WO2015050072A1 - クリニカルパス管理装置 - Google Patents
クリニカルパス管理装置 Download PDFInfo
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- WO2015050072A1 WO2015050072A1 PCT/JP2014/075807 JP2014075807W WO2015050072A1 WO 2015050072 A1 WO2015050072 A1 WO 2015050072A1 JP 2014075807 W JP2014075807 W JP 2014075807W WO 2015050072 A1 WO2015050072 A1 WO 2015050072A1
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
- G06Q10/105—Human resources
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/06—Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
- G06Q10/063—Operations research, analysis or management
- G06Q10/0631—Resource planning, allocation, distributing or scheduling for enterprises or organisations
- G06Q10/06313—Resource planning in a project environment
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H70/00—ICT specially adapted for the handling or processing of medical references
- G16H70/20—ICT specially adapted for the handling or processing of medical references relating to practices or guidelines
Definitions
- the present invention relates to a clinical path management apparatus that manages clinical paths.
- a clinical path indicates a treatment plan (treatment, examination, etc.) for a patient.
- a medical institution can be used between medical staff such as doctors and nurses. Information sharing is possible, and stable and high-quality treatment is possible.
- the patient can receive the treatment with peace of mind after agreeing to the treatment plan.
- the clinical path shows the treatment plan at the time of creation
- the patient's medical condition is lighter or heavier than expected when creating the clinical path
- the situation at the time of creating the clinical path differs from the current situation There is also. In such a case, it is necessary to appropriately change the clinical path according to the current situation.
- hospital resources necessary for the implementation of the treatment are allocated for each treatment according to the treatment date and time.
- hospital resources include human resources such as medical staff, specifically doctors, nurses, and laboratory technicians. including.
- Patent Document 1 is known as a technique that considers such a change in the clinical path.
- the contents of the change are checked against the schedule of the hospital resource to determine whether or not the change can be made, and when the change is possible, the clinical path is changed. Specifically, if there is a vacancy in the hospital resource schedule, it is determined that it can be changed, and the clinical path is changed. If there is no space, it is determined that the change cannot be made, and the clinical path is not changed. Further, in the following Patent Document 1, when a clinical path is changed, a notification to that effect is given to related parties (such as affected doctors and nurses).
- the clinical path may need to be changed depending on the situation, but when there is no vacancy in the hospital resource schedule, it is determined that the change cannot be made uniformly. There was a problem that the change could not be handled.
- Patent Document 1 when it is desired to add a CT examination in the clinical path to be changed, hospital resources (CT apparatus and radiographer) necessary for performing the CT examination are allocated to other clinical paths. If there is no vacancy in the schedule, no changes can be made. That is, the change can be made only within a range that does not affect the clinical path other than the change target clinical path, and there is room for improvement in terms of flexibility.
- the object of the present invention is to provide a clinical path management apparatus that can cope with a flexible change of the clinical path.
- the clinical path management apparatus of the present invention includes a database, a reception unit, a duplication determination unit, a change plan generation unit, an influence calculation unit, and a clinical path change unit.
- the database includes a plurality of clinical paths indicating a treatment plan for each patient, and schedule data representing an operation schedule of hospital resources including at least one of human resources and physical resources allocated to individual treatments in each clinical path. Is memorized.
- the reception unit receives a change request for changing at least one of the contents of the clinical path treatment and the implementation date.
- the duplication determination unit changes the change-target clinical path in response to a change request, the measures included in the change-target clinical path and another clinical path different from the change-target clinical path are included.
- the change plan generation unit When there is an overlap, the change plan generation unit generates a plurality of types of change plans for avoiding the overlap by changing at least one of the clinical path to be changed and another clinical path.
- the influence degree calculation unit calculates an influence degree indicating the magnitude of change for each of a plurality of types of change plans.
- the clinical path is a clinical path changing unit that changes the clinical path. When there is no duplication, it is changed according to the change request, and when there is duplication, it is determined based on the influence degree. Change the clinical path with the change plan.
- the clinical path change unit changes the clinical path with the change plan selected by the automatic selection unit. Preferably it is done.
- a manual selection unit that distributes a plan selection screen including the contents of each change plan and the degree of influence of each change plan to the user's terminal, and allows the user to select which of the change plans to adopt, and a clinical path change unit May change the clinical path with the change plan selected through the manual selection unit.
- the influence degree calculation unit calculates the influence degree based on the parameters.
- the parameter includes a treatment reward that changes with a change in the clinical path.
- the parameter preferably includes the number of patients with another clinical path that is affected by the change of the clinical path to be changed.
- the parameter preferably includes the number of medical staff, which are human resources, affected by changes in the clinical path.
