WO2020082796A1 - Procédé, dispositif et appareil de traitement d'informations de visite médicale basé sur une analyse de données, et support - Google Patents

Procédé, dispositif et appareil de traitement d'informations de visite médicale basé sur une analyse de données, et support Download PDF

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WO2020082796A1
WO2020082796A1 PCT/CN2019/095029 CN2019095029W WO2020082796A1 WO 2020082796 A1 WO2020082796 A1 WO 2020082796A1 CN 2019095029 W CN2019095029 W CN 2019095029W WO 2020082796 A1 WO2020082796 A1 WO 2020082796A1
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WIPO (PCT)
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medical
organ transplant
information
visit
address
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PCT/CN2019/095029
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English (en)
Chinese (zh)
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车惯红
李佳阳
刘晓瑞
王飞
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平安医疗健康管理股份有限公司
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Publication of WO2020082796A1 publication Critical patent/WO2020082796A1/fr

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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
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
    • 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
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Definitions

  • the present application relates to the medical technology field, and in particular, to medical treatment information processing methods, devices, equipment, and media based on data analysis.
  • organ transplant patients need to take anti-rejection drugs for a long time to avoid rejection reactions. Anti-rejection drugs are expensive, and organ transplant patients need to spend tens of thousands of dollars to buy each year
  • special reimbursement policies for organ transplant patients For example, organ transplant patients enjoy special reimbursement policies for the purchase of medicines in designated retail pharmacies, which brings medical reimbursement for organ transplant patients. Very convenient.
  • some organ transplant patients use their special identities to brush or empty the medical insurance fund to obtain illegitimate benefits, which not only brings economic losses to the country, but also severely damages the public interest. Therefore, how to recognize the abnormal treatment of organ transplant patients Behavior is a problem that needs to be solved urgently.
  • Embodiments of the present application provide a medical information processing method, device, equipment, and medium based on data analysis, which can automatically recognize abnormal medical treatment behaviors of organ transplant patients.
  • an embodiment of the present application provides a medical information processing method based on data analysis.
  • the method includes:
  • the medical information includes any one or more of the following: time of visit, medical insurance card number, ID card number, address information of the hospital to visit, and cost of treatment;
  • the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, distribution characteristic information of the address of the medical treatment hospital, and household registration address of the organ transplant patient Distribution characteristic information of the hospital, distribution characteristic information of the visit cost, and distribution characteristic information of the visit time;
  • the visit information of the organ transplant patient who has abnormal visit behavior is marked.
  • an embodiment of the present application provides a medical information processing device, which includes:
  • Obtaining module used to obtain the medical information of each organ transplant patient in multiple organ transplant patients, the medical information includes any one or more of the following: the time of the visit, the medical insurance card number, the ID number, and the address information of the hospital And the cost of visiting a doctor.
  • the parsing module is used to parse the medical information to obtain medical characteristic data
  • the medical characteristic data includes any one or more of the following: medical insurance card number distribution characteristic information, address distribution characteristic information of the hospital, organ Distribution characteristic information of the transplanted patient's household registration address, distribution characteristic information of the visit cost, and distribution characteristic information of the visit time.
  • the judging module is used for judging whether there is abnormal visit behavior according to the visit characteristic data.
  • the labeling module is used for labeling the medical information of the organ transplant patients with abnormal medical behavior when it is determined that there is abnormal medical behavior.
  • an embodiment of the present application provides another medical management device, the device includes: a processor and a memory, the processor and the memory are interconnected; wherein the memory stores one or more instructions, The one or more instructions are suitable to be loaded by the processor and execute the following steps:
  • the medical information includes any one or more of the following: time of visit, medical insurance card number, ID card number, address information of the hospital to visit, and cost of treatment;
  • the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, distribution characteristic information of the address of the medical treatment hospital, and household registration address of the organ transplant patient Distribution characteristic information of the hospital, distribution characteristic information of the visit cost, and distribution characteristic information of the visit time;
  • the visit information of the organ transplant patient who has abnormal visit behavior is marked.
  • an embodiment of the present application provides a computer-readable storage medium, including: the computer-readable storage medium stores one or more instructions, the one or more instructions are suitable for being loaded and executed by a processor The following steps:
  • the medical information includes any one or more of the following: time of visit, medical insurance card number, ID card number, address information of the hospital to visit, and cost of treatment;
  • the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, distribution characteristic information of the address of the medical treatment hospital, and household registration address of the organ transplant patient Distribution characteristic information of the hospital, distribution characteristic information of the visit cost, and distribution characteristic information of the visit time;
  • the visit information of the organ transplant patient who has abnormal visit behavior is marked.
