an error or for an improper purpose, the disease type having a higher medical fee than the actual disease type is given. However, according to this aspect, the classification suitability determination unit selects the disease type assigned to each patient by the medical institution as the disease type candidate by the selection unit. It is determined whether or not it is included in one or more disease types. Here, if the disease type assigned to each patient by the medical institution is included in one or more disease types selected as a disease type candidate by the selection means, it is determined that the disease type is appropriate. it can. vice versa,
The disease types given to each patient by medical institutions are
If the disease type is not included in one or a plurality of disease types selected as the disease type candidate by the selecting means, it can be determined that the disease type is not appropriate or fraudulent. Further, by adjusting the predetermined reference value used in the selection by the selection means, it is possible to prevent the judgment of fraud from becoming too strict, which is practically convenient. From such a viewpoint, the predetermined reference value is empirically, experimentally, or theoretically greater than 0% and 10
Although a numerical value of 0% or less is set, an upper limit is set for the number of DRGs for each patient to be selected by the selecting means, and DRGs that are more likely to be present than the predetermined reference value are selected in order from the highest to the highest. It may be configured to select only the upper limit number (for example, three). Further, such a predetermined reference value may be changed in real time according to the number of DRGs that are candidates at the time of selection.

The third disease type selection system of the present invention is as follows.
In order to solve the problem
The validity of the disease type given to each patient by Seki
It is a disease type selection system that is used to judge
Then, using multiple disease types as a population (a)
A series of clinical processes for one patient
Types of multiple medical treatment activities in (b) the disease
First file means for storing in advance the probability that the types correspond
And the procedure performed for each patient at the medical institution
Input to input medical care information indicating each type of medical care
Means and the information indicated by the input medical practice information
In the first file means for each type of medical treatment
Of the multiple disease types based on the stored probabilities
Predetermined reference value that may be the disease type for each patient
One or more disease types that are higher than
And a selecting means for selecting, and the selecting means,
Of the plurality of disease types, the most likely disease type for each patient is selected as the disease type candidate, and the disease type assigned to each patient by the medical institution is selected. A classification suitability determination unit that determines whether or not the candidate type matches the disease type candidate is further provided.

The third disease type selection system of the present invention also comprises
It is preferably used by the medical insurance organization that pays medical fees. That is, according to this aspect, the selection unit selects, as a disease type candidate, a disease type that is most likely to be a disease type for each patient among the plurality of disease types. Then, the classification suitability determination unit determines whether or not the disease type given to each patient by the medical institution matches one disease type selected as a disease type candidate by the selection unit. Here, if the disease type given to each patient by the medical institution matches one disease type selected as a disease type candidate by the selection means, it can be determined that the disease type is appropriate. . vice versa,
The disease types given to each patient by medical institutions are
If it does not match the one disease type selected as the disease type candidate by the selecting means, it can be determined that the addition of the disease type is not proper or fraudulent. Next, the disease type and main disease name thus determined are output in a predetermined format in association with each patient by an output means such as a display or a printer.

The fourth disease type selection system of the present invention is as follows.
In order to solve the problem
The validity of the disease type given to each patient by Seki
It is a disease type selection system that is used to judge
Then, using multiple disease types as a population (a)
A series of clinical processes for one patient
Types of multiple medical treatment activities in (b) the disease
First file means for storing in advance the probability that the types correspond
And the procedure performed for each patient at the medical institution
Input to input medical care information indicating each type of medical care
Means and the information indicated by the input medical practice information
In the first file means for each type of medical treatment
Of the multiple disease types based on the stored probabilities
Predetermined reference value that may be the disease type for each patient
One or more disease types that are higher than
Selection means to select and select as the disease type candidate
Output one or more disease types in a predetermined format
Output means, designation means capable of externally designating any one or a plurality of disease types outputted by the output means, and the disease pattern given to each patient by the medical institution is the designating means. Further, there is further provided a classification suitability judging means for judging whether or not it matches with the disease type candidate designated externally by.

The fourth disease type selection system of the present invention is
It is preferably used by the medical insurance organization that pays medical fees. That is, according to this aspect, one or more of the one or more disease types output by the output means are externally designated by the designation means such as a keyboard or a mouse. Such external designation is performed, for example, by a fraud monitor in the medical insurance organization.
Then, the classification suitability determination unit determines whether or not the disease type given to each patient by the medical institution matches the disease type candidate designated externally in this way. Here, if the disease type given to each patient by the medical institution matches one of the one or more disease types externally designated by the designating means, the granting of the disease type is appropriate. You can judge. On the contrary, if the disease type given to each patient by the medical institution does not match one or more of the disease types externally designated by the designating means, it is not appropriate or incorrect to assign the disease type. It can be determined that

The first to third disease type selection systems of the present invention
In one aspect systems out, belong to the medical insurance mechanism, the disease
Predetermine one or more disease types selected as type candidates
An output means for outputting in a format is further provided.

The disease type selection system according to this aspect is preferably used in the medical insurance organization which pays medical fees. Then, by the output means, the medical insurance mechanism
One or more diseases that belong to
The disease type is output in a predetermined format.

The fifth disease type selection system of the present invention is as follows.
In order to solve the above problems, the medical institution belongs to a medical institution
The validity of the disease type given to each patient.
Is a disease type selection system used to
Then, using multiple disease types as a population (a)
A series of clinical processes for one patient
Types of multiple medical treatment activities in (b) the disease
First file means for storing in advance the probability that the types correspond
And the procedure performed for each patient at the medical institution
Input to input medical care information indicating each type of medical care
Means and the information indicated by the input medical practice information
In the first file means for each type of medical treatment
Of the multiple disease types based on the stored probabilities
Predetermined reference value that may be the disease type for each patient
One or more disease types that are higher than
Selecting means for selecting and selecting the diseases by the selecting means.
If one disease type is selected as a type candidate,
Disease type of each patient as a disease type
By the first determining means and the selecting means
If multiple disease types are selected as a supplement,
Before related information that has a predetermined relationship with the identified multiple disease types
A display hand that displays a predetermined screen that prompts input by the input means.
And the related information is input by the input means.
And a plurality of the selected information according to the input related information.
The second determining means for determining one of the disease types of
Prepare for

The fifth disease type selection system of the present invention is
It is preferably used at each medical institution that requests medical fees. That is, according to this aspect, the sorting means
When one disease type is selected as a more likely disease type candidate
Is the same disease type as it is for this patient.
The disease type is determined by the first determining means. On the other hand,
Multiple disease types are selected as disease type candidates by the selection means.
If separated, these multiple disease types are associated with a given relationship.
A predetermined screen that prompts you to enter related information
Is displayed. When a user such as a doctor who sees this predetermined screen enters
By means of force, for example, the patient's sex, age, hospitalization
When you enter the relevant information, the relevant information entered like this
One of the multiple disease types selected according to
2 Determined by the determining means. At this time, by the selection means
By adjusting the predetermined reference value used when sorting, the second decision
Limit the number of disease type candidates that can be determined by stages to an appropriate number
Related information prompted by the second deciding means.
The amount of information required is relatively small. Therefore enter the relevant information
The input work burden on the user, such as a doctor, is light and practical
It is convenient.

[0022] One of the fifth disease type selection system of the present invention
In an aspect, it belongs to the medical institution and is selected as the disease type candidate.
Format of one or more disease types selected by
Output means for outputting with
A finger that can externally specify one of one or more disease types
And a fixing means.

The disease type selection system of this aspect is preferably used in each medical institution that requests medical fees. That is, according to this aspect, the sorting means
One of the selected one or more disease types is designated
Can be specified externally by the step. Therefore, the patient's symptoms and medical examination
According to the treatment process, two or more disease types
Regardless of the classification, there is no problem with medical insurance (ie, fraudulent
If the problem of claiming medical fees does not occur, these
Use one of these to specify the keyboard, mouse, etc.
It can be determined according to the user's request such as a doctor by the operation used.
It Of the predetermined reference value used when sorting by this sorting means
By adjustment, it is possible that the user of the designated means such as a doctor can specify
Since the complement can be set to an appropriate number, and if there is only one candidate,
Also requires confirmation by doctors, etc.
Disease type after checking with a doctor etc.
The main disease name can be determined, which is practically convenient.

