JP5992234B2 - Receipt analysis system and analysis method - Google Patents

Description

  The present invention relates to a receipt analysis system and an analysis method. More specifically, the present invention extracts active data for each patient by extracting data for a predetermined period from a database storing medicinal products and medical practices described in the reception in association with the name of the disease. The present invention relates to a receipt analysis system and an analysis method for identifying a non-active disease name (also referred to as “unnecessary disease name”).

  When a patient is examined at a medical institution such as a hospital, the patient's disease name, medical condition, medical practice, prescription drug name, etc. are written in the medical record. The medical record includes the name of the patient, medical condition, medical practice, prescription drug name, etc. from the past to the present. A receipt (medical fee description) is created from the medical record. In addition, the dispensing pharmacy delivers the drug to the patient based on the prescription issued by the medical institution and creates a receipt.

  There are paper-based receipts and paper-based ones from the beginning, but paper-based ones can be converted into electronic data using OCR conversion technology or the like. The receipt includes a medical receipt and a dispensing receipt, and describes the name of the wound and the medical practice and medication information performed on the patient. Medical practice refers to all acts that can be counted as insurance claim points.

  FIG. 1 is a diagram illustrating an example of a receipt. The receipt includes identification information (insurer number, symbol, number), disease information (such as name of injury and illness), and summary column information (such as prescription dispensing and medical practice).

  Here, the insurer number, symbol, and number, which are identification information, are issued to the insured by various insurers (for example, a health insurance association whose company is the parent, a national health insurance operated by a municipality, etc.). It is written on the insurance card. The disease name code and the disease name, which are the disease information, indicate the disease name identification number corresponding to the disease name defined under a predetermined rule. The prescription dispensing and the medical practice included in the summary column information respectively indicate a pharmaceutical code and a pharmaceutical name defined under a predetermined rule, and a medical practice code and a medical practice name.

  As shown in FIG. 2, the receipt is sent from the hospital 201 or the pharmacy 202 to the examination organization 203 and from the examination organization 203 to the insurer 204. The examination organization 203 performs examination of the contents of the receipt, distribution work for each insurer, and medical expenses work (billing to the insurer, payment to the medical institution, etc.). The insurer 204 performs billing / payment operations and various insurance operations relating to the insured with the examination organization.

  As a problem that has been recognized in the past, a receipt is created from a medical record, but the medical record includes the patient's past disease name, medical condition, medical practice, prescription drug name, etc. There was a problem that even irrelevant disease names appeared on the reception.

  For such a problem, it is known to use a medical cost decomposition analysis apparatus and method (Patent Document 1) that associates medical expenses such as medical treatments and prescription medicines described in the reception with each wound name. . In Patent Document 1, for a plurality of wounds and illnesses described in the receipt, prescription medicines and performed medical treatments are associated with wounds and sicknesses, and names of wounds and sicknesses that have been visited in the past but have not been visited in the current month are listed. An apparatus and a method are disclosed that are capable of tabulating the correct medical expenses for the current month for each disease name after being excluded. By using the device and method disclosed in Patent Document 1, it is possible to grasp what medicine was used for each disease name or what medical practice was performed for the current month. It is possible.

Japanese Patent No. 4312757

  Depending on the type of injury or illness, a long-term medical checkup and medication are required. However, since the general prescription period of the drug is 90 days at the maximum, it is not always necessary to visit a medical institution every month. For this reason, the device and method described in Patent Document 1 can be associated with the name of the disease, medical practice, and prescription medicines of the medical examination conducted in the current month from the current month's receipt. It was difficult to identify active and non-active names for patients.

  The present invention has been made in view of such a problem, and an object of the present invention is to identify active and inactive disease names for a specific patient from a medium- and long-term receipt of injuries and diseases. It is to provide a system, an apparatus and a method.

  In order to solve the above-described problem, a receipt analysis system according to the present invention is based on means for reading data of a specific patient from a first DB including a first period, and the read first period. Means for reading out association data about a specific patient from the second DB, the association data being a specific patient identifier, injury information, pharmaceutical information and medical care generated from a receipt of a predetermined year and month A means that includes information on an action, a means for comparing an injury / illness name DB included in the retrieved association data and an injury / illness name DB, and identifying an active injury / illness name from the information on the matching injury / illness; Means for reading out all data about the patient from the second DB, comparing all the read out data with information on the wound identified as being the name of the active wound; Means for identifying a nonactive sick name from information illness that do not match, characterized by comprising a.