  • abnormal medical treatment behaviors of organ transplant patients can be automatically identified based on medical characteristic data corresponding to a large amount of medical treatment information, and the accuracy of abnormal medical treatment behavior identification can be improved, which can avoid fraudulent medical insurance funds through abnormal medical treatment methods and reduce The country's economic losses ensure the public's medical interests; and when it is determined that there is abnormal medical behavior, the medical information of the organ transplant patients with abnormal medical behavior is marked so that it can be easily learned which organ transplant patients have abnormal medical behavior.
  • FIG. 1 is a schematic flowchart of a method for processing medical information based on data analysis provided by an embodiment of the present application
  • FIG. 2 is a schematic flowchart of a method for processing medical information based on data analysis according to another embodiment of the present application
  • FIG. 3 is a schematic structural diagram of a medical treatment information processing device provided by an embodiment of the present application.
  • FIG. 4 is a schematic structural diagram of a medical management device according to another embodiment of the present application.
  • the example of the present application may be executed by a medical management device, and the medical management device may refer to a device such as an intelligent terminal, server, computer, or medical service terminal.
  • the application example can be applied to fraud insurance application scenarios, for example, organ transplant patients can upload medical information to medical management equipment, analyze the medical information to obtain medical characteristic data, and the medical characteristic data is used to indicate the regularity of organ transplant patients,
  • the visit characteristic data includes the distribution characteristic information of the medical insurance card number, the address distribution characteristic information of the hospital to be visited, the distribution characteristic information of the household registration address of the organ transplant patient, the distribution characteristic information of the visit cost, the distribution characteristic information of the visit time, etc.
  • the feature data determines whether the organ transplant patient has abnormal medical treatment behavior.
  • Organ transplant patients with abnormal medical treatment can avoid deceiving the medical insurance fund, reduce the national economic burden, and ensure the interests of the public; and mark the medical treatment information of organ transplant patients with abnormal medical treatment behavior so that they can Czech Republic to learn that there is an abnormal behavior which doctor organ transplant patients.
  • FIG. 1 is a schematic flowchart of a medical information processing method based on data analysis provided by an embodiment of the present application.
  • the method in the embodiment of the present application may be performed by the medical management device mentioned above.
  • the medical information processing method based on data analysis includes the following steps.
  • the medical treatment information includes any one or more of the following: medical treatment time, medical insurance card number, ID card number, address information of the medical treatment hospital, and medical treatment cost.
  • the medical management device can acquire multiple belonging to the same area or medical treatment Visiting information of multiple organ transplant patients in the same hospital.
  • the visiting information can be obtained from the local database of the medical management equipment, or can be obtained from the information management system of other hospitals.
  • the hospital management equipment can obtain the medical treatment information of organ transplant patients in such hospitals .
  • the number of organ transplant patients in multiple hospitals is obtained.
  • the medical information of the multiple organ transplant patients is obtained from the information management system of the target hospital.
  • the medical management device includes not only the medical consultation information of the organ transplant patient, but also the medical treatment information of the non-organ transplant patient, so before step S101, it also includes determining whether the patient is an organ transplant patient. Specifically, it can be judged whether the patient is an organ transplant patient according to the patient's physical parameters and / or disease identification, and determining whether the patient is an organ transplant patient according to the patient's physical parameters includes: obtaining the body parameters of the organ transplant patient, when the target patient visits When the body parameters in the information match the obtained body parameters, the target patient is determined to be an organ transplant patient.
  • the patient's disease identifier includes: obtaining the patient's disease identifier for the organ transplant, when the disease identifier in the target patient's medical information matches the obtained disease identifier, the target patient is determined to be an organ transplant patient,
  • the target patient is any one of multiple patients.
  • the medical management device can determine whether the patient is an organ transplant patient based on the identification information of the target patient, and compare the identification information of the target patient with the identification information of the patient in the database.
  • the identity identification information of the organ transplant patient when the comparison result reflects that there is identity identification information in the database that matches the identity identification information of the target patient, the target patient is determined to be an organ transplant patient, and the identity identification information may include the patient's name and ID card Number, face image or fingerprint information, etc.
  • the medical management device may provide a human-computer interaction interface through which the user manually enters patient's medical consultation information, or the medical management device enters the medical consultation information by taking a photo of the medical examination certificate. Therefore, the medical consultation information may be Formats such as images, tables, or plain text are stored in medical management equipment.
  • the consultation information may be stored in the medical management device in the form of an image, and the medical management device may obtain the consultation information through the image.
  • the medical management device may use a text recognition method to obtain from the image corresponding to the consultation information
  • the initial visit information can be corrected to obtain the visit information of the organ transplant patient.
  • the character recognition method may refer to an optical character recognition method (Optical Character Recognition, OCR), etc. Correcting the initial consultation information here refers to correcting the erroneous characters in character recognition, filtering out redundant characters, or normalizing the format of the characters, and so on.