[0024] In another aspect of the fifth disease type selection system of the present invention, a second file which belongs to the medical institution and stores in advance an index of medical fee to be comprehensively paid for each of the plurality of disease types. Means further comprising the second
When a plurality of disease types are selected as the disease type candidates by the selecting means , the determining means stores an index of medical fee stored in the second file means and corresponding to the selected plurality of disease types. Based on the above, one of the selected plurality of disease types is determined as the disease type for each patient.

The disease type selection system of this aspect is preferably used at each medical institution that requests medical fees. That is, according to this aspect, the index of the medical treatment fee comprehensively paid for each of the plurality of disease types is stored in the second file means in advance. Then, when one disease type is selected as a disease type candidate by the selection means, the selected one disease type is as it is,
The disease type for this patient is determined by the first determining means. On the other hand, particularly in the present invention, when a plurality of disease types are selected as disease type candidates by the selection means,
One of the selected disease types is secondly determined as a disease type for this patient, which is stored in the second file means and is based on the index of the medical fee corresponding to the selected disease types . Determined by means . Therefore, according to the patient's symptoms and the medical treatment process, if there is no problem in medical insurance (that is, the problem of fraudulent medical fee claim) even if it is classified into two or more disease types. For example, if the one with the highest medical fee among these disease types is determined as the disease type to which the one patient belongs, the maximum medical fee will be given to the medical institution, even though the medical treatment process is performed in the same manner. It is possible to obtain profits and efficiently pursue profits. For example, if one of these illness types with an average medical fee is determined as the type of illness to which the one patient belongs, the medical institution can obtain an average medical fee, which is objective and fair. It is possible to pursue profits fairly. Alternatively, for example, if one of these disease types with the lowest medical treatment fee is determined as the disease type to which the one patient belongs, the medical institution can obtain the minimum medical treatment fee and burden society and patients. It is possible to pursue profits while reducing them. At this time, by adjusting the predetermined reference value Pref used at the time of selection by the selection means, a DRG that is unlikely to be seen from the medical treatment process and is considered as an illegal bill by the examination on the payer side of the medical fee is not listed as a candidate. Since it is sufficient, it is possible to pursue maximum profit with peace of mind and it is practically convenient.

[0026] In this aspect, the second deciding means determines , based on the index of the medical fee stored in the second file means, the one having the highest medical fee among the plurality of selected disease types, It may be configured to determine the disease type for each patient.

According to this structure, when a plurality of disease types are selected as the disease type candidates by the selection means, they are stored in the second file means and the medical treatment corresponding to the selected plurality of disease types is performed. Based on the reward index, the second determination means automatically determines, as the disease type for this patient, the one with the highest medical fee among the selected disease types. Therefore, the medical institution can automatically obtain the optimal and maximally profitable disease type based on the information related to the medical care process.

[0028] In another aspect of the fifth disease type selection system of the present invention, a second file which belongs to the medical institution and stores in advance an index of medical treatment fee comprehensively paid to each of the plurality of disease types. And a plurality of disease types are selected as the disease type candidates by the selecting means, the medical treatment fee index corresponding to the selected plurality of disease types is extracted from the second file means, and Display means for displaying in a predetermined format in association with a plurality of selected disease types, and for determination by the first or second determining means
Instead, it further comprises a designation means capable of externally designating one of the displayed disease types.

This aspect is preferably used by the medical institution that is the party who requests the medical fee. That is, according to this aspect, the index of the medical treatment fee comprehensively paid for each of the plurality of disease types is stored in the second file means in advance. Then, when a plurality of disease types are selected as the disease type candidates by the selection means, the indicator of the medical fee corresponding to the selected plurality of disease types is extracted from the second file means by the display means and selected. The information is displayed in a predetermined format in association with the plurality of disease types that have been selected. Then, the designation means externally designates one of the plurality of disease types thus displayed.
Examples of such designation means include a keyboard and a mouse, but preferably, a plurality of selected candidates are displayed in a menu, and a desired one can be designated from among these by a keyboard, a mouse and the like. To configure. Therefore, according to the patient's symptoms and the medical treatment process, if one of the two or more disease types does not cause any problem in medical insurance, one of It can be determined as desired by a user such as a doctor by an operation using a designating means such as a mouse.

In another aspect of the disease type selection system of the present invention, the first file means further preliminarily sets in advance the probability that the number of executions of each of the medical care actions in the series of medical care processes corresponds to the one disease type. The medical practice information further indicates the number of executions of each of the medical practice, and the selecting unit stores the number of executions of each of the medical practice indicated by the input medical practice information in the first file unit. Based on the stored probabilities, one or more disease types are selected as the disease type candidates.

According to this aspect, in the first file means, in addition to the probability that each type of medical care action in the series of medical care processes corresponds to one disease type, the number of executions corresponds to one disease type. The probability of doing is stored in advance. Then, when the medical practice information indicating the type of each medical practice and the number of executions thereof is input by the input means, the first file means for each type of medical practice indicated by the input medical practice information and the number of executions thereof. One or a plurality of disease types having a higher possibility of being a disease type for each patient than the predetermined reference value among the plurality of disease types based on the probability stored in the. This is because it is possible to more accurately identify (estimate) the disease type if at least the number of medical care actions that make up a series of medical care processes and the number of times each medical care action is performed can be more accurately identified (estimated), or at least a smaller number of medical process This is based on the enthusiastic investigation and research by the present inventor that it is possible to narrow down to candidates. It has been found that not only the type of each medical practice but also the type of disease and the disease name corresponding to a specific number of times of execution are significantly limited. Furthermore, the number of medical care performed for each patient is particularly limited. In the case of, for example, since there are many types over a long period of time, even if there is no information about the disease name and symptoms, there are multiple medical treatments that form a series of medical treatment processes that are originally performed to treat one patient. The disease type and disease name for the patient can be more accurately identified (estimated) based on the probability that each type of action and the number of executions of the action correspond to the disease type for the patient.

In another aspect of the disease type selection system of the present invention, the first file means has a probability that the relative execution timing of each of the medical care actions in the series of medical care processes corresponds to the one disease type. Is further stored in advance, the medical care action information further indicates execution timing of each of the medical care actions, and the selection unit is configured to perform the first execution timing of each of the medical care actions indicated by the input medical care action information. Based on the probability stored in the file means, one or more disease types are selected as the disease type candidates.

According to this aspect, in the first file means, in addition to the probability that the types of medical care actions in the series of medical care processes correspond to one disease type, their relative execution timing and one disease The probabilities that the types correspond to each other are stored in advance. Then, when the medical practice information indicating the type of each medical practice and the execution timing thereof is input by the input means, the first file means for each type of medical practice indicated by the input medical practice information and the execution timing thereof. One or a plurality of disease types having a higher probability of being a disease type for each patient than a predetermined reference value among the plurality of disease types based on the probabilities stored in 1. are selected as disease type candidates by the selection means. This is because it is possible to more accurately identify (estimate) the disease type if at least the number of types of medical care actions that make up a series of medical care processes and the execution timing of each medical care action are known, or at least a smaller number This is based on the enthusiastic investigation and research by the inventor of the present application that it is possible to narrow down to candidates.
It is known that not only the type of each medical treatment, but also the type of disease and the disease name corresponding to a specific execution timing are significantly limited, and the medical treatment performed for each patient is particularly limited to the case of hospitalization. Since there are many types of information over a long period of time, even if there is no information about the disease name, symptoms, etc., there are multiple medical actions that constitute a series of medical treatment processes originally performed to treat one patient. The disease type and disease name for the patient can be more accurately specified (estimated) based on the probability that each type and execution timing thereof correspond to the disease type for the patient. In addition, one or a plurality of disease types may be selected as disease type candidates based on the type of each medical practice, the number of times of execution, and the probability of the execution timing.

In another aspect of the disease type selection system of the present invention, the first file means is (a) M of the medical treatment act.
The probability that the combination of m (where M is a natural number less than M) medical care actions out of (where M is a natural number) types and (b) the one disease type is stored in advance, and the selection means Selects one or a plurality of disease types as the disease candidates based on the probabilities stored in the first file means for the m kinds of combinations of the medical care actions indicated by the input medical care action information.

