JPS63305459A - Medical information processing system - Google Patents

Abstract

PURPOSE:To easily execute maintenance at the time of correcting a law by assigning port numbers to the insurance sorts of respective pacients by means of a table and forming bills or other data based on the insurance number data. CONSTITUTION:An insurance port information table 121 to which insurance sort numbers are assigned is formed and a corresponding part based upon the insurance port information of an inputted pacient is extracted from the table 121 to set up a determination table 113. About specific plural items out of the pacient data, the contents of a retrieval table 111 are compared with that of the table 113, and at the time of detecting coincidence, the insurance sort number is outputted together with the pacient number in the pacient data, and if coincidence is not obtained, the contents of a partial items in the table 111 are converted into non-specific data and compared with the contents of the table 113. When coincidence is obtained, an insurance sort number is assigned to each pacient and then totalizing processing is executed. Consequently, efficient correspondence can be obtained at the time of correcting a law.

Description

[Detailed Description of the Invention] [Summary] The present invention provides a system for creating monthly medical fee claims for each insurance organization based on each patient's medical record data. A table is used to assign classification numbers to the types of insurance related to insurance, and invoices and other materials are created based on the number data.

[Industrial Application Field] The present invention relates to a medical information processing system for billing medical treatment fees at medical institutions such as hospitals and for creating various statistical materials, and in particular, the present invention relates to a medical information processing system for billing medical treatment fees at medical institutions such as hospitals and for creating materials such as various statistics. This system relates to a medical information processing system that creates medical fee claims (summary tables) and various monthly reports to be submitted to one or more hospitals.

[Prior Art] First, the current payment of medical expenses, which is the premise of the present invention, will be explained. Payment of medical expenses to medical institutions is billed and paid to each insurer (insurance institution) through the payment fund of each prefecture in the case of social insurance, and the National Health Insurance Federation in the case of national health insurance.

For this reason, medical institutions classify and organize each patient's medical records according to the patient's insurance and create medical fee statements (receipts) for each patient.
In addition, it is necessary to create and submit a medical fee bill (&! summary table) that summarizes the details for each insurance as a total bill for one month.

Therefore, aggregation and billing work for each insurance constitutes a large portion of medical work for medical institutions, but the insurance system, which is the unit of aggregation, is revised by law every few years, and the aggregation standards change accordingly.

Furthermore, the format of medical fee billing forms, which are the mainstay of medical institution aggregation work, is the one submitted by the National Health Insurance Federation, but each prefecture and municipality has its own insurance system, so each prefecture and municipality uses its own format for -a.

In other words, in the case of social insurance, patients are divided into the following types.

Combined use for the elderly (combined health insurance for the elderly and public funds), Individual use for the elderly (health insurance for the elderly), combined use of social insurance (combined use of social insurance and public funds), Individual use of social insurance alone, combined use of social insurance for family members (combined use of social insurance for family and public funds) combination), social insurance family alone.

In addition, in the case of National Health Insurance (National Health Insurance), it is divided into the following types depending on the insurer of each prefecture.

General, combined (National Health Insurance and public funds), retired person, retired family, combined retirement family, combination of elderly insurance, elderly insurance alone.

In the case of social insurance, the format of the actual medical fee bill (receipt) for each patient is almost uniform throughout the country, and the aggregation unit is as follows.

(b) Regarding this kind of social insurance, combined landing (combination of health insurance for the elderly and public expenditure), single landing... single social insurance for family members,
These classifications are almost uniform throughout the country as shown in the above-mentioned summary table.

In addition, in the case of National Health Insurance (National Health Insurance), it is classified by the insurer number determined by each prefecture, etc., and is divided into the following types.

(b) In other words, the classifications such as general (National Health Insurance alone), retirees themselves...old age insurance alone, etc. are also classified according to the summary table mentioned above depending on the National Health Insurance Federation, and although there are slight differences, they are basically the same. follows this classification.

There are multiple types of public funds, such as the Tuberculosis Prevention Act and the Public Assistance Act.

