JP5939757B2 - Health insurance information management system - Google Patents

Description

  The present invention relates to a health insurance information management system that manages information related to health insurance cards and medical certificates.

  2. Description of the Related Art Conventionally, a technique for confirming that there is no problem in information on a health insurance card of a patient who has come to a hospital is known. For example, in Patent Document 1, information is obtained from an insurance card received from a patient (insured person) and collated with information held by an insurance secretariat that issued the insurance card or an organization (insurer) such as a mutual insurance association. And a technology for confirming that the insurance card is valid is disclosed.

  For example, the national health insurance card issued by the local government, as well as the health insurance insured card issued by the National Health Insurance Association, health insurance associations for corporate employees, and mutual aid associations with public employees as members. There are health insurance insured cards and late elderly medical care insured cards issued by the late elderly medical care wide area association recently established.

  There are various types of insurance cards, but in Japan, almost all patients have insurance cards under the universal health insurance system except in some limited cases. For this reason, in hospitals, the work of requesting the presentation of health insurance cards from all patients and confirming the information on the health insurance cards presented by the patients has been established as a reception work. The hospital determines the medical cost for the patient based on the information obtained from the health insurance card and bills the patient. Then, the insurer who has issued the health insurance card is charged for the remaining medical expenses for the insurer.

JP 2007-48146 A

  However, according to the above-described prior art, it is possible to confirm the information on the health insurance card, but it is not possible to confirm the information on the medical card necessary for calculating the medical cost for the patient. A medical certificate is issued by a local government or the like for the purpose of reducing the burden of medical expenses on a patient, apart from a health insurance card. When a patient presents a medical certificate at a hospital and is examined, the medical cost borne by the patient is further borne by the issuer of the medical certificate from the amount of the patient's share determined based on the health insurance card. The amount will be deducted. As in the case of the health insurance card, the hospital bills the local government or the like that issued the medical card for the medical expenses of the burden.

  The medical certificate is issued, for example, when a resident makes an application to a local government where the resident lives. When an application from a resident satisfies a predetermined condition, the local government issues a medical certificate that describes the proportion of medical expenses and the expiration date of the medical expenses. For example, each condition for issuing a medical certificate to an infant, a person with a specific disease, an elderly person, etc. is defined. In this way, there are a plurality of conditions for issuing a medical certificate, and even for a medical certificate for infants, for example, the age at which the medical certificate is issued may differ depending on the local government. For this reason, the hospital may not be able to determine whether the patient has a medical certificate.

  The medical certificate is not possessed by almost all of the patients like the health insurance card, and the reception work for requesting the patient from the hospital at the time of reception has not been established. In the hospital, for example, this was accepted only when the patient presented a medical certificate. For this reason, patients often forget to present their medical certificate.

  After the medical expenses for the patient are calculated on the hospital side without presenting the medical certificate from the patient at the time of reception, if it is discovered that the patient has a medical certificate, the medical certificate is confirmed again and the medical expenses are calculated. It became a burden on the hospital. In addition, if the patient notices that he / she has forgotten to present his / her medical certificate after paying the medical fee, he / she goes to the local government office where he / she issued his / her medical certificate and submits an application for medical expenses. This had to be done, and the patient was also burdened.

  Even when a medical certificate is presented by a patient, for example, if the medical certificate has already been invalidated, it is necessary to redo the processing of the medical expenses. Hospitals often charge local governments for medical expenses at the end of each month. If the medical certificate is invalid and the medical fee is not paid at the time of claiming to the local government, the medical fee will be reclaimed from the hospital to the patient. Sometimes it was necessary.

  The same problem may occur with health insurance cards, but medical cards have a shorter expiry date than insurance cards and become invalid if the medical card issuance conditions are not met. In comparison with this, problems related to the treatment of medical expenses occurred more frequently.

  In this way, since the expiration date, issuance conditions, etc. of a medical certificate are different from those of an insurance card, a medical certificate management system will be built to facilitate and accurately process medical expenses from both the hospital and patient side. It was requested.

  The present invention has been made to solve the above-described problems caused by the prior art, and an object thereof is to provide a health insurance information management system capable of managing information related to a medical card in addition to the health insurance card. To do.

In order to solve the above-described problems and achieve the object, the present invention provides a reception terminal that acquires medical certificate information from a medical certificate received from a patient, an electronic medical record database that manages the patient's examination information as an electronic medical record, and The health insurance information database that manages the medical certificate information, and the health insurance information database that manages the health insurance information database based on the medical certificate information acquired by the reception terminal, and information related to the insurance card that is managed by the health insurance information database Or an information management terminal for maintaining the consistency of the information between the electronic medical record database and the health insurance information database when the information related to the medical certificate is included in the electronic medical record database; The received information includes information that satisfies the medical certificate issuance requirements. Case, and displaying a screen for prompting the acquisition of the medical certificate information.

The present invention also provides a reception terminal that acquires medical certificate information from a medical certificate received from a patient, an electronic medical record database that manages the patient's examination information as an electronic medical record, and a health insurance information database that manages the medical certificate information And managing the health insurance information database based on the medical certificate information acquired at the reception terminal, and information relating to the insurance card or information relating to the medical certificate managed in the health insurance information database is included in the electronic medical record database An information management terminal that maintains the consistency of the information between the electronic medical record database and the health insurance information database, the information management terminal receives information received at the reception terminal, The medical certificate is issued in the electronic medical record database and the health insurance information database. That when the medical issuance satisfying information is included, and displaying a screen for prompting the acquisition of the medical certificate information on the reception terminal.

  In the present invention, the information management terminal includes information indicating that the patient received at the reception terminal has the medical certificate in the electronic medical record database and the health insurance information database. And the information received at the reception terminal, the electronic medical record database, and the health insurance information database include information indicating that the medical certificate issuance conditions are no longer satisfied. A screen for prompting deletion of the medical certificate information is displayed on the screen.

  In the present invention, the medical certificate issuance condition is a condition based on the age of the patient, which is determined by a bearer who issues the medical certificate and bears a part of the medical expenses of the patient. It is characterized by.

  Also, in the present invention according to the present invention, the medical certificate issuance condition is a condition based on a place of residence of the patient determined by a bearer who issues the medical certificate and bears a part of the medical expenses of the patient. It is characterized by that.