According to this aspect, the first file means stores in advance the probability that a combination of m kinds of medical care actions out of M kinds of medical care actions corresponds to one disease type. Then, when the medical practice information indicating the type of each medical practice is input by the input means, the probability of being stored in the first file means for the combination of m types of medical care indicated by the input medical practice information is obtained. Based on this, one or more disease types as the disease types are selected by the selection means. Here, when a plurality of types of medical care actions that make up a series of medical care processes are performed in combination, the number of disease types that may be supported is drastically reduced compared to when one type of medical care action is performed. Therefore, from the viewpoint of efficiently reducing the amount of information required by the first file means and the amount of processing required by the selecting means, it is advantageous to configure as in this aspect. Therefore, even if there is no information about the disease name or symptom, etc., the combination of each type of multiple medical care actions that constitutes a series of medical care processes originally performed to treat one patient and the type of disease for the patient. The disease type and disease name for the patient can be efficiently identified (estimated) based on the probabilities that and correspond to each other.

In another aspect of the disease type selection system of the present invention, the first file means is (a) M of the medical examination action.
(Where M is a natural number) combinations of m (where m is a natural number less than M) types of medical care actions, (b) relative execution timing of the m types of medical care actions, and (c) the one The probability that the disease type of the medical treatment corresponds to that of the medical treatment type is stored in advance, and the selection unit stores in the first file unit the combination and the execution timing of m types of medical treatment of the medical treatment indicated by the input medical treatment information. Based on the stored probabilities, one or more disease types are selected as the disease candidates.

According to this aspect, the first file means stores in the first file means a combination of m kinds of medical care actions out of M kinds of medical care actions and relative execution timings of the m types of medical care actions (for example, immediately before and at the same time). , Immediately, the same day, one day later, two days later,
The probability that an execution timing code obtained by classifying execution timings according to a predetermined standard as in (1) and one disease type is stored in advance. Then, when the medical practice information indicating the type and the execution timing of each medical practice is input by the input means, the first file means for the combination of m types of medical practice indicated by the input medical practice information and the execution timing. One or more disease types as the disease types are selected by the selection means based on the probabilities stored in. Here, in the case where a plurality of types of medical care actions constituting a series of medical care processes are performed in combination and are performed at a relatively specific execution timing, it is possible to deal with them in comparison with the case where one type of medical care action is performed. Since the number of disease types that can occur is drastically reduced, it is advantageous to configure in this manner from the viewpoint of efficiently reducing the amount of information required by the first file means and the amount of processing required by the selecting means. Therefore, even if there is a lack of information about the disease name, symptoms, etc., the combination of each type of multiple medical treatment actions that constitutes a series of medical treatment process originally performed to treat one patient, the timing of execution, and The disease type and disease name for the patient can be efficiently identified (estimated) based on the probability that the disease type for the patient corresponds.

In a mode including the above-mentioned output means , the selection means includes an extraction means for extracting from the first file means a probability for each type of the medical care action indicated by the input medical care action information. Comparing means for calculating the possibility of being a disease type for each patient based on the extracted probability and comparing the calculated possibility with the predetermined reference value; and the comparing possibility with the predetermined probability. a, and a selection output control means for outputting to said output means as the disease type candidates according to one or more sorting control signal of one or more disease types higher than the reference value
Good .

According to this structure, when the medical care action information is input by the input means, the probabilities of the types of medical care actions indicated by the input medical care action information are
It is extracted from the first file means by the extracting means. Subsequently, the comparison means calculates the possibility of being a disease type for each patient based on the extracted probabilities, and further compares the calculated possibility with a predetermined reference value. Then, under the control of the selection output control means according to a selection control signal generated in response to an external command input or parameter setting, the probability of being compared is higher than a predetermined reference value. One or more of them are output by the output means as disease type candidates. Therefore,
The selection process of disease type candidates by the selection means can be performed efficiently and reliably.

In another aspect of the disease type selecting system of the present invention, a predetermined error process is performed when there is no disease type in the selecting means that is more likely to be a disease type for each patient than a predetermined reference value. Error processing means is further provided.

According to this aspect, when there is no disease type having a higher possibility of being a disease type for each patient in the selection means than the predetermined reference value, the error processing means performs a predetermined error processing. Therefore, when there is a high possibility that the disease type is appropriate, the disease type can be automatically selected, and on the other hand, when it is unlikely that the disease type is appropriate or the appropriate disease type cannot be selected, It is practically convenient because the user can flexibly cope with the error processing.

In another aspect of the disease type selecting system of the present invention, the input means is at least one of an input device for manual input, a reading device for reading and inputting from a medium, and a communication device for inputting by communication. including.

According to this aspect, the input means includes:
An input device for manual input, a reading device for reading and inputting from a medium, or a communication device for inputting by communication is used when monitoring (examination) the disease type assigned by each medical institution in the Medical Insurance Agency, or by each medical When the institution performs a series of medical care processes for each patient, medical care action information indicating the type of each medical care action performed for each patient is input. More specifically, as input devices for manual input, there are keyboards, mice, etc. that allow doctors, clerks, inspectors, etc. to directly input to the computer. There is a magnetic disk device, an optical disk device, a memory card, etc. in which the medical practice information is stored, and as a communication device for inputting by communication, there is a device for performing communication through a dedicated line, a general line, wireless or the like. As described above, in various usage environments, the medical practice information can be input to the disease type management system, which is convenient.

In the aspect including the above-mentioned output means, it further comprises disease type master file means for storing the contents of the plurality of disease types as text information, respectively, and the output means includes the disease type master file means. By referring, one or more disease types selected as the disease type candidates are output in a predetermined format including the text information.

According to this structure , one or a plurality of disease types selected as the disease type candidates are, for example, DRG.
Like # ○○○, it is convenient because not only the type number but also text information explaining the contents can be output by the output means. Moreover, such text information can be output efficiently by using the disease type master file means, which is advantageous.

In another embodiment of the disease type selecting system of the present invention, the disease type is DRG (Diagnosis Related Gr).
oup).

According to this aspect, the first file means stores in advance the probabilities that the types of the plurality of medical care actions in the series of medical care processes correspond to the respective DRGs. A DRG for each patient among a plurality of DRGs based on the probability stored in the first file means for each type of medical care action indicated by the input medical care action information
One or more DRs that are likely to be higher than a predetermined reference value
The G type is selected as a DRG candidate by the selecting means.
Here, if it is possible to identify (estimate) the disease type accurately in most cases, if there are about 500 classifications such as DRG, if the types of a plurality of medical care actions constituting a series of medical care processes are known, at least. Since it is possible to narrow down to a sufficiently small number of candidates in practical use, it is possible to extremely effectively select or narrow down DRGs by the disease type selection system of the present invention.

[0048] In another aspect of the disease type selection system of the present invention, the selection means, based on the probability stored in the first file means, one or a plurality of medical treatments indicated by the inputted medical treatment action information. When there is one disease type having a probability of 1 corresponding to an action, the one disease type is selected as the disease type candidate.

According to this aspect, when the medical practice information is input via the input means, one or a plurality of medical care actions indicated by the medical practice information are selected based on the probability stored in the first file means. When there is one disease type having a corresponding probability of 1, the one disease type is selected by the selecting means as a disease type candidate. Therefore, when it is a special medical practice and corresponds to a disease type on a one-on-one basis, one disease type can be selected by a simple process.

In another aspect of the disease type selecting system of the present invention, the selecting means does not use the predetermined reference value, but based on the probability stored in the first file means, the plurality of disease types are selected. Of these, one or a plurality of disease types having a relatively high possibility of being a disease type for each patient are selected as the disease type candidates.

According to this aspect, when the medical practice information is input through the input means, it can be a disease type for each patient among a plurality of disease types based on the probability stored in the first file means. One or more disease types having a relatively high sex are selected as disease type candidates. Therefore, even if there is no information about the disease name, symptoms, etc., each type of multiple medical care actions that constitutes a series of medical care processes originally performed with the purpose of treating one patient, and the disease for the patient. The disease type and disease name for the patient can be specified (estimated) based on the probability that the types correspond.

The machine-readable medium of the present invention solves the above-mentioned problems by using a computer and the above-mentioned invention.
To function as the 1st to 5th disease type selection system
Record the program for saving.

According to the machine-readable medium of the present invention, if the computer is made to mechanically read the medium and the program is executed, the above-mentioned first to fifth aspects of the present invention are realized .
It is possible to realize a disease type selection system on the computer. It should be noted that the medium can also take various aspects like the various aspects of the disease type selection system according to any one of the first to fifth aspects of the present invention described above.

