JP6984994B2 - Medical accounting system, medical accounting program - Google Patents

Description

Embodiments of the present invention relate to a medical accounting system and a medical accounting program used in this system.

At medical institutions such as hospitals and clinics, the person in charge of medical affairs inputs daily medical care contents into the medical accounting system based on the medical practice and the name of injury or illness recorded in the medical record. A self-pay invoice, a medical fee statement (receipt), etc. are created based on the entered medical treatment details.

The insured person such as a patient pays a part of the medical fee to the medical institution according to the self-pay bill. On the other hand, medical institutions submit medical receipts to examination bodies such as payment funds and the National Health Insurance Federation. The examination body examines the contents of the submitted receipt, and if there is no error in the insurance system, submits the receipt to the relevant insurer. As a result, the medical institution obtains the remaining medical fees from the insurer.

By the way, the medical practice actually performed may not be charged for some reason. Such omission of claims is a factor that puts pressure on the management of medical institutions. The medical office staff is trying to input the daily medical care contents into the medical accounting system so as to eliminate billing omissions, but the burden on the staff is heavy and the input contents may differ depending on the person in charge. be.

Patent No. 3316969

The purpose is to provide a medical accounting system and a medical accounting program used in this system, which can efficiently input medical treatment contents while eliminating individual differences between persons in charge.

According to the embodiment, the medical accounting system includes first to third storage units, input guidance units, and display units. The first storage unit stores medical information in association with identification information that identifies a patient. The second storage unit stores the basic patient information in association with the identification information. The third storage unit stores a plurality of types defining medical practices, medicines, or specific equipment that can be calculated when the medical information and the basic patient information satisfy preset conditions. The input guidance unit reads the medical care information from the first storage unit, reads the patient basic information from the second storage unit, and the medical care information and the patient basic information are obtained from the input identification information. It is determined whether or not the condition set for each type is satisfied, and the guidance information prompting the input of the medical practice, the drug, or the specific equipment specified by the type satisfying the condition is output. The display unit displays the guidance information.

FIG. 1 is a diagram showing a configuration of a medical accounting system according to the present embodiment. FIG. 2 is a diagram showing a display of a display circuit showing a list of registered patterns. FIG. 3 is a diagram showing a screen for detailed pattern setting for the pattern with the pattern number: "13000001" shown in FIG. 2. FIG. 4 is a diagram showing a screen for setting the basic check unit shown in FIG. FIG. 5 is a diagram showing a screen for setting the injury / illness name condition shown in FIG. FIG. 6 is a diagram showing a screen for setting the item condition 1 shown in FIG. FIG. 7 is a diagram showing a screen for setting a combined calculation condition registered in the condition set unit. FIG. 8 is a flowchart showing a processing operation of the signal processing circuit shown in FIG. FIG. 9 is a diagram showing a screen for displaying the pointed out sentence shown in FIG.

Hereinafter, embodiments will be described with reference to the drawings.

FIG. 1 is a diagram showing a configuration example of the medical accounting system 1 according to the present embodiment. The medical accounting system 1 is included in, for example, HIS (Hospital Information System). The medical accounting system 1 shown in FIG. 1 includes a medical information input device 10 and a server 20. The medical information input device 10 and the server 20 are connected to a LAN (Local Area Network). In addition, an electronic medical record order system is connected to the LAN. The connection to the LAN may be a wired connection or a wireless connection. Further, as long as security is ensured, the connected line is not limited to the LAN. You may connect to a public communication line such as the Internet.

The server 20 includes, for example, a large-capacity storage device such as a hard disk, and electronically manages information in the medical accounting system 1. For example, the server 20 stores the patient basic information database 21, the medical care information database 22, and the injury / illness name database 23. The server 20 provides the managed information to the medical information input device 10 in response to the request from the medical information input device 10. In this embodiment, the case where the server 20 stores the patient basic information database 21, the medical care information database 22, and the injury / illness name database 23 will be described. However, when the server exists other than the server 20, the patient basic information database is described. 21, the medical information database 22, and the injury / illness name database 23 may be stored in different servers.

The patient basic information database 21 is a collection of data that stores a patient name, date of birth, gender, age, insurer information, etc. in association with a patient ID.

The medical information database 22 is a collection of data for storing medical information in association with a patient ID. The medical information includes a product number representing a medical practice, a drug, a specific equipment, etc., a medical treatment date, an inpatient outpatient classification, a clinical department code, a score, and the like. The medical information refers to, for example, information on the date, medical practice, medicine, specific equipment, clinical department, etc. described in the electronic medical record transmitted from the electronic medical record order system, and the medical information database from the medical information input device 10. It is input to 22. The medical care information database 22 stores medical care information input from the medical care information input device 10. Based on the medical information stored in the medical information database 22, a self-pay invoice for the patient to pay the medical fee at the counter and a medical receipt to be submitted by the medical institution to the examination institution are created.

The injury / illness name database 23 is a collection of data that stores the injury / illness name, the date of medical treatment, comments from the doctor regarding the symptom, etc. in association with the patient ID. The injury / illness name is generally represented by the disease name code corresponding to the injury / illness name, but may be represented by the injury / illness name itself. The injury / illness name, date, comment, etc. are extracted from the electronic medical record transmitted from the electronic medical record order system, for example, and stored in the injury / illness name database 23. Extraction of injury / illness name, date, comment, etc. from the electronic medical record may be automatic or manual.

The medical information input device 10 includes a signal processing circuit 11, a communication interface circuit 12, an input interface circuit 13, an output interface circuit 14, and a storage circuit 15.

The communication interface circuit 12 is realized by, for example, a communication port or the like. The communication interface circuit 12 serves as an interface for communication with the LAN. The communication interface circuit 12 converts the signal output from the signal processing circuit 11 according to a preset method, and outputs the converted signal to the LAN. Further, the communication interface circuit 12 receives a signal via the LAN and converts the received signal according to a preset method. The communication interface circuit 12 outputs the converted signal to the signal processing circuit 11.

The input interface circuit 13 is realized by, for example, a mouse, a keyboard, a touch pad on which instructions are input by touching an operation surface, and the like. The input interface circuit 13 is connected to the signal processing circuit 11, converts an operation instruction input from the operator into an electric signal, and outputs the electric signal to the signal processing circuit 11. In the present specification, the input interface circuit 13 is not limited to the one provided with physical operating parts such as a mouse and a keyboard. For example, there is also an electric signal processing circuit that receives an electric signal corresponding to an operation instruction input from an external input device provided separately from the medical information input device 10 and outputs this electric signal to the signal processing circuit 11. It is included in the example of the input interface circuit 13.

The output interface circuit 14 is realized by, for example, connection ports such as an HDMI (registered trademark) terminal, a DVI terminal, and a USB terminal. The output interface circuit 14 is connected to, for example, a display circuit 16 or the like. The output interface circuit 14 outputs the signal output from the signal processing circuit 11 to the connected display circuit 16.

The storage circuit 15 has a recording medium that can be read by a processor, such as a magnetic or optical recording medium or a semiconductor memory. The storage circuit 15 stores various programs for the signal processing circuit 11 to realize a predetermined function.

Further, the storage circuit 15 stores the calculation navigation master 151. In the calculation navigation master 151, a pattern corresponding to a case where there is a possibility of omission of billing and a condition for corresponding to this pattern are defined. The pattern is a medical practice, drug, or specific equipment that may be missed, in other words, a medical practice, drug, or specific equipment that is reported to be able to be calculated if certain conditions are met. Etc. are specified. For example, the pattern is a medical practice that is reported to be able to be calculated in combination with a medical practice, a drug, a specific equipment, etc. that has already been entered when a medical examination with a predetermined injury or illness name is made. , Pharmaceuticals, or specified equipment, etc. Further, for example, the pattern defines a medical practice, a drug, a specific equipment, etc., which is reported to be able to be calculated in combination with the predetermined medical practice when a predetermined medical practice or the like is performed. .. The pattern is defined based on a plurality of items specified in the pattern definition master. Multiple items specified in the pattern definition master are related to identification information set for each pattern, information on preconditions for determining whether or not the pattern is applicable, guidance information set for each pattern, etc. Is. Hereinafter, the definition of a pattern is referred to as a pattern definition. The pattern definition will be described in detail later.

The conditions for corresponding to the pattern are defined based on a plurality of items defined by the condition set definition master, the item definition master, and the disease name definition master. The plurality of items specified in the condition set definition master relate to information for classifying the conditions to be set, information for quantitatively evaluating the classified conditions, and the like. The plurality of items specified in the item definition master are related to the items to be compared under the conditions defined by the condition set definition. The plurality of items specified in the disease name definition master relate to the disease names to be compared under the conditions defined by the condition set definition. In the following, the definitions of conditions will be referred to as condition set definitions, item definitions, and disease name definitions. The condition set definition can create n records for the pattern definition. The item definition can create n records for the condition set definition. The disease name definition can create n records for the condition set definition. The condition set definition, item definition, and disease name definition will be described in detail later.

Further, the storage circuit 15 stores information read from the patient basic information database 21, the medical care information database 22, and the injury / illness name database 23.

The signal processing circuit 11 is a processor that reads and executes each program for realizing the processing function from the storage circuit 15. The signal processing circuit 11 realizes various functions shown in FIG. 1 by executing a program read from the storage circuit 15. That is, the signal processing circuit 11 includes a master registration function 111, a medical treatment content input function 112, an input guidance function 113, and a display control function 114. Note that FIG. 1 describes a case where the master registration function 111, the medical treatment content input function 112, the input guidance function 113, and the display control function 114 are realized by a single processor, but the present invention is not limited thereto. For example, a signal processing circuit is configured by combining a plurality of independent processors, and a master registration function 111, a medical treatment content input function 112, an input guidance function 113, and a display control function 114 are realized by each processor executing a program. It doesn't matter.

The master registration function 111 is a function for registering a pattern definition, a condition set definition, an item definition, and a disease name definition for a condition corresponding to this pattern in the calculation navigation master 151. In the master registration function 111, the signal processing circuit 11 causes the display circuit 16 to display the calculation navigation master registration screen. The calculation navigation master registration screen is provided with an area for inputting necessary items in a plurality of items specified by the pattern definition master, the condition set definition master, the item definition master, and the disease name definition master. By inputting necessary items in the predetermined area on the calculation navigation master registration screen via the input interface circuit 13, the operator defines the pattern, and the condition set definition, item definition, and disease name definition for the conditions corresponding to this pattern definition. Is registered.

The registered pattern definition, the condition set definition, the item definition, and the disease name definition for the conditions corresponding to this pattern definition will be specifically described below. FIG. 2 is a diagram showing a display example of the display circuit 16 showing a list of registered patterns. The screen shown in FIG. 2 includes a search condition area F1 and a search result list F2.

The search condition area F1 includes a target month F11, a range designation F12, a pattern number F13, a pattern name F14, and an inspection F15. The year and month of the system date is entered as the default value in the target month F11, and either "only", "after", or "less than" the year and month entered in the target month F11 is entered in the range specification F12. Entered. In FIG. 2, "H25-6" month "after" is input, and a pattern whose expiration date is set to "after June 2013" is searched.

A "pattern number" is input to the pattern number F13 as a search condition. In FIG. 2, there is no input for the pattern number F13. In the pattern name F14, a "pattern name" is input as a search condition. In FIG. 2, there is no input for the pattern name F14. In the inspection F15, selections of "inspection target" and "non-inspection target" are input as search conditions. In FIG. 2, both "inspection target" and "non-inspection target" are checked, and the pattern in which "inspection target presence / absence" is set as "inspection target" in the pattern definition and "not inspected" And the set pattern will be searched.

In the search result list F2, the pattern extracted by the search condition input in the search condition area F1 is displayed. According to FIG. 2, eight patterns are presented.

"Inspection" in the search result list F2 indicates whether or not "inspection target presence / absence" in the pattern definition is set as "inspection target". That is, if the "Inspection" box is checked, "Inspection target" in the pattern definition is set to "Inspection target", and if it is not checked, it is set to "Not inspected". There is. In FIG. 2, in the upper four patterns, "presence or absence of inspection target" in the pattern definition is set as "inspection target", and in the lower four patterns, "not inspected" is set.