  • the consultation information when the consultation information is stored in the medical management device in a table format, the consultation information is shown in Table 1, which includes the patient's identity information, disease identification, physical parameters, etc.
  • the device can obtain the medical information of the organ transplant patient from the medical information in the form of field retrieval.
  • the patient's identification may refer to an identity identification, such as an ID card or name
  • the target patient's identification may also refer to the number of the hospitalization, etc.
  • the disease identification may refer to the name or number of the disease, etc.
  • the number can uniquely indicate a disease
  • the physical parameters can refer to blood glucose, blood pressure, electrocardiogram, electroencephalogram, or body temperature, etc.
  • the medical management device can retrieve the consultation information of the organ transplant patient from the consultation information in the form of field retrieval.
  • the medical characteristic data includes any one or more of the following: the distribution characteristic information of the medical insurance card number, the distribution characteristic information of the address of the visiting hospital, and the distribution characteristic information of the household registration address of the organ transplant patient 1. Distribution characteristic information of the visit cost and distribution characteristic information of the visit time.
  • the medical management equipment can input the consultation information into the basic statistical model for training to obtain the characteristic data of the consultation.
  • the basic statistical model is a model for collecting the characteristic data of the consultation.
  • the basic statistical model is trained by the consultation information of a large number of organ transplant patients And adjust what you get.
  • the medical management device includes the correspondence between the medical information of the organ transplant patient and the medical characteristic data, and the hospital management device can obtain the medical characteristic data corresponding to the medical information according to the corresponding relationship.
  • the hospital management equipment can determine whether there are abnormal medical treatment behaviors such as organ transplantation anti-exclusion drugs using serial numbered medical insurance card sets for brushing organ transplants, or deceptive medical insurance by means of off-site medical treatment according to the characteristic data of the medical treatment. Annotate the medical information of organ transplant patients with abnormal medical behavior; when it is determined that there is no abnormal medical behavior, obtain the use and reimbursement strategy of organ transplant patients, and use the reimbursement strategy to reimburse the organ transplant patients for medical expenses.
  • abnormal medical treatment behaviors such as organ transplantation anti-exclusion drugs using serial numbered medical insurance card sets for brushing organ transplants, or deceptive medical insurance by means of off-site medical treatment according to the characteristic data of the medical treatment.
  • the medical treatment information of the organ transplant patient who has the abnormal medical treatment behavior is marked.
  • the labeling refers to setting a label on the medical treatment information, and the label may include instructions to the organ transplant patient corresponding to the medical treatment information.
  • the identification of the presence of abnormal medical treatment can also include the number of abnormal medical treatments or the amount of money involved in the abnormal medical treatment, etc. According to the labeling, it can quickly know which organ transplant patients have abnormal medical treatment behavior.
  • the medical management device may use voice announcements and output prompt boxes to present the medical information and labeling of the medical information of organ transplant patients with abnormal medical behavior.
  • medical management equipment can choose a reimbursement strategy based on the labeling of the medical information, and use the reimbursement strategy to reimburse the medical expenses of organ transplant patients, for example, specifically, When the labeling of the medical information indicates that the number of abnormal medical behaviors of the organ transplant patient is greater than the preset number of times, the first reimbursement strategy is selected, and the first reimbursement strategy is used to reimburse the medical expenses of the organ transplant patient; When the number of abnormal visits to the transplant patient is less than or equal to the preset number, the second reimbursement strategy is selected, and the second reimbursement strategy is used to reimburse the hospitalization expenses of the organ transplant patient.
  • the first reimbursement strategy may be a reimbursement strategy that rejects reimbursement, or a reimbursement strategy that reduces the normal reimbursement ratio
  • the second reimbursement strategy may refer to a reimbursement strategy with a higher reimbursement ratio than the first reimbursement strategy.
  • the reimbursement ratio of the second reimbursement strategy is 50%
  • the reimbursement ratio of the first reimbursement strategy is 20%.
  • the target organ transplant patient when the target organ transplant patient has abnormal medical treatment behavior, the number of abnormal organ medical treatment behavior of the target organ transplant patient is obtained, and when the number of acquisitions is greater than a certain value (such as 5 times), the target organ transplant is received and received
  • the identity information of the patient record the identity information of the target organ transplant patient into a blacklist, and send the blacklist to multiple hospitals, so that multiple hospitals can control and control the focus of the organ transplant patients on the blacklist.
  • the probability of occurrence of abnormal medical treatment behavior the blacklist records the identity information of multiple organ transplant patients with abnormal medical treatment behavior.