  The method for analyzing a receipt according to the present invention includes a step of reading data of a specific patient from the first DB including the first period, and an association for the specific patient based on the read first period. A step of reading data from the second DB, wherein the association data includes a specific patient identifier, injury information, pharmaceutical information and medical practice information generated from a receipt of a predetermined year and month And comparing the wound information contained in the read association data with the wound name DB, and identifying an active wound name from the matched wound information, and all data for a specific patient. A step of reading from the second DB, comparing all the read data with the information on the wounds and diseases identified as the active wound names, Identifying a nonactive sick name from information have illness, characterized by comprising a.

  ADVANTAGE OF THE INVENTION According to this invention, the active sickness name and non-active sickness name about a specific patient can be identified from the receipt of the sickness over a long term. Moreover, the following effects can be acquired when the receptor analysis system and method according to the present invention are used.

  For medical institutions such as hospitals, it is possible to obtain data from which unnecessary wound names have been deleted, so that the accuracy of management of patient databases can be improved. Since it can be sent, it can contribute to improving the accuracy of examinations by inspectors and insurers, and the number of items subject to assessment return from the institution can be reduced.

  The insurer receives the post-examination receipt from the examination organization, but can improve the accuracy of the single month receipt check and the multi-month receipt check. In addition, for insurers, it can be used for insurance business services such as consultation recommendations for individual patients.

It is a figure which shows an example of a receipt. It is a figure which shows the flow of a reception, and the flow of an accompanying business. It is a figure explaining the whole structure of the receipt analysis system concerning the present invention. It is a block diagram explaining the system configuration | structure of a medical expense decomposition | disassembly apparatus. It is a figure which shows an example of wound name DB, pharmaceutical DB, and medical treatment DB. It is a figure which shows the format of an example of the data after decomposition | disassembly. It is a figure which shows an example of a personal master. It is a figure which shows the presence or absence of the receipt in each month, and the relationship of whether there is association data in the data after decomposition. It is a flowchart explaining the update process of the analysis object period for every patient. It is a flowchart of the process which identifies which of a patient's wound name is active. It is a figure explaining the system configuration | structure of an active disease name identification apparatus.

  Hereinafter, embodiments of the present invention will be described in detail. FIG. 3 is a diagram for explaining the overall configuration of the receipt analysis system 300 according to the present invention. The receipt analysis system 300 includes a medical cost decomposing device 310, post-decomposing data 320, and an active disease name identifying device 330.

  The medical cost decomposing apparatus 310 is a medical cost decomposing / analyzing apparatus that is a conventional technique, and associates prescription medicines and performed medical care activities with injuries and diseases for a plurality of injuries and diseases described in a receipt, Identify active injury and illness names, practices and medicines for the current month's visit. Here, “active” means an actually illness.

  The post-decomposition data 320 is a database (DB) that accumulates association data of active wound names, medical treatments, and pharmaceuticals for the current month identified by the medical cost decomposing apparatus 310.

  The active disease name identification device 330 identifies an active disease name and a non-active disease name for a specific patient from medium- to long-term association data read from the post-decomposition data 320.

  Hereinafter, each configuration included in the receipt analysis system 300 will be described in detail. In addition, in FIG. 3, although the receipt analysis system 300 demonstrated with the structure containing the above-mentioned component 310-330, the structure set as a separate system and apparatus according to mounting form may be sufficient.

  FIG. 4 is a block diagram for explaining the system configuration of the medical cost decomposing apparatus 310. The medical cost disassembling apparatus 310 includes a control unit 401, a main storage unit 402, an auxiliary storage unit 403, an interface (I / F) unit 404, a display unit 405, a receipt DB 406, a wound name DB 407, a medicine DB 408, a medical practice DB 409, and a decomposition. Post data 320 is included. These components 401 to 409 and 320 are connected to each other by a bus 420, and each component is controlled by the control unit 401. In FIG. 4, for convenience of explanation, the disassembled data 320 is depicted inside the medical cost disassembling apparatus 310. However, the medical expenses disassembling apparatus 310 and the disassembled data 320 are configured as separate systems and devices. May be.

  The control unit 401 is also called a central processing unit (CPU), performs control of each of the above-described constituent elements and data calculation, and reads various programs stored in the auxiliary storage unit 403 to the main storage unit 402 and executes them. To do. The main storage unit 402 is also called a main memory, and stores various data received by the medical cost disassembling apparatus 310, computer-executable instructions, data after arithmetic processing by the instructions, and the like.

