JP4250284B2 - Medical remuneration statement analysis system - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention is a medical treatment fee statement accumulated by processing information processing of a medical treatment fee statement mainly distributed by paper from a medical institution to a payment fund, a national health insurance association, and a payment fund, from the national health insurance association to an insurer. The present invention relates to a medical fee statement analysis system that statistically processes information in a database, extracts a medical fee statement that deviates from a standard medical practice, and evaluates and analyzes differences between medical institutions.
[0002]
[Prior art]
Remuneration for insurance medical care conducted at medical institutions such as hospitals and clinics is billed using a medical remuneration statement prepared by the medical institution. The medical remuneration statement is distributed from the medical institution to the payment fund, the National Health Insurance Federation, and to an insurer such as a health insurance association. Currently, most of the medical remuneration statement uses paper. Payment funds, National Health Insurance Federations, and insurers manually input a part of the medical treatment details described in the medical treatment remuneration statement, digitize it using means such as OCR, and perform various tabulation processes on the computer.
[0003]
In the payment fund, according to the electronic medical fee description, it is classified for each insurer, the amount charged for each insurer is calculated, and the amount paid for each medical institution is calculated. Statistical information such as the number of confirmed cases by medical institution classification, insurance type, etc., confirmed amount, confirmed number of changes, and confirmed amount transition is disclosed. Insurers also collect statistical information such as the number and amount of money by age, district, and disease category. However, these statistical information is information necessary for the original work such as calculation of the invoice amount for each insurer or information for grasping the situation, and automatically discovers a foreign value or evaluates a medical institution. It is not information.
[0004]
In addition, it is possible to perform statistical analysis of electronic medical treatment remuneration statements using a general statistical analysis package, but there are many aspects such as effective classification selection, database search, and operation of statistical analysis package. Knowledge learning and cumbersome operations are necessary and not realistic.
[0005]
[Problems to be solved by the invention]
As described above, it has been impossible to automatically find a foreign value from conventional statistical information or to evaluate a medical institution.
[0006]
In addition, when using the conventional general-purpose statistical analysis package, there is a problem that it is not practical because it requires a variety of knowledge learning and complicated operations.
[0007]
The present invention was made to solve the above-described problems. The standard value and the heterogeneous value are calculated by statistical analysis for each classification in which the medical treatment contents are considered to be similar. To realize a medical fee statement analysis system that provides a series of processing that can be associated with the statement as it may be, and that is used for evaluation by analyzing the degree of deviation of the standard value from each medical institution. With the goal.
[0008]
It is another object of the present invention to realize a medical fee remuneration statement analysis system that performs analysis and evaluation of heterogeneous standard values online while trial-and-error for securing a statistically meaningful sample number and adjusting the balance of classification.
[0009]
[Means for Solving the Problems]
The medical fee statement analysis system according to the present invention includes an electronic medical fee statement database,
From this medical remuneration statement database, gender, date of birth, name of illness, start date of medical treatment, number of actual treatment days, distinction of outpatient admission, patient attributes such as type of insurance, scale, attributes of medical institutions such as region, presence / absence of prescription , Evaluation numerical data such as the number of medical treatment fees by action and the total number of medical treatment fees selected and classified according to the attributes specified in advance from the attributes of medical treatment activities such as the presence of guidance presumed to be comprehensive payment A categorical standard value alien value extraction means that calculates and extracts alien value list and categorical standard value statistical data such as mean, standard deviation, skewness, kurtosis, test statistic, etc. When,
Heterogeneous value display means for retrieving a medical fee statement record corresponding to the heterogeneous value list from the medical fee statement database and displaying the detailed information on a screen, a form output, or a recording medium such as a magnetic disk When,
Analytical evaluation / display means for calculating the degree of divergence between each data in the medical remuneration statement database and the standard value by classification, and performing medical institution evaluation, etc.
It is equipped with.