  Further, the present invention is the above invention, wherein the medical certificate issuance condition is a condition based on a specific disease determined by a bearer who issues the medical certificate and bears a part of the medical expenses of the patient. And

The present invention is also a health insurance information management system, a reception terminal that acquires medical certificate information from a medical certificate received from a patient, a health insurance information database that manages the medical certificate information, and the examination information of the patient and an electronic medical record database for managing the electronic chart, and health insurance information database for managing the medical card information, as well as managing the health insurance information database on the basis of the medical card information acquired in the reception terminal, the electronic An information management terminal for maintaining consistency between the medical record database and the health insurance information database;
When the reception terminal includes information that satisfies a medical certificate issuing condition for issuing the medical certificate in the received information, the reception terminal displays a screen that prompts the acquisition of the medical certificate information. Features.
Also, the present invention includes information received by the information management terminal at the receiving terminal, the electronic medical record database, and the health insurance information database including information satisfying a medical certificate issuing condition for issuing the medical certificate. If it is, a screen prompting the acquisition of the medical certificate information is displayed on the reception terminal .

  According to the present invention, the medical card information necessary for determining the medical cost burden ratio can be obtained by the reception terminal that accepts the patient, and this can be managed as a health insurance information database. The medical cost burden ratio can be easily and accurately determined. In addition, it is possible to maintain consistency between the electronic medical record and the health insurance information, including the electronic medical record accumulated before the introduction of the system according to the present invention, and to centrally manage information about the patient.

  Further, according to the present invention, whether or not a patient's medical certificate is valid by collating the information on the medical certificate obtained from the medical certificate with the information on the medical certificate held by the local government or the like that issued the medical certificate. Therefore, it is possible to easily and accurately determine the medical cost burden ratio of the patient.

  Further, according to the present invention, when the electronic medical record or health insurance information stored for the revisited patient includes information indicating that the patient has a medical certificate, the patient or patient Therefore, it is possible to prevent the patient from forgetting to give out the medical certificate, and to easily and accurately determine the medical cost burden ratio of the patient.

  In addition, according to the present invention, when the information received at the reception terminal, the electronic medical record or health insurance information stored for the patient includes information that satisfies the condition for issuing the medical certificate, the patient The patient's reception staff can be prompted to obtain medical certificate information, so that it is possible to prevent the patient from forgetting to issue the medical certificate and to easily and accurately determine the medical cost burden ratio of the patient.

  According to the present invention, the patient who is said to have a medical certificate from the electronic medical record database or the health insurance information database can receive information received from the reception terminal, from the data included in the electronic medical record database and the health insurance information database. If there is a possibility that you no longer have a medical certificate, you can prompt the patient or patient receptionist to confirm the medical certificate information. Thus, it is possible to easily and reliably determine the medical cost burden ratio of the patient.

  In addition, according to the present invention, the information received at the reception terminal, the electronic medical record and health insurance information stored for the patient satisfy the patient's age, address or specific disease name managed as the medical certificate issuance condition If the information is included, the patient and the patient's receptionist can be encouraged to obtain medical certificate information, preventing the patient from forgetting to obtain the medical certificate and ensuring the patient's share of medical expenses. Can be determined.

FIG. 1 is a configuration diagram illustrating an outline of a health insurance information management system according to the present embodiment. FIG. 2 is a block diagram showing a schematic configuration of the first automatic reception terminal and the second automatic reception terminal. FIG. 3 is a diagram illustrating a part of the basic information included in the health insurance information database. FIG. 4 is a diagram showing a part of the insurance card information and the insurance card image included in the health insurance information database. FIG. 5 is a diagram showing a part of the medical certificate information and the medical certificate image included in the health insurance information database. FIG. 6 is a flowchart showing an outline of reception processing for a first visit patient. FIG. 7 is a flowchart showing an outline of a re-examination patient reception process. FIG. 8 is a diagram showing a management condition setting screen related to insurance card information. FIG. 9 is a diagram illustrating a management condition setting screen regarding medical certificate information. FIG. 10 is a diagram illustrating a configuration example of a health insurance information management system that also uses an information management terminal as a reception terminal. FIG. 11 is a diagram illustrating a configuration example of a health insurance information management system that outsources management of an information management terminal.

  Exemplary embodiments of a health insurance information management system according to the present invention will be described below in detail with reference to the accompanying drawings. There are various types of health insurance cards issued by health insurance societies and mutual aid societies. Below, these health insurance cards are collectively referred to as “insurance cards” and health insurance cards are issued. The institution is described as “insurer”. There are various types of medical certificates, but in the following, these are collectively referred to as “medical certificates”, and local governments that issue medical certificates and bear medical expenses are referred to as “bearers”. Describe.

  FIG. 1 is a diagram showing an outline of a health insurance information management system 1 that manages information on insurance cards and medical certificates. In the health insurance information management system 1, a system in the hospital 10, a health insurance card database 41 in which an insurer manages information relating to a health insurance card, and a medical health certificate database 42 in which a bearer manages information relating to a health insurance card are included in the network 20. Are communicably connected. In order to prevent leakage of personal information, the network 20 is constructed using, for example, a dedicated line. When a public line such as the Internet is used as the network 20, information leakage is prevented by encrypting data to be transmitted and received.

  In the hospital 10, a first automatic reception terminal 11 for accepting an application for a medical examination from a patient unattended, a second automatic reception terminal 12 for accepting an insurance card and a medical certificate from a patient unattended, and a receptionist at a window Includes a window reception terminal 13 for accepting a patient's examination application and processing an insurance card and medical certificate, an electronic medical record database 15 for managing the patient's examination contents, and information on the insurance card and medical card A health insurance information database 17 and an information management terminal 16 that manages the database 17 are connected by a network 21 so that they can communicate with each other. The window reception terminal 13 is connected to a scanner 14 that is used to generate an image from an insurance card and a medical certificate and acquire information.

  Although not shown in FIG. 1, the network 21 in the hospital 10 includes a terminal that uses the electronic medical record database 15 in the examination room, a terminal that is used in the examination window, and a health insurance information database 17 that is used at the checkout window. A terminal that calculates medical expenses to be charged to a patient by using the terminal, a terminal that performs a process called a receipt request that uses the health insurance information database 17 in the office department to charge the insurer or a burdenor for medical expenses, etc. It is connected. Each terminal connected to the network 21 is granted access authority to the electronic medical record database 15 and the health insurance information database 17 as necessary.