[Problems to be solved by the invention] As described above, from the medical administrative system side, the total must be printed in the above order, and the insurance number, which does not have to be a problem with social insurance, is Now, in order to submit it to the National Health Insurance Federation for each prefecture, we have to tally it up by insurer number.

Also, although the summary table does not have to be very detailed, it is desirable that the statistical data by insurance used within the medical institution be similar to the summary table. However, for the reasons mentioned above, mechanical uniform processing is not suitable for creating summary tables and associated insurance statistical data, and processing is performed exclusively according to each insurance, and occasionally When laws and regulations are revised and the corresponding processes change, the programs have to be modified one by one, making it impossible to achieve efficient processing.

[Means for Solving the Problems] The present invention provides for a medical institution such as a hospital, when each patient creates a monthly bill corresponding to each insurance organization based on each patient's medical record data. Classification numbers are assigned to related insurance types using a table, and bills and other materials are created based on the classification number data.

FIG. 1 shows a basic configuration diagram of the present invention.

In the figure, 10 is a terminal device for inputting patient data of each patient's medical fee statement, 11 is an information processing device, 12 is a storage device, 13 is a file (external storage device), 110 is a patient data register, and 111 is a search 112 is a comparison means, 113 is a determination table, 114 is an addressing means, 121 is an insurance classification information table, and 131 is an example of output data of search results.

[Operation] From the terminal device 10, data regarding a certain number of items, such as the patient's number, the main insurance type number, and the related legal number, are input and set in the patient data register 110. Next, from this insurance type number, address specification method 1
14 and obtain an address from the corresponding column, and use that address to store the insurance classification information table 12 in the storage device 12.
1 is accessed, and a one-minute table having the same insurance type number is taken out and held as a decision table 113 in the work diary tQ section of the information processing device 11.

On the other hand, if other data in the patient data register 110 is set in the search table 111 and a match is detected by comparing and collating with various contents in the decision table 113, the insurance classification number, which is the data contained in that column, is set to the search table 111. It is output to the file 13 together with the patient number in the data register 110. If no match is detected, a search is performed by sequentially converting some of the items in the search table 111 into non-specific data and comparing and collating them, and an insurance classification number is assigned to each patient.

〔Example〕

The configuration of the embodiment of the present invention is shown in FIG. 2 Ta+, and a specific example of the insurance classification information table therein is shown in FIG.
The operational flow of the configuration of the embodiment is shown in FIG. 3 (al and 3rd issue).

In FIG. 2(a), 20 is an information processing device, 21 is a storage device, 22 is a register that holds patient data, 23 is a search table, 24 is an index table, 25 is a decision table, 26 is a comparison means, and 27 is a A search table change instruction means, 28 a search result output means, and 29 an insurance classification information table.

The insurance classification information table shown in FIG.
0 represents each type of insurance payment form, and the patient falls under one of these types. ×1 in the column direction of this table
~×5 contains social insurance, national insurance, public expense, other classification, separation number, person/family classification, public expense 1, public expense 2, and insurance classification number, and the value does not matter for books in the figure (0 A value other than that indicates a match), and 0 indicates that it does not match.

This table is based on (a) described in the prior art section, and in the case of social insurance, there are 1 separation number, 1 individual and family, and 1 public expense. Public expense 2 is used as information for insurance classification, and according to (b), in the case of National Health Insurance, insurer number 1 (individual/family), public expense 1, public expense 2 is used as information for insurance classification (upper 2 of insurer number) The digit is the prefecture code).

First, when patient data is input into the register 22, four items from the separation number 203 to the separation number 206 of the public expense 2 are set in the search table 23 (300) in T8 of FIG. 3).

In addition, the insurance classification value in register 22 (1: social insurance,
2: National Health Insurance, 3: Public funds), the index table 24 is read out, the storage device 21 is accessed using the contents of the start point and end point address of the storage device 21, and the corresponding part of the insurance classification information table 29 is processed. Set as a decision table in the device 20 (310 to 360 in ta+ in FIG. 3)
.

As a result, the comparison means 26 compares the search table 23 and the decision table 25 from the farewell number to the public expense 2 item (different types for each row of the 2nd issue). Figure (al. 370).