In the "pattern number", the "pattern number" in the pattern definition is displayed. In FIG. 2, patterns of pattern numbers: "13000001" to "13000004", "1300101" to "1300103", and "1300201" are displayed.

In the "pattern name", the "pattern name" in the pattern definition is displayed. In FIG. 2, for example, the pattern name of the pattern number: "13000001" is "check for omission of calculation of virus disease guidance fee 1."

As the "display order", the "display priority order" in the pattern definition is displayed. The value of the display order is set from 0 to 9. Higher values are displayed in order from the set pattern. If the display order overlaps, the pattern number will be in ascending order. In FIG. 2, for example, the display order of the pattern number: "13000001" is "1". In FIG. 2, since the judgment result of the inspection target is displayed with priority, the pattern (13000001 to 13000004) whose display order is "1" is displayed rather than the pattern (1300 0101 to 13000103) whose display order is "9". Is displayed at the top.

For "disease diagnosis", the "disease diagnosis category" in the pattern definition is displayed, and either "all", "clinic", "hospital (less than 200 beds)", or "hospital (200 beds or more)" is displayed. Will be done. In FIG. 2, for example, the “disease diagnosis” of the pattern number: “13000001” is “all”.

For "entrance / outside", the "entrance / outside classification" in the pattern definition is displayed, and either "entrance / outside", "outpatient", or "hospitalization" is displayed. In FIG. 2, for example, the entry / exit classification of the pattern number: “13000001” is “outpatient”.

For "medical tooth", "medical and dental classification" in the pattern definition is displayed, and either "medical dentistry", "medical department", or "dentistry" is displayed. In FIG. 2, for example, the medical tooth having the pattern number: "13000001" is "medical".

For the "inspection period", the "inspection period" in the pattern definition is displayed, and "only the corresponding month" or "the corresponding month-n months" is displayed. In addition, "corresponding month only" is represented by 0, and "corresponding month-n months" is represented by n having a maximum value of 12. In FIG. 2, for example, the inspection period of the pattern number: “13000001” is “2”, that is, “corresponding month-2 months”.

As the "processing method", the "processing method" in the pattern definition is displayed, and "check", "generation within the division", "generation outside the division", or "item replacement" is displayed. In addition, "check" means to display the pointed out sentence message when the condition is matched. "Generation within the delimiter" indicates that if the conditions are met, a pointed-out text message is displayed, and if there is a corresponding parent item, generation within the delimiter is possible. "Generation outside the delimiter" indicates that the indication text message is displayed when the conditions are met, and the generation outside the delimiter is possible. "Item replacement" indicates that a pointed-out text message is displayed when the conditions are met, and if there is a corresponding replacement item, the item is replaced. In FIG. 2, for example, the processing method of the pattern number: "13000001" is "check".

When any of the patterns described in the search result list F2 is specified, the detailed setting screen of the specified pattern is displayed. In the following, a case where a pattern with the pattern number: "13000001" in FIG. 2 is specified will be described as an example. FIG. 3 is a diagram showing an example of a screen for detailed pattern setting for a pattern with the pattern number: “13000001” shown in FIG. 2.

The screen shown in FIG. 3 includes a common pattern unit F3, a basic check unit F4, a condition set unit F5, and a calculation navigation setting F6. The items included in the common pattern unit F3, the basic check unit F4, and the calculation navigation setting F6 relate to the pattern definition. Further, the items included in the condition set unit F5 relate to the condition set definition, the item definition, and the disease name definition. The common pattern unit F3 has a pattern number F31, an effective start date F32, an effective end date F33, a pattern name F34, an inspection target F35, a medical examination category F36, an entry / exit category F37, a medical / dental category F38, an inspection period F39, and a display order. Includes F310.

In the pattern number F31, the "pattern number" in the pattern definition is set. In FIG. 3, the pattern number: "13000001" is set.

In the effective start date F32, the "application start date" in the pattern definition is set. In the valid end date F33, the "application end date" in the pattern definition is set. In FIG. 3, "H24-4" is set in the "application start date" and "not set" is set in the "application end date". As a result, the expiration date will be after April 2012.

In the pattern name F34, the "pattern name" in the pattern definition is set. In FIG. 3, the pattern name: “Check for omission of calculation of virus disease guidance fee 1” is set.

In the inspection target F35, the "inspection target presence / absence" in the pattern definition is set from either "inspection target" or "inspection target non-inspection target". In FIG. 3, the "inspection target" is set.

In the medical examination category F36, the "disease examination category" in the pattern definition is "clinic", "hospital (less than 200 beds)", "hospital (200 beds or more)", "any two", or "all". It is set from any of. In FIG. 3, all the boxes of "clinic", "hospital (less than 200 beds)", and "hospital (200 beds or more)" are checked, and "all" is set.

In the entry / exit classification F37, the “entrance / exit classification” in the pattern definition is set from either “entrance / outside”, “outpatient”, or “hospitalization”. In FIG. 3, "outpatient" is set.

In the medical and dental division F38, the "medical and dental division" in the pattern definition is set from either "medical dentistry", "medical department", or "dental". In FIG. 3, "medical department" is set.

In the inspection period F39, the "inspection period" in the pattern definition is set from 0 to 12. In FIG. 3, "2" is set.

In the display order F310, the "display priority order" in the pattern definition is set from 0 to 9. In FIG. 3, "1" is set.

The basic check unit F4 includes a clinical department F41, an age check category F42, an age lower limit F43, an age upper limit F44, and a gender F45. When the basic check unit F4 is specified, the screen of FIG. 4 in which the clinical department F41, the age check category F42, the age lower limit F43, the age upper limit F44, and the gender F45 can be set is displayed. FIG. 4 is a diagram showing an example of a screen for setting the basic check unit F4 shown in FIG.

Item shown in FIG. 4: The set value of the “clinical department” corresponds to the clinical department F41 shown in FIG. 3, and corresponds to the “clinical department” in the pattern definition. A plurality of "clinical department" setting values can be set from among the clinical department candidates. In FIGS. 3 and 4, "01, 02" is set.

Item shown in FIG. 4: “Age check category” corresponds to the age check category F42 shown in FIG. 3, and corresponds to the “age check category” in the pattern definition. As the set value of the age check category, either "no check", "age of medical treatment month" or "day age" is input. The age of the medical treatment month means the age of the first day of the calculation month, and the day age means the age of the calculation day. In FIGS. 3 and 4, the “age of the medical treatment month” is set.