  First, the first automatic reception terminal 11 will be described. The first automatic reception terminal 11 is installed in the hospital 10 and has a function of receiving an application for medical examination from a patient who has visited the hospital. FIG. 2A is a block diagram showing an overview of the first automatic reception terminal 11. The first automatic reception terminal 11 includes an operation unit 31 for receiving an operation by a patient, a display unit 32 for displaying various information, an examination ticket receiving unit 33 for receiving an examination ticket, an information management terminal 16, and the like. A communication unit 34 for performing data communication with the window reception terminal 13 and the like, a reception slip issuing unit 35 for issuing a reception slip after receiving a medical examination, and a control unit 30 for controlling the operation of each of these units have.

  For example, a touch panel display is used as the operation unit 31 and the display unit 32, and the patient can input necessary information through the touch panel while confirming information and instructions displayed on the display. In addition, a scanner is used as the examination ticket receiving unit 33, and information printed on the examination ticket can be acquired using OCR (Optical Character Reader) technology. In addition, magnetic cards, IC cards, or cards containing barcodes may be used as examination tickets. In these cases, a magnetic card reader, IC card reader, barcode reader, etc. The information reading device is used as the medical examination ticket receiving unit 33, and information is similarly acquired from the medical examination ticket. In addition, when a printer is used as the reception form issuing unit and the reception of the medical examination is completed, a reception form on which the location of the medical examination room where the patient should go for the medical examination, the reception number, and the like is printed.

  The 1st automatic reception terminal 11 is mainly used in order to receive a medical examination of a reexamination patient. When a patient who has come to the hospital 10 operates the operation unit 31 and desires a revisit, the control unit 30 displays operation details necessary for accepting the reexamination on the display unit 32. When the examination ticket is inserted into the examination ticket receiving unit 33 according to the operation content displayed on the display unit 32, information is acquired from the examination ticket, and this information is transmitted from the communication unit 34 via the network 21 to the information management terminal 16 and the window. It is transmitted toward the reception terminal 13.

  After receiving the application for reexamination by the first automatic reception terminal 11, if it is not necessary to receive the insurance card and medical certificate or to confirm at the window, the control unit 30 receives the reception card from the reception card issuing unit 35. Is issued. The reexamination acceptance process is completed with the issuance of the receipt slip.

  On the other hand, when the insurance card and the medical card are required to be received, a screen for guiding the patient to the second automatic reception terminal 12 is displayed on the display unit 32 by the control unit 30. When confirmation work at the window is necessary, the control unit 30 displays a screen for guiding the patient to the reception window on the display unit 32. The reexamination patient extracts the examination ticket discharged from the examination ticket receiving unit 33 according to the display on the display unit 32, and heads to the second automatic reception terminal 12 or the reception window.

  For example, when a predetermined period has passed since the health insurance card or medical certificate was confirmed in the previous medical examination, the reexamination patient checks the contents of the health insurance card and the medical card in order to check the contents of the second automatic reception terminal 12. Be guided to. In addition, when it is necessary to confirm details with the patient regarding the contents of the insurance card and medical certificate, the patient is guided to the reception desk.

  Next, the second automatic reception terminal 12 will be described. The second automatic reception terminal 12 has a function of accepting an application for a medical examination from a first medical examination patient and accepting an insurance card and a medical certificate from a reexamination patient. FIG. 2B is a block diagram showing an outline of the second automatic reception terminal 12. In addition to the configuration of the first automatic reception terminal 11 shown in FIG. 2A, the second automatic reception terminal 12 has an insurance card reception unit 36 for receiving an insurance card from a patient, and a medical care for receiving a medical card. A certificate acceptance unit 37.

  For example, a scanner is used as the insurance card reception unit 36 and the medical card reception unit 37, and images of the insurance card and the medical card received from the insertion slot are generated. In addition, information printed on the insurance card and the medical card is acquired by the OCR technique using this image. It should be noted that the examination ticket receiving unit 33, the insurance card receiving unit 36, and the medical certificate receiving unit 37, which are functional units for acquiring information from a card or a paper medium, are provided independently of each other. Alternatively, two or all three may be realized by one component.

  A process of accepting a first visit patient by the second automatic acceptance terminal 12 will be described. In the second automatic reception terminal 12, when a first visit patient who visits the hospital 10 operates the operation unit 31 and desires a diagnosis, the control unit 30 indicates that it is necessary to receive an insurance card for receiving the first check. The operation content necessary for this is displayed on the display unit 32. When a health insurance card is inserted into the health insurance card accepting unit 36 according to the operation content displayed on the display unit 32, a health insurance card image is generated and insurance card information is acquired from the health insurance card image. The insurance card image and the insurance card information acquired from the image are transmitted from the communication unit 34 to the information management terminal 16 and the window reception terminal 13 via the network 21.

  In addition, the display unit 32 displays information indicating that it is necessary to accept a medical certificate when the medical card is possessed, and operation contents necessary for this. When a patient who has a medical card inserts a medical card into the medical card receiving unit 37 as in the case of an insurance card, the medical card receiving unit 37 generates a medical card image and uses the medical card from this image. Information is acquired and transmitted from the communication unit 34 to the information management terminal 16 and the window reception terminal 13 via the network 21.

  Re-examination patient acceptance processing by the second automatic acceptance terminal 12 will be described. When the reexamination patient who applied for the reexamination by the first automatic reception terminal 11 and is guided to the second automatic reception terminal 12 performs an operation indicating that the reexamination is accepted by the operation unit 31, the control unit 30 Then, a screen for instructing to insert the examination ticket into the examination ticket receiving unit 33 and inserting the insurance card into the insurance card receiving unit 36 is displayed on the display unit 32. In addition, when the revisit patient has a medical certificate, a screen for instructing to insert the medical certificate is displayed on the display unit 32. Thus, as in the case of the first visit patient, image generation and information acquisition are performed from the insurance card and medical certificate, and the information is transmitted from the communication unit 34 to the information management terminal 16 and the window reception terminal 13 via the network 21. In addition, in the case of a reexamination patient, the examination ticket information acquired by the examination ticket reception unit 33 is transmitted to the information management terminal 16 and the window reception terminal 13.