  The auxiliary storage unit 403 is a storage device typified by a hard disk (HDD) and is used when data and programs are stored for a long period of time. Since the main storage unit 402 has a relatively smaller storage capacity than the auxiliary storage unit 403, it is used for temporary data storage, arithmetic processing, and the like, whereas the auxiliary storage unit 403 stores necessary data and information. Used for long-term storage and storage. That is, when the control unit 401 executes a program to perform data calculation, it reads necessary data and programs from the auxiliary storage unit 403 to the main storage unit 402, and stores and saves the calculation result data for a long time. In this case, the control unit 401 writes the calculation result data in the auxiliary storage unit 403.

  The interface (I / F) unit 404 plays a role of an interface when data is transmitted / received to / from one or more computer apparatuses outside the medical cost decomposing apparatus 310 and a storage including one or more DBs. Data received from the outside is temporarily stored in the main storage unit 402. The interface unit 404 provides an interface (an application program such as an input screen) for receiving various commands and input data (such as various masters and tables) from the system operator. The display unit 405 provides a display screen that displays the data processed by the medical cost decomposing apparatus 310.

  The receipt DB 406 stores receipt data received from the outside. The stored receipt data is not limited to a specific format as long as it includes at least identification information, disease information, and summary column information as shown in FIG.

  Here, referring to FIGS. 5A to 5C, examples of wound name DB 407, pharmaceutical DB 408, and medical practice DB 409 are shown.

  The wound name DB 407 includes the wound name code 501, the wound name 502, and the wound name generic name 503 included in the receipt. Some doctors describe a specific injury / illness name 502 in the medical chart and others describe the injury / illness name generically. Therefore, the injury / illness name code 501 can be identified from either the injury / disaster name 502 or the injury / disorder name generic name 503. It is for doing so.

  The medicine DB 408 includes a medicine code 511, a medicine name 512, and a medicine generic name 513 included in the receipt. The drug name 512 and the drug generic name 513 are included for the same reason as the injury and illness name.

  The medical practice DB 409 includes a medical practice code 521, a medical practice 522, and a medical practice generic name 523 included in the receipt. The medical practice 522 and the medical practice generic name 523 are included for the same reason as the injury and illness name.

  The post-decomposition data 320 stores the association data of the active wound name, medical practice, and medicine for the current month identified by the medical expense decomposing apparatus 310. Here, in the limited process of generating the association data, One embodiment that does not exist will be described.

  First, the control unit 401 reads the receipt data from the receipt DB 406 and collates the medical practice code of the read receipt data with the medical practice code 521 of the medical practice DB 409. It is also possible to collate using the medical practice 522 or the medical practice generic name 523 instead of the medical practice code.

  Then, a wound name code 501 corresponding to the matched medical practice code 521 is read from the medical practice DB 409. The read wound name code 501 is checked against the wound name code 501 in the wound name DB 407, and the wound name 502 and wound name generic name 503 associated with the matched wound name code 501 are identified.

  In addition, the control unit 401 reads the receipt data from the receipt DB 406 and collates the drug code of the read receipt data with the drug code 511 of the drug DB 408. It is also possible to collate using the drug name 512 and the drug generic name 513 instead of the drug code.

  Then, the wound name / name code 501 corresponding to the matched drug code 511 is read from the drug DB 408. The read wound name code 501 is checked against the wound name code 501 in the wound name DB 407, and the wound name 502 and wound name generic name 503 associated with the matched wound name code 501 are identified.

  By the above two processes, the association data of the active injury / sickness name, medical practice, and medicine for the current month is generated. It should be noted that there are cases where pharmaceuticals are not prescribed depending on the medical practice (for example, only examination without medication). The generated association data of the active disease name, medical practice, and medicine for the current month is stored in the post-decomposition data 320 after the duplicate data is removed.

  FIG. 6 shows an exemplary format of the decomposed data 320. The post-decomposition data 320 includes a year / month 601, an individual ID 602, a wound name code 501, a pharmaceutical code 511, and a medical practice code 521. The year / month 601 indicates the month for receipt. The personal ID 602 is a personal ID identified by an insurer number 701, a symbol 702, a number 703, and a name 704 included in the personal master 700 illustrated in FIG. The personal master 700 can be located inside the medical expense disassembling apparatus 310 shown in FIG. 3, or can be located in an external apparatus connected to the network. The insurer number 701, the symbol 702, the number 703, and the name 704 are information for specifying the individual indicated on the insured card.