[0054]

[0055]

The operation and other advantages of the present invention will be apparent from the embodiments described below.

[0057]

DETAILED DESCRIPTION OF THE INVENTION Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 is a block diagram of the overall configuration of a disease type selection system used in each embodiment of the present invention.

In FIG. 1, a disease type selection system 10
Reference numeral 0 includes a CPU (central processing unit) 2, a storage device 4, a recording medium reading device 6, an input device 8, a display device 10, a printer 12, and a communication device 14.

The storage device 4 is a hard disk device or RA.
M (Random Access Memory), ROM (Read Only Memo)
ry) and the like. The reading device 6 includes an optical disk drive, a magneto-optical disk drive, a floppy disk drive, and the like. Input device 8
Is composed of a keyboard, a mouse, an input pen, and the like. The display device 10 is a CRT (Cathode Ray Tub).
e), LCD (Liquid Crystal Display) and the like. The printer 12 is composed of a laser printer, an inkjet printer, or the like. In addition, the communication device 14 is configured to include a modem or the like for exchanging various data with an external device via a communication line.

In each of the embodiments described below, the computer program stored in the recording medium 20 is read by the reading device 6.
It is configured to perform each selection operation by causing the disease type selection system 100 to execute the program. Alternatively, from the viewpoint of improving the processing speed, preferably, the program is once stored in the storage device 4 and then the disease type selection system 100 is caused to execute the program. As such a recording medium 20, a DVD-ROM, a CD-ROM,
Any known recording medium such as a magneto-optical disk and a floppy disk may be used. However, such a program may be downloaded from the external device by the communication device 14, once stored in the storage device 4, and then the program may be executed in accordance with the downloaded program.

Each of the embodiments described below has the above-mentioned DRG (Diagnosis Related) as a disease type for comprehensive payment.
Group) is adopted, and a DRG for the one patient is selected from information indicating a plurality of medical care actions constituting a series of medical care processes for the one patient (that is, information indicating a disease name, medical condition, etc. of the one patient). Without estimating the DRG for the one patient) disease type selection system 100
It is about. Then, on the computer constituting such a disease type selection system 100, each DRG is expressed as a disease type code DRGj (where j is a natural number).
, And each medical care action code Ci (however,
It is assumed that i is a natural number, and the medical fee paid for each DRG is the medical fee code Rj. (First Embodiment) A first embodiment will be described with reference to FIGS.

Disease type selection system 10 of the first embodiment
0 is preferably used in the medical insurance organization, which is the side charged by the medical institution with medical fees according to the DRG for each patient.

As shown in FIG. 2, in the first embodiment, the probability information as an example of the first file means is included in the storage device 4a which is an example of the storage device of the disease type selection system 100 shown in FIG. A probability information file 101 in which Pij is stored and a DRG master file 102 having each DRGi name (content description of each DRGi) as text information are constructed. A selecting unit 210 is built in the CPU 2a which is an example of the CPU 2 of the disease type selecting system 100 shown in FIG.
Extraction means 211 for extracting from the probability file 101 the probability Pij for each of the plurality of medical practice codes Ci input via the input device 8, the reading device 6 or the communication device 14 shown in FIG. Based on each D
RGj is a DRG for this patient. Comparing means 212 for calculating the possibility PTj and comparing the calculated possibility PTj with a predetermined reference value Pref, and the compared possibility PTj from the predetermined reference value Pref. Also, a selection output control unit 213 that causes the display unit 10 or the printer 12 illustrated in FIG.

The probability information file 101 is, for example, as shown in FIG.
As shown in, the probability Pij that the medical care action code Ci indicating each medical care action corresponds to each DRGj is stored in a table format.

The predetermined reference value Pref may be set to a fixed value in advance, or the set value may be changed in real time after confirming the number of DRG 'displayed on the display device 10. Further, the sorting control signal Sc is sent to the sorting control means 21.
In order to control the selection and output conditions in No. 3, the input device 8
Is a control signal input in accordance with an external command from the computer or an operation setting in a computer program. For example,
According to the selection output control signal Sc, the selection output control means 21
3 selects only one DRGj having the highest possibility PTj from the plurality of DRGj determined to have the possibility PTj by the comparison means 212, or sets an upper limit on the number of DRG's to be output.

The operation of the first embodiment will be described with reference to the flowchart of FIG.

As shown in FIG. 4, when monitoring (inspecting) a disease type assigned by each medical institution in the medical insurance mechanism, first, the input device 8, the reading device 6 or the communication device 14 is applied to each patient. The medical care code Ci indicating the type of each medical care performed is input (step S1). Such medical care or medical care code Ci is usually information provided together with the DRG from each medical institution that requests medical fees. This input may be a manual input by an inspector or the like using a keyboard, a mouse or the like that constitutes the input device 8, or a large number of medical action codes Ci stored as electronic data in a medical institution are stored for each patient. It may be a read input or a communication input from the recorded recording medium 20 or an external device.

Next, the probability PTj for all DRGj
1 for the count value j of the dedicated counter for checking
(Step S2), the probability Pij (here, Pi) corresponding to the set count value (here, “1”) is set.
1) is extracted by the extraction means 211 and the probability information file 101
(Step S3). Next, from the extracted probabilities Pij, a possibility PTj (here, PT1) that the plurality of input medical care codes Ci correspond to this DRGj (here, DRG1) is obtained. For example, three medical care action codes Ci are input, and the probabilities for DRG1 are P11 = 0.5, P21 = 0.9, and P31 =, respectively.
If 0.6, P11 × P21 × P31 =
0.27 (= 27%) is calculated as the possibility PT1 and DR
The probabilities for G1 are P11 = 0.1 and P21 =
0.4 and P31 = 0.2, P11 × P
21 × P31 = 0.008 (= 0.8%) possibility PT
Calculate as 1. And the probability PT obtained in this way
j is compared with the above-mentioned predetermined reference value Pref (step S
4).

As a result of this comparison judgment, if the possibility PTj> the reference value Pref (step S4: YES), the corresponding DRGj (here, DRG1) is temporarily held in the selection output control means 213. After (Step S
5) It is determined whether or not the count value j has reached a preset last value (maximum value) (step S
6). On the other hand, as a result of the comparison determination in step S4, the possibility P
If Tj> reference value Pref is not satisfied (step S4: N
O), the process directly proceeds to step S6.

Next, if the result of determination in step S6 is that the count value j is not the last (step S6: NO), this count value j is incremented by +1 (step S6).
7), returning to step S3, the next DRGj (here,
The above-described processing of steps S3 to S6 is repeated for DRG2). On the other hand, if the result of determination in step S6 is that the count value j is the final value (step S6: YES), the sorting output control means 213 performs sorting output processing according to the sorting output control signal Sc, and among the held DRGj. After selecting one or more DRG's to be output as candidates, the selected one or more DRG's are displayed on the display device 1.
0 or output to the printer 12 (step S9). As such an output, if a number indicating one or a plurality of DRG's (for example, DRG # 245) is output, the user of the system can select one (estimated) of one or more of these patients. It is possible to determine whether or not any of the plurality of numbers matches the DRG number given to this patient by the medical institution. That is, it is possible to check whether or not an inappropriate medical treatment fee is being claimed by the medical institution.

However, in the present embodiment, the selection output control means 213 refers to the DRG master file 102 to select one or a plurality of D's selected as DRG candidates.
The RG's can be output in a predetermined format that includes textual information that describes the contents of each DRG '. For example, "DRG
# 245: It is convenient because the text information indicating the DRG name (content) such as "bone disease and specific arthropathy without complications" can be outputted. Moreover, such text information is outputted. This can be efficiently performed by using the master file 102. In addition to these, the possibility PTj corresponding to the selected DRG '
As numerical information (for example, “DRG # 245: bone disease and specific arthropathy without complications (probability 70%)”)
Output).

As described above with reference to FIGS. 1 to 4, according to the disease type selection system 100 of the first embodiment, a series of medical treatment procedures for one patient can be performed without information about the disease name or medical condition. Appropriate DRG for the one patient based on the plurality of medical care action codes Ci
Since it is possible to select (estimate), the medical insurance mechanism will be the basis for the medical fee given by the medical institution.
Efficient and objective inspection (monitoring) of RG for errors and fraud is possible. Further, in the selection output control means 213,
Instead of simply selecting the one with the largest probability PTj, the selection result is given after comparing with the predetermined reference value Pref. It is possible to prevent the reliability of the system from being deteriorated, and the medical insurance organization can uncover errors and fraud with conviction based on the selection result of the system.