  In either case of a first visit patient or a reexamination patient, after the image is generated from the insurance card and the medical card by the second automatic reception terminal 12 and information is acquired, control is not required at the window. The receipt form is issued from the receipt form issuing section 35 by the unit 30. The acceptance process is completed with the issuance of the acceptance slip. On the other hand, when the confirmation work at the window is necessary, the control unit 30 displays a screen for guiding the patient to the reception window on the display unit 32.

  The second automatic reception terminal 12 also has a function for managing medical certificate issuance conditions and performing a process for requesting the patient to present a medical certificate based on the conditions. Will be described later.

  Next, the window reception terminal 13 will be described. The window reception terminal 13 includes a computer device and a scanner 14 connected to the network 21. The window reception terminal 13 is operated by a reception person at the window of the hospital 10. The window reception terminal 13 is used by a window person in charge to confirm and input information when the automatic reception terminals 11 and 12 cannot acquire information from the examination ticket, insurance card, or medical certificate.

  Specifically, for example, when an error such as an image not being generated normally occurs in the processing of the automatic reception terminals 11 and 12, the patient is guided to the window. The person in charge of reception at the hospital 10 who operates the window reception terminal 13 receives an examination ticket, insurance card or medical certificate from the patient guided to the window, and performs reception processing by the window reception terminal 13. When an error occurs during reception of a medical examination ticket, information such as a medical examination ticket number to be acquired from the medical examination ticket is input from the window reception terminal 13. If an error occurs when accepting an insurance card or medical certificate, and the image has not been generated normally, an image is generated using the scanner 14 provided in the window receiving terminal 13, and information is acquired from the image using the OCR technology. Is done.

  The window reception terminal 13 confirms and corrects the information acquired from the image generated by the second automatic reception terminal 12 or the scanner 14. On the display device provided in the window reception terminal 13, an image of a health insurance card or a medical card and character information acquired from the image are displayed. The person in charge of the reception compares the character on the displayed image with the character information recognized by the OCR, and performs an operation of correcting the character information when there is omission, error or content change.

  Next, the information management terminal 16 will be described. The information management terminal 16 is configured by a computer device and has a health insurance information database 17 therein. The information management terminal 16 has a function of managing information related to the health insurance card and medical certificate received from the patient using the health insurance information database 17.

  Specifically, for example, when an insurance card or medical certificate is received from a first visit patient, data relating to the first visit patient is newly created. In addition, when an instruction for inputting information on the health insurance card or medical certificate is displayed on the second automatic reception terminal 12 or the window reception terminal 13 for the reexamination patient and information on the health insurance card or medical card is input, Check whether the input information matches the data created in the past. If the input information does not match the past data, check and modify the insurance card and medical card information as necessary, or approve the input information if there is a change from the past data. A window for instructing this is displayed on the window reception terminal 13. When the insurance card information and the medical card information are updated or corrected, the database is updated while leaving the correction history. In the information management terminal 16, when data is corrected or updated, the history is saved, and if a problem occurs later, the past history can be checked and the data can be corrected again. It is like that.

  The health insurance information database 17 includes basic information on each patient, information on insurance cards, and information on medical cards. A management number for identifying each patient is assigned to each patient, and each piece of information is stored in association with this management number. By specifying a management number on the information management terminal 16, for example, the information shown in FIGS. 3 to 5 can be confirmed. As for the management number, in addition to assigning the management number in the order in which the patients are received, the examination ticket number can be used as the management number. Further, although the information management terminal 16 is shown as an independent terminal, the present embodiment is not limited to this, and for example, the window reception terminal 13, an existing terminal used in a payment counter or an office department is used. Thus, the function of the information management terminal 16 may be realized.

  FIG. 3 shows a part of data stored as basic information about a patient. As described above, data such as the patient contact information such as the examination ticket number, name and address, and the examination related information such as the examination date are managed in association with the management number.

  FIG. 4 shows a part of data stored as insurance card information. Information that can be obtained from a health insurance card may differ depending on the type of health insurance card. Information to be acquired from the insurance card is set in advance. The automatic reception terminals 11 and 12 and the window reception terminal 13 try to acquire all information from the insurance card image based on this setting, and the information acquired as a result is managed as insurance card information. For example, as shown in FIG. 4A, insured related information such as an insurance card number and name, insurer related information such as an insurer number, and the like are managed in association with a management number. As shown in FIG. 4B, the insurance card image obtained from the insurance card information in FIG. 4A is also managed in association with the management number.

  FIG. 5 shows a part of data stored as medical certificate information. Regarding the medical certificate, the information that can be acquired differs depending on the type of medical certificate, but all information set in advance is tried, and the information acquired as a result is managed as the medical certificate information. As shown in FIG. 5A, insured person-related information such as a medical card number and name, burdener-related information such as a bearer number, and the like are managed in association with the management number. Further, as shown in FIG. 5B, the medical certificate image obtained from the medical certificate information in FIG. 5A is also managed in association with the management number.

  There are various types of insurance cards and medical cards, so if you try to visually check the description using the insurance card image or medical card image, you need to find where the information is on the image. is there. For this reason, the information extracted from the insurance card and medical certificate is held as a database as shown in FIGS. 4A and 5A so that necessary information can be easily grasped on the information management terminal 16. It has become. As shown in FIGS. 4B and 5B, in addition to text data, the insurance card image and the medical card image are stored in the database. For example, character recognition and reception by OCR If there is an error in the input by the person in charge, this can be visually confirmed on the image and corrected. Data included in the health insurance information database 17 can be confirmed on each terminal such as the window reception terminal 13 connected to the network 21.

  The information management terminal 16 also has a function for managing medical certificate issuance conditions and prompting the acquisition of medical certificate information based on the conditions, or urging the deletion of already registered medical certificate information. . The medical certificate issuance conditions are managed by the information management terminal 16, but are used inside the information management terminal 16 and on other terminals such as the second automatic reception terminal 12 connected to the network 21. Is also possible. Details of processing related to medical certificate issuance conditions will be described later.

  Next, the electronic medical record database 15 will be described. The electronic medical record database 15 is a database that stores electronic medical records generated by inputting various information when a patient is examined. The health insurance information management system 1 has a health insurance information database 17 that is independent from the electronic medical record database 15. However, in the hospital 10 that has been using the electronic medical record database 15 in the past, the electronic medical record database 15 may include data on insurance cards and medical certificates. In the system 1, information that can be used for the health insurance information database 17 can be extracted from the electronic medical record database 15 in which information has been accumulated in the past.