In this comparison operation, when a match is detected, the insurance classification number of the matching row in the decision table 25 and the patient number 201 in the register 22 that holds patient data are given to the search result output means 28, and both numbers are are mapped and output (Fig. 3 (al. 380, 390)).

If no match is detected from the decision table 25,
The search table 23 is changed by the search table change instruction means 27.
Check whether the content of the first item is 1**", and if not, change the content of that item. This change is done by changing the legal number, which is an item in the search table 23, regardless of the value. (0
This is done by setting it to "*** (2-digit value), which indicates that the search result (excluding 200.410.370 in Fig. 3 (al)) is set to "*** (2-digit value).

If no result is obtained in this search, the content of the family is changed to "*", which indicates that the value does not matter, and a further search is performed (see 420.430 of FIG. 3 (al)).

If no match is found in this search, then check whether the items Public Expenditure 1 and Public Expenditure 2 in the search table 23 contain significant values (related to public expenses), and if no, If there is no public funds, the main insurance is used alone, and a match should be obtained before then), and if there is public funds, the process moves to the operation shown in FIG. 3 ('b).

Here, the law number of public expense 1 in the search table 23 is “**
”, and since it is initially negative, the content is set to °**” and the search is performed (see 45 in Figure 3).
0,460).

If this does not yield a match, check the code number of Public Expenditure 2, and if it is "00", then stop the search. If public expense 2 is not "00", return the law number of public expense l in the search table 23 to its original value (contents of register 22), change the law number of public expense 2 to "this book",
Search further (in Figure 3) for 470.480.490
).

If this search does not yield a match, please refer to Figure 3 (bl. 4).
In step 50, public expense 1 is not "**", so in the next step 460, change the contents of the item of public expense 1 to "**" and search further. If there is public expense, this change setting will eventually change the patient number. An insurance classification number will be assigned.

As mentioned above, after assigning the applicable insurance classification number to each patient, each patient's data can be used to create medical fee billing forms (summary tables) and monthly reports required by each medical institution (hospital, etc.). During creation, the desired data can be obtained by executing the process corresponding to the applicable insurance classification number.

[Effects of the Invention] According to the present invention, in a medical information processing system related to medical claims, an insurance number is calculated for each patient through processing that uses an insurance classification information table as a basic aggregation unit when tabulating aggregation forms by insurance. After that, ■ aggregate the medical practices for each patient's data on the patient side, ■ arrange each patient's data in order of insurance classification number, and proceed to the summary sheet printing process.
Alternatively, the process of printing each form (, etc.) has the effect of easily classifying summary tables or statistical tables by insurance created within a medical institution.

In this way, processing that requires classification by insurance receives and receives data after it has been roughly classified by insurance classification number, which eliminates the inefficiency of the conventional method and facilitates maintenance when laws and regulations are revised. It can be realized.

[Brief explanation of drawings]

Fig. 1 shows a basic configuration diagram of the present invention, and Fig. 2 (al indicates the structure of an embodiment of the present invention, in Fig. 2) shows an example of an insurance classification information table in the structure of the embodiment. , Figure 3 (al
and in FIG. 3) show the operational flow of the embodiment. In FIG. 1, IO: Terminal device 11: Information processing device 12: Storage device 13: File (external storage device) 110: Patient data register 111: Search table 112: Comparison means 113: Decision table 114 Near address specifying means 121: Insurance classification information table 131: Output data of search results

Claims (1)

[Claims] In an information processing system that creates payment invoices and various statistical information in medical institutions such as hospitals, a combination that requires different aggregation processing for each combination of multiple items representing payment forms. An insurance classification information table (121) is provided with a different insurance classification number added for each patient, and a determination table (113) is set by extracting the corresponding portion from the insurance classification information table according to the insurance type information of the input patient data. Then, a search table (111) is used for specific multiple items of the patient data and compared with the decision table, and if a match is found, the insurance classification number at that time is output together with the patient number in the patient data, and a match is found. If not, a match is obtained by changing the content of the one-minute item in the search table to non-specific data and comparing it, and then assigning an insurance classification number to each patient and performing subsequent aggregation processing using that number. A medical information processing system characterized by: