JP4393112B2 - Insurance medical support computer system and insurance medical support method - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a medical support computer system for supporting medical care in a hospital, a clinic, and the like, and in particular, an insurance medical support computer system and an insurance medical support method for timely authentication of patient medical care in a system employing an electronic medical record. About.
[0002]
[Prior art]
FIG. 5 shows an example of a medical support computer system in a hospital. In hospitals that are relatively large compared to clinics, the medical department is divided into departments such as medical office work and examinations, and the medical support computer system enables efficient support that supervises these tasks.
[0003]
In the figure, a medical assistance system 1 provided for a plurality of examination rooms, a medical office system 2 provided in a centralized examination reception and accounting department, an examination department 3 for blood tests and radiography, and a pharmacy department 4 And a server 5 including a database for managing information such as medical records for centralized management of medical information are connected by communication via a LAN (local area network). Furthermore, communication connection is possible via the wide area network to the linked medical facility 6, the support center 7 of the medical support computer system, the outsourcing test facility 8 such as a blood test corporation, and the like.
[0004]
The medical support by such a medical support computer system includes an automatic reception process in the medical office system 2 when a medical subject (outpatient or inpatient) brings an examination ticket, and a medical record support system 1 by this automatic reception Automatic delivery processing to the side, automatic notification processing of the examination content to the examination department 3 side at the time of medical treatment by the doctor in charge, automatic presentation processing of appropriate medicine information and automatic presentation of examination results, medication information to the pharmacy department 4 side Supports information processing such as automatic notification processing. Furthermore, the medical information exchange process by the cooperative medical facility 6 or the like and the inspection content instruction processing to the outsourced inspection facility 8 are supported.
[0005]
The medical support computer system corresponding to the clinic is configured as a simplified system in which the examination department 3 and the server 5 are integrated into the medical assistance system 1 and the pharmacy department 4 is integrated into the medical office system 2.
[0006]
Further, as a medical chart, an electronic medical chart system shown as an electronic medical chart 9 in FIG. 5 is becoming popular instead of the conventional paper system. This electronic medical chart system transmits medical chart information including patient identification information, medical examination / treatment information, medication history information, etc. adopted in the paper system medical chart, and the doctor in charge displays the screen on the display device of the medical support system 1, In addition to this, it is possible to input diagnosis, treatment, medication information, etc. from an electronic pen or keyboard. Furthermore, electronic data can be automatically transferred to the medical office system 2 and stored in the server 5 database. To.
[0007]
On the other hand, as an IC card usage method, an IC card that allows recording / updating of examination ticket information such as the date and time of the patient's visit and the subject to be examined is configured, and this IC card is carried by the patient and accepted at the hospital and the hospital side A method that enables automatic conveyance and information transmission of medical assistance information based on medical examination ticket information in Japan has been studied.
[0008]
Further, as a method of using an IC card, a system in which health insurance card information can be recorded / updated on the IC card in place of the health insurance card has been studied. As for health insurance cards, instead of the previous insured card that registers the family owner and their family together, a system that allows the individual to issue an insured person card and to carry it by individual person is also being considered. Yes.
[0009]
From the above, by making it possible to record / update the medical ticket information and health insurance card information on the IC card, the patient can manage the medical card and health insurance card in a lump, and the hospital side from the consultation reception to the medication Medical support management can be collectively managed from an IC card that receives a presentation from a patient.
[0010]
[Problems to be solved by the invention]
Conventional hospital consultation procedures are as follows: Outpatients at hospitals receive a medical examination ticket at the reception desk at the reception unless it is the first visit, receive a medical examination receipt slip at the medical appointment confirmation, and submit it to the reception for the corresponding clinical subject. Receive the prescription, present the prescription and health insurance card to the medical office system 2 and pay the medical fee. If the medicine is taken, the pharmacy department 4 or the external prescription reception pharmacy pays the medicine and receives the medicine.
[0011]
These consultation procedures are simplified but similar to the consultation at the clinic. In medical examinations equipped with a medical support computer system that employs the above-mentioned electronic medical record system, the automatic medical record transport system and the instruction voucher system for medical office work, examination, and medication are omitted, but the procedure is almost the same. Become.