In this embodiment, the disease type is 50.
Since the DRG of about 0 classification is adopted, it is possible to use
Due to the configuration and operation as shown in FIG.
It is possible to accurately specify (estimate) G, or at least narrow down to a sufficiently small number of candidates for practical use, and the disease type selection system 100 of the present invention can extremely effectively select or narrow down DRGs. It will be possible.

In the above embodiment, as shown in FIG. 3, the probability Pij is stored in the probability information file 101, and DRG 'is selected based on this.
In the above-described embodiment and each embodiment described below, the probability information file 101 has a format other than the probability Pij,
The probability P that each of the plurality of medical care actions constituting the series of medical care processes corresponds to the DRGj may be stored.

For example, in the probability information file 101,
(a) Probability probability Pi ₁ corresponding to a combination of m types (where m is a natural number less than M) of all M types (where M is a natural number) of the medical practice code Ci and (b) one DRGj. , i
₂ , ..., i _m , j (where i = 1, 2, ..., j = 1, 2,
...)) may be stored in advance. And in this case,
When a plurality of medical care action codes Ci are input via the input device 8, the reading device 6 or the communication device 14, about m kinds of combinations of a plurality of medical care actions indicated by the input plurality of medical care action codes i. Probability information file 101
Probability Pi _1, i ₂ stored in, ..., i _m, based on j, selecting one or more of DRG '. In other words, in the example of the probability information file 101 shown in FIG. 3, a two-dimensional table relating to the probability Pij may be created in advance. In this example, the probabilities Pi ₁ , i ₂ , ... It is sufficient to create in advance a multi-dimensional table for i, i _m , j.

Alternatively, in the probability information file 101,
(a) Combination of m kinds of medical care codes Ci of all M kinds of medical care codes Ci and (b) Relative execution timing of these m kinds of medical care codes Ci (immediately before, at the same time, immediately after, on the same day, after one day, Two days later, the execution timing code Tk (k = 1, 2,
…)) And (c) the probability that one DRGj corresponds to Pi ₁ ,
i ₂ , ..., i _m , k, j) may be stored in advance. In this case, the input device 8, the reading device 6 or the communication device 14
When a plurality of medical care action codes Ci and execution timing codes Tk are input via the, m types of combinations and execution timings of a plurality of medical care actions indicated by the input plurality of medical care action codes i and execution timing codes Tk Based on the probabilities Pi ₁ , i ₂ , ..., i _m , k, j stored in the probability information file 101 for
Select RG '. In other words, in the example of the probability information file 101 shown in FIG. 3, a two-dimensional table relating to the probability Pij may be created in advance. In this example, the probabilities Pi ₁ , i ₂ , ... It suffices to create a multidimensional table for i, _m , k, and j in advance.

The probability information file 101 corresponds not only to information relating to a combination of a plurality of medical care processes constituting a series of medical care processes but also to the number of times of execution of each medical care act in a series of medical care processes and one disease type. The probabilities may also be stored in advance. In this case, when the DRG is selected for one patient, the medical practice information further indicating the number of times each medical practice is performed is input via the input device 8, the reading device 6 or the communication device 14, and the selecting means is selected. 210 is configured to select one or a plurality of DRG's further based on the probabilities stored in the probability information file 101 regarding the number of executions of each medical care action indicated by the input medical care action information. This makes it possible to more accurately identify (estimate) the DRG by at least the number of times each medical practice is performed in addition to the plurality of types of medical practice that form a series of medical processes, or at least more. It is possible to narrow down to a small number of candidates.

Alternatively, in the probability information file 101, not only information relating to a combination of a plurality of medical care processes constituting a series of medical care processes, but also relative execution timing of each medical care action in a series of medical care processes and one disease type The probabilities that and correspond to each other may be stored in advance. In this case, when the DRG is selected for one patient, the medical care action information further indicating the execution timing of each medical care action,
It is input via the input device 8, the reading device 6 or the communication device 14, and the selection means 210 further calculates the probability stored in the probability information file 101 regarding the execution timing of each medical care action indicated by the input medical care action information. On the basis of,
It is configured to select one or more DRG's. This makes it possible to more accurately identify (estimate) the DRG because of the limited execution timing of each medical practice in addition to the plurality of types of medical practice that constitute a series of medical care processes, or at least more It is possible to narrow down to a small number of candidates. Note that such execution timing may be simply coded information indicating the context of a plurality of types of medical treatment, for example, one day before, immediately before, at the same time,
Immediately, 1 day later, 2 days later, 3 days later, 1 week later, 1 month later, etc., it may be coded information indicating a predetermined classification. (Second Embodiment) A second embodiment will be described with reference to FIGS.
Will be described with reference to.

Disease type selection system 10 of the second embodiment
0 is preferably used in the medical insurance organization, which is the side charged by the medical institution with medical fees according to the DRG for each patient.

As shown in FIG. 5, particularly in the second embodiment, the DRG given to each patient by the medical institution is given.
Whether or not the point is input via the input device 8, the reading device 6 or the communication device 14 and one of the one or more DRG's selected by the selection means 210 is determined. It is different from the first embodiment in that a means 220 is further provided, and other configurations are the same as in the case of the first embodiment shown in FIG.

The operation of the second embodiment will be described with reference to the flowchart of FIG. In FIG. 6, the same steps as those in FIG. 4 are designated by the same step numbers, and the description thereof will be omitted.

In FIG. 7, when monitoring (inspecting) the DRG given by each medical institution in the medical insurance mechanism, first, the medical treatment performed on each patient by the input device 8, the reading device 6 or the communication device 14. The medical care action code Ci indicating the type of each action is input together with the DRG thus given by the medical institution (step S11). This input may be a manual input by an inspector or the like using a keyboard, a mouse or the like that constitutes the input device 8, or a large number of medical action codes Ci stored as electronic data in a medical institution are stored for each patient. It may be a read input or a communication input from the recorded recording medium 20 or an external device.

Next, steps S2 to S8 are performed in the same manner as in the first embodiment.

Then, following step S8, the classification suitability determination means 220 determines the suitability of the DRG input by the input device 8 or the like with reference to the DRG ′ output from the selection means 210 (step S12). ). Then, together with the DRG ′ output from the selection unit 210 and the input DRG, the determination result by the classification suitability determination unit 220 is output by the display device 10 or the printer 12 in a predetermined format (step S13).

As described above, according to the disease type selection system 100 of the second embodiment, the classification suitability determination means 220 gives the DRG assigned to each patient by the medical institution.
Is one or more DRs selected by the selection means 210.
Depending on whether or not it matches any of G ', it can be determined that the DRG is not properly or improperly granted by the medical institution.

Further, by adjusting the predetermined reference value Pref used in the selection by the selection means 210, it is possible to prevent the judgment of fraud from becoming too strict, which is practically convenient.
From such a viewpoint, the predetermined reference value Pref is empirically determined in advance,
Although a numerical value greater than 0% and 100% or less is set experimentally and theoretically, an upper limit is set to the number of DRG 'for each patient to be selected by the selection means 210 by the selection output control means 213, and the predetermined reference value Pref is set. More likely DR
The Gj may be configured to be selected from one with the highest possibility to the maximum number (for example, three) from the highest possibility. Further, with respect to such a predetermined reference value Pref, D
The change may be made in real time according to the number of RG's.

The selection output control means 213 determines a plurality of D's having a high possibility PTj by the comparison means 212.
The RGj having the highest possibility PTj is selected as DRG ′, and the DRG given to each patient by the medical institution by the classification suitability determination unit 220 matches one DRG ′ thus selected. It may be configured to determine whether or not to do. Even with such a configuration, it is possible to simply inspect a case in which a DRG different from the most probable DRG ′ is given by a medical institution.