  For example, when the system 1 is installed in a hospital 10 in which an electronic medical record database 15 already exists, when the health insurance card information of a revisited patient is input from the automatic reception terminals 11 and 12 and the window reception terminal 13, the information management The terminal 16 newly creates data related to the inputted insurance card information. At the same time, the electronic medical record database 15 is referred to and it is confirmed whether or not the information input by the reexamination patient matches the insurance card information recorded in the electronic medical record in the past. If the information does not match, the patient is guided to the window, and information confirmation by the window reception terminal 13 is instructed. Then, the electronic medical record database 15 is updated as necessary. In this way, data for the newly introduced health insurance information database 17 is generated using the existing electronic medical record database 15. Further, processing for maintaining consistency between the electronic medical record database 15 and the health insurance information database 17 is performed.

  In the present system 1, the health insurance information database 17 can be created from the electronic medical record database 15 without waiting for the visit of the revisit patient. Specifically, for example, when the present system 1 is newly introduced, the information management terminal 16 refers to the electronic medical record database 15, and the insurance card and medical care included in the electronic medical record of the patient who has consulted in the past. Information on the card is extracted, and data for the health insurance information database 17 regarding each patient is created. Of the data managed as the health insurance information database 17, information that is not included in the electronic medical record, that is, deficient data is acquired from an insurance card or medical certificate when the patient next receives a medical examination. Further, when there is a change in the information on the revisited patient, both the health insurance information database 17 and the electronic medical record database 15 are updated so that the consistency between the two databases 15 and 17 is maintained. It has become.

  As described above, even when the system 1 is newly introduced into the hospital 10, the electronic medical record database 15 accumulated in the past is used, and the electronic medical record database that has been conventionally used after the introduction of the system 1 is used. 15 can be used continuously.

  Next, the insurance card database 41 and the medical card database 42 will be described. The insurance card database 41 is a database in which the insurer manages information related to the insured. In the insurance card database 41, for example, out of the information shown in FIG. 4A, insurance card issuance information corresponding to insured-related information such as an insurance card number and name is managed. The medical certificate database 42 is a database in which the bearer manages information on the insured person. In the medical certificate database 42, for example, of the information shown in FIG. 5A, medical certificate issuance information corresponding to insured-related information such as a medical certificate number and name is managed. In the system 1, as long as similar information is managed, the database 1 is not limited to a database managed by an insurer and a bearer. For example, the database 1 is managed by a professional contractor outsourced by an insurer or a bearer. You can also use the database.

  The information management terminal 16 installed in the hospital 10 can access the insurance card database 41 and the medical card database 42 via the networks 20 and 21. The information management terminal 16 manages the insurance card information and medical card information newly received from the patient, and the insurance card information and medical card information stored in the health insurance information database 17 in the insurance card database 41 of the insurer. Whether the medical card information and the medical card information managed in the medical card database 42 of the bearer coincide with each other.

  For example, when the medical certificate information shown in FIG. 5A is acquired from the medical certificate at the second automatic reception terminal 12 or the window reception terminal 13, and this medical certificate information is transmitted to the information management terminal 16, the information management terminal 16 Uses the medical certificate number, the bearer number, etc. included in the medical certificate information to specify the medical certificate database 42 to be inquired about the received medical certificate. Then, medical certificate information corresponding to the medical certificate number received from the patient is acquired from the specified medical certificate database 42 and collated with the medical certificate information received from the patient. As a result, if the two pieces of information match, the information final confirmation date shown in FIG. 4A is updated here, and the update history of the information final confirmation date is also saved.

  If the medical certificate information received from the patient and the medical card information managed by the bearer do not match, the information that does not match and the information for instructing confirmation of the information are the information management terminal 16 or the window receiving terminal. 13 is displayed. Subsequently, for example, information that does not match and the medical certificate image shown in FIG. 4B are displayed on the window reception terminal 13. The reception person confirms the information on the medical certificate image, and corrects the information when there is an error in the character recognition by OCR or the input by the reception person. When the medical certificate information is corrected, the information final confirmation date shown in FIG. 4A is updated. When the person in charge of the reception who has confirmed the medical certificate image determines that there is a problem with the medical certificate received from the patient, an operation of confirming the details with the patient or the bearer is performed. Similar work is done for insurance cards.

  Data verification between the insurance card information and medical card information managed by the health insurance information database 17 and the insurance card database 41 and medical card database 42 managed by the insurer and the bearer is performed by the second automatic reception terminal 12 or the window. In addition to the case where a patient is received by the reception terminal 13, there may be a case where it is periodically performed.

  For example, data verification may be performed every time after the examination time at the hospital 10 ends, or data verification may be performed on a predetermined day and date set in advance. Further, for example, data collation may be performed at predetermined intervals such as every 15 days. For data that is subject to data verification, for example, data verification may be performed only for data relating to insurance cards and medical certificates newly added after the previous data verification, or data verification may be performed for all data. Good.

  The timing of data collation and the designation of data to be collated can be set on the information management terminal 16. Based on the set information, data collation for predetermined data is performed at a predetermined timing.

  Further, whether or not to perform data collation can be changed by setting. For example, in the case where a failure has occurred in the network 20 for accessing the insurance card database 41 and the medical card database 42, the related processing is omitted by setting so as not to collate data in advance. The occurrence of network errors can be avoided. At this time, in addition to setting not to perform data collation completely, it can be set to automatically omit data collation only when a network error is detected. Furthermore, the data collation can be omitted depending on the communication load on the networks 20 and 21 and the processing load on the information management terminal 16. Whether data collation is always performed, is always omitted, or is temporarily omitted according to the processing load of each unit, can be set according to the operation of the user.

  In FIG. 1, only one insurance card database 41 and one medical card database 42 are shown, but it is possible to use the databases 41 and 42 possessed by a plurality of insurers and bearers connected to the network 20. it can. The information management terminal 16 manages information necessary for accessing the insurance card database 41 possessed by each insurer and information necessary for accessing the medical certificate database 42 possessed by each bearer. Specifically, for example, address information on the network 20 of each database, authentication information for accessing the database, information on an encryption method for transmitting and receiving data, and the like are managed. Based on these, the insurance card database 41 and the medical card database 42 are accessed, the necessary insurance card information and the medical card information are acquired, and data collation with the information stored in the health insurance information database 17 is performed.