  FIG. 8 is a diagram showing the relationship between whether or not a receipt occurs in each month and the name of each disease are described in the receipt, and whether or not there is association data in the post-decomposition data 320. According to FIG. 8, the receipt occurred in odd months (1, 3, 5, and July) (that is, the patient has visited). Indicates that association data is generated in odd months (1, 3, 5, and July), but for disease name B, association data is generated only in January and July.

  In such a case, for disease name A, if data for at least two months is analyzed, disease name A is identified as an active injury / illness name for the patient, but for disease name B, data for five months is used. Even if analyzed, the disease name B may be identified as a non-active injury disease name for the patient.

  Hereinafter, as will be described in detail, when the receipt analysis system 300 according to the present invention is used, it becomes possible to identify active / non-active disease names for each patient with higher accuracy than before.

  As shown in FIG. 8, the data period to be analyzed is different for each patient's injury and illness. Therefore, as shown in FIG. 9, the analysis period for each patient is specified. FIG. 9 is a flowchart for explaining the update process of the analysis target period for each patient.

  In step S <b> 901, the active disease name identification apparatus 330 reads data about a specific patient read from the personal master 700 from the decomposed data 320. The data read out here is all data about the patient stored in the post-decomposition data 320.

  In step S902, the active wound name identification device 330 identifies one or more wound name codes included in the data read from the post-decomposition data 320, and accesses the wound name DB 407 based on the identified wound name codes. The maximum value is specified in the period 504 obtained as described above. Here, although the wound name DB 407 includes a period 504, the period 504 indicates an average consultation interval of the wound. For example, when a certain illness is a standard visit interval for bimonthly visits, “2” is stored in the period 504 of the injury / illness name DB 407.

  In step S903, the active disease name identification device 330 identifies one or more drug codes included in the data read from the disassembled data 320, and obtains the drug DB 408 based on the identified drug code. The maximum value is specified in the given period 514. Here, the drug DB 408 also includes a period 514, which indicates the maximum prescription period of the drug. For example, when a certain medicine is prescribed for a patient for 90 days, “3” is stored in the period 514 of the medicine DB 408.

  In step S904, the active disease name identification apparatus 330 identifies the maximum value among the periods specified in steps S902 and S903.

  In step S905, the active disease name identification apparatus 330 updates the period 705 of the personal master 700 with the period data obtained in step S904. By the update, it is possible to obtain the analysis target period for each patient based on the latest receipt data. In another embodiment, the patient may change his / her visit to the next month for some reason, and the updated period may be updated by adding one month.

  As another embodiment, the period 524 included in the medical practice DB 409 may be applied to the above process and used for updating the personal master 700. For example, when there is no medication and only the examination, the association data of the post-decomposition data 320 does not include the drug code but only the medical practice code.

  FIG. 10 is a flowchart of a process performed by the active disease name identification device 330 to identify which of the patient's disease names is active.

  In step S <b> 1001, the active disease name identification device 330 reads specific patient data from the personal master 700. The read data includes a period 705 in addition to the personal ID 602.

  In step S1002, the active disease name identification apparatus 330 reads data about a specific patient from the disassembled data 320 for the year and month of the period 705 read in step S1001. For example, in the case of a certain patient, data for 6 months is read, and in the case of another patient, data for 3 months is read.

  In step S1003, the active disease name identification device 330 collates the disease name code 407 included in the association data of the post-decomposition data 320 read in step S1002 with the disease name DB 407, and specifies a matching disease name. It can be seen that the matched injury / illness name is an active injury / illness name in which medical practice is actually performed or prescription of a medicine is performed in a mid-to-long-term medical examination.

  In step S <b> 1004, the active disease name identification device 330 reads all data about the specific patient from the decomposed data 320.

  In step S1005, the active disease name identification device 330 collates all the disease name codes identified in step S1004 with the disease name codes identified as the active disease names in step S1003, and identifies inconsistent disease names. . It can be seen that the injured disease name that was not matched was an active injured disease name in the past, but is currently determined to be a non-active injured disease name.

  FIG. 11 is a diagram illustrating a system configuration of the active disease name identification device 330. The active disease name identification apparatus 330 includes a control unit 1101, a main storage unit 1102, an auxiliary storage unit 1103, an interface (I / F) unit 1104, a display unit 1105, a personal master 700, an injury name DB 407, a medicine DB 408, and a medical practice DB 409. Including. These components are mutually connected by a bus 1110, and each component is controlled by the control unit 1101.