  • abnormal medical treatment behaviors of organ transplant patients can be automatically identified based on medical characteristic data corresponding to a large amount of medical treatment information, and the accuracy of abnormal medical treatment behavior identification can be improved, which can avoid fraudulent medical insurance funds through abnormal medical treatment methods and reduce The country's economic losses ensure the public's medical interests; and when it is determined that there is abnormal medical treatment, the medical information of the organ transplant patients with abnormal medical treatment is marked, so that it can be easily learned which organ transplant patients have abnormal medical treatment.
  • FIG. 2 is a schematic flowchart of another medical information processing method based on data analysis provided by an embodiment of the present application.
  • the method in the embodiment of the present application may be performed by the medical management device mentioned above.
  • the medical information processing method based on data analysis includes the following steps.
  • the medical treatment information includes any one or more of the following: medical treatment time, medical insurance card number, ID card number, address information of the medical treatment hospital, and medical treatment cost.
  • the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, distribution characteristic information of the address of the visiting hospital, and distribution characteristic information of the household registration address of the organ transplant patient 1. Distribution characteristic information of the visit cost and distribution characteristic information of the visit time.
  • the medical consultation information includes the medical insurance card number
  • the medical characteristic data includes the distribution characteristic information of the medical insurance card number
  • step S202 includes: linearly fitting the medical insurance card numbers of multiple organ transplant patients to obtain information about the medical insurance card number Fitting the line segment; analyzing the fitting line segment to obtain the distribution characteristic information of the medical insurance card number of multiple organ transplant patients.
  • medical management equipment can analyze the medical insurance card numbers of organ transplant patients. Specifically, the medical insurance card numbers of multiple organ transplant patients Perform linear fitting to obtain the fitted line segment of the medical insurance card number, and analyze the fitted line segment to obtain the distribution characteristic information of the medical insurance card number of multiple organ transplant patients.
  • the distribution characteristic information of the medical insurance card number includes discrete distribution characteristics and continuous distribution Feature, when the medical insurance card number is on the fitted line segment, it indicates that the medical insurance card number has a linear relationship with other medical insurance card numbers on the fitted line segment, that is, the medical insurance card number has a continuous distribution feature; when the medical insurance card number is not in the fit On the line segment, it shows that the medical insurance card number does not have a linear relationship with other medical insurance card numbers on the fitted line segment, that is, the medical insurance card number has a discrete distribution feature,
  • the visit information includes the ID number and the address information of the hospital
  • the visit characteristic data includes the address distribution characteristic information of the visit hospital and the distribution characteristic information of the household registration address of the organ transplant patient
  • step S202 includes: Perform cluster analysis on the hospital address information of the organ transplant patient to obtain the address distribution characteristic information of the hospital; determine the household registration address information of each organ transplant patient according to the ID number of each organ transplant patient in multiple organ transplant patients; Cluster analysis of household registration address information of multiple organ transplant patients to obtain the distribution characteristic information of household registration addresses of multiple organ transplant patients.
  • medical management equipment can perform cluster analysis on the hospital address information of multiple organ transplant patients to obtain the address distribution characteristic information of the hospital, and according to Mapping relationship between ID number and household registration address, determine the household registration address information of each organ transplant patient, cluster analysis of household registration address information of multiple organ transplant patients, to obtain the distribution characteristic information of household registration addresses of multiple organ transplant patients, So that the medical management device can determine the organ transplant patients to be treated in different places and the organ transplant patients to be treated locally according to the address distribution feature information of the visiting hospital and the household register address distribution feature information of the organ transplant patients.
  • the medical characteristic data includes distribution characteristic information of the medical insurance card number
  • step S203 includes: acquiring the first number of medical insurance cards whose medical insurance card number belongs to the continuous distribution feature according to the distribution characteristic information of the medical insurance card number, and the medical insurance card number The second number of medical insurance cards belonging to the discrete distribution feature; when the ratio between the first number and the second number is greater than the first threshold, it is determined that there is an abnormal medical treatment behavior.
  • the medical management device can determine whether the organ transplant patient has abnormal medical treatment according to the distribution characteristic information of the medical insurance card number. Specifically, according to the distribution characteristic information of the medical insurance card number, the first number of medical insurance cards whose medical card numbers belong to the continuous distribution characteristics are obtained, and The medical insurance card number belongs to the second quantity of medical insurance cards with discrete distribution characteristics; when the ratio between the first quantity and the second quantity is greater than the first threshold, it indicates that there is an organ transplant patient and there is an application of another medical insurance card to purchase organ transplant The behavior of anti-exclusion drugs is determined to be abnormal.
  • the first threshold may be set according to the ratio of the number of medical insurance cards with continuous distribution features to the number of medical insurance cards with discrete distribution features under normal circumstances (when there is no abnormal medical behavior), or may be set manually by the user.