  Next, with respect to the health insurance information management system 1 having the above-described configuration, processing performed at each terminal will be described with reference to FIGS. 6 and 7. FIG. 6 is a flowchart showing an outline of processing performed when a first visit patient is received. FIG. 7 is a flowchart showing an outline of processing performed when a reexamination patient is received.

  First, a process when receiving a first visit patient shown in FIG. 6 will be described. When the first visit patient who visits the hospital 10 tries to operate the first automatic reception terminal 11, a screen prompting the use of the second automatic reception terminal 12 is displayed on the display unit 32. When the first visit patient guided to the second automatic reception terminal 12 operates the operation unit 31 according to the information displayed on the display unit 32 and selects the first visit reception (step S1), an insurance card is displayed on the display unit 32. A screen for instructing to insert the medical card into the medical card receiving unit 37 is displayed on the receiving unit 36 (step S2).

  The first visit patient inserts his / her insurance card into the insurance card receiving unit 36 according to the display on the display unit 32, and inserts the medical card into the medical card receiving unit 37 if he / she has a medical card (step S3). ).

  When a health insurance card is inserted into the health insurance card receiving unit 36, a health insurance card image is generated, and insurance card information such as a health insurance card number is obtained from the insurance card image by OCR processing (step S4).

  Similarly, when a medical certificate is inserted into the medical certificate receiving unit 37, a medical certificate image is generated, and medical certificate information is acquired from the medical certificate image. The second automatic reception terminal 12 stores medical certificate issuance conditions for determining a patient possessing a medical certificate. If the medical card information is not inserted into the medical certificate receiving unit 37 within a predetermined time even though the previously acquired insurance card information satisfies the medical card issuance condition, the control unit 30 A screen that prompts the user to insert a medical certificate is displayed on the display unit 32. The second automatic reception terminal 12 acquires and uses the medical certificate issuance conditions set by the information management terminal 16 via the network 21.

  Specifically, for example, if there is a local government that issues a medical certificate if the age meets a predetermined condition for infants and the elderly, information on the age and the address under the jurisdiction of the local government is used as the medical certificate issuing condition. It is stored in the second automatic reception terminal 12. In the second automatic reception terminal 12, it is determined whether or not the patient's address and age included in the insurance card information acquired from the insurance card reception unit 36 satisfy the medical card issuance condition. If it is determined that the medical certificate issuance condition is satisfied, the patient is highly likely to have a medical certificate. Therefore, the display unit 32 displays the name of the local government and the type of medical certificate to the patient. Display a screen prompting you to accept a medical certificate.

  As described above, in the second automatic reception terminal 12, when the first medical examination reception is started, the display unit 32 is prompted to accept the medical certificate, so that the first medical examination patient can be prevented from forgetting to give the medical certificate. . In addition, when the medical certificate issuance condition is satisfied, more specific information is displayed and the acceptance of the medical certificate is promoted, so that the medical certificate can be received more reliably.

  The insurance card image and the insurance card information acquired at the second automatic reception terminal 12 and the medical card image and the medical card information are transmitted to the window reception terminal 13 (step S6). Then, a check-in operation of the insurance card information and the medical card information acquired by the second automatic reception terminal 12 is performed by a reception person who operates the window reception terminal 13. Specifically, for example, a confirmation operation is performed to confirm that the image has been generated normally and that the character has been correctly recognized by OCR. In addition to the case where the receptionist visually confirms all cases, this confirmation work is performed only when the validity of the images and information is automatically determined and it is determined that there is a problem. 13 may be a mode in which confirmation work is performed. For example, it is possible to determine an abnormality of an image from the data capacity or color distribution of an insurance card image and a medical certificate image, to determine an abnormality of a character type from character information acquired by OCR, or to acquire from an insurance card and a medical certificate. The possibility of a character recognition error is determined by comparison with a dictionary in which a predicted character string is registered. These processes may be performed by the information management terminal 16 in addition to the mode performed by the window reception terminal 13.

  When it is determined that there is an abnormality in the image and information acquired at the second automatic reception terminal 12 (step S8; No), a window guidance notification is transmitted from the window reception terminal 13 to the second automatic reception terminal 12. (Step S9). When receiving the window guidance notice, the second automatic reception terminal 12 displays a screen for instructing the patient to go to the window on the display unit 32 (step S10).

  On the other hand, when it is determined that there is no problem in the image and information acquired by the second automatic reception terminal 12 (step S8; Yes), the insurance card image and the insurance card information, the medical card image and the medical card information, Is transmitted to the information management terminal 16 (step S11).

  In the information management terminal 16, the received insurance information is registered as new data in the health insurance information database 17 (step S12). Further, from the received insurance information, the insurance card database 41 that is the inquiry destination of the insurance card information and the medical certificate database 42 that is the inquiry destination of the medical card information are specified, and information inquiry is performed (step S13). Specifically, the insurance card number is transmitted to the insurance card database 41, and the insurance card information relating to the insurance card number is requested. Similarly, a medical certificate number is transmitted to the medical certificate database 42 to request medical certificate information.

  In the insurance card database 41, when the information request from the information management terminal 16 is received, the received insurance card number is searched (step S14). Then, the insured person information regarding the corresponding insurance card number is transmitted to the information management terminal 16 (step S15). Similarly, the medical certificate number is searched in the medical certificate database 42 (step S14), and the insured person information is transmitted to the information management terminal 16 (step S15).

  When the information management terminal 16 receives the insured person information from the insurance card database 41 and the medical card database 42, the information management terminal 16 compares these information with the information received from the patient (step S16).

  As a result of the collation, when the information received from the patient and the insured person information managed by the insurer and the bearer do not match (step S17; No), the information management terminal 16 sends a mismatch information notification to the window receiving terminal 13. It is transmitted (step S18). In the window reception terminal 13 that has received the mismatch information notification, information that is determined not to match and a display that prompts information confirmation are displayed on the terminal, and insurance information is confirmed and corrected by the person in charge of reception (step S19). .

  As a result, for example, when it is found by checking the medical certificate image that there is an error due to a character recognition error by OCR, the medical certificate information is corrected on the terminal. Thus, when the person in charge of the reception can correct the information mismatch at the window reception terminal 13 (step S20; Yes), the contents of the health insurance information database 17 stored earlier are replaced with the corrected information ( Step S12).