Item shown in FIG. 4: The set value of "age lower limit" corresponds to the age lower limit F43 shown in FIG. 3, and corresponds to "age (lower limit)" in the pattern definition. Further, the set value of the item shown in FIG. 4: "age upper limit" corresponds to the age upper limit F44 shown in FIG. 3, and corresponds to "age (upper limit)" in the pattern definition. In FIGS. 3 and 4, the lower limit of age and the upper limit of age are set to "0" and "15", respectively.

Item shown in FIG. 4: The set value of "gender" corresponds to gender F45 shown in FIG. 3, and corresponds to "gender" in the pattern definition. As the gender setting value, either "no check", "male", or "female" is input. In FIGS. 3 and 4, "no check" is set.

The calculation navigation setting F6 includes the guidance method F61 and the indication document F62. In the guidance method F61, the "processing method" in the pattern definition is set from any of "check", "generation within the division", "generation outside the division", or "item replacement". In FIG. 3, "check" is set.

In the indication document F62, the "guidance indication sentence" in the pattern definition is set. In the pointed out document F62, for example, "Isn't it possible to calculate" XXX "as guidance information? ] Is set. In "XXXX", the name of the item for which the calculation is to be guided is input. The item name for which the calculation is to be guided is a medical practice, drug, or specific equipment that is reported to be able to be calculated if the conditions specified by the condition set definition, item definition, and disease name definition are met. And so on. In Fig. 3, isn't it possible to calculate the "virus disease guidance fee 1"? ] Is set.

As a result, necessary items are input to a plurality of items included in the pattern definition. That is, according to the example shown in FIG. 3, "pattern number: 13000001", "application start date: H24-4", "application end date: not set", "pattern name: virus disease guidance fee 1 omission of calculation". "Check", "Inspection target: Inspection target", "Display priority: 1", "Disease diagnosis category: All", "Entry / exit category: Outpatient", "Medical and dental category: Medical department", "Inspection period: Applicable month" -2 months "," Department: 01,02 "," Age check category: Age of medical treatment month "," Age (lower limit): 0 "," Age (upper limit): 15 "," Gender: No check ", Isn't it possible to calculate "Processing method: Check" and "Induction pointed out sentence:" Virus disease guidance fee 1 "? ], And the pattern definition will be registered.

The condition set unit F5 includes a plurality of condition tabs. The conditions include classifications of "combination calculation conditions", "combination non-combination conditions", and "injury and illness name conditions", and these classifications are defined by "check classification" in the condition set definition. Condition set definition and item definition are registered for each condition tab corresponding to "combination calculation condition" or "combination non-conformity condition". In addition, the condition set definition and the disease name definition are registered for each condition tab corresponding to the "injury / disease name condition". The condition set unit F5 shown in FIG. 3 includes three condition tabs, namely, injury / illness name condition F51, item condition 1F52, and item condition 2F53. Note that FIG. 3 shows an example in which one "injury / disease name condition" and one "non-combination condition" are registered in the condition set unit F5, but the "combination calculation condition" and "combination calculation condition" are shown. A plurality of "impossible conditions" and "injury / illness name conditions" can be registered for each pattern definition.

The injury / illness name condition F51 includes a disease name inspection method F511, a main disease name check F512, a check method F513, and a product number designation F514. When the tab T1 is selected, the screen of FIG. 5 in which the disease name inspection method F511, the main disease name check F512, the check method F513, and the product number designation F514 can be set is displayed. FIG. 5 is a diagram showing an example of a screen for setting the injury / illness name condition F51 shown in FIG.

The setting screen shown in FIG. 5 includes a condition designation F7 for the injury / illness name condition F51 and a product number designation F8. The condition designation F7 designates the calculation condition of the disease name designated in the product number designation F8. The product number designation F8 designates a disease name to be confirmed whether or not it is included in the injury / illness name read from the injury / illness name database 23.

Item shown in the condition designation F7 of FIG. 5: The set value of the "check method" corresponds to the check method F513 shown in FIG. 3, and corresponds to the "check method" in the condition set definition. Either "AND" or "OR" is set as the setting value of the "check method". "AND" means that the condition is satisfied when all the specified items exist, and "OR" means that the condition is satisfied when the specified items exist. In FIGS. 3 and 5, "OR" is set.

The item shown in the condition designation F7 in FIG. 5: The set value of the "disease name check method" corresponds to the disease name inspection method F511 shown in FIG. 3, and corresponds to the "disease name check method" in the condition set definition. The "disease name check method" represents a method of injury / illness name when comparing the injury / illness name read from the injury / illness name database 23 with the disease name designated by the product number designation 8. As the setting value of the "disease name check method", either "name", "disease name code", or "ICD10" is set. In FIGS. 3 and 5, a “disease name code” is set.

The item shown in the condition designation F7 of FIG. 5: The set value of the "main disease name" corresponds to the main disease name check F512 shown in FIG. 3, and corresponds to the "main disease name check" in the condition set definition. The "main disease name" indicates whether the main disease name or the suspected disease name is to be compared. The setting value of the "main disease name" is set to either "all" or "only the main disease name". "All" means that both the main disease name and the suspected disease name are subject to the check. In FIG. 3, the box for "main disease name" and the box for "suspected disease name" are checked, and in FIG. 5, "all" is set. That is, in FIGS. 3 and 5, both the main disease name and the suspected disease name are subject to determination.

The input values for "No", "disease name", and "ICD" shown in the product number designation F8 in FIG. 5 correspond to the product number designation F514 shown in FIG. 3, and correspond to the "disease name code" in the disease name definition. .. The input values for "No", "disease name", and "ICD" are the names of injuries and illnesses. In FIGS. 3 and 5, for example, "No: 1", "disease name: fulminant hepatitis A", and "ICD: B150" are set.