  • the visit characteristic data includes the address distribution feature information of the visiting hospital and the distribution characteristic information of the household registration address of the organ transplant patient
  • step S203 includes: according to the address distribution feature information of the visiting hospital and the distribution of the household registration address of the organ transplant patient
  • the characteristic information determines the number of organ transplant patients who visit the clinic in different places; obtain the total number of organ transplant patients in multiple organ transplant patients; when the ratio of the number of organ transplant patients who visit the clinic to the total number is greater than the second threshold, it is determined that there is Abnormal visit behavior.
  • the medical management equipment can determine the organ transplant patients to be visited in different places according to the distribution feature information of the household registration address and the hospital hospital, and count the number of organ transplant patients in different places and the total number of organ transplant patients among multiple organ transplant patients , When the ratio of the number of organ transplant patients to the total number and the total number is greater than the second threshold, it indicates that there is an act of organ transplant patients defrauding the medical insurance fund through the method of off-site treatment, and it is determined that there is abnormal medical treatment.
  • the address and the hospital address do not belong to the same province or city.
  • the medical characteristic data further includes distribution characteristic information of the medical treatment cost
  • step S203 includes: determining the organ transplant patient to be treated in another place according to the distribution characteristic information of the hospital address and the distribution characteristic information of the household registration address;
  • the distribution characteristic information of the cost determines the cost of the visit of the organ transplant patient who visits in different places, and the total cost of the multiple organ transplant patients; the ratio between the cost of the organ transplant patient who visits in different places and the total cost is greater than the When setting the cost value, it is determined that there is abnormal medical treatment.
  • the medical management equipment can determine whether there is an abnormal medical treatment behavior based on the distribution characteristic information of the visit cost, the distribution characteristic information of the hospital address and the distribution characteristic information of the household registration address, specifically, based on the distribution characteristic information of the hospital address and the household registration
  • the distribution characteristic information of the address determines the organ transplant patients who visit the clinic in different places, and determines the cost of the organ transplant patients who visit the clinic according to the distribution characteristic information of the visit cost, and the total cost of the multiple organ transplant patients; When the ratio between the cost of medical treatment and the total cost is greater than the preset cost value, it indicates that the cost of organ transplantation in a remote place is high, indicating that there is an act of organ transplant patients defrauding the medical insurance fund through a remote place visit, and it is determined that there is an abnormal behavior .
  • the visit characteristic data includes the distribution characteristic information of the visit time; step S203 includes: determining the number of organ transplant patients visited within a preset time period according to the distribution characteristic information of the visit time; when the preset time When the number of organ transplant patients visited within the segment is greater than the third threshold, it is determined that there is an abnormal visit behavior.
  • the medical management device can determine whether there is an abnormal visit behavior based on the distribution characteristic information of the visit time. Specifically, the number of organ transplant patients who are treated within a preset time period can be determined according to the distribution characteristic information of the visit time. When the number of organ transplant patients visited is greater than the third threshold, it indicates that the number of organ transplant patients has increased abnormally within a preset period of time. Further, it indicates that there is an act of applying a medical insurance card to the organ transplant patient, and it is determined that there is an abnormal medical treatment.
  • the medical management device can obtain the number of abnormal medical treatments of the target organ transplant patient within a certain period of time (such as within one year).
  • the medical management equipment can mark the visit information of the target organ transplant patient according to the number of abnormal visits of the target organ transplant patient, that is, the number of abnormal visits of the target organ transplant patient, so that the reimbursement strategy can be selected according to the label, and the reimbursement strategy can be selected according to the selected Reimburse the medical expenses of the target organ transplant patients.
  • abnormal medical treatment behaviors of organ transplant patients can be automatically identified based on medical characteristic data corresponding to a large amount of medical treatment information, and the accuracy of abnormal medical treatment behavior identification can be improved, which can avoid fraudulent medical insurance funds through abnormal medical treatment methods and reduce The country's economic losses ensure the public's medical interests; and when it is determined that there is abnormal medical treatment, the medical information of the organ transplant patients with abnormal medical treatment is marked, so that it can be easily learned which organ transplant patients have abnormal medical treatment.
  • FIG. 3 is a schematic structural diagram of a medical information processing device provided in an embodiment of the present application.
  • the device in the embodiment of the present application may be in the medical management device mentioned above.
  • the medical information processing device includes:
  • the obtaining module 301 is used to obtain the medical information of each organ transplant patient among multiple organ transplant patients.
  • the medical information includes any one or more of the following: time of medical treatment, medical insurance card number, ID card number, and address of the hospital Information and medical expenses.
  • the parsing module 302 is configured to parse the medical information to obtain medical characteristic data.