[0010]
Moreover, the medical fee remuneration statement analysis system according to the present invention includes an electronic medical fee remuneration statement database,
From this medical remuneration statement database, gender, date of birth, name of illness, start date of medical treatment, number of actual treatment days, distinction of outpatient admission, patient attributes such as type of insurance, scale, attributes of medical institutions such as region, presence / absence of prescription , Evaluation numerical data such as the number of medical treatment fees by action and the total number of medical treatment fees selected and classified according to the attributes specified in advance from the attributes of medical treatment activities such as the presence of guidance presumed to be comprehensive payment A categorical standard value alien value extraction means that calculates and extracts alien value list and categorical standard value statistical data such as mean, standard deviation, skewness, kurtosis, test statistic, etc. When,
Heterogeneous value display means for retrieving a medical fee statement record corresponding to the heterogeneous value list from the medical fee statement database and displaying the detailed information on a screen, a form output, or a recording medium such as a magnetic disk When,
Analytical evaluation / display means for calculating the degree of divergence between each data in the medical remuneration statement database and the standard value by classification, and performing medical institution evaluation,
Standard statistical data for each category that performs standardized statistical data for each category such as disease name, hospital scale, whether or not prescriptions are issued, output to a recording medium such as a magnetic disk, multidimensional analysis screen display, etc. Display means.
[0011]
In the medical remuneration statement analysis system according to the present invention, the output of the heterogeneous value display means and the analysis evaluation / display means is output to a form output or a recording medium such as a magnetic disk, and the standard processing is performed off-line.
[0012]
In the medical fee remuneration statement analysis system according to the present invention, the heterogeneous value display means or the analysis evaluation / display means outputs a form output or a recording medium such as a magnetic disk, and performs a standard processing offline.
[0013]
Further, the classification-specific standard value heterogeneous value extraction means according to the present invention includes an electronic medical fee detailed statement database,
From this medical remuneration statement database, gender, date of birth, name of illness, start date of medical treatment, number of actual treatment days, distinction of outpatient admission, patient attributes such as type of insurance, scale, attributes of medical institutions such as region, presence / absence of prescription , Evaluation numerical data such as the number of medical treatment fees by action and the total number of medical treatment fees selected and classified according to the attributes specified in advance from the attributes of medical treatment activities such as the presence of guidance presumed to be comprehensive payment A categorical standard value alien value extraction means that calculates and extracts alien value list and categorical standard value statistical data such as mean, standard deviation, skewness, kurtosis, test statistic, etc. When,
Heterogeneous value display means for retrieving a medical fee statement record corresponding to the heterogeneous value list from the medical fee statement database and displaying the detailed information on a screen, a form output, or a recording medium such as a magnetic disk When,
Analytical evaluation / display means for calculating the degree of divergence between each data in the medical remuneration statement database and the standard value by classification, and performing medical institution evaluation,
Online analysis target / classification designation means that allows the user to select and classify records online, that is, to select the analysis axis and to select the analysis target
It is equipped with.
[0014]
Also, the medical fee specification analysis system according to the present invention is characterized in that the heterogeneous value display means includes a medical fee specification detailed database, and extracts the standard value heterogeneous value by classification from the medical fee specification database or the medical fee specification detailed database. The detailed data corresponding to the heterogeneous value extracted by the means is searched online, and the standard value is recalculated as being within the standard range by inputting an instruction from the outside to be valid.
[0015]
Further, in the medical fee remuneration statement analysis system according to the present invention, the heterogeneous value display means searches the medical remuneration statement database online for the medical remuneration statement corresponding to the extracted heterogeneous value, and displays the detailed information on the screen. To do.
[0016]
DETAILED DESCRIPTION OF THE INVENTION
Embodiment 1 FIG.
In this embodiment, the classification is designated in advance, the medical remuneration statement database is searched, the heterogeneous value detection algorithm is applied and the heterogeneous value list and the standard value statistical data for each classification are calculated and extracted. A medical fee description analysis system that displays a screen and outputs a medical institution evaluation result based on a standard value will be described.
[0017]
FIG. 1 is a block diagram showing Embodiment 1 of a medical fee remuneration statement analysis system according to the present invention. In the figure, 1 is an electronic medical fee specification database, 2 is a classification-specific standard value heterogeneous value extracting means for extracting and calculating a heterogeneous value list and standard value statistical data from 1 medical fee specification database, 3 classification-specific database search processing means for searching the medical remuneration statement database according to the specified classification, 4 foreign value detection processing means for detecting the foreign value list by applying the foreign value detection algorithm, and standard value for each classification It comprises 5 classification standard value statistical data calculation processing means for calculating and extracting statistical data, 6 is a list of heterogeneous values extracted by classification standard value heterogeneous value extraction means 2, and 7 is a screen for displaying the heterogeneous value list 6. Heterogeneous value display means to be displayed above, 8 is statistical data of classification standard values calculated by classification standard value heterogeneity value extracting means 2, and 9 is medical remuneration statement data Performs discrepancy calculation of the classification by the standard value and the data in the over scan, performs evaluation of medical institutions, an analysis evaluation and result display means for displaying on the screen.
[0018]
The medical fee detailed statement database 1 is realized by using, for example, an existing relational database management system, and performs a tabulation process according to a designated classification. There is a trade-off in how much the medical fee billing statement that is normally billed is electronic, but here, for example, as shown in Figure 2, a unique serial number for associating with the paper medical fee statement (Hereinafter referred to as the reference number), date of medical treatment, type of insurance, insured number, gender, date of birth, medical institution number, main disease name classification, start date of medical examination, number of medical treatment days, number of actions, points by action, Assume that the total score is digitized as a relational table item.
[0019]
Further, the classification-specific standard value heterogeneous value extraction means 2 includes a classification-specific database search processing means 3 for searching the medical fee detailed statement database 1 according to the classification designated by the user, and a heterogeneous value detection processing means 4 for detecting the heterogeneous value. And classified standard value statistical data calculation processing means 5 for calculating standard value statistical data from which extraneous values are removed.
[0020]
First, what is known a priori as a factor for determining the medical fee score is given to the classified database search processing means 3 in the form of a parameter file, for example. Factors known a priori include: (a) type of insurance (b) distinction between outpatients and outpatients (c) size of medical institutions, e.g. hospitals and clinics (d) disease classification (e) impact on medication costs In-hospital / in-hospital prescriptions (f) Presence / absence of instruction / management fees that include medication, examination, injection, etc. For example, as a focus of analysis, select a medical fee statement record without prescription issuance and no comprehensive guidance management fee for outpatient geriatric health care, classify hospital / clinic, disease classification, and total score When performing analysis as an object, for example, it is specified as an input to the classified database search processing means by a parameter file as shown in FIG.
[0021]
The classified database search processing means 3 searches the database based on the input parameter file. In the case of the parameter file shown in FIG. 3, the following SQL sentence is automatically generated and the database is searched.
[0022]
SELECT “Insurance Type”, “Inpatient / Outpatient Distinguishing”, “Hospital / Clinic”, “Disease Classification”, “Total Score”
FROM "Medical fee statement"
WHERE "Insurance Type" = 'Geriatric Health' AND "Hospital / Outpatient" = 'Outpatient' AND
"Number of prescriptions" = 0 AND "Teaching"<735
Presence / absence of prescription is less than 735 points assuming outpatient general health care for elderly patients with chronic illness because it is targeted for outpatient health care as a comprehensive instruction and management fee when the number of prescriptions for each act is 0 It will be judged that there is no inclusion.