- a weighting coefficient for weighting is set according to the attribute of the medical staff to be changed, and the impact calculation unit calculates the impact based on the number of medical staff and the weighting coefficient corresponding to the attribute. Is preferred.
- the parameter preferably includes the number of medical devices that are physical resources that are affected by the change of the clinical path.
- the influence degree calculation unit may calculate the influence degree using the number of medical devices whose schedule is changed according to the change as a parameter.
- a weighting coefficient for performing weighting according to the operating rate of the medical device is set, and the impact calculation unit can calculate the impact based on the number of medical devices and the weighting coefficient corresponding to the operating rate. preferable.
- the influence degree calculation unit calculates the influence degree as an individual influence degree for each method using a plurality of methods including at least one parameter including the parameter, and a weighting coefficient for performing weighting according to the method Preferably, the influence degree calculation unit calculates the total influence degree based on the individual influence degree for each method and the weighting coefficient for each method.
- the present invention in order to cope with the change of one clinical path, a case where another clinical path other than this clinical path is also changed is provided, so that a flexible change is possible.
- the present invention generates a change pattern of a plurality of patterns when changing a plurality of clinical paths as described above, and changes to a change plan selected in consideration of the influence of each change plan on another clinical path. Because it changes, it can be changed to a more appropriate change plan.
- a medical support system 10 supports medical care using a clinical path 26 (see FIGS. 3 and 4) indicating a treatment plan (diagnosis, treatment, examination, etc.) performed on a patient.
- the clinical path management apparatus 12 that manages (creates, stores, distributes, changes, etc.) the clinical path 26 is provided.
- a plurality of terminals 16 of users of the medical support system 10 are connected to the clinical path management apparatus 12 via a network 14 such as the Internet.
- the clinical path management apparatus 12 distributes an operation screen such as a GUI (Graphical User Interface) to the terminal 16 via the network 14 and manages the clinical path 26 according to an operation instruction input from the terminal 16 through the operation screen.
- GUI Graphic User Interface
- the terminal 16 has a function of connecting to the network 14, an input means such as a keyboard and a mouse, and a display means such as a liquid crystal display (or a touch panel type display that serves as both the input means and the display means). And well-known electronic devices such as laptop computers, tablet terminals, mobile phones and smartphones. These terminals 16 are used by the user of the medical support system 10.
- the user of the medical support system 10 is a medical staff such as a doctor in charge of treating a patient or a nurse or a laboratory technician who assists the doctor in charge.
- the clinical path management device 12 is installed in, for example, an operating company that operates the medical support system 10.
- the clinical path management apparatus 12 includes an application server 17 that executes various functions such as distribution of operation screens and management of the clinical path 26 in accordance with an application program (AP) 31 (see FIG. 8) to be described later, and a database (DB) 18. These are configured and connected via a network 22 such as a LAN.
- AP application program
- DB database
- the DB 18 includes a template 24, a clinical path 26 (see FIGS. 3 and 4), user information 28 (see FIG. 5), schedule data 29 (see FIG. 6), a treatment fee conversion table 30 ( 7) is stored.
- the template 24 is used as a base when a clinical path 26 is newly created.
- the clinical path 26 is a record of a treatment plan for each patient.
- patient identification information patient name, patient ID, etc.
- the date and time of the treatment at each stage of the clinical path 26 the location, and the equipment used for the treatment
- Various information such as medical staff is included.
- 3 shows a data system constituting the clinical path 26
- FIG. 4 shows a state displayed on the display for browsing the clinical path 26.
- the user information 28 includes identification information for identifying the user such as a user name and a user ID, a terminal ID for identifying the terminal 16 owned by the user, and user contact information (phone number). And e-mail address), and user attribute information (such as the department and position to which the user belongs) are associated with each other.
- the user information 28 is distinguished for each user, and the user information for one person is generated, for example, in a user registration process performed at the first use of the medical support system 10 and stored (newly registered) in the DB 18.
- the user is requested to input the user name, contact information, and attribute information.
- the user ID is assigned and the information is input.
- the terminal ID of the original terminal 16 is acquired, and user information is generated by associating it with the user ID together with the user name, contact information, and attribute information.
- the schedule data 29 indicates an operation schedule for each hospital resource.
- Hospital resources include medical resources, specifically doctors and nursing staff, in addition to physical resources such as places (spaces) such as hospital rooms, treatment rooms, and operating rooms, and equipment such as testing equipment, surgical equipment, and treatment equipment. Includes human resources such as teachers and laboratory technicians. Hospital resources are allocated according to the contents of individual treatments that are components of the clinical path 26 of each patient.
- the operation schedule is a time series of treatments assigned to each hospital resource.
- the schedule data 29 is updated every time a new clinical path 26 is generated or the existing clinical path 26 is changed, and is always maintained in the latest state.