As shown in FIG. 7, the classification suitability determination means 22
The determination results based on 0 may be aggregated for each medical institution, and the suitability of DRG assignment for each medical institution for each patient may be displayed in a list format on the screen 10a of the display device 10. Furthermore, the ratio of patients to whom a disease type determined not to be included in DRG is assigned to all patients to whom DRG is assigned by each medical institution is displayed on a part 11a of the screen 10a.
You may display like "inappropriateness 32%." Furthermore,
It may be further determined that this ratio is relatively high (i.e., more fraudulent) or low (fewer fraud), or a part of the screen 10a such as "rank D" may be displayed. , Each medical institution is ranked according to this inadequacy (for example, from the cautionable rank E, which is estimated to have a large number of frauds, to the good rank A, which is estimated to have little possibility of fraud) ) May be performed.

Further, as shown in FIG. 8, a list of the inadequacy, rank, total billed amount, etc. for each medical institution is displayed on the display means 10 by using the judgment results of the adequacy of classification collected for each medical institution in this way. It can be configured to be displayed on the screen 10b. In the second embodiment, the input device 8 can externally specify either one or a plurality of DRG's displayed by the display device 10. You may comprise. And
Classification suitability determination means 22 on the basis of DRG ′ whose number has been narrowed down or confirmed by being designated externally.
It may be configured to determine the suitability of the DRG given by each medical institution of 0. (Third Embodiment) A third embodiment will be described with reference to FIGS.

Disease type selection system 10 of the third embodiment
0 is preferably used in the medical insurance organization, which is the side charged by the medical institution with medical fees according to the DRG for each patient. The hardware configuration of the third embodiment is similar to that of the second embodiment shown in FIG.

The operation of the third embodiment will be described with reference to the flowchart of FIG. In FIG. 9, the same steps as those in FIG. 6 are designated by the same step numbers, and the description thereof will be omitted.

In FIG. 9, steps S11 to S7 are performed in the same manner as in the second embodiment.

Here, if the result of determination in step S6 is that the count value j is the final value (step S6: YES), D selected as a candidate by the selection output control means 213.
It is determined whether the number of RGj is one, a plurality, or 0 (step S21). Where D
If the number of RGj is plural (step S21: ≧ 2),
A menu screen for inputting related information useful for further narrowing down the plurality of selected DRGj is displayed on the display means 10 (step S22). As the related information having a predetermined relationship with such DRGj, for example, patient information (age,
Gender, length of hospital stay, outcome, main diagnosis, secondary diagnosis, treatment code), main disease name and main diagnosis information, etc. Linked to the DRG of, for example, DR
If it is stored in the G master file 102, such a related information input menu can be displayed quickly. In this way, for example, in the state where the input menu display prompting the input of the relevant information such as the sex and age of the patient is displayed, the selection output control means inputs the relevant information through the input device 8. Waiting (step S23: NO), when the related information is input (step S23: YES), based on the related information thus input, among the plurality of DRGj that are considered to have a high possibility in step S4. One or more corresponding to the related information is selected and output as DRG '(step S
24).

On the other hand, if the number of candidates is one in the determination in step S21 (step S21: 1), the process directly proceeds to step S24.

Then, the DR output in step S24
DR input by the input device 8 or the like with reference to G '
The suitability of G is determined (step S25), and the determination result and the like are output to the display device 10 and the printer 12 (step S2).
6).

On the other hand, if it is determined in step S21 that the number of candidates is 0 (step S21: 0), the process proceeds to step S27 and predetermined error processing is performed (step S2).
7). More specifically, for example, a process of notifying the fact by display output, a voice output, a process of notifying that the predetermined reference value Pref is lowered, a process of displaying an input screen for lowering the predetermined reference value, and the like are performed. Be seen. Therefore, when DRGs with a high possibility cannot be selected, it is practically convenient because the user can flexibly cope with the error processing. (Fourth Embodiment) A fourth embodiment will be described with reference to FIG.

Disease type selection system 10 of the fourth embodiment
0 is preferably used in the medical insurance organization which is the party who requests medical fees.

The fourth embodiment has substantially the same configuration as that of the first embodiment shown in FIG. 2, but the output control method by the selection output control means 213 is different.

That is, in the fourth embodiment, one or a plurality of DRG's output from the selection output control means 213 are listed on the screen 10c of the display device 10 and are used by a user such as a doctor or an office worker. Is configured to allow the selection of one of the above.

According to the fourth embodiment, one of the one or more DRG's selected by the selecting means 210 can be externally specified by the input device 8 as an example of the specifying means. Therefore, according to the patient's symptoms and the clinical process, 2
If there is no problem in medical insurance (that is, the problem of fraudulent medical fee claim) even if it is classified into one or more types of diseases, one of these is used as a keyboard, mouse, etc. 11c using the input device 8 of
The operation can be determined according to the desire of the user such as a doctor or an office worker. Furthermore, by adjusting the predetermined reference value Pref used when selecting by the selecting means 210, the number of candidates that can be specified by the user of the specifying means such as a doctor or an office worker can be set to an appropriate number, and when there is one candidate. Also, confirmation work such as confirmation by doctors and clerks is required. For this reason, the type of disease and the name of the main disease can be determined after checking by a doctor or the like, which is not practically left to the system, and is practically convenient. In particular, even for each medical institution that requests medical fees and is relatively easy to obtain information such as disease name and symptom, an clerk unfamiliar with medical records mechanically and efficiently determines the DRG without error. It is very convenient from the viewpoint, and is also very convenient from the viewpoint that it is possible to judge whether or not there is some degree of freedom in the determination of the DRG and to select the desired DRG within the limit that does not result in fraudulent billing. (Fifth Embodiment) A fifth embodiment will be described with reference to FIGS. 11 to 13.

Disease type selection system 10 of the fifth embodiment
0 is preferably used in the medical insurance organization which is the party who requests medical fees.

As shown in FIG. 11, in the fifth embodiment, in the storage device 4b as an example of the storage device 4 shown in FIG. 1, the medical treatment fee information Ai corresponding to each DRGj (the points proportional to the amount of money) And information indicating the amount of money itself) are constructed, and the output control method by the selection output control means 213 is different from that of the first embodiment. This is similar to the case of the first embodiment.

The operation of the fifth embodiment will be described with reference to the flowchart of FIG. In addition, in FIG.
The same step number is attached to the same step as
The description is omitted.

In FIG. 12, steps S1 to S7 are performed similarly to the case of the first embodiment.

Here, if the count value j is the last as a result of the determination in step S6 (step S6: YES), the selection output control means 213 corresponds to each DRGj determined to be possible in step S4. Medical fee information A
j is read from the medical treatment fee file 103 (step S
31).

Next, based on the thus-read medical care remuneration information Aj, a selection output process is performed (step S32). Specifically, for example, among the DRGj determined to be possible in step S4, the one with the highest medical fee is selected and output as the DRG.

Finally, the one DRG output in this way
Is output in a predetermined format by the display device 10 and the printer 12 (step S33).

According to the fifth embodiment, according to the symptom of the patient and the medical treatment process, no matter how the medical insurance is classified into two or more DRGs (that is, the problem of fraudulent medical fee claim). ) Does not occur, for example, by selecting one of these DRGs with the highest medical fee, the maximum medical fee can be obtained for the medical institution, even though the medical treatment process is performed in exactly the same manner. Can
It is possible to pursue profit efficiently.

However, among these DRGj, the one with the average medical fee or the one with the lowest medical fee may be selected. Selection means 21 in step S4
By adjusting the predetermined reference value Pref used at the time of selection by 0, it is possible to prevent the selection of DRGs which are considered to be fraudulent claims by the examination of the payer side of the medical fee and which have a low possibility in the medical treatment process. Since it is possible to pursue the maximum profit, it is practically convenient. From such a viewpoint, the predetermined reference value Pref is empirically, experimentally, or theoretically 0% in advance.
A value greater than 100% is set. Further, the method of determining the DRG by the selective output control means 213 may be changeable for each patient by using the selective output control signal Sc, or may be fixed for each medical institution on a monthly basis or throughout the year.

Note that step S32 in the fifth embodiment.
13, the corresponding medical fee information Aj together with each DRGj determined to be possible in step S4 is listed in a list format on the screen 10d of the display device 10, as shown in FIG. Alternatively, a user such as a doctor or an office worker may be made to select one of them by the cursor 11d. As a result, according to the symptoms of the patient and the medical treatment process, if there is no problem in medical insurance even if the disease is classified into two or more types, the doctor, clerk, etc. Can be determined according to the user's desire. (Sixth Embodiment) A sixth embodiment will be described with reference to FIGS. 11 and 14.