[0023]
The extraneous value detection processing means 4 applies an extraneous value detection algorithm to the search result in the classified database search processing means. Statistical methods such as the method for obtaining the extraordinary value detection method based on the difference from the generally known average value and the simple detection method for multiple outliers in Applied Statistics Vol.25, No.1 (1996) Various detection methods have been proposed. For example, if the difference from the average value exceeds 3 times the standard deviation, it is defined as a foreign value, and the difference between the average value and the average value exceeds 3 times the standard deviation. The heterogeneous value list 6 is obtained by repeating the value removal, the average value, and the standard deviation calculation.
[0024]
The standard value statistical data calculation processing means 5 for each category is a standardized value for each category such as mean, standard deviation, skewness, kurtosis, test statistic, etc. Statistical data is calculated and stored as a table in a relational database management system in which, for example, a file or medical fee description database is stored.
[0025]
The heterogeneous value list 6 is a list of serial numbers of medical remuneration billing specifications having heterogeneous values created by the two classification standard value heterogeneous value extracting means, for example, in the form of a file, a table, an array on a program, or the like. Passed to foreign value display means, analysis evaluation / result display means.
[0026]
The extraneous value display means 7 displays all information stored in the medical fee detailed statement database 1 corresponding to the extraneous value list on the screen using a screen display tool such as spreadsheet software. FIG. 4 shows a display example. In addition to the contents of the medical remuneration statement table, the type of classification, average value, standard deviation in classification, and the like are displayed.
[0027]
The classified standard value statistical data 8 is the standard value statistical data calculated by the classified standard value heterogeneous value extraction means, and is stored in, for example, a relational database management system in which a file or medical fee statement database is stored. As shown in FIG. 5, the average of standard values from which extraneous values are removed, standard deviation, skewness, kurtosis, and the like are provided as elements for each category.
[0028]
The analysis evaluation / result display means 9 analyzes the difference from the standard value statistical data in various ways using the medical fee detailed statement database excluding the heterogeneous value list 6 and the standard value statistical data 8 classified by classification. For example, the average value and the deviation value of the total score for each medical institution by classification are obtained and displayed in order on the screen. For example, an OLAP tool or spreadsheet software that can organize and display multidimensional data can be used as a means for displaying by classification. FIG. 6 shows a display example of the average and deviation values of the total score by disease for each medical institution.
[0029]
Next, the basic processing flow of the medical remuneration statement analysis system according to this embodiment will be described with reference to FIG.
FIG. 7 is a flowchart of basic processing of the medical fee remuneration statement analysis system according to this embodiment.
First, in step 10 (hereinafter, step S ** is referred to as S **, here S10), the medical fee details for the classification and total items specified in the parameter file or the like based on factors known a priori. Search the document database and retrieve the corresponding record.
[0030]
Next, in S20, the heterogeneous value detection algorithm is applied to the record searched in S10 to obtain a heterogeneous value list. Next, in S30, statistical processing is applied to the record from which the extraneous values are removed, and the average, standard deviation, skewness, kurtosis, etc. are stored in the relational database management system in which the file or medical fee description database is stored. Store.
[0031]
Next, in S40, if no foreign value is found in S20, the process proceeds to S60. If a foreign value is found in S20, the process proceeds to S50.
[0032]
Next, in S50, detailed information on the heterogeneous value list obtained in S20 is retrieved from the medical fee detailed statement database 1 and displayed on the screen.
[0033]
Next, in S60, for the record from which the heterogeneous value list obtained in S29 is removed from the medical fee detailed statement database 1, the degree of divergence from the classified standard value statistical data obtained in S30 is obtained. Display the degree of deviation from another standard value in order.
[0034]
According to this embodiment, it is possible to perform analysis and evaluation classified for each factor that determines the total number of medical fees. In addition, it is possible to improve the statistical value by automatically separating heterogeneous values by statistical analysis. In addition, it is possible to realize evaluation by medical institution based on the degree of deviation from the standard value by classification.
[0035]
Embodiment 2. FIG.