- the schedule data 29 may be created or updated by a user manually inputting an operation schedule of each hospital resource according to a predetermined template. Further, the CPU 31 (see FIG. 8) may function as a schedule data generation unit by an AP 31 (see FIG. 8) described later, and the schedule data 29 may be automatically generated by the schedule data generation unit.
- the clinical pal 26 records the date and time of treatment and the hospital resources allocated to the treatment. If a plurality of clinical paths 26 are read from the DB 18 and each clinical path 26 is analyzed, the date and time when one hospital resource operates can be grasped.
- the schedule data generation unit extracts the operation date and time for each hospital resource from the plurality of clinical paths 26, grasps the operation schedule for each hospital resource, and generates schedule data 29. Further, not only the schedule data 29 is newly generated, but updating may be performed in the same manner.
- the treatment fee conversion table 30 is obtained by scoring rewards for treatments performed at medical institutions, and is determined by a predetermined organization (for example, the Central Social Insurance Medical Council).
- the treatment fee conversion table 30 is used when charging a treatment fee to a patient or a country that bears insurance. Further, as will be described later, in the present embodiment, the treatment reward conversion table 30 is also used to calculate the degree of influence when changing the clinical path 26.
- the application server 17 is configured by installing a control program such as an operating system and an AP 31 for causing the computer to function as the application server 17 based on a computer such as a personal computer or a workstation.
- a control program such as an operating system
- an AP 31 for causing the computer to function as the application server 17 based on a computer such as a personal computer or a workstation.
- the application server 17 includes a storage device 32, a memory 34, a CPU 36, and a communication I / F 38, which are connected via a data bus 40.
- the storage device 32 is, for example, a hard disk drive, and is an internal storage built in the main body of the application server 17.
- the storage device 32 stores a control program, an AP 31 such as application server software, images and messages displayed when the AP 31 is executed, and display data 42 for displaying various operation screens. .
- the memory 34 is a work memory for the CPU 36 to execute processing.
- the CPU 36 centrally controls each part of the computer by loading the control program stored in the storage device 32 into the memory 34 and executing processing according to the program.
- the communication I / F 38 includes an interface for communicating with the networks 14 and 22, and the application server 17 communicates with the DB 18 and the terminal 16 via the networks 14 and 22 via the communication I / F 38.
- AP31 is a program for causing a computer to execute various functions.
- the CPU 36 centrally controls each unit of the computer by loading the AP 31 stored in the storage device 32 into the memory 34 and executing processing according to the program.
- the CPU 36 functions as a clinical path generation unit 52, a clinical path distribution unit 54, and a clinical path change unit 56 in cooperation with the memory 34.
- the clinical path generation unit 52 distributes a clinical path generation screen, which is an operation screen for generating the clinical path 26, to the user's terminal 16 in response to a request from the user's terminal 16, and is made through the clinical path generation screen.
- a new clinical path 26 is generated in accordance with an instruction from the user.
- the user selects one of the templates 24 of the clinical path 26 stored in the DB 18 in accordance with the clinical path generation screen, and then selects the components of the patient's clinical path (treatment plan) 26 and the selected template 24. Enter individual treatment information.
- a generation request for requesting generation of a new clinical path 26 with this content is input from the user terminal 16 to the clinical path generation unit 52.
- the clinical path generation unit 52 generates a new clinical path 26 based on this clinical path creation request and stores it in the DB 18.
- the clinical path distribution unit 54 distributes a clinical path selection screen, which is an operation screen for selecting a clinical path 26 desired to be browsed, to the user terminal 16.
- a clinical path selection screen which is an operation screen for selecting a clinical path 26 desired to be browsed
- the user selects a clinical path 26 desired to be browsed from the clinical paths 26 stored in the DB 18.
- a browsing request for the selected clinical path 26 is input from the user terminal 16 to the clinical path distribution unit 54.
- the clinical path distribution unit 54 distributes the requested clinical path 26 to the user's terminal 16.
- the clinical path changing unit 56 distributes a clinical path changing screen, which is an operation screen for changing the clinical path 26, to the user's terminal 16, and is made through the clinical path changing screen.
- the clinical path 26 stored in the DB 18 is changed in accordance with an instruction from the user.
- the user designates the change contents including selection of the clinical path 26 to be changed and at least one change of the contents of the treatment and the execution date and time through the clinical path change screen.
- the change of the content of the treatment and the execution date / time includes deletion and addition of the treatment.
- the clinical path changing unit 56 changes the clinical path 26 based on the change request.
- the clinical path changing unit 56 includes a receiving unit 56A, an overlap determining unit 56B, a change plan generating unit 56C, and an influence degree calculating unit 56D.
- the accepting unit 56A accepts a request for changing the clinical path 26.
