JP4986986B2 - Hospital information comprehensive system with diagnostic group classification verification function, hospital information processing program with diagnostic group classification verification process, and hospital information processing method with diagnostic group classification verification - Google Patents

Description

The present invention relates to a medical office system, a program, and a method for supporting medical expenses claiming work in an insurance handling organization. In particular, hospital information having the hospital Information Technology systems and diagnostic related groups verification process with a validation of the diagnostic related groups when performing based medical billing acute inpatient care in such particular function hospital diagnostic related groups The present invention relates to a hospital information processing method with processing program and diagnostic group classification verification .

  Conventionally, a volume payment system has been widely used for medical billing in medical institutions handling insurance. According to the volume payment system, individual fees such as initial examination / re-examination fee, hospitalization fee, instruction management fee, home medical care, examination, diagnostic imaging, medication, injection, rehabilitation, psychiatric therapy, treatment, surgery, anesthesia, radiotherapy, etc. Medical treatment fees are set in detail for the medical practice, the total of the points accumulated for each medical practice is calculated, and the medical treatment fee is calculated in terms of 10 yen per point. The insured person was charged directly at the medical institution's window, and the medical expenses paid by the insurer were sent to the insurer in the form of a receipt and claimed.

  In recent years, due to the pressure on health insurance finances due to the increase in medical expenses, acute hospitalization is required in order to curb medical expenses related to treatments that require acute hospitalization in specific function hospitals where medical expenses are likely to increase. A comprehensive payment system for medical expenses per day based on the “diagnostic group classification” was introduced. In the comprehensive payment system for medical expenses based on this "diagnostic group classification", the medical treatment fee is calculated as the total amount of the comprehensive evaluation part and the volume of the transaction part. The number of points per day × coefficient by medical institution × number of hospital stays ”is calculated, and the amount of the volume is calculated by converting the total score based on the medical score table into a monetary amount. Among these, the “coefficient by medical institution” is determined by the sum of the function evaluation coefficient and the adjustment coefficient, and the function evaluation coefficient is a coefficient for evaluating the function of the medical institution, and is a coefficient determined by the equipment and the medical system. It is. The adjustment coefficient is a coefficient set by the country for each medical institution in order to guarantee the previous year's performance so that the medical institution does not receive any profit or loss due to the introduction of a billing system called diagnosis group classification.

  In this way, the amount of medical expenses required for treatment requiring acute hospitalization varies depending on which diagnosis group classification is used to request medical expenses.

  The “diagnostic group classification” is defined in accordance with a code system called an ICD code, and the ICD code allows the World Health Organization (WHO) to compare statistics on causes of death and diseases internationally and annually. It is a code system defined as the standard disease classification.

  Here, the rule for selecting which diagnosis group classification to select for medical expenses is based on the rule that the “diagnostic group classification” to which the injury or illness that has invested the most medical resources during the hospitalization period is selected. The comprehensive evaluation portion of the medical expenses is determined based on the selected diagnosis group classification.

  Injuries and diseases with the most input of medical resources during the hospitalization period are injuries and diseases that have invested the most human / physical medical resources among the injuries and diseases treated throughout the hospitalization period. Even when a plurality of injuries and diseases are treated during hospitalization, one “injury or disease with the most medical resources” is determined. Medical resources include human resources and physical resources. Human resources include, for example, the labor costs of doctors performing surgery, the labor costs of nurses performing procedures, and the physical resources include, for example, Examples include drugs, injections, surgery, treatments, and surgical materials.

For example, in the case where a plurality of injuries and diseases are treated during one hospitalization, an example will be described in which one “injury or disease in which most medical resources are invested” is determined.
An example is the selection of the diagnosis group classification when a fractured patient is hospitalized and undergoes fracture treatment, and during that hospitalization, pneumonia is caused by nosocomial infection and also treated for pneumonia. This patient is treated for fractures and pneumonia during hospitalization.

  As shown in FIG. 11, as a breakdown of medical resources, for example, regarding fracture treatment, a total of 11000 medical resources required for fracture surgery, 10,000 medical resources, 500 medical resources for medication, and 500 medical resources for infusion Suppose that the medical resources have been invested. On the other hand, it is assumed that a total of 6500 medical resources including 1000 points for pneumonia treatment, 5000 points for infusion resources, and 500 points for X-ray resources are used. In this case, the patient is hospitalized for the purpose of fracture treatment, but pneumonia is also accompanied by pneumonia treatment in the middle, but the medical resources invested for fracture treatment are 11500 points, and the medical treatment invested for pneumonia treatment. Since the resource is 6,500 points, the “injury or disease with the most medical resources” is “fracture treatment”, and the diagnosis group classification to which the fracture treatment belongs is selected.

JP 2002-132936 A

As described above, the diagnosis group classification is determined by the diagnosis contents of the doctor who examined the patient at the beginning of hospitalization, and thereby the medical cost per day is determined for the amount of the comprehensive evaluation portion.
Basically, as described above, if the diagnosis group classification is determined based on the diagnosis contents at the time of hospitalization, the correct insurance score is calculated based on objectively determined values such as length of hospital stay and medical institution coefficient, etc. Is done.

However, the following problems may occur in the above flow.
For example, when a wound or illness that did not occur at the beginning of hospitalization occurred and treatment had to be performed in parallel, the medical resources invested for the wounds and diseases that were added later were large. This is a case where the “sickness and illness” is different from that at the time of hospitalization. As a simple example, after having been hospitalized with pneumonia at the beginning, the doctor who was in charge of the hospitalization correctly selected the diagnostic group classification to which the pneumonia treatment belongs, and then fell off the bed during the hospitalization and had a fracture treatment in parallel. List the cases where you no longer get them.

  As shown in FIG. 12, as a breakdown of medical resources, for example, regarding pneumonia treatment, it is assumed that a total of 6500 medical resources including 1000 medicinal resources, 5000 infusion resources, and 500 X-ray resources are input. On the other hand, regarding the fracture treatment, suppose that a total of 11,000 medical resources, ie, 10,000 medical resources required for fracture surgery, 500 medical resources for medication, and 500 medical resources for infusion are used. In this case, the patient is hospitalized for the treatment of pneumonia, but fractures are also treated with fractures from the middle. Since the resources are 11,000 points, “the wound or disease in which the most medical resources have been invested” is called “fracture treatment”, and the correct diagnosis group classification is the diagnosis group classification to which the fracture treatment belongs. However, the diagnosis group classification related to pneumonia treatment is selected at the beginning of hospitalization, and the diagnosis group classification to which the fracture treatment, which is the diagnosis group classification that should be originally selected, belongs is not correctly selected. In this case, the selection of the diagnostic group classification to which the pneumonia treatment at the time of hospitalization belongs is correctly performed, and in many cases, there is no problem with the selection of the diagnostic group classification at the time of hospitalization. However, there are situations where the medical resources invested for injuries that developed later during hospitalization become larger, and in this case, the diagnosis group classification needs to be changed. In this way, if the diagnosis group classification is different, the actual medical fee to be charged differs. In other words, the medical fee that can be selected and charged for the pneumonia diagnosis group classification and the medical fee that can be selected for the fracture diagnosis group classification are changed.

  As another example, there is a situation in which selection of the diagnosis group classification is affected even if other diseases are not caused. That is, there are cases where the diagnosis group classification is finely branched depending on the treatment policy even if the disease is the same. For example, when treatment was performed according to the treatment policy determined by the initial diagnosis of hospitalization, it was judged that more advanced treatment was required by close examination, or more advanced treatment was required due to the severity of injury and disease during hospitalization. In some cases, the diagnosis group classification is different with the change of the treatment policy. As a simple example, a patient who had previously been treated for gastric cancer in the past was admitted for the purpose of checking for recurrence, and the diagnosis group classification to which the gastric cancer test treatment belongs was correctly selected by the doctor in charge at the beginning of hospitalization. After that, a case of recurrence of a small gastric cancer was found as a result of the test, and it was given as a case of treatment with chemotherapy as it is.

  At the beginning of hospitalization, the diagnosis group classification for “stomach cancer: examination” is selected. As shown in FIG. 13, as a breakdown of medical resources, for example, regarding gastric cancer testing, it is assumed that a total of 1000 medical resources including 500 endoscopic resources and 500 X-ray resources are input.

On the other hand, it is assumed that after that, chemotherapy for gastric cancer is started and a total of 6000 medical resources including 5000 medical resources for infusion, 500 medical resources for infusion, and 500 medical resources for other treatments are input.
In this case, the patient is hospitalized for the purpose of examination, but is treated with chemical treatment by finding stomach cancer in the middle. The medical resources invested in the examination are 1000 points, whereas the medical resources invested in the gastric cancer treatment are Since it is 5000 points, “the wounds and diseases where the medical resources are most invested” is “stomach cancer: chemotherapy”. Although the wound itself is correctly selected as “gastric cancer”, the diagnostic group classification is the diagnostic group classification to which “gastric cancer: chemotherapy” belongs. However, at the beginning of hospitalization, the diagnosis group classification for “stomach cancer: examination” is selected, and even if the diagnosis group classification for the same gastric cancer treatment is selected, “gastric cancer: chemotherapy”, which is the diagnosis group classification to be originally selected, is The diagnostic group classification to which it belongs is not correctly selected.

  In the prior art, since the selection of the diagnostic group classification to which “stomach cancer: examination” belongs is correctly performed according to the treatment policy of gastric cancer examination at the beginning of hospitalization in the above case, the subsequent change is not performed. However, the diagnosis group classification may be finely branched depending on the treatment content, and when the treatment content is switched, the diagnosis group classification may need to be changed. Also in this case, it is important that the medical fee to be actually charged varies depending on the diagnosis group classification.

  In general, it is not easy to determine whether or not to change the selection of the diagnostic group classification at the beginning of hospitalization. This is because, when medical resources are invested for multiple injuries and diseases, each doctor in charge is responsible for the medical resources that have been invested in the past in other clinical subjects, and the amount of medical resources that will be invested in the future. This is because the treatment policy is not decided or changed while confirming or estimating.

  The present invention aims to solve the problems of the prior art, and for the diagnosis group classification determined by the diagnosis content of the doctor in charge at the time of hospitalization, from the data indicating the medical resources that were input, the final It is an object of the present invention to provide a diagnostic group classification verification system, a diagnostic group classification verification program, and a diagnostic group classification verification method that can verify whether or not a correct diagnostic group classification is selected.

In order to achieve the above object, the hospital information integrated system of the present invention provides:
At the time of hospitalization, the diagnosis group classification at the time of hospitalization selected based on the diagnosis contents of the doctor who examined the patient is determined, and the treatment, examination, and medicine that are input to the patient that are input as appropriate during the hospitalization A comprehensive hospital information system that verifies whether or not it is necessary to change the selection of the diagnostic group classification at the time of hospitalization based on medical resource data representing medical resources such as
A data storage device for inputting diagnosis group classification data representing a diagnosis group classification selected based on the diagnosis contents of a doctor who examined the patient at the time of admission, and storing the data as provisional diagnosis group classification data;
A medical resource-diagnostic group classification database in which correspondences between individual medical resources and diagnostic group classifications where the input of the medical resources can occur are made into a database;
Referring to the medical resource-diagnostic group classification database, classify and totalize all the medical resource data input during the hospitalization period and stored in the data storage device for each corresponding diagnostic group classification An optimal diagnosis group classification selection unit that identifies the optimal diagnosis group classification in which the most medical resources are actually invested,
Verify whether the provisional diagnosis group classification indicated by the provisional diagnosis group classification data input at the time of admission matches the optimum diagnosis group classification in which the most medical resources are actually invested. If it is, the provisional diagnosis group classification is used as it is as a definitive diagnosis group classification, and if it is verified as inconsistent, the provisional diagnosis group classification is changed and the optimum diagnosis group classification is used as the definite diagnosis group classification. equipped with a,
In the process of determining the definitive diagnosis group classification based on the verification result of the diagnosis group classification, the temporary diagnosis group classification and the optimal diagnosis for the doctor in charge who gave discharge permission at the time of discharge in the diagnosis group classification verification unit A process for presenting the verification result of the group classification, and a diagnosis group classification verification function and an approval confirmation function that are confirmed on the condition that there is an input of confirmation or change approval by the doctor in charge are provided. This is a comprehensive hospital information system.

With the above structure, a hospital information integrated system of the present invention, verification of diagnosis related groups and even more at the time of hospital discharge diagnosis group classification in the hospital from the input and decisions of hospitalization initial tentative diagnosis group classification of the DPC, the definitive diagnosis group classification It will be done until confirmation. Without being limited to the treatment purpose at the beginning of the hospitalization during the hospitalization period, the individual medical resource data indicating the medical resources input for various treatment purposes is actually classified and aggregated for each corresponding diagnosis group classification Therefore, it is possible to specify the diagnosis group classification in which the most medical resources are invested as the optimum diagnosis group classification, and to correctly verify whether or not the diagnosis group classification selected at the time of hospitalization was optimal.

  Here, in the above configuration, there are a plurality of the diagnosis group classifications corresponding to one injury and illness, and the diagnosis group classification is divided according to the condition of the treatment content, the input as the optimum diagnosis group classification selection unit A conditional branch determination function for determining which diagnostic group classification should be selected on the basis of the medical resource data that has been determined, and a function for identifying the optimal diagnostic group classification based on the medical resource data It is preferable.

  In this way, if the condition branch decision function is strengthened in the optimal diagnosis group classification selection section, there are cases where the diagnosis group classification is finely divided according to the treatment content even in one wound or illness. It is possible to verify whether or not the provisional diagnosis group classification is a correct selection based on the input medical resource data.

  In addition, the optimal diagnosis group classification selecting unit has medical resource data in which the correspondence between the medical resource and the diagnosis group classification in which the medical resource can be input does not correspond one-to-one when referring to the medical resource-diagnostic group classification database. In some cases, it is preferable that the optimum diagnosis group classification is specified by trying the classification / aggregation for all medical treatment group classifications for which the medical resource data can be classified.

  In this way, there are many cases where there is not a one-to-one correspondence between the medical resource and the diagnostic group classification that can be used, but in such cases, considering all possibilities, It is possible to verify whether or not the correct diagnosis group classification is selected.

In the diagnostic group classification verification unit, when the matching is verified, the temporary diagnostic group classification is determined as it is as the diagnostic group classification, and when the mismatch is verified, the optimal diagnostic group is replaced with the temporary diagnostic group classification. It is preferable to have a diagnosis group classification determination function for determining a classification as a diagnosis group classification.
That is, as a result of the verification of the diagnosis group classification, it is possible to finally determine which diagnosis group classification is the correct diagnosis group classification.

Here, hospital information integrated system is provided with a receipt creation system comprising a medical fees calculating function and receipt creation function, also configured to execute the medical fees calculated and receipt created in accordance with the definitive diagnosis related groups against receipt creation system Is possible.

Thus, with the configuration of Les concept creation system to work, the approved correct diagnosis related groups and medical resources data can be output with respect to receipt creation system, it is possible to make the correct medical fee billing, the medical office Efficiency can be improved.

Next, the hospital information processing program provided with the diagnosis group classification verification processing of the present invention,
At the time of hospitalization, the diagnosis group classification at the time of hospitalization selected based on the diagnosis contents of the doctor who examined the patient is determined, and the treatment, examination, and medicine that are input to the patient that are input as appropriate during the hospitalization Based on medical resource data representing medical resources such as, a program having a diagnostic group classification verification function that verifies whether or not it is necessary to change the selection of the diagnostic group classification at the time of admission,
A diagnosis group classification data representing a diagnosis group classification selected based on the diagnosis contents of a doctor who examined the patient at the time of admission, and provisional diagnosis group classification data determination processing step for tentative determination as provisional diagnosis group classification data;
A medical resource-diagnostic group classification database reference processing step in which a correspondence between each medical resource and a diagnostic group classification in which the medical resource can be input is databased;
By referring to the medical resource-diagnostic group classification database and classifying and totaling all the medical resource data input during the hospitalization period for each corresponding diagnostic group classification, An optimal diagnostic group classification selection processing step for identifying an optimal diagnostic group classification in which resources are invested;
Verify whether the provisional diagnosis group classification indicated by the provisional diagnosis group classification data input at the time of admission matches the optimum diagnosis group classification in which the most medical resources are actually invested. If it is, the provisional diagnosis group classification is used as it is as a diagnosis group classification, and if it is verified that there is a discrepancy, the provisional diagnosis group classification is changed and the optimum diagnosis group classification is used as the diagnosis group classification. ,
At the time of discharge, the optimal diagnostic group classification selected by the optimal diagnostic group classification selection processing step and verified as the diagnostic group classification in which the most medical resources are actually invested by the diagnostic group classification verification processing step is confirmed diagnosis group A diagnosis group classification confirmation processing step to be classified ,
In the process of determining the diagnosis group classification based on the diagnosis group classification verification result in the diagnosis group classification determination processing step, there is an input of confirmation or approval of change by a doctor in charge who gave discharge permission at the time of discharge It is a hospital information processing program having a diagnosis group classification verification process characterized by being determined as a condition .
As described above, by loading and implementing a program including these steps into a computer system, it is possible to construct a hospital information integrated system including the diagnosis group classification verification process of the present invention using the computer system.

According to the hospital information integrated system with a diagnostic groups classification verification process of the present invention, DPC hospitalization This first diagnostic groups classification in the hospital from the input and the determination of the provisional diagnostic groups further classified the examiner of discharge at the time of diagnosis related groups testimony can be handled organically to confirm definitive diagnosis related groups, without being limited to the hospital initial therapeutic purposes during hospitalization, individual medical resource data indicating the medical resources having been put in a variety of therapeutic purposes By categorizing and tabulating the data for each corresponding diagnosis group classification, it is possible to identify the diagnosis group classification where the most medical resources are actually invested as the optimal diagnosis group classification, and the diagnosis group selected at the beginning of hospitalization It is possible to correctly verify whether or not the classification is optimal, and to select the correct diagnosis group classification in a timely manner at the time of discharge.
Furthermore, diagnosis includes a receipt creation system to charge a care fees, if it is possible to output a correct diagnosis related groups and medical resources data to receipt creation system, the medical fee billing office, that make the correct medical fee billing Can improve the efficiency of medical office work.

  Hereinafter, the best mode for carrying out the present invention will be described specifically by way of examples. The scope of the technical idea of the present invention is not limited to the specific shapes and numerical values of these examples.

FIG. 1 is a block diagram schematically showing the basic configuration of a hospital information integrated system 400 of the present invention. Configuration example of FIG. 1 is a diagnostic groups classification verification system 100 has a configuration in which example Bei the medical office system 200, receipt creation unit 230 has a configuration example that is built into the medical office system 200. In addition, illustration of the data transmission / reception interface between the diagnostic group classification verification system 100 and the medical office system 200 is omitted.
FIG. 2 is a diagram schematically showing the basic flow of processing of the hospital information integrated system 400 .

The basic configuration of the diagnostic group classification verification system 100, which is one of the components of the hospital information integrated system 400 of the present invention, includes a medical resource-diagnostic group classification database 110, an optimal diagnostic group classification selection unit 120, and diagnostic group classification verification. The unit 130 is provided.
Note that components included in a general computer system, such as a keyboard and pointing device as an input device, a monitor as an output device, a control device such as an MPU, and a memory, are not shown.
These components can be configured using computer resources by causing a personal computer system to load and mount a diagnostic group classification verification program describing processing contents to be described later.

  The medical resource-diagnostic group classification database 110 is a database of correspondences between individual medical resources and diagnostic group classifications where the medical resources can be input. For example, the correspondence relationship between medical resources and diagnostic group classifications is listed. And returns diagnostic group classification code information corresponding to the inquired medical resource data in response to an access from the optimum diagnostic group classification selection unit 120 described later. There are no particular limitations on the database data structure or language used.

  The optimum diagnosis group classification selection unit 120 has an interface with the medical office system 200, and provisional diagnosis group classification data and medical resource data input via the medical office system 200 are received from the medical office system 200. Has the ability to import.

  The provisional diagnosis group classification data is data representing the provisional diagnosis group classification selected based on the diagnosis contents of the doctor who examined the patient at the time of hospitalization. In the present invention, the diagnosis group classification determined at the time of hospitalization is referred to as “temporary diagnosis group classification”. The provisional diagnosis group classification is coded according to a predetermined code system.

  The medical resource data is data representing medical resources such as treatments, examinations, drugs, and the like that are input to a patient during hospitalization. Each medical resource is also coded according to a predetermined code system.

  The optimum diagnosis group classification selection unit 120 actually classifies and imports the imported medical resource data for each corresponding diagnosis group classification while referring to the medical resource-diagnostic group classification database 110, so that the most medical resource actually Is provided with an “optimal diagnosis group classification specifying function” for specifying the optimal diagnosis group classification.

  The diagnosis group classification verification unit 130 is specified by the temporary diagnosis group classification represented by the temporary diagnosis group classification data imported from the medical office system 200 and the “optimal diagnosis group classification specifying function” of the optimal diagnosis group classification selection unit 120. A “diagnostic group classification verification function” is provided for verifying whether or not the optimal diagnostic group classification matches.

  Further, the diagnosis group classification verification unit 130 determines the code data input as the temporary diagnosis group classification as it is as the code data of the diagnosis group classification when it is verified as coincidence in the “diagnosis group classification verification function”. If it is verified, it is equipped with a “diagnostic group classification confirmation function” that determines the code data of the optimal diagnosis group classification as the code data of the diagnosis group classification instead of the code data input as the temporary diagnosis group classification .

The diagnosis group classification verification unit 130 returns the diagnosis group classification data determined as the verification result to the medical office system 200.
The doctor in charge gives approval after confirming the confirmed diagnosis group classification data. Moves to the receipt creation process with the approval of the doctor in charge.

  On the other hand, the medical office system 200 includes a data input / output control unit 210, a data storage device 211, and a receipt creation unit 230 in the configuration shown in FIG.

  The data input / output control unit 210 is a part that provides an interface related to data input / output to the doctor in charge and the medical office staff supporting the doctor in charge. The data input / output control unit 210 is a temporary decision determined based on the diagnosis contents of the doctor who examined the patient at the time of hospitalization. Used when accepting input of provisional diagnosis group classification data representing the diagnosis group classification, and as a result of verification of the diagnosis group classification as will be described later, gives approval when the temporary diagnosis group classification is rewritten to the optimum diagnosis group classification It can also be used.

  The input means of the data input / output control unit 210 is not particularly limited. Since the diagnosis group classification consists of a combination of numbers and alphabets, it is possible to enter keys via a numeric keypad or a keyboard, or via a pointing device such as a mouse. The data input / output control unit 210 has an input support function, provides a selection input screen with medical terms understood by doctors and medical clerk through a monitor, etc., and responds by selecting the medical terms presented on the selection input screen A configuration including an input interface that is automatically converted into code data of the diagnostic group classification to be input is also possible. In this case, a medical term-diagnostic group classification correspondence database needs to be installed as appropriate, and a diagnostic group classification corresponding to a medical term selected by referring to the medical term-diagnostic group classification correspondence database via the input interface. Automatically converted into code data.

  The provisional diagnosis group classification data is input to the diagnosis group classification verification system 100 after being input via the data input / output control unit 210 by the doctor or medical office staff who was in charge of the examination at the time of hospitalization. Although the timing for transmitting the temporary diagnosis group classification data to the diagnosis group classification verification system 100 is not limited, in this configuration example, diagnosis group classification verification processing by a diagnosis group classification verification unit 130 described later is started, and medical resource data is imported into a file. It is configured to be imported along with medical resource data at the time.

  The data storage device 211 is a part for storing individual medical resource data representing medical resources of treatment, examination, and medicine that are input to the patient during the hospitalization period. The data is input via the data input / output control unit 210 by the doctor in charge or the medical office staff and stored in the data storage device 211.

  The medical resource data may be directly input code information of a predetermined code system, or may be converted into code information of a corresponding code system if a name such as treatment, examination, or drug is selected. . The medical resource data code system can correspond to a variety of programs depending on how the program is assembled. Here, it is assumed that a code system conforming to the ICD code system is used. The medical resource data individually input during the hospitalization period is accumulated in the data storage device 211 together with the patient ID information. The data storage format in the data storage device 211 is not particularly limited.

  The medical resource data stored in the data storage device 211 is transferred to the diagnostic group classification verification system 100 by file import when the timing for executing diagnostic group classification verification is reached, as will be described later.

  In the configuration example of FIG. 1, the data storage device 211 is provided in the medical office system 200, and the medical resource data is transferred from the medical office system 200 to the diagnostic group classification verification system at the timing of executing the verification of the diagnostic group classification. The configuration is such that the data is transferred in a batch in the form of file import. Instead of this configuration, the data storage device 211 is provided in the diagnostic group classification verification system 100, and data input / output is performed by the doctor in charge or the medical office staff. A configuration in which the data is frequently passed to the diagnostic group classification verification system 100 each time it is input via the control unit 210 and held in the data storage device 211 in the diagnostic group classification verification system 100 is also possible.

  The receipt creation unit 230 has a receipt creation function and a medical fee billing function, and creates receipt data from individual medical resource data using the confirmed diagnosis group classification as a result of verification of the diagnosis group classification by the diagnosis group classification verification system 100 It is a part to do. The created receipt data is used for the subsequent medical billing paperwork.

Next, a basic processing flow of the hospital information integrated system 400 of the present invention is shown.
In FIG. 2, the upper row shows the flow of the processing procedure by the doctor, and the lower row shows the flow of the processing procedure by the medical clerk. In the upper stage, the flow of the processing procedure by the doctor may be performed, and input work and the like may be performed by a medical office worker who has received an instruction from the doctor. Needless to say, in the lower row, the flow of the processing procedure by the medical clerk is naturally executed under the direction and management of the doctor.

In the flow of FIG. 2, from the input of the temporary diagnosis group classification in the upper stage (upper procedure 1) until the discharge approval in the upper stage in FIG. 2 is given (upper procedure 3), the medical office system 200 is used. a processing, confirmation of diagnosis group classification result of verification by the attending physician and the start compilation (lower Step 3) of the medical paperwork associated with the discharge of the lower stage of FIG. 2, the procedure of change approval (top Step 4), diagnosis This is processing through the group classification verification system 100. In the configuration example of FIG. 1, the last lower receipt creation / medical fee billing management (lower procedure 4) is a process through the medical office system 200.

First, when hospitalization measures are taken for a target patient at a medical institution, the doctor in charge conducts a medical examination at the time of admission, determines the injury and illness based on the findings, determines the treatment policy, etc. The temporary diagnosis group classification is input via the data input / output control unit 210 of the system 200 (procedure 1 by the doctor in charge in the upper part of FIG. 2).
The medical office starts medical office management for the target patient A based on the provisional diagnosis group classification input by the doctor in charge via the medical office system 200 (procedure 1 of the medical office section in the lower part of FIG. 2).

  Next, the doctor in charge who has examined at hospitalization and determined the diagnosis group classification, or the doctor in charge who has inherited the treatment, performs necessary treatments according to the wound and illness, and invests medical resources. Medical resource data is input through the data input / output unit 210 of the medical office system 200 for the input medical resources (procedure 2 by the doctor in charge in the upper part of FIG. 2).

  Thereafter, until the subject patient can be discharged from the hospital, a number of treatments necessary for wound treatment are performed, and medical resources are invested. In other words, it is added each time a medical resource is input by the doctor in charge. Here, the doctor in charge inputs corresponding medical resource data via the data input / output unit 210 for medical resources such as treatments, examinations, and drugs that are individually input to the patient during the hospitalization period. (Repeat procedure 2 by the attending physician in the upper part of FIG. 2). The actual input may be performed by a nurse or medical clerk who supports the doctor in charge under the instruction of the doctor in charge.

The medical office system 200 receives the medical resource data input by the doctor in charge, reflects the medical resource data input to the target patient A in the medical office management, and manages the used medicines, materials, etc. Perform (procedure 2 of the medical office section in the lower part of FIG. 2). The medical resource data individually input via the data input / output unit 210 is accumulated in the data storage device 211.

  When treatment for the target patient progresses throughout the hospitalization period and the doctor in charge determines that the target patient's injury or illness has reached the level at which he / she can be discharged, discharge approval is issued (procedure 3 by the doctor in charge in the upper row of FIG. 2).

In the medical office system 200 , when the discharge approval is given by the doctor in charge, the medical office management is started for the target patient (procedure 3 of the medical office section in the lower part of FIG. 2). In this process, the diagnostic group classification verification process by the diagnostic group classification verification system 100 is executed.

The optimal diagnosis group classification selection unit 120 of the diagnosis group classification verification system 100 accesses the data storage device 211 of the medical office system 200 and receives each stored medical resource data by file import.
The optimal diagnosis group classification selection unit 120 classifies and aggregates each received medical resource data for each corresponding diagnosis group classification while referring to the medical resource-diagnostic group classification database 110. The diagnosis group classification in which medical resources are most invested is determined from the result of the aggregation, and the optimum diagnosis group classification is determined.

  The diagnosis group classification verification unit 130 verifies whether or not the provisional diagnosis group classification determined by the doctor in charge at the time of hospitalization is the optimum diagnosis group classification in which the most medical resources are input.

If it is verified that the correct diagnosis group classification is selected in the diagnosis group classification verification result by the diagnosis group classification verification unit 130, the medical office system 200 confirms the temporary diagnosis group classification selected at the time of hospitalization. As a group classification, it is displayed through the data input / output control unit 210 of the medical office system 200 that, as a result of the verification, it is not necessary to change the diagnostic group classification, and the provisional diagnostic group classification is a confirmed diagnostic group classification.

On the other hand, in the verification result of the diagnostic group classification by the diagnostic group classification verification unit 130, if it is verified that the diagnostic group classification needs to be changed and a different diagnostic group classification is selected, the diagnostic group classification is instructed to the doctor in charge. Ask for approval for changes. The doctor in charge who has received the change request gives approval for the change of the diagnosis group classification, and inputs approval data via the data input / output control unit 210. (Procedure 4 by the doctor in charge in the upper part of FIG. 2).

As a result of the diagnostic group classification verification by the diagnostic group classification verification unit 130, it is not necessary to change the diagnostic group classification, or as a result of the diagnostic group classification verification by the diagnostic group classification verification unit 130, the diagnostic group classification needs to be changed. When the approval data input from the doctor in charge is obtained for the change, the medical office system 200 uses the receipt creation unit 230 to calculate the medical expenses according to the definitive diagnosis group classification, and to determine the confirmed diagnosis group classification. Receipt creation is executed accordingly (procedure 4 of the medical office section in the lower part of FIG. 2).

The above is the basic processing flow of the hospital information integrated system 400 of the present invention.
Note that the configuration shown in FIG. 3 can be used instead of the configuration shown in FIG. The configuration example of FIG. 3 is a configuration in which the system configuration is integrated as a hospital information integrated system 400, and there are three subsystems, a diagnostic group classification verification system 100, a medical office system 200, and a receipt creation system 300. . That is, the configuration example in FIG. 1 is a configuration example in which the receipt creation function is incorporated in the medical office system 200, but the configuration example in FIG. 3 is linked with the diagnostic group classification verification system 100 as a subsystem. It is a structural example. In the case of the configuration example of FIG. 3, the diagnostic group classification verification system 100 includes a data transmission / reception interface with the receipt creation system 300, and causes the receipt creation system 300 to perform medical fee calculation according to the confirmed diagnosis group classification and confirm It is configured to execute receipt creation according to the diagnostic group classification. In FIG. 3, the data transmission / reception interface between the subsystems in the hospital information integrated system 400 is not shown.