By inputting necessary items in a plurality of items in the injury / illness name condition F51, the condition set definition and the disease name definition will be registered. That is, according to the example shown in FIG. 3, "pattern number: 13000001", "check category: injury / disease name condition", "check method: OR", "disease name check method: disease name code", and "main disease name check:". All will be set and the condition set definition will be registered. Further, according to the example shown in FIG. 3, "Pattern number: 13000001", "Disease name code 1: B150", "Disease name code 2: B159", ..., "Disease name code 8: B169" are set. The disease name definition will be registered.

Item condition 1F52 includes a calculation inspection method F521, a category F522, a period F523, a period F524, F525, a quantity F526, a quantity F527, F528, a comprehensive F529, a check method 5210, and a product number designation F5211. In the item condition 1F52, the calculation inspection method F521 is set as a "condition that cannot be used together". Under the conditions that cannot be used in combination, guidance fees and management fees that specify drugs, medical practices, specific equipment, etc. that cannot be combined on the same day or the same month, previous month, and all periods are specified. When the tab T2 is selected, the classification F522, the period F523, the period F524, F525, the number F526, the quantity F527, F528, the comprehensive F529, the check method 5210, and the product number designation F5211 can be set for the conditions that cannot be used together, the screen of FIG. Is displayed. FIG. 6 is a diagram showing an example of a screen for setting the item condition 1F52 shown in FIG.

The setting screen shown in FIG. 6 includes a condition designation F9 and a product number designation F10 for the item condition 1F52 indicating the “non-combinable condition”. The condition designation F9 designates the calculation condition of the product number specified in the product number designation F10. The product number designation F10 designates a medical practice, a drug, a specific device, etc. that is a target for confirming whether or not it is included in the medical practice, drug, or specific equipment read from the medical information database 22.

Item shown in the condition designation F9 of FIG. 6: The set value of the "check method" corresponds to the check method F5210 shown in FIG. 3, and corresponds to the "check method" in the condition set definition. Either "AND" or "OR" is set as the setting value of the "check method". In FIGS. 3 and 6, "OR" is set.

The item shown in the condition designation F9 of FIG. 6: The set value of "number of times / number identification" corresponds to the number F526 shown in FIG. 3, and corresponds to "calculation check number identification" in the condition set definition. The setting value of "number of times / number identification" is set to either "number of times" or "quantity x number of times". In FIGS. 3 and 6, "quantity x number of times" is set.

The item shown in the condition designation F9 in FIG. 6: The set value of "number of times / number" corresponds to the quantity F527 shown in FIG. 3, and corresponds to the "calculation check quantity" in the condition set definition. The setting value of "number of times / number" is set to any one of 0 to 999999.99999. In FIGS. 3 and 6, "1" is set.

The item shown in the condition designation F9 of FIG. 6: The set value of the "number of times / quantity determination category" corresponds to the quantity F528 shown in FIG. 3, and corresponds to the "calculation check quantity determination category" in the condition set definition. The setting value of the "number of times / quantity determination category" is set to either "items are n times or more" or "items are less than n times". In FIGS. 3 and 6, "items are n times or more" is set.

The item shown in the condition designation F9 of FIG. 6: The setting value of "0-point delimiter target control" corresponds to "0-point delimiter target control" in the condition set definition. As the set value of "0-point delimiter control", either "0-point delimiter target" or "0-point delimiter target" is set. In FIG. 6, "0-point delimiter target" is set.

Item shown in the condition designation F9 of FIG. 6: The set value of the "check period classification" corresponds to the classification F522 shown in FIG. 3, and corresponds to the "calculation check classification" in the condition set definition. The set values of "Check period classification" are "None", "Period", "First hospitalization date", "This hospitalization date", "This discharge date", "Discharge date", "First visit date", "Surgery date". , "Implantation day", "Transplant day", "Cardiovascular rehabilitation", "Cerebrovascular rehabilitation", "Exercise rehabilitation", "Respiratory rehabilitation", "Disability child rehabilitation", "Cancer rehabilitation", Alternatively, either the "onset date" is set. In the "period", it is checked every calculation period (n months, n weeks, n days) from the processing date. In the "first hospitalization date", the starting date of the hospitalization history belonging to the processing date is checked as the reference date. In the "current hospitalization date", the hospitalization date of the hospitalization history belonging to the processing date is checked as the reference date. In the "current discharge date", the discharge date of the hospitalization history belonging to the processing date is checked as the reference date. In the "discharge date", the discharge date before the processing date is checked as the reference date. The "first visit date" is checked on the reference date based on the first visit date before the treatment date. In "surgery date", "implantation surgery date", and "transplant surgery date", the surgery date before the treatment date is checked as the reference date. In "cardiovascular rehabilitation", "cerebrovascular rehabilitation", "motor organ rehabilitation", "respiratory rehabilitation", "disabled child rehabilitation", "cancer rehabilitation", and "onset date", the onset date before the treatment date is indicated. Checked on base date. In FIGS. 3 and 6, a "period" is set.

Item shown in the condition designation F9 of FIG. 6: The set value of the "check unit" corresponds to the period F523 shown in FIG. 3, and corresponds to the "calculation check unit" in the condition set definition. The setting value of the "check unit" is set to any one of "days", "months", "calendar month", "weeks", or "calendar week". In FIGS. 3 and 6, a "calendar month" is set.

The item shown in the condition designation F9 of FIG. 6: The set value of the “number of check periods” corresponds to the period F524 shown in FIG. 3, and corresponds to the “number of calculation check periods” in the condition set definition. The number of calculation check periods is set in the set value of "number of check periods". In FIGS. 3 and 6, "1" is set.

Item shown in the condition designation F9 of FIG. 6: The set value of the "check condition" corresponds to the period F525 shown in FIG. 3, and corresponds to the "calculation check condition" in the condition set definition. "Within" or "after" is set as the setting value of the "check condition". In FIGS. 3 and 6, "within" is set.

Item shown in condition designation F9 of FIG. 6: The setting value of "presence or absence of comprehensive item target" corresponds to comprehensive F529 shown in FIG. 3, and corresponds to "presence or absence of comprehensive item target" in the condition set definition. “Presence / absence of comprehensive item target” indicates whether or not the item specified by the product number designation F10 is subject to comprehensive evaluation. Either "Comprehensive item target" or "Not comprehensive item target" is set in the set value of "Presence / absence of comprehensive item target". In FIGS. 3 and 6, "comprehensive item target" is set.