- the duplication determination unit 56B refers to the schedule data 29 and changes the clinical path 26 to be changed in accordance with the change request, the duplication determination unit 56B changes the clinical path 26 to be changed and the clinical path 26 ( Hereinafter, it is determined whether or not the hospital resources allocated to the respective treatments overlap with each other.
- Hospital resources are allocated for each treatment. However, when the clinical path 26 is changed, the contents and the execution date and time of the treatment are changed. Therefore, the hospital resources need to be reassigned accordingly.
- the duplication of hospital resources means that, for example, when a change is made to the change-target clinical path 26 as requested, the medical staff and test equipment assigned to the treatment of the change-target clinical path 26 are already different. The case where it is assigned to the treatment of the same date and time of the clinical path 26.
- the duplication determination unit 56B determines the presence or absence of such duplication. In this way, since the hospital resources are related to a plurality of clinical paths 26, if one clinical path 26 is changed, the influence may extend to other clinical paths 26.
- the clinical path changing unit 56 changes the clinical path 26 in accordance with the change request when it is determined that there is no duplication.
- the change plan generation unit 56C changes a plurality of types for avoiding duplication by changing at least one of the clinical path 26 to be changed and another clinical path 26. Generate a change plan. In the generation of the change plan, for example, the change plan is generated by the following methods 1 to 4.
- Method 1 A method for generating a change plan for changing the execution date and time of a procedure to which a duplicate hospital resource is allocated without changing the duplicate hospital resource. For example, in the plurality of clinical paths 26, when the same inspection device or person in charge of the inspection is assigned to a plurality of treatments performed at the same date and time, duplication is avoided by changing the execution date and time of one of the treatments. Generate a change plan to [Method 2] A method of generating a change plan for changing hospital resources for one treatment where hospital resources overlap without changing the execution date and time of the overlapping hospital resources.
- Method 3 A method of generating a change plan that changes both the duplicated hospital resources and the implementation date and time of the treatment to which the hospital resources are allocated. For example, in the plurality of clinical paths 26, when the same inspection device or person in charge of the inspection is assigned to a plurality of treatments performed on the same date and time, the combination of the method 1 and the method 2 described above is used to reduce duplication Generate a change plan to avoid.
- Method 4 A method of generating a change plan by changing the content of a procedure to which duplicate hospital resources are assigned. For example, in the plurality of clinical paths 26, when the same inspection device or person in charge of inspection is assigned to a plurality of treatments performed on the same date and time, one treatment is abolished or the number of inspection items is reduced. A change plan that avoids duplication is generated by a change such as simplification of the content of the treatment of the above, or replacement with a treatment of another content having the same function.
- the number of change plans generated by each method described above is not limited to one.
- two types of change plans may be generated: a change plan in which the execution dates and times of overlapping treatments are shifted by 1 hour, and a change plan shifted by 2 hours.
- the method described above is an example, and the change plan generation method may generate the change plan using a method other than the method described above.
- the number of change plans to be generated can be set freely.
- the change plan generated by the clinical path changing unit 56 includes three or more clinical paths so as to avoid all hospital resource duplications that occur in a chain due to the change of one clinical path 26 as described above. Also included are those in which 26 is changed.
- the impact calculation unit 56D calculates the impact of each change plan.
- the degree of influence is a numerical value of the magnitude of change for each change plan.
- the influence degree calculation unit 56D calculates the influence degree based on a predetermined parameter.
- the treatment fee that changes before and after the change according to the change based on each change plan, and the number of patients in another clinical path 26 that is changed according to the change based on each change plan are the parameters. Used as.
- the number of patients of another clinical path 26 is the number of patients according to the number of other clinical paths 26 that are affected by the change of the clinical path 26 to be changed. Since the clinical path 26 is created for each patient, the number of other clinical paths 26 and the number of patients of the other clinical paths 26 are the same after all.
- the current situation is “CT imaging with a 12-row multi-slice type (original plan of the clinical path 26 to be changed)”.
- CT imaging with a 12-row multi-slice type original plan of the clinical path 26 to be changed
- the patient is in a remote place and is not in time for imaging or imaging due to poor physical condition
- the clinical path changing unit 56 uses the treatment reward conversion table 30 to calculate the degree of influence according to the following equation 1.
- Impact “Difference between treatment fee (point) after change and current treatment fee (point)” + “number of affected patients (people) ⁇ 500 (weighting coefficient)” * Weighting coefficient is set to an arbitrary value Possible.
- the treatment fee is “780 (points)” for the current state, “950 (points)” for the change plan 1, “900 (points)” for the change plan 2, and “780 (points)” for the change plan 3 ] ”(See FIG. 7).