Disease type selection system 10 of the sixth embodiment
0 is preferably used in a medical institution that requests medical fees. The hardware configuration of the sixth embodiment is similar to that of the fifth embodiment shown in FIG.

The operation of the third embodiment will be described with reference to the flowchart of FIG. In addition, in FIG.
The same step as 2 is given the same step number, and the description thereof is omitted.

In FIG. 14, steps S11 to S7.
The steps up to this are performed in the same manner as in the case of the fifth embodiment.

Here, if the result of determination in step S6 is that the count value j is the final value (step S6: YES), D selected as a candidate by the selection output control means 213.
Whether the number of RGj is one or more, or 0
Is determined (step S41). here,
If the number of DRGj is plural (step S41: ≧
2), a menu screen for inputting related information useful for further narrowing down the plurality of selected DRGj is displayed on the display means 10 (step S42). Examples of the related information having a predetermined relationship with the DRGj include patient information (age, sex, hospitalization days, outcome, main diagnosis, secondary diagnosis, treatment code), main disease name, main diagnosis information, and the like. But,
If it is stored in the DRG master file by associating with each DRG in advance which kind of related information is useful for selection of each DRG, for example, display of an input menu for such related information. Can be done quickly. Thus, for example, in the state where the input menu for prompting the input of the relevant information such as the sex and age of the patient is displayed, the selection output control means 213 inputs the relevant information through the input device 8. Waiting (step S43: NO), when the related information is input (step S43: YES), based on the related information input in this way, among the plurality of DRGj that are considered to have a high possibility in step S4. One or more corresponding to the related information is output as DRG '(step S4
4) The data is output in a predetermined format by the display means 10 and the printer 12 (step S45).

On the other hand, if it is determined in step S41 that the number of candidates is one (step S41: 1), the process directly proceeds to step S44.

On the other hand, if it is determined in step S41 that the number of candidates is 0 (step S41: 0), the process proceeds to step S46 and predetermined error processing is performed (step S4).
6). More specifically, for example, a process of notifying the fact by display output, a voice output, a process of notifying that the predetermined reference value Pref is lowered, a process of displaying an input screen for lowering the predetermined reference value, and the like are performed. Be seen. Therefore, when DRGs with a high possibility cannot be selected, it is practically convenient because the user can flexibly cope with the error processing.

Particularly, by adjusting the predetermined reference value Pref, the number of DRGj that is considered to be possible in step S4 can be narrowed down to an appropriate number, so that the amount of related information prompted for in step S42 is relatively small. I'm done. Therefore, the burden of input work on the user such as a doctor who inputs the relevant information is light and convenient for practical use.

In each of the embodiments described above, there is one DRG having a probability of 1 corresponding to one or more medical care actions indicated by the medical care action code, based on the probabilities stored in the probability information file 101. In this case, the one DRG may be immediately selected. If configured in this way, it is a special medical practice, and one-on-one DR
If it corresponds to G, a simple process
RG can be selected. In addition, the DRG for each patient is selected from the plurality of DRGs based on the probability stored in the probability information file 101 without using the predetermined reference value Pref.
It may be configured to select one or a plurality of DRGs having a relatively high possibility of being. If configured in this way, even if information about the disease name, symptoms, etc. is still lacking, it is based on the probability that the DRG for the patient corresponds to each type of the plurality of medical care actions that make up the series of medical care processes. Thus, the DRG or disease name for the patient can be specified (estimated).

[0120]

According to the present invention, when the medical insurance organization adopts the comprehensive payment system according to the disease type in the future, even if there is no information about the disease name, the symptom, etc., the medical care process such as the medical treatment remuneration code. Since it is possible to appropriately identify the disease type based on the information related to the above and narrow down to at least some candidates, the Medical Insurance Agency will automatically or semi-automatically check whether the disease type assigned by each medical institution is correct or incorrect. You can judge it. On the other hand, each medical institution can appropriately select the disease type based on the information related to the medical treatment process without using the information about the disease name, symptom, etc., and avoid the risk of being falsely claimed by the medical insurance organization later. it can.

[Brief description of drawings]

FIG. 1 is a block diagram showing an overall configuration of a disease type selection system of each embodiment.

FIG. 2 is a block diagram showing a main configuration of a disease type selection system according to the first embodiment.

FIG. 3 is a conceptual diagram showing an example of a data structure of a probability information file in the first embodiment.

FIG. 4 is a flowchart showing an operation in the first embodiment.

FIG. 5 is a block diagram showing a main configuration of a disease type selection system according to a second embodiment.

FIG. 6 is a flowchart showing an operation in the second embodiment.

FIG. 7 is a plan view showing an example of a display screen in the second embodiment.

FIG. 8 is a plan view showing another example of the display screen in the second embodiment.

FIG. 9 is a flowchart showing an operation in the third embodiment.

FIG. 10 is a plan view showing an example of a display screen in the fourth embodiment.

FIG. 11 is a block diagram showing a main configuration of a disease type selection system according to a fifth embodiment.

FIG. 12 is a flowchart showing an operation in the fifth embodiment.

FIG. 13 is a plan view showing an example of a display screen in the fifth embodiment.

FIG. 14 is a flowchart showing an operation in the sixth embodiment.

[Explanation of symbols]

2 ... CPU 4 ... Storage device 6 ... Recording medium reading device 8 ... Input device 10 ... Display device 12 ... Printer 20 ... Recording medium 100 ... Disease type selection system 101 ... Probability information file 102 ... DRG master file 103 ... Medical fee information file 210 ... Selection means 211 ... Extraction means 212 ... Comparison means 213 ... Selection output control means 220 ... Classification suitability determination means

Continuation of the front page (56) Reference JP-A-8-263568 (JP, A) JP-A-7-160770 (JP, A) JP-A-7-182429 (JP, A) JP-A-6-208575 (JP , A) JP 5-257952 (JP, A) JP 8-263562 (JP, A) JP 5-108676 (JP, A) JP 10-198750 (JP, A) JP 9-282366 (JP, A) (58) Fields surveyed (Int.Cl. ⁷ , DB name) G06F 17/60 126 JISST file (JOIS)

Claims (22)