  On the other hand, if the person in charge of the reception who has confirmed the inconsistency information determines that the correction cannot be made by himself and needs to be confirmed by the patient (step S20; No), the window reception terminal 13 to the second automatic reception terminal 12 A window guidance notification is transmitted toward (step S9). In this case, a screen for instructing the patient to go to the window at the second automatic reception terminal 12 is displayed (step S10). When the patient is guided to the window, the subsequent processing is advanced between the receptionist and the patient using the window reception terminal 13.

  If it is determined that the information received from the patient matches the insured person information managed by the insurer and the bearer (step S17; Yes), the insurance card information and the medical card information are used. Thus, a new electronic medical record is created (step S21). The electronic medical record created by extracting the basic patient information as shown in FIG. 3 from the insurance card information and the medical card information is stored in the electronic medical record database 15. This electronic medical record is used at the time of medical examination.

  Subsequently, a reception completion notification is transmitted from the information management terminal 16 to the window reception terminal 13 (step S22). The reception completion notification is also received by the second automatic reception terminal 12 (step S23).

  When the second automatic reception terminal 12 receives the reception completion notification, the second automatic reception terminal 12 displays a screen indicating that the reception is completed on the display unit 32, and the next action to be taken by the patient and the patient should go from the reception form issuing unit 35. A receipt slip on which information such as the examination room is printed is issued (step S24).

  In this way, when the initial examination acceptance process is completed, the information on the accepted insurance card and medical certificate is stored in the health insurance information database 17. This includes information on the medical expenses share of patients, insurers and bearers. For this reason, the checkout terminal connected to the network 21 can easily and accurately determine the medical expenses to be borne by the patient with reference to the health insurance information database 17. In addition, even a terminal that makes a claim claim that charges the insurer or the bearer for the medical expenses, the patient can easily and accurately make a claim by referring to the health insurance information database 17 via the network 21. . Requests for receipts at the hospital 10 are often performed collectively, for example, once a month, on medical expenses for a plurality of patients. However, in the present system 1, since it is possible to easily make a receipt request, it is also possible to make a receipt request at a preset timing such as every patient, every examination day, or every week.

  In this way, when an insurance card and medical certificate are received from a patient, the medical information burden ratio of the patient based on the insurance card and the medical card can be obtained by inquiring the obtained information to the insurer or the bearer. As it becomes clear, the medical costs to be charged to the patient can be determined easily and accurately. Even if a medical certificate is presented by a patient, whether or not this medical certificate is valid can be confirmed by an inquiry to the bearer. Therefore, the hospital 10 charges the bearer for the share of medical expenses as a receipt request later. In this case, it is possible to avoid a situation in which the medical certificate is invalid and medical expenses are not paid from the bearer.

  Moreover, the reception process can be completed in a short time by automating the reception of the insurance card and the medical card. Only when confirmation by the receptionist is necessary, the patient is guided to the window and the necessary processing is performed, so the burden on the receptionist can be reduced.

  Further, since the window reception terminal 13 can realize the same function as the second automatic reception terminal 12 using the scanner 14, the window reception terminal 13 can be used to receive patients who cannot operate the terminal. It can be carried out.

  Thereby, not only the aspect which receives the first examination reception by the 2nd automatic reception terminal 12, but it is also possible to perform all the first examination reception by the window reception terminal 13, for example. Further, for example, when the second automatic reception terminal 12 is not operated for a predetermined time, the information is displayed on the display unit 32, the patient is guided to the window, and the reception person performs the patient reception process. You can also.

  The automatic reception terminals 11 and 12 can be operated by remote operation from the window reception terminal 13 or the information management terminal 16 in addition to the operation based on the preset setting contents. For example, when there is a patient queue waiting for reception before the second automatic reception terminal 12, the patient is displayed on the display unit 32 of the second automatic reception terminal 12 by remote operation from the window reception terminal 13. It is also possible to display a screen for guiding to a certain patient and guide some patients to the window for acceptance. Thus, by monitoring the patient reception process at the automatic reception terminals 11 and 12, the patient can be guided to the window as necessary, so that the patient reception process can be performed without delay.

  In addition, since the health insurance information database 17 stores the insurance card image and the medical card image, even if there is a problem with the information read from the insurance card and the medical card, the image can be confirmed and information can be easily obtained. It can be corrected.

  Next, processing when receiving a reexamination patient shown in FIG. 7 will be described. The medical examination ticket of the hospital 10 is issued to the reexamination patient, and each information shown in FIGS. 3 to 5 acquired in the past regarding the patient is stored in the health insurance information database 17.

  When the revisited patient who visited the hospital operates the operation unit 31 according to the information displayed on the display unit 32 on the first automatic reception terminal 11 and selects the reexamination reception (step S31), the display unit 32 examines an examination ticket. A screen for instructing insertion into the ticket receiving unit 33 is displayed (step S32).

  The reexamination patient inserts the possession examination ticket into the examination ticket reception part 33 according to the display of the display part 32 (step S33). When the examination ticket is inserted into the examination ticket reception unit 33 of the first automatic reception terminal 11, the examination ticket information such as the examination ticket number is acquired (step S34).

  The medical examination ticket information acquired by the first automatic reception terminal 11 is transmitted to the information management terminal 16 (step S35). In the information management terminal 16, the health insurance information database 17 is searched from the received medical examination ticket information, and the insurance card information shown in FIG. 4 and the medical card information shown in FIG. 5 are read out as information relating to this patient (step S 36). Further, the basic information shown in FIG. 3 is read (step S37). And, from the read information, when the predetermined period has passed since the previous examination or the first examination in the month, the insurance card or medical care possessed by the patient, satisfying the preset insurance information confirmation conditions When it is determined that it is necessary to reacquire information related to the certificate (step S38; No), an insurance information request notification is transmitted to the first automatic reception terminal 11.