- the number of patients affected by the change is “0 (person)” for change plan 1, “1 (person)” for change plan 2, and “2 (person)” for change plan 2. Therefore, the impact level is “170” for change plan 1, “620” for change plan 2, and “1000” for change plan 3.
- the clinical path changing unit 56 determines the change plan having the smallest influence degree (in this embodiment, the change plan 1) as the change plan to be adopted. Then, the corresponding clinical path 26 is changed according to the determined change plan.
- the accepting unit 56 ⁇ / b> A accepts a change request for changing the contents of the clinical path 26.
- the duplication determination unit 56B refers to the schedule data 29, and when the clinical path 26 is changed according to the change request, whether or not hospital resources overlap between the clinical path 26 to be changed and another clinical path 26 is determined. judge. If there is no overlap, the clinical path changing unit 56 changes the clinical path 26 as requested by the change.
- the change plan generation unit 56C changes multiple types of change plans for avoiding duplication by changing at least one of the clinical path 26 to be changed and another clinical path 26. Generate.
- the influence degree calculation unit 56D calculates the influence degree for each change plan in which the magnitude of change by each change plan is quantified.
- the clinical path changing unit 56 compares the influence levels of the plurality of change plans, automatically selects a change plan having the smallest influence degree from the plurality of change plans, and follows the selected change plan.
- the path 26 is changed.
- the clinical path changing unit 56 functions as an automatic selection unit.
- the clinical path management device 12 responds to the change of the clinical path to be changed by changing the clinical path different from the change-target clinical path. For example, only the change of the clinical path of the change target is changed. In this case, even if the hospital resources are duplicated and cannot be changed, the change can be made by changing another clinical path, so that a flexible change is possible.
- the clinical path management device 12 changes the change plan from the plurality of change plans to the change plan with the least influence, the other clinical path is changed more than necessary, resulting in confusion. Problems can also be prevented.
- the detailed configuration of the present invention is not limited to the above-described embodiment, and can be changed as appropriate.
- the example is described in which the clinical path management device is installed in the operating company of the medical support system.
- the clinical path management device may be installed in a medical institution to which the user of the medical support system belongs.
- the influence degree is calculated using the treatment reward and the number of affected patients as parameters.
- the specific calculation method of the influence degree can be changed as appropriate.
- the degree of influence may be calculated using only one of the treatment fee and the number of affected patients as a parameter, or a new element is used as a parameter without using either the treatment fee or the number of affected patients as a parameter.
- the degree of influence may be calculated as Of course, the degree of influence may be calculated using a combination of two or more parameters such as the treatment fee, the number of affected patients, and the new factors described above.
- the degree of influence is calculated using the weighting correspondence table 110 shown in FIG. 11 and the weighting correspondence table 120 shown in FIG.
- the weighting correspondence table 110 associates medical staff with weighting coefficients set for each type of medical staff.
- the medical staff is classified into two categories of doctors and non-doctoral staff, and the types of doctors and non-doctoral staffs are further subdivided.
- the weighting correspondence table 120 associates the level of qualification possessed by each medical staff with the weighting coefficient set for each level of qualification.
- These weighting correspondence tables 110 and 120 are stored in, for example, the DB 18 (see FIGS. 1 and 2).
- qualification and type are attributes of medical staff. As the attribute, only one of the qualification and type may be used, or a position and position other than the qualification and type may be included.
- the medical staff calculates the impact of the change plan, taking into account the number and attributes of the medical staff to be changed, assuming that there is a difference in the impact depending on the attributes. Is.
- the clinical path changing unit 56 calculates the degree of influence according to the following equation 2.
- Influence “degree of influence of the first medical staff whose operation schedule is changed (weighting coefficient by this medical staff type (see FIG. 11) ⁇ weighting coefficient by this medical staff qualification level (see FIG. 12))” + “Influence of the second medical staff whose operation schedule is changed” + ... (omitted) ... + “Influence of the last medical staff whose operation schedule is changed”
- the change plan 5 having the smallest influence is determined as the change plan to be adopted, and the corresponding clinical path 26 is changed according to the change plan 5.
- the impact is calculated by weighting according to the type of medical staff and the level of qualification, but the operation schedule is changed when changing from the current state to each change plan without weighting.
- the degree of influence may be calculated by simply adding the number of medical staff to be changed. Of course, only one of the type of medical staff and the level of qualification may be weighted.
- this example is based on the assumption that the degree of impact of medical devices varies depending on the operating rate. The degree is calculated.
- the degree of influence is calculated using the weighting correspondence table 130 shown in FIG. 13 and the operation rate list 140 shown in FIG.
- the weighting correspondence table 130 associates the operating rate of the medical device with the weighting coefficient.
- the operation rate list 140 associates the types of medical devices with the operation rates of the respective medical devices, and is updated with the update (change) of the schedule data 29 (see FIG. 6) and is always in the latest state. It is kept in.