[0012]
Here, medical fees and drug charges are based on the contents of the health insurance card carried by the patient, the type of insurance that the patient joins (health insurance association, national health insurance association, etc.), the difference between the patient himself and his / her family, It is automatically calculated based on the difference between the elderly and ordinary people. Medical fees and drug charges are collected from the patient himself / herself, based on the contents of the health insurance card, and the difference is collected from the insurance association to which the patient belongs.
[0013]
In this way, the current collection of medical fees and drug charges is calculated based on the contents of the health insurance card, so if the patient forgets to bring his / her health insurance card, he / she does not pay for the insurance, If the health insurance card has expired, etc., the medical facility or pharmacy will receive a decision from the health insurance association at the time of requesting payment to the health insurance association to the medical facility or pharmacy that performed the medical practice, In the case of invalidity, the medical facility or pharmacy will be denied payment.
[0014]
On the other hand, there is an inconvenience that the patient cannot receive medical care when he / she does not have a health insurance card due to a sudden illness at the destination.
[0015]
The above-described problems also exist in a medical support computer system that uses an IC card that records only one of the examination ticket information and the health insurance card information, and further uses an IC card that records both the examination ticket information and the health insurance card information. .
[0016]
An object of the present invention is that in a computer system that performs medical support using an electronic medical record or medical support using an IC card, the patient brought an inappropriate health insurance card, or the patient could not bring a health insurance card In some cases, an insurance medical assistance system and an insurance medical assistance method that enable appropriate insurance medical care and medication are provided.
[0017]
[Means for Solving the Problems]
In order to solve the above-mentioned problems, the present invention makes it possible to present the validity / invalidity of a patient's health insurance card and the contents of the health insurance in an easy-to-understand manner without the physician in charge being aware of it at the time of medical care.
That is, in a medical support computer system that employs an electronic medical record method or an IC card method, the validity / invalidity of a patient's health insurance card and the patient's health insurance card and Obtaining health insurance certification, the validity / invalidity of the health insurance card and the contents of the health insurance are displayed on the medical examination screen such as the electronic medical chart display screen at the time of medical treatment, regardless of the operation of the electronic medical chart (switching the operation screen, etc. ) So that the attending physician can always see on the screen.
[0018]
With the validity of the health insurance card attached to the electronic medical chart display and the display function of the insurance contents, the doctor can know the payment method of the patient's treatment cost in advance before starting medical treatment, It is possible to select a treatment method in consideration. In addition, when taking medication at the pharmacy based on a prescription issued by medical care, the validity / invalidity of the health insurance card and the contents of the insurance have been confirmed, so that no mistakes are made in the cost of the medicine.
[0019]
In addition, the present invention obtains authentication of this card by presenting a credit card (including a bank's tebit card) when the patient does not have a health insurance card due to a sudden illness or the like at the destination. In order to receive health insurance card as a temporary certification of health insurance card and insurance contents.
[0020]
That is, when a patient presents a credit card instead of a health insurance card before receiving medical care, if the validity of the credit card can be confirmed, insurance treatment with the card as collateral (usually treated as non-insurance, So that you can get a refund later. At a later date, the patient will be notified by notifying the medical facility of the symbol / number of the health insurance card. If there is no notification from the patient by the due date, it will be possible to claim a shortfall for the presented credit card.
[0021]
The above-mentioned health insurance card authentication and credit card authentication as provisional authentication are connected to a wide-area data communication network such as the Internet and a voice / image communication network such as a telephone / fax, etc. As an additional function of the medical support computer system installed in
[0022]
As described above, the present invention is characterized by the following insurance medical support computer system and insurance medical support method.
(1) An insurance medical care support computer system that supports medical operations such as medical care, medical office work, and medication in a medical facility, and enables display and input operation and management of medical information of patients. When you receive a credit card or debit card instead of a health insurance card, enter the name of the card issuing institution, membership number, name of the card presenter, and identity verification information presented in advance by the card issuing institution A card by the computer system of the card issuing institution is transmitted to the computer system including the input means, the member master consisting of the database of the card issuing institution and the card verification mechanism through the wide area network. The result of verification of validity or invalidity is received via the wide area network, If the card is valid, it will be treated as insurance treatment, and if the card is invalid, the card approval mechanism will be treated as non-insurance medical treatment, information on insurance treatment treatment or non-insurance medical treatment treatment from the card approval mechanism, the electronic medical record Display means for displaying the contents, and when the electronic medical chart is displayed on the screen for the doctor to treat the patient under the control of the computer, the information on the insurance treatment or non-insurance treatment is displayed on the display screen. It is displayed.