  • the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, address distribution characteristic information of the hospital, Distribution characteristic information of household registration address of organ transplant patients, distribution characteristic information of treatment costs, and distribution characteristic information of treatment time;
  • the judging module 303 is used to judge whether there is an abnormal medical treatment behavior according to the medical characteristic data
  • the labeling module 304 is configured to label the medical information of the organ transplant patient who has the abnormal medical treatment behavior when it is determined that the abnormal medical treatment behavior exists.
  • the medical treatment information includes a medical insurance card number
  • the medical characteristic data includes distribution characteristic information of the medical insurance card number
  • the analysis module 302 is specifically configured to linearly fit the medical insurance card numbers of the multiple organ transplant patients To obtain the fitting line segment of the medical insurance card number; analyze the fitting line segment to obtain the distribution characteristic information of the medical insurance card number of the multiple organ transplant patients.
  • the medical characteristic data includes distribution characteristic information of the medical insurance card number
  • the judgment module 303 is specifically configured to obtain the first part of the medical insurance card whose medical insurance card number belongs to continuous distribution characteristics according to the distribution characteristic information of the medical insurance card number A number, and the second number of medical insurance cards whose medical insurance card numbers belong to the discrete distribution feature; when the ratio between the first number and the second number is greater than the first threshold, it is determined that there is abnormal medical behavior.
  • the visit information includes ID card number and address information of the visiting hospital
  • the visit feature data includes address distribution characteristic information of the visiting hospital and household registration address distribution characteristic information of the organ transplant patient
  • the parsing module 302 specifically used For cluster analysis of the hospital address information of the multiple organ transplant patients, the address distribution characteristic information of the hospital can be obtained; each of the multiple organ transplant patients is determined according to the ID number of each organ transplant patient Household registration address information of an organ transplant patient; performing cluster analysis on the household registration address information of the multiple organ transplant patients to obtain distribution characteristic information of the household registration addresses of the multiple organ transplant patients.
  • the medical characteristic data includes address distribution characteristic information of the medical treatment hospital and distribution characteristic information of the household registration address of the organ transplantation patient
  • the judgment module 303 is specifically used for distributing the medical treatment device's address distribution characteristic information and all
  • the distribution feature information of the household registration address of the organ transplant patient determines the number of organ transplant patients who visit the clinic remotely; obtains the total number of organ transplant patients among the plurality of organ transplant patients; When the ratio of the total number is greater than the second threshold value, it is determined that there is an abnormal medical behavior.
  • the medical characteristic data further includes distribution characteristic information of the medical treatment cost
  • the judgment module 303 is specifically configured to determine the organ transplantation of the off-site treatment based on the distribution characteristic information of the hospital address and the distribution characteristic information of the household registration address Patients; according to the distribution characteristic information of the visit cost, determine the visit cost of the organ transplant patient who visits in different places, and the total cost of the multiple organ transplant patient visits; When the ratio between the total costs is greater than the preset cost value, it is determined that there is an abnormal behavior of seeing a doctor.
  • the visit characteristic data includes distribution characteristic information of the visit time; the judgment module 303 is specifically configured to determine the number of organ transplant patients visited within a preset time period based on the distribution characteristic information of the visit time; When the number of organ transplant patients visiting the preset time period is greater than the third threshold, it is determined that there is an abnormal behavior of seeing a doctor.
  • abnormal medical treatment behaviors of organ transplant patients can be automatically identified based on medical characteristic data corresponding to a large amount of medical treatment information, and the accuracy of abnormal medical treatment behavior identification can be improved, which can avoid fraudulent medical insurance funds through abnormal medical treatment methods and reduce The country's economic losses ensure the public's medical interests; and when it is determined that there is abnormal medical treatment, the medical information of the organ transplant patients with abnormal medical treatment is marked, so that it can be easily learned which organ transplant patients have abnormal medical treatment.
  • FIG. 4 is a schematic structural diagram of a medical management device according to an embodiment of the present application.
  • the medical management device in this embodiment may include: one or more processors 401; one or more inputs Device 402, one or more output devices 403 and memory 404.
  • the processor 401, the input device 402, the output device 403, and the memory 404 are connected via a bus 405.
  • the processor 401 may be a central processing unit (Central Processing Unit, CPU), the processor may also be other general-purpose processors, digital signal processors (Digital Signal Processor, DSP), application specific integrated circuits (Application Specific Integrated Circuit, ASIC ), Ready-made programmable gate array (Field-Programmable Gate Array, FPGA) or other programmable logic devices, discrete gate or transistor logic devices, discrete hardware components, etc.
  • the general-purpose processor may be a microprocessor or the processor may be any conventional processor or the like.
  • the input device 402 may include a touchpad, a fingerprint sensor (for collecting user's fingerprint information and fingerprint direction information), a microphone, etc.
  • the output device 403 may include a display (LCD, etc.), a speaker, etc., and the output device 403 may output abnormality Number of visits.