- the weighting correspondence table 130 and the operation rate list 140 are stored in, for example, the DB 18 (see FIGS. 1 and 2).
- the number of times of change means the number of times of change of the operation schedule related to one medical device. For example, when the implementation date of a medical device is changed in one clinical path 26, the operation schedule is changed. In this case, the number of changes is counted as one. Furthermore, if there is a change in another clinical path 26, the operation schedule is also changed accordingly, so the number of changes is added once, for a total of two times.
- the clinical path changing unit 56 calculates the degree of influence according to Equation 3.
- the change plan 6 having a small influence is determined as the change plan to be adopted, and the corresponding clinical path 26 is changed according to the change plan 6.
- the influence degree may be calculated using the operating rate of the medical device as a parameter. In this example, weighting is performed based on the operation rate. However, without weighting, the number of medical devices whose operation schedule is changed when the current plan is changed to each change plan or change of the operation schedule The influence degree may be calculated by simply integrating the number of times.
- the total influence is calculated using the weighting correspondence table 150 shown in FIG.
- the weighting correspondence table 150 associates change items (parameter types) with weighting coefficients.
- the weighting correspondence table 150 is stored in, for example, the DB 18 (see FIGS. 1 and 2).
- treatment content change indicates a method (method 1) for calculating the individual influence level using parameters that vary depending on the change in the treatment content. Specifically, the treatment reward and the number of affected patients And a method of calculating the individual influence level using as a parameter.
- the staff change is a method (method 2) for calculating the individual influence level using a parameter that varies depending on the change of the medical staff. Specifically, the number of medical staff whose schedule is changed is used as a parameter. This includes a method for calculating the degree of individual influence.
- the medical device change indicates a method (method 3) for calculating the individual influence level using a parameter that varies depending on the change of the medical device. Specifically, the number of medical devices whose schedule is changed, A method of calculating the individual influence degree using the number of changes as a parameter is included.
- the individual influence degree of the generated change plan is calculated by each of the three methods 1 to 3 of treatment content change, staff change, and medical device change. Even if the plan is the same, if the method for calculating the individual influence is different, the evaluation standard changes, and therefore the value of the individual influence changes. Then, the individual influence degree calculated by each of the methods 1 to 3 is classified into one of a plurality of levels (for example, 10 stages) according to the magnitude of the individual influence degree.
- the individual influence degree is calculated for the generated [change plan 1] by the method 1 (treatment content change) (in this case, the current treatment fee ( 780 points) and “170 points”, which is the difference between the treatment rewards (950 points) of [Change Plan 1], are calculated as the degree of influence) (see FIG. 7).
- the level of the calculated individual influence in this case, “170 (point)” is determined at which level, and for example, it is classified as “level 5 (fifth stage)”.
- the individual influence degree of [change plan 1] is calculated by method 2 (change in charge) (see FIGS. 11 and 12), and this individual influence degree is, for example, “level 3 (third stage)”. As in some cases, it is classified into one of 10 levels. Furthermore, the individual influence degree of [change plan 1] is calculated by method 3 (change of medical device) (see FIGS. 13 and 14), and this individual influence degree is, for example, “level 7 (seventh stage)”. Thus, it is classified into one of 10 levels.
- the individual impact level is calculated for each method for other change plans, and the total impact level is calculated based on the individual impact level.
- the clinical path 26 is changed according to the change plan having the smallest overall influence degree.
- the parameters included in the respective methods are all different from each other.
- the individual influence degree may be calculated by a method other than the above-described methods 1 to 3 in which only some of the parameters are different. Good.
- the number of calculation methods for calculating the individual influence degree is not limited to three, but may be two or four or more.
- the contents of the method for calculating the individual influence level that is, the types and number of parameters included in each method can be changed as appropriate.
- calculation method of the influence degree is not limited to the above-described method, and an appropriate method can be used.
- the clinical path management apparatus has been described with an example in which the clinical path is automatically changed with the change plan having the smallest influence degree.
- the change terminal and the influence degree of each change plan are set to the user terminal. It is also possible to notify the user by distributing to the user and to allow the user to select which change plan to adopt.
- the CPU 36 of the clinical path management device functions as a manual selection unit that distributes a plan selection screen that allows the user's terminal to select a change plan and receives information on the changed plan selected through the plan selection screen.
- the plan selection screen includes the contents of the change plan and the degree of influence.
- the clinical path management apparatus automatically changes the clinical path. It may be.
- the clinical path management device detects the current position of the user using, for example, a GPS system, collates the detected current position of the user with the schedule data, and the user reaches the place where the treatment is performed at the time when the treatment is performed. Determine whether it is possible. If it is determined that the place where the treatment is performed cannot be reached at the time when the treatment is performed, the procedure of the clinical path is similar to the above-described procedure (the procedure for changing the clinical path based on the transmission of the change request). Change it.