[0027]
(2) on the occasion to the issuance of the prescription after medical, in response to said credit card authentication result, and notifies the additional information when the patient accounting and dosing, automatically calculate a billing amount based on a patient burden rate It has the means to perform.
[0028]
(3) input means of the medical insurance support computer system, approved master card authorization mechanism, the display unit, a medical insurance support method performed by the control of the computer, a credit card or in place of the health insurance card from the patient When receiving the presentation of the debit card, a step of inputting the card issuing institution name, the membership number, the name of the card presenter, and personal identification information to be presented in advance by the card issuing institution by the input means; The approval mechanism transmits the input card information to the computer system including the member master composed of the database of the card issuing organization and the card verification mechanism via the wide area network. The result of validation of validity or invalidity of wide area network When the card is valid, the treatment is treated as insurance treatment, and when the card is invalid, the treatment is treated as non-insurance treatment, and when the doctor displays the electronic medical record on the screen for treating the patient, The display means includes a step of displaying information on the treatment for insurance treatment or treatment for non-insurance treatment on the display screen .
[0033]
(4) on the occasion to the issuance of the prescription after medical, in response to said credit card authentication result, and notifies the additional information when the patient accounting and dosing, automatically calculate a billing amount based on a patient burden rate And a step of performing.
[0034]
DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 is an insurance medical authentication processing procedure diagram showing an embodiment of the present invention. Among the medical support computer systems shown in FIG. 5, a system that employs an electronic medical record as an additional function in a simple system for a clinic. It is a case where it applies to.
[0035]
When the medical facility accepts an examination ticket or a first visit from a patient (S1), it checks whether or not an insurance card is presented at this reception (S2). If the insurance card is presented in this check, the insurance card number is read automatically or by key input by the receptionist (S3), and the insurance card is authenticated (S4). As will be explained in detail later, this insurance card authentication is authenticated by an external authentication mechanism through a wide area network from a medical support computer system. If it cannot be obtained, it will be treated as non-insurance medical treatment.
[0036]
Next, in the process S2, if no health insurance card is presented, it is checked whether or not the health insurance card has been presented at the previous visit (S5). The health insurance card number is read from the stored database (S6), and the process proceeds to S4 health insurance card authentication (S4). These check process S5 and read process S6 can be automated by accessing a database. By these processes S2 to S6, it is possible to obtain the validity / invalidity of the patient's health insurance card and the authentication of the contents of the health insurance before the patient's medical care.
[0037]
Next, in process S5, if the patient has forgotten to bring his / her health insurance card at the first visit or if he / she has not had his / her previous visit, or if he / she is suddenly ill and cannot present his / her health insurance card, If a credit card (or debit card) is held, the validity of the credit card is confirmed (S7). The validity of the credit card is confirmed by an external authentication mechanism in the same manner as the insurance card authentication described above. If the credit card is valid in the confirmation in the process S7, it is determined that it is treated as insurance medical treatment with the credit card as collateral (S8). If the credit card is invalid, it is determined that it is treated as non-insurance medical treatment (S9). Through these processes S7 to S9, it is possible to obtain the validity / invalidity of the patient's health insurance card and the provisional authentication of the contents of the health insurance from the authentication of the patient's credit card before the medical treatment of the patient.
[0038]
Information regarding insurance medical treatment and non-insurance medical treatment determined by the processes S4, S8, and S9 described above is displayed as a constantly displayed image on the electronic medical chart display screen during actual medical treatment (S10). As shown in the display screen example in FIG. 2, the display form is a display of photographs and data of the contents of the electronic medical record, the name of the doctor in charge, and various examination results (radiography, ultrasound, CT, blood, urine, etc.) In the case of collective display or window switching display), the health insurance contents are always displayed in the case of the distinction between insurance medical treatment / non-insurance medical treatment for the patient and insurance medical treatment. For this display, a method that is easy to understand without being conscious of the doctor in charge, for example, changing the frame of the window constituting the screen, the color scheme of the window itself, or performing it in one fixed position frame of the window, the upper right corner, etc. Is preferred.
[0039]
This insurance treatment and non-insurance treatment treatment and insurance contents are always displayed, so that the doctor in charge of medical treatment can recognize the electronic health record etc. without being aware of the validity / invalidity of the patient's health insurance card and the insurance contents. Therefore, the clinician can know the payment method of the patient's treatment cost in advance and select a treatment method considering the patient's burden before proceeding to the diagnosis (S11). After completing the medical treatment, the process proceeds to accounting or medication by issuing a prescription (S12). The validity / invalidity of these health insurance cards and the contents of insurance are notified as additional information at the time of accounting and medication, and the amount of claim based on the patient burden ratio is automatically calculated.
[0040]
In the procedure shown in FIG. 1, the health insurance card is presented (S2) at a relatively large hospital or the like, where the first examiner first receives the health insurance card. This is often done on the medical office system 2 side after completing medical treatment by presentation. In order to apply this embodiment to this medical system, the patient's health insurance card number is read from the database based on the accepted medical examination ticket (S6) and the health insurance card authentication (S4) is performed.
[0041]
Next, for the health insurance card authentication (S4) and the credit card validity authentication (S7) in FIG. 1, the applicant has already proposed a member authentication system (Japanese Patent Application No. 2002-222695). This can be realized as a modification. This system is described in detail below.
FIG. 3 is a configuration diagram of the credit card authentication system. In this system, a verification mechanism 11A is prepared on the credit card issuing institution 11 side, a credit card approval mechanism 12A is prepared on a medical support computer system on the medical service provider (medical facility) side 12 by presenting the credit card, and the wide area network 13 is provided. Enable them to communicate through. Furthermore, a guarantee mechanism 14 is provided which provides the other party via the network 13 and provides encryption / guarantee guarantee for communication performed by both parties.
[0042]
Hereinafter, various functions installed in each mechanism as computer processing means and information communication means will be described.
(1) Verification mechanism 11A
Verification function: credit card information (card number, address, etc.) transmitted from the credit card approval mechanism 12A, the name of the person who presented the credit card, and the information of the person himself / herself not described in it (for each credit card issuing institution unit) Presentation: Thereafter, the member master 11B is searched using the personal identification information), and if it is valid, the fact is returned to the credit card approval mechanism 12A.
Change notification function: When there is a change in the registration details related to a credit card member, a notification that the registration details have changed is sent to the medical service provider 12 who has previously requested authentication for the credit card member whose change has occurred. Send.
[0043]
Update presence / absence verification function: The credit card number transmitted from the medical service provider 12 is replied according to the transmitted credit card number indicating whether or not the registration contents are updated.
Verification request history management function: Validity authentication request history from the medical service provider 12 is “credit request date”, “authentication requester (medical service provider)”, “information used for authentication”, in credit card units, “Authentication results” etc. are stored for a certain period (credit card validity period, etc.) and used for credit card change notification functions and for responses to accidents and incidents related to authentication.
[0044]
(2) Credit card approval mechanism 12A
Credit card approval function: The credit card issuer name, membership number, accompanying information described in the credit card, the name of the credit card presenter, and the identity verification information presented in advance by the credit card issuer 11 It is input and the approval master 12B held by itself is searched. If the qualification information is unknown, it is verified by using the issuing institution verification mechanism 11A determined by the issuing institution name, and the result is presented. If it is qualified, it is additionally stored in the approval master 12B. To do.
[0045]
Approval master automatic update function (part 1): Upon receiving an update notification from the credit card issuing institution 1, all membership card numbers are sent to the issuing institution from the membership card information of the issuing institution that sent the update notification on the approval master 12B. In addition, the presence / absence of renewal is received for each membership card, and the membership card information before renewal on the approval master in which renewal has occurred is invalidated (or deleted).
Approval master automatic update function (part 2): automatically invalidates (or deletes) membership card information that has reached the expiration date described in the membership card.
[0046]
(3) Guarantee mechanism 4
Since the credit card issuer 1 and the medical service provider 2 are not in a clear relationship, in the event of a relationship between the two, the other party's communication destination is provided, including authenticity, and communication safety is ensured. Secure.
[0047]
FIG. 4 shows an example in which the credit card authentication system of FIG. 3 is applied to a health insurance card verification system, and the flow of verification function processing for approving name, relationship, office phone number, etc. as personal information is as follows: Become.
[0048]
(S21) The medical service provider 22 obtains the symbol, insurance card number, insured person's address, name, date of birth, insured company name, and insured company address from the information on the presented insurance card. The information is input to the membership card approval mechanism 22A, and the name, the relationship with the insured person, and the office phone number are input to the membership card approval mechanism 22A from the information of the person (patient).
(S22) The health insurance card approval mechanism 22A compares the input contents with its own approval master 22B, and presents the validity if it can be verified.
[0049]
(S23) If the verification cannot be made in the above (S22), the inputted symbol + insurance card number is encrypted with the public key of the guarantee mechanism 24 and transmitted to the guarantee mechanism 24.
(S24) The guarantee mechanism 24 encrypts the address and public key of the health insurance association 21 corresponding to the symbol + insurance card number received in the processing of (S23) above with the public key of the medical facility, and health insurance of the medical facility It returns to the certificate approval mechanism 22A.
[0050]
(S25) The health insurance card approval mechanism 22A receives the health insurance association address and public key in the process of (S24) described above (entered in S21) and the identification name of the health insurance association public key. Is encrypted and transmitted to the health insurance association verification mechanism 21A.
(S26) The health insurance association verification mechanism 21A collates the information of the member master 21B with the insured person information (contents input in S21) received in the process of (S25), and the collation result is obtained in the following procedure. It returns to the health insurance card approval mechanism 22A of the medical facility.
[0051]
(S27) The health insurance association verification mechanism 21A encrypts the identification name of the medical facility obtained by the above processing (S26) with its public key and transmits it to the guarantee mechanism 24.
(S28) The guarantee mechanism 24 encrypts and returns the address of the medical facility corresponding to the identification name received in the processing of (S27) and the public key thereof with the public key of the health insurance association 21.
[0052]
(S29) The verification mechanism 21A of the health insurance association 21 encrypts the collation result received in the processing of (S28) with the public key of the medical facility 22 and returns it to the health insurance card approval mechanism 22A of the medical facility.
(S30) The health insurance card approval mechanism 22A of the medical facility presents the verification result received in the process of (S29) and registers the content input in (S21) in its own approval master 22B.
[0053]
With the insurance medical assistance system and the insurance medical assistance method as described above, the medical facility can perform appropriate insurance medical care based on the authentication of the patient's credit card and health insurance card.
[0054]
In the above embodiments, the insurance medical support system and the insurance medical support method using the electronic medical record method are shown, but the same applies to insurance medical support using an IC card that records medical ticket information and / or health insurance card information. The effect of this can be obtained.
[0055]
For example, the hospital side that received the IC card reads the medical ticket information recorded on it, transfers the patient's electronic medical record information to the medical care support system side, and validates the health insurance card information read from the IC card. / Obtain valid / invalid and health insurance details authentication, and always display the validity / invalidity of health insurance card and health insurance contents on the medical care screen regardless of the operation of the electronic medical record during the medical examination. Allows for appropriate insurance practice and medication. For medical treatment using an IC card, the health insurance card is valid / invalid for medical treatments that display medical information such as medical records and medication information on the screen without using a system combined with electronic medical records. The contents of health insurance can be applied to a medical form that is always displayed on a medical information display screen.
[0056]
In addition, the health insurance association side provides a verification mechanism for the validity / invalidity of health insurance card information recorded on the IC card and authentication of the health insurance content, and the health insurance card approval mechanism is installed in the medical support computer system on the medical facility side. It can be applied to a system or method prepared and obtained by both mechanisms through communication over a wide area network.
[0057]
In addition, when receiving an examination with an IC card that contains only the information of the examination ticket, when receiving a credit card or debit card from the patient, the health insurance card is validated / invalidated by obtaining the card's authentication and the contents of the health insurance It can be applied to a system or method for temporary authentication. Credit card authentication is a system in which a verification mechanism is prepared on the credit card issuing institution side, a credit card approval mechanism is prepared in the medical support computer system on the medical facility side, and both mechanisms are obtained by communication via a wide area network or Applicable to the method.
[0058]
In addition, when receiving a medical checkup using an IC card, the medical support computer system issues the patient's account according to the health insurance card and the authentication result of the contents of the health insurance when issuing the prescription after the medical treatment or according to the authentication result of the credit card. In addition, the present invention can be applied to a system or method for notifying additional information at the time of medication and automatically calculating a charge amount based on a patient burden rate.
[0059]
【The invention's effect】
As described above, according to the present invention, the validity / invalidity of the health insurance card of the patient and the contents of the health insurance can be presented in an easy-to-understand manner without the physician being aware of it at the time of medical care. Appropriate insurance treatment and medication are possible even if the patient has failed to bring a health insurance card.
[0060]
In addition, when a patient presents a credit card, etc., the patient can receive medical treatment as a temporary certification of the health insurance card and insurance contents by obtaining the card's certification. Thus, even if you do not have a health insurance card, appropriate medical care and medication are possible.
[Brief description of the drawings]
FIG. 1 is a flowchart of authentication processing procedures for insurance medical treatment showing an embodiment of the present invention.
FIG. 2 is a display screen example at the time of medical care in the embodiment.
FIG. 3 is a configuration diagram of a credit card authentication system in the embodiment.
FIG. 4 is a configuration diagram of a health insurance card authentication system in the embodiment.
FIG. 5 is a configuration diagram of a medical support computer system.
[Explanation of symbols]
1 ... Medical support system 2 ... Medical office system 3 ... Inspection department 4 ... Pharmacy department 5 ... Server 6 ... Linked medical facility 7 ... Support center 8 ... External inspection facility

Claims (4)

An insurance medical support computer system that supports medical operations such as medical treatment, medical office work, and medication in a medical facility, and enables display and input operation and management of patient medical information,
A computer,
When receiving a credit card or debit card from a patient instead of a health insurance card, the card issuing institution name, membership number, name of the card presenter, and identification information presented in advance by the card issuing institution Input means for inputting;
Validate or invalidate the card by the computer system of the card issuing institution by transmitting the input card information via the wide area network to the computer system including the member master consisting of the database of the card issuing institution and the card verification mechanism. A card approval mechanism that receives the result of verification via a wide area network, treats the card as valid if it is valid, treats it as non-insurance if the card is invalid, and
Display information for displaying insurance treatment treatment or non-insurance treatment treatment information from the card approval mechanism , the contents of the electronic medical record,
An insurance medical treatment characterized in that when the doctor displays an electronic medical record on the screen for medical treatment by the computer, the information on the insurance treatment or non-insurance treatment is displayed on the display screen. Support computer system. On the occasion to issue a prescription after medical, according to the authentication result of the credit card, then the notification as additional information when a patient's accounting and dosing means for calculating automatically the billing based on a patient burden rate The insurance medical assistance computer system according to claim 1, further comprising: Said input means of claim 1 in serial placement has been health insurance support computer system, approved master card authorization mechanism, the display unit, a medical insurance support method performed by the control of the computer,
When receiving a credit card or debit card instead of a health insurance card from a patient, the card issuing institution name, membership number, name of the card presenter, and the card issuing institution are presented in advance by the input means. Entering identity verification information;
The card approval mechanism transmits the input card information to the computer system including the member master composed of the database of the card issuing organization and the card verification mechanism via the wide area network. Receiving a card validity / invalidity verification result via a wide area network, treating the card as an insurance treatment when the card is valid, and treating as a non-insurance medical treatment when the card is invalid,
When the doctor displays the electronic medical record on the screen for medical treatment of the patient, the display means includes a step of displaying information on the insurance treatment or non-insurance treatment on the display screen. Insurance medical support method. Upon issuance of the prescription after medical, according to the authentication result of the credit card, then the notification as additional information when a patient's accounting and dosing, and a step of calculating a billing amount based on a patient burden rate automatically The insurance medical treatment support method according to claim 3 .

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