In this embodiment, online (a) record selection by specifying values of patient attributes, medical institution attributes, and medical practice attributes (b) classification for simultaneous analysis of inpatient / outpatient distinction, disease name, etc. When the axis selection and classification are discrete value data, specify the range of the category (c) Specify numerical data to be analyzed such as total score and score by action, search the medical remuneration statement database, and detect foreign value Applying algorithm to calculate and extract heterogeneous value list and standard value statistical data by classification, display heterogeneous value list on screen, and output evaluation result of medical institution based on standard value, evaluation result An explanation will be given of a medical fee remuneration statement analysis system that enables a user to repeatedly perform analysis by changing the target and classification based on the above.
[0036]
FIG. 8 is an example of a configuration diagram of a medical fee remuneration statement analysis system showing Embodiment 2 of the present invention.
In the figure, 1 to 9 are the same as in the first embodiment, 1 is an electronic medical fee specification database, and 2 is a heterogeneous value list and standard value statistical data extracted and calculated from one medical fee specification. The classification-specific standard heterogeneity value extraction means, the classification-specific database search processing means for retrieving the medical fee detailed statement database according to the specified classification, and the heterogeneous value detection algorithm to detect the heterogeneous value list. It comprises heterogeneous value detection processing means and 5 classification standard value statistical data calculation processing means for calculating and extracting standard value statistical data by classification, 6 is a list of heterogeneous values extracted by 2, 7 is a heterogeneous value list 6 is a heterogeneous value display means for displaying 6 on the screen, 8 is the statistical data of the standard value by classification calculated by the standard value extraneous value extraction means 2 by classification, and 9 is each data in the medical fee description database. Performs discrepancy calculation of the motor and the categorical standard value, performs medical institutions evaluation, etc., the analysis evaluation and result display means for displaying on the screen.
[0037]
10 is an on-line analysis target / classification designation means that is added to the first embodiment and allows a user to select a record, specify a classification, and an analysis target online, and perform analysis by trial and error. .
[0038]
In the first embodiment, the online analysis target / classification designation means 10 designates the analysis target and classification in batches by a parameter file or the like, while online (a) patient attribute, medical institution attribute, medical practice Selection of records by specifying attribute values (b) Classification for simultaneous analysis of inpatient / outpatient distinction, disease name, etc., that is, analysis axis selection and when classification is discrete value data such as age and bed number, Specification of the range indicating the degree of detail of the classification (c) The numerical data to be analyzed, such as the total score and the score by action, is specified, and the information is given to the standard value heterogeneous value extraction means 2 by classification.
[0039]
For example, by mouse operation, keyboard operation, etc., as shown in Fig. 9, (a) As a record selection, the insurance type is geriatric health, outpatient, no prescription, no inclusion (b) As a classification, hospital / clinical Location, disease classification (c) The total score is designated as numerical data to be analyzed, and the result is given as an argument to the standardized heterogeneous value extraction means 2 by classification.
[0040]
Next, the basic processing flow of the medical remuneration statement analysis system according to this embodiment will be described with reference to FIG.
FIG. 10 is a flowchart of the process of the medical remuneration statement analysis system according to this embodiment.
First, in S01, online (a) enter patient attribute, medical institution attribute, and medical practice attribute values for record selection. (B) specify inpatients, and analyze hospitalization distinction, disease name, etc. at the same time. If the classification, that is, analysis axis selection, and the classification is discrete value data, enter the range of the category. (C) To specify the analysis target, enter the numerical data items to be analyzed, such as the total score and score by action. The classification-specific standard value heterogeneous value extraction means 2 is provided.
[0041]
The processes from S10 to S60 are the same as those in the first embodiment described above, and are therefore omitted.
In S70, when the user designates from the screen that he wants to continue the analysis from a different viewpoint from the displayed analysis evaluation result, the process returns to S01. In S70, when the user designates from the screen when the analysis is finished, the process is finished.
[0042]
According to this embodiment, in addition to the effects of the first embodiment, the cause of the medical fee remuneration statement corresponding to the heterogeneous value can be pursued in real time. In addition, it is possible to analyze the viewpoint of analysis while atypically modifying it online.
[0043]
Embodiment 3 FIG.
In this embodiment, a medical fee remuneration statement analysis system that enables online searching for records corresponding to the different value list created by the classification-specific standard value heterogeneous value extraction means 2 in the medical fee remuneration statement database. Give an explanation.
[0044]
FIG. 11 is an example of a configuration diagram of the medical fee remuneration statement analysis system according to the third embodiment of the present invention.
In the figure, 1 to 6 and 8 to 10 are the same as in the second embodiment, 1 is an electronic medical fee specification database, and 10 is an online analysis target / classification designation that designates an analysis target / classification online. Means 2 is a classification-specific standard value heterogeneous value extraction means for extracting and calculating the heterogeneous value list and the standard value statistical data from one medical fee description, and the medical fee description database according to the classification designated by the user 3 database search processing means classified by category, 4 foreign value detection processing means detecting a heterogeneous value list by applying a heterogeneous value detection algorithm, and 5 calculating and extracting standard value statistical data classified by classification The classification-specific standard value statistical data calculation processing means comprises 6 a list of foreign values extracted by the classification-specific standard value foreign value extraction means 2, and 11 a foreign value list 6. Heterogeneous value online search means for online searching for medical fee remuneration specifications having relevant heterogeneous values, 8 is the statistical data of classification standard values calculated by the standard value heterogeneous value extracting means 2 by classification, and 9 is the medical fee description It is an analysis evaluation / result display means for calculating the degree of divergence between each data in the database 1 and the standard value for each classification, performing medical institution evaluation, etc., and displaying it on the screen.
[0045]
The heterogeneous value online search means 11 performs search, statistical display, heterogeneity, such as (a) display by medical institution (b) display in order of deviation value (c) monthly occurrence frequency transition, etc. Check the value with online specification. As a result of the check, if it is determined that the value is not a heterogeneous value but valid, it is excluded from the heterogeneous value list. These functions can be easily realized by using a known database search technique, and can also be realized by using a general-purpose relational database search tool.
[0046]
Since the other means excluding the heterogeneous value online search means 11 are the same as those in the second embodiment, description thereof will be omitted.
[0047]
Next, the basic processing flow of the medical fee remuneration statement analysis system of this embodiment will be described with reference to FIG.
FIG. 12 is a basic process flowchart of the medical fee remuneration statement analysis system according to this embodiment.
Since the processing from S01 to S30 is the same as that of the second embodiment, the description thereof is omitted.
[0048]
In S41, the next operation is instructed. The next operation is (a) on-line search for foreign values (b) analysis and evaluation (c) analysis from a new viewpoint (d) termination, and proceed to each step according to the user's specification.
[0049]
In S51, (a) Display by medical institution, (b) Display by order of deviation value, (c) Monthly occurrence frequency transition, etc. for medical fee remuneration statements corresponding to the heterogeneous value list online, and display the results on the screen To do. The user performs analysis work using the displayed result, and returns to S41 when finished.
[0050]
In S60, for the record from which the heterogeneous value list obtained in S29 is removed from the medical remuneration statement database, the degree of deviation from the standard value statistical data classified by classification obtained in S30 is obtained. For example, the standard value for each medical institution The degree of deviation from is displayed in order. The user performs analysis work using the displayed result, and returns to S41 when finished.
[0051]
If the analysis from a new viewpoint is designated in S41, the process returns to S01, and a record is newly selected, classified, and the analysis target is designated, and the analysis from the new viewpoint is continued. If the end is selected in S41, the process ends.
[0052]
According to this embodiment, in addition to the effects of the first and second embodiments, the user can analyze online the medical fee description corresponding to the heterogeneous value list in the medical fee description database. In addition, it is possible to analyze the viewpoint of analysis while atypically modifying it online.
[0053]
Embodiment 4 FIG.
In this embodiment, standard statistics by classification such as mean, standard deviation, skewness, kurtosis, test statistic, etc. calculated by removing extraneous values are classified for each classification such as disease name, hospital size, presence of prescription, etc. An explanation will be given of a medical fee detailed statement analysis system that can output a form, output to a recording medium such as a magnetic disk, and display a multidimensional analysis screen.
[0054]
FIG. 13 is an example of a configuration diagram of the medical fee remuneration statement analysis system according to the fourth embodiment of the present invention.
In the figure, except for the addition of 12 classification standard value statistical data display means, it is the same as in the third embodiment, so the description thereof is omitted. Reference numeral 12 denotes classification standard value statistical data display means for displaying the classification standard value statistical data 8 output from the classification standard value heterogeneous value extraction means 2 in a multidimensional manner for each classification.
[0055]
The classified standard value statistical data display means 12 displays the contents of the classified standard value statistical data on an existing multidimensional analysis tool or a spreadsheet tool, and enables analysis from various viewpoints. For example, FIG. 14 shows an example in which the standard value statistical data for each disease classification including geriatric health, hospital, outpatient, no prescription, and no inclusion is displayed on a spreadsheet tool.
[0056]
Next, the flow of processing of the medical remuneration statement analysis system of this embodiment will be described with reference to FIG.
FIG. 15 is a flowchart of the process of the medical remuneration statement analysis system according to this embodiment.
Except for the addition of the process of S52, the process is the same as that of the third embodiment, and the description of the processes other than S52 is omitted.
[0057]
If the standard value analysis is selected in S41, the process proceeds to S52.
In S52, the standard value statistical data for each category is output as a form, output to a recording medium such as a magnetic disk, and a screen output such as a multidimensional analysis tool display. The user performs analysis work using the output result, and returns to S41 when finished.
[0058]
According to this embodiment, in addition to the effects of the first, second, and third embodiments, the user can analyze the standard value statistical data by classification.
[0059]
【The invention's effect】
According to the present invention, since the medical remuneration statement is classified and selected according to the patient attribute, the medical institution attribute, and the medical practice attribute, the analysis evaluation classified according to the factors determining the total medical remuneration score becomes possible.
[0060]
Further, according to the present invention, the heterogeneous values are automatically separated by statistical analysis, so that the statistical value can be improved.
[0061]
Further, according to the present invention, since the electronic medical fee description is searched using the heterogeneous value list as a key, the cause of the medical fee specification corresponding to the heterogeneous value can be pursued in real time.
[0062]
Further, according to the present invention, when it is determined that the result of pursuing the cause of the medical fee remuneration statement corresponding to the heterogeneous value is appropriate, it is removed from the heterogeneous value list and the standard value statistical data is recalculated. Can be evaluated.
[0063]
Further, according to the present invention, since the statistical data of the standard value is obtained for each classification, it is possible to realize the evaluation for each medical institution by the degree of deviation from the standard value for each classification.
[0064]
In addition, according to the present invention, since statistical analysis is repeatedly performed by changing the viewpoint of analysis according to the user's specification on a trial and error basis, it is possible to analyze the viewpoint of analysis while atypically modifying it online. Become.
[0065]
In addition, according to the present invention, all results are output as a form or output to a recording medium such as a magnetic disk, so that statistical processing for routine analysis processing can be performed offline.
[Brief description of the drawings]
FIG. 1 is a block diagram showing Embodiment 1 of a medical fee remuneration statement analysis system according to the present invention.
FIG. 2 is a diagram showing an example of a table structure of a medical fee remuneration statement database.
FIG. 3 is a diagram illustrating an example of a parameter file input to a categorical heterogeneous value standard value extraction unit.
FIG. 4 is a diagram showing an output example of a heterogeneous value display means.
FIG. 5 is a diagram showing an example of the structure of a table for storing standard value statistical data by classification.
FIG. 6 is a diagram illustrating an example of an output of an analysis / evaluation result display unit.