  The control unit 1101, the main storage unit 1102, the auxiliary storage unit 1103, the interface (I / F) unit 1104, and the display unit 1105 of the active disease name identification device 330 are the control unit 401, main storage unit 402, Since it has the same functions as the auxiliary storage unit 403, the interface (I / F) unit 404, and the display unit 405, detailed description thereof is omitted. In addition, the wound name and disease name DB 407, the pharmaceutical product DB 408, and the medical practice DB 409 are synchronized at a predetermined timing between the active wound and disease name identification device 330 and the medical cost decomposing device 310.

(Summary)
The methods, functions, and means described in the above-described embodiments can be implemented as a computer-executable program, or can be implemented as a computer-readable recording medium that stores the program.

  The embodiment described above is merely an example, and the present invention is not limited to the above embodiment, and various modifications are possible. That is, as long as it is based on the technical idea described in the scope of claims, the modifications are included in the technical scope of the present invention.

DESCRIPTION OF SYMBOLS 300 Recto-analysis system 310 Medical expense decomposition | disassembly apparatus 320 Data after decomposition | disassembly 330 Active disease name identification apparatus 401 Control part 402 Main memory part 403 Auxiliary memory part 404 Interface (I / F) part 405 Display part 406 Receipt DB
407 Sick Name DB
408 Pharmaceuticals DB
409 Clinical practice DB
700 Individual master

Claims (8)

A database storing association data including injury and illness information, medical practice information and pharmaceutical information for each patient, the association data generated from a receipt of a predetermined year and month;
A personal master storing patient data, including a first period;
Means for reading data of a particular patient, including the first period, from the personal master ;
Means for reading the association data for the particular patient from the database based on the first period read from the personal master ;
Means for comparing the wound and disease information contained in the read association data with the wound and disease information stored in the wound and disease name DB , and identifying an active wound and disease name for the specific patient from the matching wound and disease information ;
It means for reading all associated data for the particular patient from the database,
It said injuries information included in all of the associated data for the particular patient read, the active compared with the sickness information that have been identified as sick name, nonactive injuries name from unmatched illness information And a means for identifying the receipt analysis system. The wound name DB further includes a second period indicating an average visit interval of the wound,
The receipt analysis system further includes a drug DB that stores drug information and a third period indicating the maximum prescription period of the drug,
Wherein the first period of time and the second period obtained by accessing the victim name DB based on the victim information contained in the associated data read from the database, read from the database data indicating a longer period of the associated accessing said medicament DB based on the drug information contained in the data obtained by comparing the third period, the third period and the second period receipt analysis system according to claim 1, characterized in that that it will be determined based on. The first period is determined based on a fourth period obtained by accessing the medical practice DB based on the medical practice information included in the association data read from the database. The receipt analysis system according to claim 2.   The receipt analysis system according to claim 2, wherein the first period is increased when a predetermined condition is satisfied. A receipt analysis method executed by a receipt analysis system, comprising:
The receipt analysis system includes:
A database storing association data including injury and illness information, medical practice information and pharmaceutical information for each patient, the association data generated from a receipt of a predetermined year and month;
A personal master for storing patient data, including a first time period;
The receipt analysis method comprises:
Reading data of a particular patient from the personal master, including the first time period;
A step of reading on the basis of the first period read from the personal master, the association data for the particular patient from the database,
Comparing the wound and disease information included in the read association data with the wound and disease information stored in the wound and disease name DB , and identifying an active wound and disease name for the specific patient from the matching wound and disease information ;
Reading out all the associated data for the particular patient from the database,
It said injuries information included in all of the associated data for the particular patient read, the active compared with the sickness information that have been identified as sick name, nonactive injuries name from unmatched illness information And a step of identifying a receipt analysis method. The wound name DB further includes a second period indicating an average visit interval of the wound,
The receipt analysis system further includes a drug DB that stores drug information and a third period indicating the maximum prescription period of the drug,
Wherein the first period of time and the second period obtained by accessing the victim name DB based on the victim information contained in the associated data read from the database, read from the database data indicating a longer period of the associated accessing said medicament DB based on the drug information contained in the data obtained by comparing the third period, the third period and the second period receipt analysis method according to claim 5, characterized in that that will be determined based on. The first period is determined based on a fourth period obtained by accessing the medical practice DB based on the medical practice information included in the association data read from the database. The receipt analysis method according to claim 6.   The method of claim 6, wherein the first period is increased when a predetermined condition is satisfied.

Images