- the present invention may be applied when changing an already created clinical path.
- the present invention may be applied when creating a new clinical path.
- multiple types of creation plans including changes in other clinical paths are generated, and the degree of influence of each creation plan on each other clinical path is calculated.
- a new clinical path may be generated with a creation plan with the least influence.
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Abstract
Description
重複している病院資源は変更せずに重複している病院資源が割り当てられている処置の実施日時を変更する変更プランを生成する方法。
例えば、複数のクリニカルパス26において、同一日時に実施される複数の処置に対して、同じ検査機器や検査担当者が割り当てられている場合に、一方の処置の実施日時の変更により、重複を回避する変更プランを生成する。
[方法2]
重複している病院資源の実施日時は変更せずに、病院資源が重複している一方の処置について病院資源を変更する変更プランを生成する方法。
例えば、複数のクリニカルパス26において、同一日時に実施される複数の処置に対して、同じ検査機器や検査担当者が割り当てられている場合に、一方の処置に割り当てる検査機器や検査担当者を変更して、重複を回避する変更プランを生成する。
[方法3]
重複している病院資源及び病院資源が割り当てられている処置の実施日時の両方を変更する変更プランを生成する方法。
例えば、複数のクリニカルパス26において、同一日時に実施される複数の処置に対して、同じ検査機器や検査担当者が割り当てられている場合に、上記方法1及び上記方法2の組み合わせによって、重複を回避する変更プランを生成する。
[方法4]
重複している病院資源が割り当てられている処置の内容を変更することによって変更プランを生成する方法。
例えば、複数のクリニカルパス26において、同一日時に実施される複数の処置に対して、同じ検査機器や検査担当者が割り当てられている場合に、一方の処置の廃止や、検査項目数を減らすなどの処置の内容の簡略化、同様の機能を有する別の内容の処置への置き換えなどの変更によって、重複を回避する変更プランを生成する。
なお、以下では、現状が「12列マルチスライス型によるCT撮影(変更対象のクリニカルパス26の当初の計画)」であり、例えば、患者が遠隔地におり撮影に間に合わなかったり、体調不全により撮影に適していない状態であるなどの理由により、前述した現状のクリニカルパス26を変更する必要が生じ、この変更の過程で下記3つの変更プランが生成された例で説明を行う。
64列マルチスライス型によるCT撮影(当初の計画内容を変更したものであり、別のクリニカルパス26への変更無し(影響を受ける患者数無し))
[変更プラン2]
32列マルチスライス型によるCT撮影(当初の計画内容を変更したものであり、別のクリニカルパス26への変更「1」(影響を受ける患者数は1名))
[変更プラン3]
12列マルチスライス型によるCT撮影(当初の計画時間を変更したものであり、別のクリニカルパス26への変更「2」(影響を受ける患者数は2名))
[式1]
影響度=「変更後の処置報酬(点)と現状の処置報酬(点)との差分」+「影響を受ける患者数(人)×500(重み付け係数)」※重み付け係数は任意の値に設定可能。
稼働スケジュールが変更される医療スタッフの種別及び資格レベル「外科医1名(資格レベル5)、看護士5名(資格レベル3の看護士が4名、資格レベル1の看護士が1名)」
[変更プラン5]
稼働スケジュールが変更される医療スタッフの種別及び資格レベル「放射線科医1名(資格レベル3)、診療放射線技師3名(全員、資格レベル2)」
[式2]
影響度=「稼働スケジュールが変更される一人目の医療スタッフの影響度(この医療スタッフの種別による重み付け係数(図11参照)×この医療スタッフの資格レベルによる重み付け係数(図12参照))」+「稼働スケジュールが変更される二人目の医療スタッフの影響度」+・・・(省略)・・・+「稼働スケジュールが変更される最後の医療スタッフの影響度」
稼働スケジュールが変更される医療機器及び変更回数「CTの稼働スケジュールが4回変更、MRIの稼働スケジュールが3回変更」
[変更プラン7]
稼働スケジュールが変更される医療機器及び変更回数「マンモグラフィーの稼働スケジュールが2回変更、超音波検査装置の稼働スケジュールが10回変更」
[式3]