The input values for the "product number" and the "product name" shown by the product number designation F10 in FIG. 6 correspond to the product number designation F5211 shown in FIG. 3, and correspond to the "internal part number" in the item definition. The input values for the "product number" and the "product name" are for medical practice, pharmaceutical products, specific equipment, and the like. In FIGS. 3 and 6, for example, "product number: 150" and "product name: virus disease guidance fee 1" are set.

By inputting necessary items in a plurality of items in the item condition 1F52, the condition set definition and the item definition will be registered. That is, according to the example shown in FIG. 3, "Pattern number: 13000001", "Check category: Cannot be used in combination", "Check method: OR", "Calculation check category: Period", "Calculation check unit: Calendar month". , "Calculation check period: 1", "Calculation check condition: Within", "Calculation check quantity identification: Quantity x number of times", "Calculation check quantity: 1", "Calculation check quantity judgment category: n or more items , And "Presence / absence of comprehensive item target: Comprehensive item target", and the condition set definition will be registered. Further, according to the example shown in FIG. 3, "Pattern number: 13000001", "Internal part number: 150", "Internal part number: 454", ..., "Internal part number: 325" are set, and the item definition is set. It will be registered.

Although nothing is specified in the item condition 2 shown in FIG. 3, a "combination calculation condition" may be registered depending on the pattern. In the combined calculation conditions, the guidance fee and management fee that specify the drug, medical practice, specific equipment, etc. to be calculated are specified. When the tab for "combination calculation conditions" is selected, for example, the screen of FIG. 7 is displayed in which predetermined items can be input to the items for the combination calculation conditions. FIG. 7 is a diagram showing an example of a screen for setting a combined calculation condition registered in the condition set unit.

The setting screen shown in FIG. 7 includes a condition designation F101 for a “combination calculation condition” and a product number designation F102. The condition designation F101 specifies the calculation condition of the product number specified in the product number designation F102. Each item shown in the condition designation F101 is the same as the condition designation F9 shown in FIG.

The product number designation F102 designates a medical practice, a drug, a specific device, or the like to be checked whether or not it is included in the medical practice, the drug, or the specific device, etc. read from the medical information database 22. The input values for the "product number" and the "product name" shown in the product number designation F102 in FIG. 7 are for medical practice, pharmaceutical products, specific equipment, and the like. In FIG. 7, for example, “product number: 470377” and “product name: artificial kidney (chronic maintenance dialysis) (less than 4 hours)” are set.

Condition set definition and item definition are registered by inputting necessary items in multiple items in the combined calculation condition.

In FIGS. 3 to 6, the pattern definition, the condition set definition, the item definition, and the disease name definition are specifically described for the already registered “pattern number: 13000001”. The screens shown in FIGS. 3 to 6 are also used when newly registering a pattern. When a pattern is newly registered, the signal processing circuit 11 accepts inputs for the items described with reference to FIGS. 3 to 6, and based on the input contents, the pattern definition, the condition set definition, the item definition and the disease name definition are defined. To register. For example, the pattern definition is registered by inputting necessary items into the items included in the common pattern unit F3, the basic check unit F4, and the calculation navigation setting F6 shown in FIG. Further, by inputting necessary items into the items included in the condition set unit F5 shown in FIG. 3, the condition set definition, the item definition, and the disease name definition are registered. When it becomes necessary to newly register a pattern, there are cases where a new report regarding omission of claims is received, or where the law is amended.

The medical treatment content input function 112 is a function for inputting medical treatment information into the medical treatment information database 22. The operator (medical office staff) of the medical information input device 10 refers to, for example, an electronic medical record transmitted from an electronic medical record order system, and inputs medical information from the input interface circuit 13 to the signal processing circuit 11. The signal processing circuit 11 stores the input medical information in the server 20 via the communication interface circuit 12.

The input guidance function 113 is a function for inducing an operator to input a measurable medical practice, a drug, a specific device, or the like based on the calculation navigation master 151. In the input guidance function 113, the signal processing circuit 11 stores in the calculation navigation master 151 whether or not there is a calculable item in addition to the medical information already stored in the medical information database 22 in response to an instruction from the operator. Check for each pattern. The signal processing circuit 11 causes the display circuit 16 to display items that are further determined to be calculable. When the signal processing circuit 11 receives consent from the operator for the displayed item, the signal processing circuit 11 stores the consented item in the medical information database 22.

The specific operation of the signal processing circuit 11 when inducing the input of calculable medical information will be described with reference to FIG. FIG. 8 is a flowchart showing an example of processing when the signal processing circuit 11 shown in FIG. 1 presents items that can be calculated and the presented items are stored in the medical information database 22.
First, the signal processing circuit 11 receives an instruction to start calculation guidance (step S81). The start instruction includes information that can identify the patient inputting the medical information, for example, the patient ID. When the signal processing circuit 11 receives the instruction to start the calculation guidance, the signal processing circuit 11 reads out the basic patient information regarding the patient ID from the basic patient information database 21 based on the received patient ID (step S82). Here, the basic patient information regarding the patient ID is, for example, the gender, age, and the like of the patient.

The signal processing circuit 11 reads out the information set in the registered pattern definition, condition set definition, item definition, and disease name definition from the calculation navigation master 151 (step S83). For example, the signal processing circuit 11 has, regarding the registered pattern definition, "pattern number", "application start date", "application end date", "pattern name", "inspection target presence / absence", "display priority order", "Disease diagnosis category", "entrance / exit category", "medical / dental category", "inspection period", "clinical department", "age check category", "age (lower limit)", "age (upper limit)", "gender" , "Processing method", and "Induction pointed out sentence" are read out. Further, the signal processing circuit 11 has "pattern number", "check classification", "check method", "calculation check classification", "calculation check unit", and "number of calculation check periods" for the registered condition set definition. , "Calculation check condition", "Calculation check quantity identification", "Calculation check quantity", "Calculation check quantity judgment classification", "Comprehensive item target presence / absence", "Disease name check method", and "Main disease name check" are read out. Further, the signal processing circuit 11 reads out the "pattern number" and the "internal part number" for the registered item definition. Further, the signal processing circuit 11 reads out the "pattern number" and the "disease name code" for the registered disease name definition.

The signal processing circuit 11 reads out the medical care information associated with the patient ID from the medical care information database 22. Further, the signal processing circuit 11 reads the injury / illness name associated with the patient ID from the injury / illness name database 23 (step S84). At this time, the signal processing circuit 11 reads out the medical information and the name of the injury or illness for the period corresponding to the "inspection period" defined for each pattern.

The signal processing circuit 11 compares the read basic patient information and medical care information with the setting contents of the pattern definition, and extracts a pattern that matches the basic patient information and medical care information from the registered patterns (). Step S85). For example, the current date is "October 2015", the medical institution is "hospital (less than 200 beds)", and "age: 13" and "gender: male" are indicated by the basic patient information. , When the medical information indicates "entrance / exit category: outpatient", "medical / dental category: medical", "clinical department: internal medicine", these information are for "pattern number: 13000001" shown in FIG. Setting contents, that is, "application start date: H24-4", "application end date: not set", "inspection target presence / absence: inspection target", "medical examination category: all", "entrance / outside category: outpatient", " Medical / Dental Category: Medical Department, Medical Department: 01,02, Age Check Category: Age of Medical Month, Age (Lower Limit): 0, Age (Upper Limit): 15, and Gender: Check No "matches. The signal processing circuit 11 extracts the pattern of "pattern number: 13000001".

The signal processing circuit 11 determines whether or not the pattern can be extracted (step S86). If the extraction could not be performed (No in step S86), the signal processing circuit 11 ends the processing. If it can be extracted (Yes in step S86), the signal processing circuit 11 defines the medical information and the injury / illness name read in step S84, and the condition set definition, the item definition, and the disease name definition corresponding to the pattern extracted in step S85. Compare with the settings of. The signal processing circuit 11 extracts a pattern in which the condition is satisfied by the read medical information and the name of the injury or illness (step S87).

For example, when the disease name read from the injury / disease name database 23 is “B150 (hepatitis A fulminant hepatitis)”, the read disease name satisfies the injury / disease name condition F51 of “pattern number: 13000001”. In addition, the medical information read from the medical information database 22 is "calculation check category: period", "calculation check unit: calendar month", "calculation check period number: 1", "calculation check condition: within", "calculation check". In "quantity identification: quantity x number of times", "calculation check quantity: 1", "calculation check quantity judgment classification: item is n times or more", and "presence or absence of comprehensive item target: comprehensive item target", "product number: 150 (virus disease) If it does not match "Instruction fee 1)", "Product number: 454 (virus disease instruction fee 2)", ..., And "Product number: 325 (pediatric medical treatment instruction fee)", the read medical information is "Pattern number: 13000001". Item condition 1F52 is satisfied. The signal processing circuit 11 extracts "pattern number: 13000001" that satisfies the injury / illness name condition F51 and the item condition 1F52.

The signal processing circuit 11 refers to the “processing method” and the “guidance indication sentence” set in the pattern extracted in step S87, and causes the display circuit 16 to display the guidance indication sentence (step S88). For example, when "Pattern number: 13000001" is extracted in step S87, "Isn't it possible to calculate" Virus disease guidance fee 1 "?" Set in "Pattern number: 13000001" is displayed on the display circuit. Displayed at 16. FIG. 9 is a diagram showing a display example of the display circuit 16 on which the guidance indication sentence is displayed. In FIG. 9, for example, "type A fulminant hepatitis" is displayed in the "pointed out item", and the "guided pointed out sentence" set in the pattern definition is displayed in the "pointed out sentence". In the "pointed out item", for example, the disease name presented in the "injury / disease name condition", that is, the disease name that matches the injury / disease name read from the injury / disease name database 23 among the disease names set in the disease name definition is described. Will be done. In addition, the "pointed out item" includes, for example, the medical practice, drug, or specific equipment presented in the "combination calculation conditions", that is, the medical practice, drug, or specific equipment set in the item conditions. , The medical practice, the drug, the specific device, etc. that match the medical practice, the drug, or the specific device, etc. read from the medical information database 22 are described.

The signal processing circuit 11 determines whether or not the operator has consented to the guidance text to be displayed (step S89). When consent is obtained from the operator, the signal processing circuit 11 stores the consented guidance sentence and the corresponding item name in the medical information database 22 (step S810), and ends the process. For example, "Pointed item: Fulminant hepatitis A" and "Pointed text:" "Virus disease guidance fee 1" can be calculated as shown in Fig. 9. Isn't it possible? If the operator approves the "virus disease guidance fee 1", the "virus disease guidance fee 1" is associated with the medical treatment date when "type A fulminant hepatitis" was diagnosed and the score of the "virus disease guidance fee 1". It is stored in the medical information database 22.

As described above, in the above embodiment, the medical care information input device 10 reads out the medical care information stored in the medical care information database 22. The medical information input device 10 compares the read medical information with the conditions stored in the calculation navigation master 151 for the pattern of possible bill omission. When the read medical care information satisfies the condition, the medical care information input device 10 determines that the pattern corresponds to the pattern, and displays a sentence for guiding the input of the medical care information that can be calculated. Then, the medical information input device 10 stores the medical information in the medical information database 22 when the person in charge of the medical office approves the input of the medical information that can be calculated. As a result, regardless of the knowledge possessed by the person in charge, the medical information that can be calculated based on the medical information stored in the medical information database 22 is stored in the medical information database.

Therefore, according to the medical accounting system according to the present embodiment, it is possible to efficiently input medical treatment contents while eliminating individual differences between persons in charge.

Further, in the present embodiment, the medical information input device 10 further reads out the injury / illness name stored in the injury / illness name database 23. The medical information input device 10 compares the read medical information and the name of injury or illness with the conditions specified for the pattern of possible omission of billing stored in the calculation navigation master 151. If the read medical information and the name of the injury or illness satisfy the conditions, the medical information input device 10 determines that the pattern is applicable, and displays a sentence for guiding the input of the medical information that can be calculated. Then, the medical information input device 10 stores the medical information in the medical information database 22 when the person in charge of the medical office approves the input of the medical information that can be calculated. As a result, regardless of the knowledge possessed by the person in charge, the medical information that can be calculated based on the medical information stored in the medical information database 22 and the injury / illness name stored in the injury / illness name database 23 is stored in the medical information database. Will be.

Further, in the present embodiment, the pattern is defined by the pattern definition, and the conditions related to the pattern are defined by the condition set definition, the item definition and the disease name definition. This makes it possible to efficiently register a plurality of patterns.

Further, the medical care information input device 10 according to the present embodiment defines the medical care information read from the medical care information database 22 and the injury / illness name read from the injury / illness name database 23 as a pattern definition, a condition set definition, an item definition, and a disease name definition. I try to compare with. As a result, even when a plurality of patterns are registered, it is possible to efficiently present calculable medical information for each pattern.

Further, in the present embodiment, the condition set definition is represented by the injury / illness name condition, the combination calculation condition, and the combination non-combination condition. This makes it possible to efficiently register even if the conditions are complicated patterns.

The word "processor" used in the above description is, for example, a CPU (central processing unit), a GPU (Graphics Processing Unit), an integrated circuit for a specific application (Application Specific Integrated Circuit (ASIC)), or a programmable logic device (for example). , Simple Programmable Logic Device (SPLD), Complex Programmable Logic Device (CPLD), and Field Programmable Gate Array (FPGA)). The processor realizes the function by reading and executing the program stored in the storage circuit 15.

Although embodiments of the present invention have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. This embodiment can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the gist of the invention. This embodiment and its modifications are included in the scope and gist of the invention as well as the invention described in the claims and the equivalent scope thereof.

1 ... Medical accounting system, 10 ... Medical information input device, 11 ... Signal processing circuit, 12 ... Communication interface circuit, 13 ... Input interface circuit, 14 ... Output interface circuit, 15 ... Storage circuit, 151 ... Calculation navigation master, 16 ... Display Circuit, 20 ... server, 21 ... basic patient information database, 22 ... medical information database, 23 ... injury / illness name database, 111 ... master registration function, 112 ... medical treatment content input function, 113 ... input guidance function, 114 ... display control function

Claims (10)

A first storage unit that stores medical information, which is information related to medical treatment for a patient, in association with identification information that identifies a patient.
A second storage unit that stores basic patient information in association with the identification information, and
A third storage unit that stores a plurality of patterns defining a medical practice, a drug, or a specific device that can be calculated when the medical information and the basic patient information satisfy preset conditions.
A registration unit that registers the conditions set for each pattern according to the input from the operator, and the registration unit.
Based on the input identification information, the medical information is read from the first storage unit, the patient basic information is read from the second storage unit, and the medical treatment information and the patient basic information are set for each pattern. An input guidance unit that determines whether or not the conditions are met and outputs guidance information for guiding the calculation of the medical practice, drug, or specific equipment specified by the pattern that meets the conditions.
A medical accounting system including a display unit for displaying the guidance information. When the guidance information is accepted, the input guidance unit stores information about a medical practice, a drug, or a specific device whose calculation is induced by the consented guidance information in the first storage unit. The medical accounting system according to claim 1. The pattern stored in the third storage unit includes a pattern definition that defines a precondition for determining whether or not the pattern corresponds to the pattern, and a condition set definition for quantitatively evaluating the condition. Defined using
The input guidance unit determines whether or not the medical information and the basic patient information satisfy the preconditions, and is quantitatively evaluated by the condition set definition defined for the pattern definition that satisfies the preconditions. The medical accounting system according to claim 1 or 2, wherein it is determined whether or not the medical treatment information and the basic patient information satisfy the conditions. The medical accounting system according to claim 3, wherein the condition set definition defines at least one of a condition for an item that can be calculated in combination and a condition for an item that cannot be calculated in combination. It further comprises a fourth storage unit that stores the name of the injury or illness in association with the identification information that identifies the patient.
The input guidance unit further reads the injury / illness name from the fourth storage unit based on the input identification information, and the medical treatment information, the injury / illness name, and the basic patient information are set for each pattern. The medical affairs according to claim 1 or 2, which determines whether or not a certain condition is satisfied and outputs guidance information for guiding a calculation for a medical practice, a drug, or a specific device specified by a pattern satisfying the above condition. Accounting system. The pattern stored in the third storage unit includes a pattern definition that defines a precondition for determining whether or not the pattern corresponds to the pattern, and a condition set definition for quantitatively evaluating the condition. Defined using
The input guidance unit determines whether or not the medical information, the injury / illness name, and the basic patient information satisfy the preconditions, and quantifies them according to the condition set definition defined for the pattern definition that satisfies the preconditions. The medical accounting system according to claim 5, wherein it is determined whether or not the medical information, the name of injury or illness, and the basic patient information satisfy the conditions to be evaluated. The medical accounting system according to claim 6, wherein the condition set definition defines at least one of a condition for an item that can be calculated in combination, a condition for an item that cannot be calculated in combination, and a condition for an injury or illness name. Registration process to register the conditions set for each pattern according to the input from the operator,
When the identification information for identifying the patient is input, the first reading process for reading out the medical information, which is the information related to the medical treatment for the patient, which is stored in the first storage unit in association with the identification information,
When the identification information is input, a second read process for reading out the basic patient information stored in the second storage unit in association with the identification information, and
Judgment processing for determining whether or not the medical care information and the basic patient information satisfy the conditions set for each of the patterns stored in the third storage unit.
When the medical information and the basic patient information satisfy the conditions, an output for guiding the calculation of the medical practice, the drug, or the specific equipment that is associated with the conditions and can be calculated is output. Processing and
A medical accounting program that causes a computer of a medical accounting system to execute a display process for displaying the guidance information. When the guidance information is accepted, the computer executes a process of storing information about a medical practice, a drug, or a specific device whose calculation is guided by the consented guidance information in the first storage unit. The medical accounting program according to claim 8. When the identification information is input, the computer is further made to perform a third reading process of reading the injury / illness name stored in the fourth storage unit in association with the identification information.
The determination process determines whether or not the medical information, the injury / illness name, and the basic patient information satisfy the conditions set for each pattern stored in the third storage unit.
When the medical information, the injury / illness name, and the basic patient information satisfy the conditions, the output processing calculates the medical practice, the drug, or the specific equipment that can be calculated by being associated with the conditions. The medical accounting program according to claim 8 or 9, which outputs guidance information for guidance.

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