(57) [Claims] 1. A medical insurance organization belonging to each medical institution.
To determine the adequacy of the disease type assigned to the patient
A disease type selection system used for this purpose, in which a plurality of disease types are used as a population, and (b) a first file means for previously storing a probability that the disease type of the one correspond, input means for inputting the medical care action information indicating the intervention respective kinds to be performed on each patient in the medical institutions And a disease type for each patient among the plurality of disease types based on the probability stored in the first file means for each type of medical action indicated by the input medical action information. sex one or more disease types higher than a predetermined reference value, and selecting means for selecting as a disease type candidates, one disease such as the disease type candidates by said selection means
When the type is selected, the one disease type is treated as the above-mentioned each patient.
First deciding means for deciding as a disease typology for a plurality of diseases as the disease typology candidates by the selecting means
When the types are selected, the selected plurality of diseases
Input of related information having a predetermined relationship with the type by the input means.
When the relevant information is input by the display means for displaying a predetermined screen for prompting the user, the input means
The plurality of diseases classified according to the related information provided
Second determining means for determining one of the types, and a disease given to each patient by the medical institution
Diseases whose type is determined by the first or second determination means
Classification suitability determination means for determining whether or not it matches a type candidate
Disease category selecting system characterized by comprising and. 2. A medical insurance organization belonging to each medical institution.
To determine the adequacy of the disease type assigned to the patient
It is a disease type selection system used for the purpose of belonging to one disease type with a plurality of disease types as a population.
A series of clinical processes for one patient
And the type of each of the plurality of medical care actions, and (b) the disease type
A first file means for storing in advance the corresponding probability, and the medical treatment performed for each patient at the medical institution.
Input means for inputting medical care action information indicating the type of each action
And the medical practice indicated by the input medical practice information
Stored in the first file means for each type
Of each of the plurality of disease types based on the probability of
More likely to be a disease type for people
Select one or more disease types as disease type candidates
And a classification adequacy determining means for determining whether or not the disease type given to each patient by the medical institution is included in one or more disease types selected as the disease type candidate.
A disease type selection system comprising: 3. A medical insurance mechanism belonging to each medical institution.
To determine the adequacy of the disease type assigned to the patient
It is a disease type selection system used for the purpose of belonging to one disease type with a plurality of disease types as a population.
A series of clinical processes for one patient
And the type of each of the plurality of medical care actions, and (b) the disease type
A first file means for storing in advance the corresponding probability, and the medical treatment performed for each patient at the medical institution.
Input means for inputting medical care action information indicating the type of each action
And the medical practice indicated by the input medical practice information
Stored in the first file means for each type
Of each of the plurality of disease types based on the probability of
More likely to be a disease type for people
Select one or more disease types as disease type candidates
Selecting means, the selecting means selects the most likely disease type for each patient among the plurality of disease types as the disease type candidate, and the medical institution It is characterized by further comprising a classification suitability determination means for determining whether or not the disease type given to the patient matches the selected disease type candidate .
Disease type selection system. 4. A medical insurance organization belonging to each medical institution.
To determine the adequacy of the disease type assigned to the patient
It is a disease type selection system used for the purpose of belonging to one disease type with a plurality of disease types as a population.
A series of clinical processes for one patient
And the type of each of the plurality of medical care actions, and (b) the disease type
A first file means for storing in advance the corresponding probability, and the medical treatment performed for each patient at the medical institution.
Input means for inputting medical care action information indicating the type of each action
And the medical practice indicated by the input medical practice information
Stored in the first file means for each type
Of each of the plurality of disease types based on the probability of
More likely to be a disease type for people
Select one or more disease types as disease type candidates
Selecting means and one or more disease types selected as the disease type candidates
Output means for outputting in a predetermined format, designation means capable of externally designating any one or a plurality of disease types output by the output means, and assigned to each patient by the medical institution and a determining classification appropriateness determination means whether matches outside the specified disease type candidates by disease type is the designation unit
A disease type selection system characterized by 5. The disease type belonging to the medical insurance mechanism
One or more disease types selected as candidates are selected from
It is characterized by further comprising an output means for outputting in a mat
Disease type selection according to any one of claims 1 to 3.
Fixed system. [Claim 6] belongs to a medical institution, each medical
To determine the appropriateness of the disease type given to the person
A disease type selection system for use in, belong to (a) one disease type multiple disease types as population
A series of clinical processes for one patient
And the type of each of the plurality of medical care actions, and (b) the disease type
A first file means for storing in advance the corresponding probability, and the medical treatment performed for each patient at the medical institution.
Input means for inputting medical care action information indicating the type of each action
And the medical practice indicated by the input medical practice information
Stored in the first file means for each type
Of each of the plurality of disease types based on the probability of
More likely to be a disease type for people
Select one or more disease types as disease type candidates
Selecting means and one disease type as the disease type candidate by the selecting means
When the type is selected, the one disease type is treated as the above-mentioned each patient.
First deciding means for deciding as a disease typology for a plurality of diseases as the disease typology candidates by the selecting means
When the types are selected, the selected plurality of diseases
Input of related information having a predetermined relationship with the type by the input means.
When the relevant information is input by the display means for displaying a predetermined screen for prompting the user, the input means
The plurality of diseases classified according to the related information provided
A second determining means for determining one of the types
A disease type selection system characterized by the following. 7. One or more diseases belonging to the medical institution and selected as the disease type candidates
Output means for outputting the type in a predetermined format, and one or more disease types output by the output means
One of the
The disease type selection system according to claim 6,
Mu. 8. The apparatus further comprises a second file means for preliminarily storing an index of medical treatment fee which belongs to the medical institution and is comprehensively paid for each of the plurality of disease types, and the second determining means. When a plurality of disease types are selected as the disease type candidates by the selection means, based on an index of medical fee corresponding to the selected plurality of disease types stored in the second file means, claims, characterized in that to determine one of a plurality of disease types that the sorted diseases type wherein for each patient
The disease type selection system according to 6 or 7 . 9. The second determining means , based on the index of the medical fee stored in the second file means, selects the one with the highest medical fee among the plurality of selected disease types,
The disease type selection system according to claim 8, wherein the disease type is determined as a disease type for each patient. 10. A second file unit that belongs to the medical institution and stores in advance an index of medical fee to be comprehensively paid to each of the plurality of disease types, and a plurality of the plurality of disease type candidates as the disease type candidates by the selection unit. When the disease type is selected, the index of the medical fee corresponding to the selected plurality of disease types is extracted from the second file means and associated with the selected plurality of disease types in a predetermined format. It further comprises display means for displaying and designation means capable of externally designating one of the plurality of disease types shown in the table instead of the determination by the first or second determination means . From claim 6 , characterized in that
9. The disease type selection system according to any one of 9 above. 11. The first file means stores in advance the probability that the type of each medical care action and the number of times each medical care action is performed and the one disease type in the series of medical care processes are stored in advance. The action information further indicates the type and the number of executions of each medical action, and the selection unit stores the type and the number of executions of each medical action indicated by the input medical action information in the first file unit. The disease type selection system according to claim 1, wherein one or more disease types are selected as the disease type candidates based on the determined probability. 12. The first file means further pre-stores a probability that the number of times each of the medical treatment actions in the series of medical treatment processes corresponds to the one disease type, and the medical treatment action information is the medical treatment information. The number of executions of each action is further indicated, and the selection unit is configured to perform the first count of the number of executions of each of the medical action indicated by the input medical action information.
The disease type selection system according to any one of claims 1 to 10, wherein one or a plurality of disease types are selected as the disease type candidates based on the probability stored in the file means. 13. The first file means is (a) m (however, of the M (where M is a natural number) types of the medical treatment (however,
m is a natural number less than M)
(b) A probability that the one disease type corresponds to is stored in advance, and the selection unit stores in the first file unit about m kinds of combinations of the medical care actions indicated by the input medical care action information. The disease type selection system according to claim 1, wherein one or a plurality of disease types are selected as the disease candidate based on the determined probability. 14. The first file means is (a) m (however, of M (where M is a natural number) types of the medical treatment)
m is a natural number less than M)
(b) Relative execution timing of the m types of medical care actions and (c)
The probability that the one disease type corresponds is stored in advance, and the selection unit includes the first file regarding the combination and execution timing of m types of medical care actions of the medical care action indicated by the input medical care action information. The disease type selection system according to claim 1, wherein one or a plurality of disease types are selected as the disease candidate based on the probability stored in the means. 15. The selecting means extracts, from the first file means, a probability for each type of the medical care action indicated by the input medical care action information, and an extracting means based on the extracted probability. Comparing means for calculating the possibility of being a disease type for each patient and comparing the calculated possibility with the predetermined reference value, and one or more of which the compared possibility is higher than the predetermined reference value. claims in accordance with one or more sorting control signal of the disease type is characterized in that a sorting output control means for outputting to said output means as said disease type candidate
The disease type selection system according to any one of 4, 5, and 7 . 16. The method according to claim 16, further comprising error processing means for performing a predetermined error processing when there is no disease type having a higher possibility of being a disease type for each patient than a predetermined reference value in the selecting means. The disease type selection system according to any one of claims 1 to 15. 17. The input means includes at least one of an input device for manual input, a reading device for reading and inputting from a medium, and a communication device for inputting by communication. 16. The disease type selection system according to any one of 16. 18. The apparatus further comprises a disease type master file means for storing the contents of the plurality of disease types as text information, wherein the output means refers to the disease type master file means to obtain the disease type. claim claims, characterized in that the output in a predetermined format including the text information sorted one or more of the diseases type as a candidate
The disease type selection system according to any one of 4, 5, 7, and 15 . 19. The disease type is DRG (Diagnosis).
Related Group) is a disease type selection system according to any one of claims 1 to 18. 20. The probability that the selection means corresponds to one or a plurality of medical care actions indicated by the input medical care action information is 1, based on the probability stored in the first file means. The disease type selection system according to any one of claims 1 to 19, wherein, when a disease type exists, the one disease type is selected as the disease type candidate. 21. The selecting means may be a disease type for each patient among the plurality of disease types based on the probability stored in the first file means, without using the predetermined reference value. 21. The disease type selection system according to any one of claims 1 to 20, wherein one or a plurality of disease types having relatively high values are selected as the disease type candidates. 22. The computer according to any one of claims 1 to 21.
Functions as a disease type selection system according to any one of the items
A machine-readable medium that records a program for
Body .