影響度=「稼働スケジュールが変更される1つ目の医療機器の影響度(この医療機器の稼働率に対応する重み付け係数)」+「稼働スケジュールが変更される2つ目の医療機器の変更回数」+・・・(省略)・・・+「稼働スケジュールが変更される最後の医療機器の変更回数」
[式4]
総合影響度=[手法1(処置内容変更)の個別影響度の値が分類されたレベル]×[対応する重み付け係数]+[手法2(担当者変更)の個別影響度が分類されたレベル]×[対応する重み付け係数]+[手法3(医療機器変更)の個別影響度が分類されたレベル]×[対応する重み付け係数]
12 クリニカルパス管理装置
17 アプリケーションサーバ
18 DB
26 クリニカルパス
28 ユーザー情報
29 スケジュールデータ
30 処置報酬換算表
31 AP
32 ストレージデバイス
34 メモリ
36 CPU
52 クリニカルパス生成部
54 クリニカルパス配信部
56 クリニカルパス変更部
56A 受付部
56B 重複判定部
56C 変更プラン生成部
56D 影響度算出部
110、120、130、150 重み付け対応表
140 稼働率一覧表
Claims (11)
- 患者毎の処置計画を示す複数のクリニカルパスと、各前記クリニカルパス内の個々の処置に割り当てられる、人的資源及び物的資源の少なくとも一方を含む病院資源の稼働スケジュールを表すスケジュールデータとが記憶されたデータベースと、
前記クリニカルパスの処置の内容及び実施日時の少なくとも1つを変更する変更要求を受け付ける受付部と、
前記変更要求に応じて、変更対象のクリニカルパスを変更した場合に、前記変更対象のクリニカルパスと、前記変更対象のクリニカルパスとは別のクリニカルパスとの間で、それぞれに含まれる処置に割り当てられる病院資源が重複するか否かを判定する重複判定部と、
重複が有る場合に、前記変更対象のクリニカルパスと前記別のクリニカルパスとの少なくとも一方を変更することによって前記重複を回避するための複数種類の変更プランを生成する変更プラン生成部と、
前記複数種類の変更プラン毎の変更の大きさを示す影響度を算出する影響度算出部と、
前記クリニカルパスの変更を行うクリニカルパス変更部であり、前記重複が無い場合には、前記変更要求の通りに変更を行い、かつ、前記重複が有る場合には、前記影響度に基づいて決定された前記変更プランで前記クリニカルパスの変更を行うクリニカルパス変更部と、を備えたことを特徴とするクリニカルパス管理装置。 - 各前記変更プランの影響度を比較して、最も影響度が小さい変更プランを自動的に選択する自動選択部を備え、
前記クリニカルパス変更部は、前記自動選択部が選択した変更プランで前記クリニカルパスの変更を行う請求の範囲第1項に記載のクリニカルパス管理装置。 - 各変更プランの内容及び各変更プランの影響度を含むプラン選択画面をユーザーの端末に配信し、前記変更プランのいずれを採用するかをユーザーに選択させる手動選択部と、を備え、
前記クリニカルパス変更部は、前記手動選択部を通じて選択された変更プランで前記クリニカルパスの変更を行う請求の範囲第1項に記載のクリニカルパス管理装置。 - 前記影響度算出部は、パラメータに基づいて前記影響度を算出する請求の範囲第1項に記載のクリニカルパス管理装置。
- 前記パラメータは、前記クリニカルパスの変更に伴って変化する処置報酬を含む請求の範囲第4項に記載のクリニカルパス管理装置。
- 前記パラメータは、前記変更対象のクリニカルパスの変更に伴って影響を受ける、前記別のクリニカルパスの患者数を含むことを特徴とする請求の範囲第4項に記載のクリニカルパス管理装置。
- 前記パラメータは、前記クリニカルパスの変更に伴って影響を受ける、前記人的資源である医療スタッフの数を含む請求の範囲第4項に記載のクリニカルパス管理装置。
- 前記変更される前記医療スタッフの属性に応じて重み付けを行うための重み付け係数が設定されており、
前記影響度算出部は、前記医療スタッフの数と前記属性に対応する重み付け係数とに基づいて前記影響度を算出する請求の範囲第7項に記載のクリニカルパス管理装置。 - 前記パラメータは、前記クリニカルパスの変更に伴って影響を受ける、前記物的資源である医療機器の数を含む請求の範囲第4項に記載のクリニカルパス管理装置。
- 前記医療機器の稼働率に応じて重み付けを行うための重み付け係数が設定されており、
前記影響度算出部は、前記医療機器の数と前記稼働率に対応する重み付け係数とに基づいて前記影響度を算出する請求の範囲第9項に記載のクリニカルパス管理装置。 - 前記影響度算出部は、前記パラメータを含み、少なくとも1つのパラメータが異なる複数の手法を用いて前記影響度を手法毎の個別影響度として算出し、かつ、
前記手法に応じて重み付けを行うための重み付け係数が設定されており、
前記影響度算出部は、手法毎の前記個別影響度と手法毎の重み付け係数とに基づいて、総合影響度を算出することを特徴とする請求の範囲第4項に記載のクリニカルパス管理装置。
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