FIG. 7 is a flowchart of basic processing of the medical remuneration statement analysis system according to the first embodiment of the present invention.
FIG. 8 is an example of a configuration diagram of a medical remuneration statement analysis system to which an online analysis target / classification designation unit according to Embodiment 2 of the present invention is added.
FIG. 9 is a diagram showing an example of a parameter input screen in the online analysis target / classification designation unit.
FIG. 10 is a flowchart of a medical remuneration statement analysis system to which an on-line analysis target / classification designation unit according to Embodiment 2 of the present invention is added.
FIG. 11 is an example of a configuration diagram of a medical fee remuneration statement analysis system to which extraneous value online search means according to Embodiment 3 of the present invention is added.
FIG. 12 is a flowchart of a medical fee statement analysis system to which extraneous value online search means according to Embodiment 3 of the present invention is added.
FIG. 13 is an example of a configuration diagram of a medical remuneration statement analysis system to which classification standard value statistical data display means according to the fourth embodiment of the present invention is added.
FIG. 14 is a screen showing an example of the output of the classification-specific standard value statistical data display means.
FIG. 15 is a flowchart of a medical fee remuneration statement analysis system to which standardized standard value statistical data display means according to the fourth embodiment of the present invention is added.
[Explanation of symbols]
1 medical remuneration statement database, 2 standard value heterogeneous value extraction means by classification, 3 database search processing means by classification, 4 heterogeneous value detection processing means, 5 standard value statistical data calculation processing means by classification, 6 heterogeneous value list, 7 heterogeneous Value display means, 8 classification standard value statistical data, 9 analysis evaluation / result display means, 10 online analysis target / classification designation means, 11 foreign value online search means, 12 classification standard value statistical data display means.

Claims (4)

A medical fee statement database in which electronic medical fee statement data is stored for each reference number;
A database search processing unit for each category that searches medical fee detailed statement data for each reference number corresponding to the classification information from the medical fee detailed statement database based on the classification information classified for each factor that determines the medical fee points, and The medical fee remuneration statement data having a heterogeneous value is detected from the medical fee remuneration statement data for each reference number corresponding to the classification information searched by the classification database search processing means , using a heterogeneous value detection algorithm , and this medical treatment is detected. A foreign matter value detection processing means for detecting a foreign value list that is a list of reference numbers corresponding to the remuneration statement data, and a medical fee detail specification for each reference number corresponding to the classification information searched by the classification database search processing means reimbursement item corresponding to the reference number of the heterogeneous value list which is detected by the foreign value detection processing unit from the write data Categorical standard value heterogeneity value and a categorical standard value statistical data computing processing means for calculating said classification information different categorical standard value of heterogeneous values reimbursement specification data exclude reimbursement specification data statistics data excluding data Extraction means;
Heterogeneous value display means for displaying medical fee detailed statement data corresponding to the foreign value list detected by the foreign value detection processing means;
Analyzing the difference for each classification information between the classification standard value statistical data calculated by the classification standard value statistical data calculation processing means and the heterogeneous medical fee specification data exclusion medical fee specification data , A medical fee statement analysis system comprising: an analysis evaluation / result display means for displaying an analysis result. Online analysis target / classification designation means for inputting the classification information online,
The database search processing unit classified by category is based on the classification information input by the online analysis target / classification specifying unit, and stores medical fee description data for each reference number corresponding to the classification information from the medical fee specification database. The medical remuneration statement analysis system according to claim 1, wherein the system is searched.   2. The heterogeneous value online search means for performing online search of medical fee detailed statement data and heterogeneous value check corresponding to the heterogeneous value list detected by the heterogeneous value detection processing means. Or the medical remuneration statement analysis system according to claim 2.   The classification standard value statistical data display means for displaying the classification standard value statistical data calculated by the classification standard value statistical data calculation processing means for each display classification in a multidimensional manner. The medical remuneration statement analysis system according to claim 3.

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