  In the case of the configuration example of FIG. 3, the basic processing flow is the same as that shown in FIG. 2, but the difference from the case of the configuration example of FIG. If there is no change in the diagnostic group classification as a result of the diagnostic group classification verification of the diagnostic group classification verification unit 130, or the diagnostic group of the diagnostic group classification verification unit 130 As a result of the classification verification, when the diagnosis group classification needs to be changed and approval from the doctor in charge is obtained for the change, the diagnosis group classification verification unit 130 accesses the receipt creation system 300 and follows the confirmed diagnosis group classification. Execute receipt creation.

  Hereinafter, an example is given and demonstrated.

As Example 1, a verification example of a diagnosis group classification in a case where department transfer is repeated is shown.
FIG. 4 is a diagram schematically illustrating an example in which the diagnosis group classification is changed by repeating transfer. As a specific example, after patient A who had a skull fracture due to an accident, etc. was accepted by the emergency department, he transferred to hematology for complications, and then transferred to internal medicine for infectious disease treatment. Is.

First, a patient A who has a skull fracture due to an accident or the like is emergency transported and accepted by an emergency department. Assume that the doctor in charge of the emergency department examined a skull fracture, no other major injury, the name of the injury was “cranium fracture”, and the treatment policy was decided to be a hospitalized treatment for a skull fracture. The doctor in charge selects the diagnosis group classification to which the “skull fracture” belongs as the temporary diagnosis group classification, and inputs the corresponding code information via the data input / output control unit 210 of the medical office system 200. In this example, the input interface is presented to the doctor in charge via the monitor, and the menu is converted into code information for the corresponding temporary diagnosis group classification by simply selecting the “cranium fracture” menu with a pointing device such as a mouse. It is a mechanism to be done.
In the medical office, necessary medical office management for the target patient A is started based on the provisional diagnosis group classification of “skull fracture”.

  Next, the doctor in charge of the emergency department or the surgeon who has succeeded the treatment of the skull fracture at the department performs the necessary treatment for the skull fracture and invests medical resources. The doctor in charge inputs corresponding medical resource data via the data input / output unit 210 of the medical office system 200 for medical resources such as treatments, examinations, and drugs that are individually input during the hospitalization period. In this example, an input screen as shown in FIG. 5 is presented as an input interface via a monitor, and input to an input column is executed simply by selecting a medical term with a pointing device such as a mouse. Is converted into medical resource code information for each specified medical resource and input. In this example, it is assumed that medical resources such as “facial multiple fracture open surgery”, “ultrasonic nebulizer”, and “bisorbone injection solution” are input to the target patient A over the hospitalization period.

The medical office section receives the medical resource data input by the doctor in charge of the emergency department, and reflects the medical resource data input to the target patient A in the medical office management. The medical resource code information input from the data input / output unit 210 is accumulated in the data storage device 211 in the medical office system 200.
During this time, the diagnosis group classification remains “skull fracture”.

  Next, it is assumed that the subject patient A has complications in the course of the skull fracture treatment and has developed symptoms of intravascular coagulation, so he / she is transferred to hematology and treated for intravascular coagulation syndrome. The doctor in charge of vascular medicine inputs the medical resource data input to the target patient A for the treatment of the intravascular coagulation syndrome via the input interface of the data input / output unit 210 of the medical office system 200. Here, it is possible to input only the input medical resource data, but also the data showing the treated subject (here “vascular internal medicine”) and the name of the wound (here “intravascular coagulation syndrome”). Preferably it is entered. Here, it is assumed that medical resources such as “Neuart”, “For Anthrobin P Injection”, and “Fusan 50” are introduced.

  The medical office section receives the medical resource data input by the doctor in charge of hematology, and reflects the medical resource data input to the target patient A in the medical office management. The medical resource code information input via the data input / output unit 210 is accumulated in the data storage device 211 in the medical office system 200.

  Next, it is assumed that the target patient A has developed a staphylococcal infection. Therefore, it is assumed that the target patient A who has completed the treatment of the intravascular coagulation syndrome has been transferred to the internal medicine and has undergone the internal medicine treatment for staphylococcal infection. The physician in charge of internal medicine inputs the medical resource data input to the target patient A for the treatment of staphylococcal infection through the data input / output unit 210 of the medical office system 200. Again, you may enter just the input medical resource data, but also enter the data indicating the subject you treated (here “Internal Medicine”) and the name of your injury (here “staphylococcal infection”). It is preferred that Here, it is assumed that medical resources such as “meropen injection solution” and “for first thin infusion” are introduced.

  The medical office receives medical resource data input by a doctor in charge of internal medicine, and reflects the medical resource data input to the target patient A in medical office management. The medical resource code information input via the data input / output unit 210 is accumulated in the data storage device 211 in the medical office system 200.

  For the target patient A, the treatment of the skull fracture is performed in parallel, the treatment of the intravascular coagulation syndrome and the treatment of staphylococcal infection in the vascular medicine are completed, and the treatment of the fracture of the skull can be discharged If it is judged that it has recovered to a certain extent, the doctor in charge of the internal medicine who conducts the last medical treatment gives discharge approval.

In the medical office section, when the discharge approval is issued by the doctor in charge, the medical office section enters the management process for medical office management for the target patient A (step 3 in the lower part of FIG. 2).
The optimum diagnosis group classification selection unit 120 receives each medical resource data stored in the data storage device 211 in the form of file import, and classifies and aggregates each diagnosis group classification. FIG. 6 is a diagram schematically showing a result of classification / aggregation for each diagnosis group classification by the optimal diagnosis group classification selection unit 120 with reference to the medical resource / diagnosis group classification database 110 in the case of FIG. As shown in FIG. 6, the medical resource input in the emergency department is 17800 based on the total result of the medical resource data input in the emergency department, the medical resource data input in the blood internal medicine, and the medical resource data input in the internal medicine. On the other hand, 19334 medical resources were invested in hematology, 4410 medical resources were invested in internal medicine, and the diagnosis group classification with the most medical resources invested during hospitalization was “Intravascular coagulation syndrome” Can be determined. In this example, the tentative diagnosis group classification of “skull fracture” selected at the beginning of hospitalization is incorrect, the diagnosis group classification of “intravascular coagulation syndrome” should be selected, and the diagnosis group of “intravascular coagulation syndrome” The classification is regarded as the optimal diagnosis group classification.

  Since the mismatch between the temporary diagnosis group classification and the optimal diagnosis group classification is verified in the diagnosis group classification verification process by the diagnosis group classification verification unit 130, the diagnosis group classification verification unit 130 is a “cranium fracture” that is a temporary diagnosis group classification. Is displayed on the monitor that “intravascular coagulation syndrome”, which is the optimal diagnosis group classification, should be selected.

Based on the verification result of the diagnostic group classification verification unit 130, the medical office system 200 presents it to a doctor in charge of internal medicine, and prompts the user to enter approval data for changing the diagnostic group classification. In this example, the attending physician of internal medicine to enter the authorization data via the data input-output control unit 210 for changing the diagnostic related groups.
The diagnosis group classification verification unit 130 receives the change approval of the diagnosis group classification and determines the optimum diagnosis group classification as the definite diagnosis group classification.

In the case of the configuration example of FIG. 1, the medical office system 200 uses the receipt creation unit 230 in the medical office system 200 to create a receipt based on the medical resource data in the definite diagnosis group classification. With the configuration example of FIG. 3, receive the medical office system 200 authorization data from the diagnostic related groups verification system 100 of the present invention through a data transmission interface for receipt creation system 300, the determined diagnostic groups classification The medical expenses are calculated according to the procedure, and the receipt is created according to the determined diagnosis group classification.

  When only the conventional medical office system is used, the medical institution cannot verify whether the diagnosis group classification with the most medical resources is selected when the department is repeated, Despite the change of the diagnostic group classification to be selected, the diagnostic group classification cannot be changed, the medical expenses are calculated with the wrong diagnostic group classification, and the determined diagnostic group classification is followed. Receipt creation might be executed.

On the other hand, when the hospital information integrated system 400 of the present invention is used, it is possible to accurately verify whether or not the diagnosis group classification with the most medical resources is selected even if the department transfer is repeated. The medical expenses are calculated based on the diagnostic group classification, and a receipt is created according to the confirmed diagnostic group classification.

As Example 2, an example is shown in which verification is performed when the diagnosis group classification is different depending on the treatment content, although the name of the wound and the medical subject are the same.
FIG. 7 is a diagram schematically showing an example in which the diagnosis group classification changes because the condition branch of the treatment is not correctly determined when the diagnosis group classification is finely divided depending on the treatment contents, although the names of wounds are the same. is there. As a specific example, patient B suffering from past gastric cancer was admitted to the hospital to check for the recurrence of gastric cancer, and no recurrence was seen, so no radiation treatment was given and chemotherapy was given. It is.

  It is assumed that the target patient B who has suffered from stomach cancer in the past visited the hospital for gastric cancer examination in order to confirm the presence or absence of gastric cancer recurrence. For the treatment of gastric cancer, the diagnostic group classification is divided according to the contents of radiotherapy, medication chemotherapy, endoscopic resection, and the like. It is assumed that the doctor in charge of internal medicine has selected a diagnosis group classification (for example, “060020xx99x0xx”) whose diagnosis is “stomach cancer” and whose diagnosis content is “test”. The doctor in charge at the time of hospitalization made a treatment policy of gastric cancer examination without radiotherapy or chemotherapy, and selected the diagnosis group classification “06020xx99x0xx” assigned to the gastric cancer examination under the name “stomach cancer” as the provisional diagnosis group classification. Assume that corresponding code information is input via the data input / output control unit 210 of the medical office system 200.

The medical office system 200 starts necessary medical office management for the target patient B based on the provisional diagnosis group classification “06020xx99x0xx” of the wound name “stomach cancer”.

Next, the doctor in charge performs necessary treatments for gastric cancer examination and invests medical resources. The doctor in charge inputs corresponding medical resource data through the data input / output unit 210 of the medical office system 200. In this example, for example, it is assumed that medical resources “Zometa injection solution” and “Zoladex LA” are input to the target patient B at the examination stage.
In the medical office section, the medical resource data input by the doctor in charge of internal medicine is reflected in the medical office management. The medical resource code information input via the data input / output unit 210 is accumulated in the data storage device 211 in the medical office system 200.

  Here, as a result of the gastric cancer examination of the target patient B, the doctor in charge could not confirm the recurrence and determined that there was no need for radiation treatment according to the original treatment policy. )). The physician in charge of internal medicine inputs chemotherapy by medication to the target patient B and inputs medical resource data via the data input / output unit 210 of the medical office system 200. Here, it is assumed that the medical resources of “TS1 capsule 20” are input.

  In the medical office section, the medical resource data input by the doctor in charge of internal medicine is reflected in the medical office management. The medical resource code information input via the data input / output unit 210 is accumulated in the data storage device 211 in the medical office system 200.

After the chemotherapy medication has been completed, the attending physician issues a discharge approval, the attending physician or medical events Tsutomu staff to enter the discharge authorization data to the medical system 200.
The medical system 200 moves to a management process of medical office management for the target patient B in response to the discharge approval from the doctor in charge.

  The optimum diagnosis group classification selection unit 120 takes in each medical resource data stored in the data storage device 211 in the medical office system 200 in the form of file import. FIG. 8 is a diagram schematically showing a process of referring to the medical resource / diagnostic group classification database 110 to classify and tabulate medical resource data for each diagnostic group classification and specify the optimum diagnostic group classification.

  As shown in FIG. 8, in the total result of the medical resource data input to the target patient B, the medical resource indicating “Zometa Injection”, “Zoladex LA”, “TS-1 Capsule 20” in the data storage device 211 Data exists. The optimum diagnosis group classification selection unit 120 specifies the diagnosis group classification while checking the conditional branch.

  In the example of FIG. 8, the optimal diagnosis group classification selection unit 120 performs operations such as “whether there has been chemotherapy”, “whether there has been radiation therapy”, and “ If there is medical resource data corresponding to the operation / procedure, the diagnosis group classification assigned to the corresponding operation / procedure is selected. If there is no medical resource data corresponding to surgery / treatment, the diagnosis group classification assigned to the gastric cancer test is selected. In this example, there is “TS1 capsule 20” in the medical resource data, and it is verified that there was chemotherapy in the check of “whether or not there was chemotherapy”. That is, the diagnosis group classification “06020xx99x3xx” corresponding to “with surgery / treatment and with chemotherapy” is selected as the optimum diagnosis group classification.

  As described above, when there are a plurality of diagnosis group classifications assigned to one injury or illness, the optimum diagnosis group classification selection unit 120 processes an algorithm for determining a conditional branch based on medical resource data regarding the injury or illness. The program is installed. Here, the condition branch when the input medical resource data is “Zometa Injection,” “Zoladex LA,” and “TS-1 Capsule 20” is checked for the name of the disease “stomach cancer”. It has a function that can check that the diagnosis group classification is “06020xx99x3xx”.

The diagnosis group classification verification unit 130 receives the identification result of the optimum diagnosis group classification by the optimum diagnosis group classification selection unit 120, and “temporal diagnosis group classification“ stomach cancer ”06020xx99x0xx” and the optimum diagnosis group classification “stomach cancer” 06020xx99x3xx. It is verified that “” is inconsistent, and the diagnosis group classification to be selected is displayed on the monitor as “stomach cancer“ 06020xx99x3xx ””.
Based on the verification result of the diagnostic group classification verification unit 130, the medical office system 200 presents it to a doctor in charge of internal medicine who is authorized to change and approve the diagnostic group classification, and prompts the user to enter approval data for the change of the diagnostic group classification. The physician in charge of internal medicine inputs approval data regarding the change of the diagnosis group classification via the data input / output control unit 210.
The diagnosis group classification verification unit 130 receives the change approval of the diagnosis group classification and determines the optimum diagnosis group classification as the definite diagnosis group classification.

  In the case of the configuration example in FIG. 1, the doctor in charge or the medical office staff uses the receipt creation unit 230 in the medical office system 200 to create a receipt based on the medical resource data in the definite diagnosis group classification. In the configuration example of FIG. 3, the diagnostic group classification verification system 100 of the present invention causes the receipt creation system 300 to perform medical fee calculation according to the determined diagnostic group classification via the data transmission / reception interface, Receipt creation is executed according to the confirmed diagnosis group classification.

  When only the conventional medical office system is used, the medical institution cannot verify whether the correct diagnosis group classification is selected or not when the conditional branching due to the treatment content is incorrect. In some cases, medical expenses are calculated with the group classification, and a receipt is created according to the confirmed diagnosis group classification.

On the other hand, when using the hospital information integrated system 400 of the present invention, if the conditional branching due to the treatment content is wrong, it is accurately verified whether the correct diagnosis group classification is selected from the input medical resource data. The medical expenses are calculated according to the optimum diagnosis group classification, and a receipt is created according to the confirmed diagnosis group classification.

  As Example 3, in the reference to the medical resource-diagnostic group classification database, there is a verification example in the case where there is medical resource data in which the correspondence between the medical resource and the diagnostic group classification in which the medical resource can be input does not correspond one-to-one Show.

  Many treatments and medications are commonly used to treat various injuries and diseases. For this reason, there are cases in which the diagnosis group classification as the classification / aggregation destination is not determined one-to-one only by receiving the input of the medical resource data. That is, in the medical resource / diagnosis group classification database 110, there is data in which the correspondence between the medical resource and the diagnostic group classification in which the medical resource can be input does not correspond one-to-one.

  Therefore, the optimum diagnosis group classification selection unit 120 of the third embodiment accumulates the data in the data storage device 211 of the medical office system 200 in the optimum diagnosis group classification selection process as shown in the first and second embodiments. Each medical resource data is imported in the form of file import, and classified and aggregated for each diagnostic group classification with reference to the medical resource-diagnostic group classification database 110. As a result of the reference, there is a pair of correspondence with the diagnostic group classification. When there is medical resource data that does not correspond to one, classification / aggregation is performed for all medical treatment group classifications for which medical resource data can be classified.

  In this way, if the diagnosis group classification that has the largest input of medical resources for all items that can be classified is obtained, all possibilities can be verified without omission, and the optimal diagnosis group classification can be identified for each case. . The diagnosis classification verification unit 150 can verify more correctly by verifying the match / mismatch between the optimal diagnosis group classification and the provisional diagnosis group classification determined in this way.

Hereinafter, a specific example will be described.
For example, “Taxotere”, an anticancer drug, is used for chemotherapy for cancer treatment at various sites. At present, the Ministry of Health, Labor and Welfare has determined “efficacy” (adaptation) for medical practice, drugs to be administered, and tests to be performed. This means that it is not used in diseases other than “efficacy”.

  FIG. 9 schematically shows the correspondence with the diagnosis group classification related to the medical resource “Taxotere” stored in the medical resource-diagnostic group classification database 110. In this example, six types of diagnosis groups corresponding to “breast cancer”, “non-small cell lung cancer”, “stomach cancer”, “head and neck cancer”, “ovarian cancer”, and “esophageal cancer” correspond. Paradoxically speaking, when using the drug "Taxotere", it is used because it suffers from any of the following diseases: breast cancer, non-small cell lung cancer, gastric cancer, head and neck cancer, ovarian cancer, esophageal cancer If “Taxotere” is present in the medical resource data, “BREAST CANCER”, “NON SMALL CELL Lung Cancer”, “Stomach Cancer”, “Head and Neck Cancer”, “Ovarian Cancer”, “Esophageal Cancer” All six diagnosis group classifications are assigned, and the optimal diagnosis group classification is selected for the six cases.

The specification of the optimum diagnosis group classification will be described with a specific example with reference to FIG.
An example in which examination A, medical practice B, medication C, and medication D are input as medical resources during the hospitalization period for the subject patient C who was hospitalized for cancer treatment that has been metastasized to multiple locations with unknown primary. I will explain.

  The doctor in charge at the time of hospitalization selects the stomach cancer whose cancer size is relatively large, selects the diagnosis group classification of “stomach cancer treatment” as the provisional diagnosis group classification, and uses the data input / output control unit 210 of the medical office system 200. Enter the corresponding code information.

The medical resource data corresponding to the medicine A, the medical practice B, the examination C, and the medicine D input during the hospitalization period is input via the data input / output unit 210, and the data storage device 211 in the medical office system 200 is received. Will be accumulated. It is assumed that the insurance score of medicine A is 2000, the insurance score of medical practice B is 3000, the insurance score of examination C is 1000, and the insurance score of medicine D is 500.
If the doctor in charge determines that the condition of the target patient C has improved and the patient is ready to be discharged, he / she is discharged.

  When the diagnosis group classification verification process is started, the optimum diagnosis group classification selection unit 120 receives each medical resource data stored in the data storage device 211 in the form of file import, and the medical resource-diagnostic group classification database 110. Refer to and classify and aggregate each diagnosis group.

  Here, when referring to the medical resource-diagnostic group classification database 110, for the drug A, there are six types of diagnosis group injuries such as breast cancer, small cell lung cancer, stomach cancer, head and neck cancer, ovarian cancer, and esophageal cancer. It is assumed that the drug can be input. In addition, the medical practice B is an examination that can be applied to three types of diagnosis group diseases and diseases of small cell lung cancer, gastric cancer, and head and neck cancer, and the inspection C is an injuries and diseases of two types of diagnosis group classification of breast cancer and small cell lung cancer. It is assumed that the test can be input, and the drug D is a drug that can be input to wounds and diseases of four types of diagnosis groups, which are small cell lung cancer, gastric cancer, ovarian cancer, and esophageal cancer.

  As described above, when the medical resource data is the medical resource data that can be input to the disease of the plurality of diagnosis group classifications, the optimum diagnosis group classification selecting unit 120, as schematically shown in FIG. Try to assign and classify for each diagnosis group classification and tabulate. In this example, it can be seen that the diagnosis group classification of small cell lung cancer is the optimal diagnosis group classification with the most medical resource data being input with 6500 points.

Here, the optimum diagnosis group classification selecting unit 120 selects the diagnosis group classification of “small cell lung cancer” as the optimum diagnosis group classification.
Since the temporary diagnosis group classification selected by the doctor in charge at the time of hospitalization was the diagnosis group classification of “stomach cancer”, the diagnosis group classification verification unit 130 indicates that the temporary diagnosis group classification and the optimal diagnosis group classification do not match. Can be verified.

The diagnosis group classification verification unit 130 displays on the monitor that “small cell lung cancer” that is the optimal diagnosis group classification should be selected instead of the provisional diagnosis group classification “stomach cancer”.
Based on the verification result of the diagnostic group classification verification unit 130, the medical office section contacts a doctor in charge of internal medicine and asks for approval for the change of the diagnostic group classification. In this example, the physician in charge of internal medicine issues an approval for a change in the diagnosis group classification, and inputs approval data via the data input / output control unit 210.

  The diagnosis group classification verification unit 130 receives the change approval of the diagnosis group classification and determines the optimum diagnosis group classification as the definite diagnosis group classification.

In the case of the configuration example of FIG. 1, the medical office system 200 uses the receipt creation unit 230 to create a receipt based on the medical resource data in the definite diagnosis group classification. In the configuration example of FIG. 3, the receipt creation system 300 is caused to execute a medical fee calculation according to the determined diagnostic group classification via the data transmission / reception interface in the hospital information integrated system 400 of the present invention, Receipt creation is executed according to the confirmed diagnosis group classification.

  When only the conventional medical office system is used, the medical institution can verify whether or not the correct diagnostic group classification is selected when there are multiple types of diagnostic group classifications into which medical resource data can be input. However, the medical expenses may be calculated with the wrong diagnosis group classification, and a receipt may be created according to the confirmed diagnosis group classification.

On the other hand, when the comprehensive hospital information system 400 of the present invention is used, even if there are a plurality of types of diagnosis group classifications into which medical resource data can be input, the correct diagnosis group classification is selected from the input medical resource data. The medical expenses are calculated according to the optimum diagnosis group classification, and a receipt is created according to the determined diagnosis group classification.

Above, shows an embodiment of a hospital information integrated system 400 of the present invention, when describing the processing steps of the hospital information integrated system of the present invention described above as a computer program, a hospital information processing program with diagnostic related groups verification process Can be offered as. In other words, the processing steps of the hospital information comprehensive system according to the present invention can be provided as a computer program written in a form supported on a computer-readable storage medium or downloaded via a computer network. .

As mentioned above, although preferred embodiment in the hospital information integrated system of this invention was illustrated and demonstrated, it will be understood that various changes are possible without deviating from the technical scope of this invention.

The comprehensive hospital information system of the present invention can be widely applied as long as it is a system for medical institutions that handle medical insurance.

The block diagram which showed typically the basic composition of the hospital information integrated system 400 of this invention The figure which showed the basic flow of the process of the hospital information integrated system 400 typically The block diagram which showed typically the basic composition of the diagnostic group classification verification system 100, the medical office system 200, and the receipt preparation system 300 in the hospital information integrated system 400 of this invention. The figure which explains typically the example where the diagnosis group classification changed by repeating the transfer Diagram showing an example of the input screen for medical resource data A diagram schematically showing the results of classification and tabulation of medical resource data for each diagnosis group classification The figure which shows the example which the diagnosis group classification changes according to the treatment contents when the name of injury is the same, but the diagnosis group classification is finely divided according to the difference of treatment contents A diagram schematically showing the process of classifying and aggregating medical resource data for each diagnosis group classification and identifying the optimal diagnosis group classification The figure which shows typically a response | compatibility with the diagnostic group classification regarding the medical resource "Taxotere" memorize | stored in the medical resource-diagnosis group classification database 110 The figure which shows the mode that the optimal diagnostic group classification selection part 120 tried classifying about all the diagnostic group classifications corresponding to medical resource data, and totaled it. Diagram showing medical resource data in a case where fracture treatment and pneumonia treatment were performed during hospitalization (prior art) Diagram showing medical resource data in a case where pneumonia treatment and fracture treatment were performed during hospitalization (prior art) Diagram showing conditional branching of diagnostic group classification for gastric cancer (prior art)

DESCRIPTION OF SYMBOLS 100 Diagnosis group classification verification system 110 Medical resource-diagnosis group classification database 120 Optimal diagnosis group classification selection part 130 Diagnosis group classification verification part 200 Medical office system 210 Data input / output device 220 Data storage device 230 Recto creation part 300 Recepto creation system
400 Hospital Information Integrated System

Claims (7)

At the time of hospitalization, the diagnosis group classification at the time of hospitalization selected based on the diagnosis contents of the doctor who examined the patient is determined, and the treatment, examination, and medicine that are input to the patient that are input as appropriate during the hospitalization A comprehensive hospital information system that verifies whether or not it is necessary to change the selection of the diagnostic group classification at the time of hospitalization based on medical resource data representing medical resources such as
A data storage device for inputting diagnosis group classification data representing a diagnosis group classification selected based on the diagnosis contents of a doctor who examined the patient at the time of admission, and storing the data as provisional diagnosis group classification data;
A medical resource-diagnostic group classification database in which correspondences between individual medical resources and diagnostic group classifications where the input of the medical resources can occur are made into a database;
Referring to the medical resource-diagnostic group classification database, classify and totalize all the medical resource data input during the hospitalization period and stored in the data storage device for each corresponding diagnostic group classification An optimal diagnosis group classification selection unit that identifies the optimal diagnosis group classification in which the most medical resources are actually invested,
Verify whether the provisional diagnosis group classification indicated by the provisional diagnosis group classification data input at the time of admission matches the optimum diagnosis group classification in which the most medical resources are actually invested. If it is, the provisional diagnosis group classification is used as it is as a definitive diagnosis group classification, and if it is verified as inconsistent, the provisional diagnosis group classification is changed and the optimum diagnosis group classification is used as the definite diagnosis group classification. equipped with a,
In the process of determining the definitive diagnosis group classification based on the verification result of the diagnosis group classification, the temporary diagnosis group classification and the optimal diagnosis for the doctor in charge who gave discharge permission at the time of discharge in the diagnosis group classification verification unit It is provided with a diagnosis group classification verification function and an approval confirmation function that presents the verification result of the group classification and executes a confirmation process on condition that confirmation data or change approval data is input by the doctor in charge. hospital information integrated system to be. It said diagnostic related groups corresponding to one of the victim is located plurality of ways, with respect to injuries of diagnostic groups classified according to the conditions of the action content is divided, the optimum diagnostic groups classification selection section, the inserted said medical resource data has been The hospital information integrated system according to claim 1, further comprising a conditional branch determination function for determining which diagnosis group classification should be selected as the optimum diagnosis group classification as a condition. The optimal diagnosis group classification selecting unit has medical resource data in which the correspondence between the medical resource and the diagnosis group classification in which the medical resource can be input is not one-to-one in the reference of the medical resource-diagnostic group classification database The hospital information comprehensive system according to claim 1, wherein the classification / aggregation is executed for all medical treatment group classifications in which the medical resource data can be classified, and the optimal diagnosis group classification is specified from the results. . It has a receipt creation system with a medical fee calculation function and a receipt creation function,
To the receipt creation system, said to execute the definite diagnosis related groups medical fees calculated in accordance with, in any one of claims 1 to 3, characterized in that to execute the receipt created in accordance with the definitive diagnosis related groups The hospital information integrated system described . In the diagnosis group classification verification unit, on the condition that there is an input of confirmation or approval of change through the approval process by the doctor in charge who gave discharge permission at the time of discharge, the confirmed diagnosis for the receipt creation system 5. The hospital information integrated system according to claim 4 , wherein medical fee calculation according to group classification is executed, and receipt creation according to the definite diagnosis group classification is executed. At the time of hospitalization, the diagnosis group classification at the time of hospitalization selected based on the diagnosis contents of the doctor who examined the patient is determined, and the treatment, examination, and medicine that are input to the patient that are input as appropriate during the hospitalization A hospital information processing program that verifies and approves whether or not it is necessary to change the selection of the diagnostic group classification at the time of admission based on medical resource data representing medical resources such as
A diagnosis group classification data representing a diagnosis group classification selected based on the diagnosis contents of a doctor who examined the patient at the time of admission, and provisional diagnosis group classification data determination processing step for tentative determination as provisional diagnosis group classification data;
A medical resource-diagnostic group classification database reference processing step in which a correspondence between each medical resource and a diagnostic group classification in which the medical resource can be input is databased;
By referring to the medical resource-diagnostic group classification database and classifying and totaling all the medical resource data input during the hospitalization period for each corresponding diagnostic group classification, An optimal diagnostic group classification selection processing step for identifying an optimal diagnostic group classification in which resources are invested;
Verify whether the provisional diagnosis group classification indicated by the provisional diagnosis group classification data input at the time of admission matches the optimum diagnosis group classification in which the most medical resources are actually invested. If it is, the provisional diagnosis group classification is used as it is as a diagnosis group classification, and if it is verified that there is a discrepancy, the provisional diagnosis group classification is changed and the optimum diagnosis group classification is used as the diagnosis group classification. ,
At the time of discharge, the optimal diagnostic group classification selected by the optimal diagnostic group classification selection processing step and verified as the diagnostic group classification in which the most medical resources are actually invested by the diagnostic group classification verification processing step is confirmed diagnosis group A diagnosis group classification decision processing step to be classified ,
In the diagnosis group classification confirmation processing step, in the process of confirming the confirmed diagnosis group classification based on the verification result of the diagnosis group classification, there is an input of confirmation or approval of change by the doctor in charge who gave discharge permission at the time of discharge A hospital information processing program comprising a diagnosis group classification verification process and an approval process that are determined on the basis of At the time of hospitalization, the diagnosis group classification at the time of hospitalization selected based on the diagnosis contents of the doctor who examined the patient is determined, and the treatment, examination, and medicine that are input to the patient that are input as appropriate during the hospitalization A method for verifying and approving whether or not it is necessary to change the selection of the diagnostic group classification upon admission based on medical resource data representing medical resources such as
At the time of hospitalization, input diagnostic group classification data representing the diagnostic group classification selected based on the diagnosis content of the doctor who examined the patient, tentatively determined as temporary diagnosis group classification data,
Refer to the medical resource-diagnostic group classification database that creates a database of correspondence between individual medical resources and the diagnostic group classifications where the medical resources can be used.
By referring to the medical resource-diagnostic group classification database and classifying and totaling all the medical resource data input during the hospitalization period for each corresponding diagnostic group classification, Identify the optimal diagnostic group classification for which resources have been invested,
Verify whether the provisional diagnosis group classification indicated by the provisional diagnosis group classification data input at the time of admission matches the optimum diagnosis group classification in which the most medical resources are actually invested. If the provisional diagnosis group classification as it is, the provisional diagnosis group classification as it is, if the mismatch is verified, the temporary diagnosis group classification is changed and the optimum diagnosis group classification as the diagnosis group classification,
At the time of discharge, the optimal diagnosis group classification selected by the selection of the optimal diagnosis group classification and verified as the diagnosis group classification in which the most medical resources were actually invested in the diagnosis group classification verification is defined as the definitive diagnosis group classification,
In the process of determining the diagnosis group classification based on the diagnosis group classification verification result in the diagnosis group classification determination, on the condition that there is an input of confirmation or approval of change by the doctor in charge who issued the discharge permission at the time of discharge A hospital information processing method characterized by confirmation and approval of diagnosis group classification to be confirmed .

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