  • the memory 404 may include a read-only memory and a random access memory, and provide instructions and data to the processor 401.
  • a part of the memory 404 may further include a non-volatile random access memory, the memory 404 is used to store a computer program, the computer program includes program instructions, and the processor 401 is used to execute the program instructions stored in the memory 404 to be used to execute a
  • a medical information processing method based on data analysis is used to perform the following operations:
  • the medical information includes any one or more of the following: time of visit, medical insurance card number, ID card number, address information of the hospital to be visited, and cost of visit;
  • the medical treatment information is analyzed to obtain medical characteristic data, and the medical characteristic data includes any one or more of the following: distribution characteristic information of the medical insurance card number, the distribution characteristic information of the address of the medical treatment hospital, the household registration address of the organ transplant patient Distribution characteristic information, distribution characteristic information of the visit cost, and distribution characteristic information of the visit time; judging whether there is abnormal visit behavior according to the visit characteristic data; when it is determined that there is abnormal visit behavior, visiting the organ transplant patient who has abnormal visit behavior Information.
  • the medical treatment information includes a medical insurance card number
  • the medical characteristic data includes distribution characteristic information of the medical insurance card number
  • the processor 401 is used to execute program instructions stored in the memory 404 for performing the following operations:
  • the medical insurance card numbers of each organ transplant patient are linearly fitted to obtain a fitted line segment about the medical insurance card number; the fitting line segment is analyzed to obtain distribution characteristic information of the medical insurance card numbers of the multiple organ transplant patients.
  • the medical characteristic data includes distribution characteristic information of the medical insurance card number
  • the processor 401 is used to execute program instructions stored in the memory 404 for performing the following operations: acquiring according to the distribution characteristic information of the medical insurance card number
  • the medical insurance card number belongs to the first number of continuously distributed medical insurance cards, and the medical insurance card number belongs to the second number of discretely distributed medical insurance cards; when the ratio between the first number and the second number is greater than the first When the threshold is reached, it is determined that there is abnormal medical behavior.
  • the visit information includes ID card number and address information of the visiting hospital
  • the visit feature data includes address distribution characteristic information of the visiting hospital and distribution characteristic information of the household registration address of the organ transplant patient
  • the processor 401 is used to execute
  • the program instructions stored in the memory 404 are used to perform the following operations: perform cluster analysis on the hospital address information of the multiple organ transplant patients to obtain the address distribution characteristic information of the hospital; according to the multiple organ transplant patients
  • the ID number of each organ transplant patient determines the household registration address information of each organ transplant patient; cluster analysis is performed on the household registration address information of the multiple organ transplant patients to obtain the distribution of the household registration addresses of the multiple organ transplant patients Characteristic information.
  • the medical characteristic data includes address distribution characteristic information of the medical treatment hospital and distribution characteristic information of the household registration address of the organ transplant patient.
  • the processor 401 is used to execute program instructions stored in the memory 404 for performing the following operations: Determine the number of organ transplant patients to be treated in different places according to the address distribution feature information of the visiting hospital and the distribution feature information of the household registration address of the organ transplant patient; obtain the total number of organ transplant patients among the multiple organ transplant patients; When the ratio of the number of organ transplant patients referred to the off-site visit to the total number is greater than the second threshold, it is determined that there is an abnormal visit behavior.
  • the medical characteristic data further includes distribution characteristic information of the medical treatment cost;
  • the processor 401 is used to execute program instructions stored in the memory 404 for performing the following operations: according to the distribution characteristic information of the hospital address and the medical treatment
  • the distribution characteristic information of the household registration address determines the organ transplant patients to be visited in different places; the cost of the organ transplant patients to be visited at different places according to the distribution characteristic information of the visit fees, and the total cost of the multiple organ transplant patients; When the ratio between the cost of visiting the organ transplant patient at a different place and the total cost is greater than the preset cost value, it is determined that there is an abnormal behavior of the doctor.
  • the visit characteristic data includes the distribution characteristic information of the visit time; the processor 401 is used to execute the program instructions stored in the memory 404 for performing the following operations: according to the distribution characteristic information of the visit time, it is determined to be at a preset time The number of organ transplant patients visited within the period; when the number of organ transplant patients visited within the preset time period is greater than the third threshold, it is determined that there is an abnormal visit behavior.
  • abnormal medical treatment behaviors of organ transplant patients can be automatically identified based on medical characteristic data corresponding to a large amount of medical treatment information, and the accuracy of abnormal medical treatment behavior identification can be improved, which can avoid fraudulent medical insurance funds through abnormal medical treatment methods and reduce The country's economic losses ensure the public's medical interests; and when it is determined that there is abnormal medical treatment, the medical information of the organ transplant patients with abnormal medical treatment is marked, so that it can be easily learned which organ transplant patients have abnormal medical treatment.
  • the processor 401, the input device 402, and the output device 403 described in the embodiments of the present application can execute the implementation methods described in the first and second embodiments of the information prompt method provided by the embodiments of the present application, and can also be executed The implementation of the medical management device described in the embodiments of the present application will not be repeated here.
  • An embodiment of the present application also provides a computer-readable storage medium.
  • the computer-readable storage medium stores a computer program, and the computer program includes program instructions.
  • the program instructions are implemented by a processor as shown in FIG. 1 and FIG. 2 The medical information processing method based on data analysis shown in the embodiment.
  • the disclosed control device and method may be implemented in other ways.
  • the device embodiments described above are schematic.
  • the division of the unit may be a logical function division.
  • there may be another division manner for example, multiple units or components may be combined or may Integration into another system, or some features can be ignored, or not implemented.
  • the above is only the specific implementation of this application, but the scope of protection of this application is not limited to this, any person skilled in the art can easily think of various equivalent modifications within the technical scope disclosed in this application Or replacement, these modifications or replacements should be covered within the scope of protection of this application. Therefore, the protection scope of the present application shall be subject to the protection scope of the claims.

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Abstract

Des modes de réalisation de la présente invention concernent un procédé, un dispositif et un appareil de traitement d'informations de visite médicale basé sur une analyse de données, et un support. Le procédé consiste à : acquérir des informations de visite médicale de chacun parmi de multiples patients transplantés ; analyser les informations de visite médicale pour obtenir des données de caractéristique de visite médicale ; déterminer, en fonction des informations de caractéristique de visite médicale, s'il y a une visite médicale irrégulière ; et s'il est déterminé qu'il y a une visite médicale irrégulière, annoter les informations de visite médicale du patient transplanté s'étant rendu à la visite médicale irrégulière. L'invention permet une reconnaissance automatique d'une visite médicale irrégulière effectuée par un patient transplanté.
PCT/CN2019/095029 2018-10-27 2019-07-08 Procédé, dispositif et appareil de traitement d'informations de visite médicale basé sur une analyse de données, et support WO2020082796A1 (fr)

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CN109509550B (zh) * 2018-10-27 2024-06-25 平安医疗健康管理股份有限公司 基于数据分析的就诊信息处理方法、装置、设备及介质
CN112036749A (zh) * 2020-08-31 2020-12-04 平安医疗健康管理股份有限公司 基于医疗数据识别风险用户的方法、装置和计算机设备

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106408481A (zh) * 2015-07-28 2017-02-15 平安科技（深圳）有限公司 异常刷卡人员信息自动提取系统及方法
CN107133438A (zh) * 2017-03-03 2017-09-05 平安医疗健康管理股份有限公司 医疗行为监控方法及装置
CN107609980A (zh) * 2017-09-07 2018-01-19 平安医疗健康管理股份有限公司 医疗数据处理方法、装置、计算机设备及存储介质
WO2018149299A1 (fr) * 2017-02-20 2018-08-23 平安科技（深圳）有限公司 Procédé d'identification d'une fraude à l'assurance sociale, dispositif, appareil et support de stockage informatique
CN109509550A (zh) * 2018-10-27 2019-03-22 平安医疗健康管理股份有限公司 基于数据分析的就诊信息处理方法、装置、设备及介质

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6434262B2 (en) * 1993-09-29 2002-08-13 Shih-Ping Wang Computer-aided diagnosis system and method
US20090094064A1 (en) * 2007-10-09 2009-04-09 Michael Tyler Healthcare Insurance Claim Fraud and Error Detection Using Co-Occurrence
CN103514576A (zh) * 2013-09-06 2014-01-15 深圳民太安信息技术有限公司 一种社保就诊违规套现的筛查方法
CN104133688B (zh) * 2014-08-08 2018-05-29 平安养老保险股份有限公司 医疗服务巡查与调查系统及方法

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106408481A (zh) * 2015-07-28 2017-02-15 平安科技（深圳）有限公司 异常刷卡人员信息自动提取系统及方法
WO2018149299A1 (fr) * 2017-02-20 2018-08-23 平安科技（深圳）有限公司 Procédé d'identification d'une fraude à l'assurance sociale, dispositif, appareil et support de stockage informatique
CN107133438A (zh) * 2017-03-03 2017-09-05 平安医疗健康管理股份有限公司 医疗行为监控方法及装置
CN107609980A (zh) * 2017-09-07 2018-01-19 平安医疗健康管理股份有限公司 医疗数据处理方法、装置、计算机设备及存储介质
CN109509550A (zh) * 2018-10-27 2019-03-22 平安医疗健康管理股份有限公司 基于数据分析的就诊信息处理方法、装置、设备及介质

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