  When the first automatic reception terminal 11 receives the insurance information request notification, a screen for guiding the patient to the second automatic reception terminal 12 is displayed on the display unit 32. When the patient guided to the second automatic reception terminal 12 operates the operation unit 31 according to the information displayed on the display unit 32 and inserts the examination ticket into the examination ticket reception unit 33, the insurance card and medical certificate possessed by the patient The process of acquiring the information is started (step S40). These processes are the same as the processes after step S3 shown in FIG. Similar to the process for the first visit patient, a process for obtaining information on the health insurance card and the medical certificate is performed, and when the data in the health insurance information database 17 is updated, a reception slip is issued and the reception process for the reexamination patient is completed.

  On the other hand, for example, when it is determined that it is not necessary to reacquire information from the insurance card and the medical certificate since only a short period has passed since the information related to the insurance card and the medical card was acquired (step S38; Yes), the information management terminal 16 performs a process of inquiring the insurance card information and the medical card information to the insurer and the bearer based on the information read from the health insurance information database 17 (step S41). Specifically, the insurance card number is transmitted to the insurance card database 41 to request insurance card information, and the medical card number is transmitted to the medical card database 42 to request medical card information.

  In the insurance card database 41, when the information request from the information management terminal 16 is received, the received insurance card number is searched (step S42). Then, the insured person information regarding the corresponding insurance card number is transmitted to the information management terminal 16 (step S43). Similarly, a medical certificate number is searched in the medical certificate database 42 (step S42), and insured person information is transmitted to the information management terminal 16 (step S43).

  When the information management terminal 16 receives the insured person information from the insurance card database 41 and the medical card database 42, the information management terminal 16 compares these information with the information read from the health insurance information database 17 (step S44).

  As a result of the collation, when the information read from the health insurance information database 17 and the insured person information managed by the insurer and the bearer do not match (step S45; No), the information management terminal 16 to the first automatic reception terminal 11 is sent to the window 11 (step S46). On the first automatic reception terminal 11 that has received the window guidance notification S46, a screen for guiding the patient to the window is displayed (step S47).

  At the reception desk, the receptionist inputs the patient's examination ticket number guided to the reception desk terminal 13. At this time, the information management terminal 16 has already transmitted to the window reception terminal 13 information that is determined not to match as a result of the collation and information indicating that confirmation work is necessary for this information. These pieces of information are displayed on the terminal when the corresponding examination ticket information is input to the window reception terminal 13. The receptionist confirms the insurance information based on this display, and corrects the information as necessary (step S48). When the insurance information is corrected, the contents of the health insurance information database 17 are replaced with the corrected information, and a process for inquiring about the insurance information is executed again (step S41).

  On the other hand, when the information read from the health insurance information database 17 and the insured person information received from the insurance card database 41 and the medical card database 42 are matched, the two match (step S45; Yes). The data stored in the electronic medical record database 15 and the health insurance information database 17 are updated. Specifically, for example, when there is information changed from the previously acquired information in the insurance card information shown in FIG. 4 and the medical card information shown in FIG. 5, these information can be corrected. Note that the information final confirmation date shown in FIG. 4 and FIG. 5 is updated to the date and time when data collation with the database 41 or 42 is performed, regardless of whether or not the information on the insurance card and the medical card has been changed.

  Subsequently, a reception completion notification is transmitted from the information management terminal 16 to the first automatic reception terminal 11 (step S50). When the first automatic reception terminal 11 receives the reception completion notification, the first automatic reception terminal 11 displays a screen indicating that the reception is completed on the display unit 32, and the next action to be taken by the patient and the patient should go from the reception card issuing unit 35. A receipt slip on which information such as the examination room is printed is issued (step 51).

  In this way, when the reexamination reception process is completed, the latest insurance card information and medical card information are stored in the health insurance information database 17. As a result, as in the case of the first medical examination reception, the medical check-up terminal can refer to the health insurance information database 17 and easily and accurately determine the medical expenses to be borne by the patient at the checkout counter terminal. In addition, even a terminal that makes a claim request to an insurer or a bearer can easily and accurately make a claim request.

  Since the window reception terminal 13 can realize the same function as the first automatic reception terminal 11 using the scanner 14, the window reception terminal 13 is used to receive patients who cannot operate the terminal. Is also possible. For this reason, a patient is guided to a window as needed, and a patient's reception process can be performed without delay.

  The health insurance information management system 1 re-acquires insurance card information and medical certificate information when predetermined insurance information confirmation conditions are satisfied, and updates the insurance card information and medical card information stored in the health insurance information database 17. At the same time, it is possible to confirm that there is no error in the information by making an inquiry to the insurer or the bearer who is the issuer. Thereby, the medical cost burden ratio of the patient becomes clear, and the medical cost charged to the patient can be easily and accurately determined.

  Specifically, for example, even when revisiting a patient who has presented a medical certificate in the past, whether or not this medical certificate is still valid can be confirmed by an inquiry to the bearer. When requesting the burden of medical expenses to the bearer, it is possible to avoid a situation where the medical certificate is invalid and the burden is not paid.

  The insurance information confirmation conditions for requesting the patient to present the health insurance card and medical certificate to obtain the insurance card and medical card information include the insurance card information confirmation condition shown in FIG. 8 and the medical card information shown in FIG. Confirmation conditions are included. These conditions are managed by the information management terminal 16 and can be set according to the operation related to the insurance card and the medical card at the hospital 10. The insurance information confirmation condition can be used from other terminals connected to the network 21.

  When setting the conditions related to the insurance card, a setting screen shown in FIG. 8 is displayed on the information management terminal 16. If the conditions displayed on the setting screen are validated, when the automatic reception terminals 11 and 12 and the window reception terminal 13 determine that this condition is satisfied, a screen prompting the acquisition of the insurance card information is displayed and the insurance card information is displayed. Processing for acquisition is started.

  For example, the first condition on the setting screen shown in FIG. 8 is a setting for performing re-acquisition of information when a predetermined period has elapsed since the acquisition of insurance card information. It is possible to change the number of days that specifies how many days have passed since the start of information re-acquisition to an arbitrary number. For example, in step S38 shown in FIG. 7, it is determined whether or not this condition is satisfied. The third condition of the setting screen shown in FIG. 8 is that the insurance card information stored in the health insurance information database 17 and the insured person information managed by the insurer who issued the insurance card do not match. For example, in step S45 shown in FIG. 7, it is determined whether or not this condition is satisfied.

  Further, the notification target for performing re-acquisition of insurance card information, that is, notification for prompting confirmation of insurance card information is also managed by the information management terminal 16 and can be set in accordance with the operation in the hospital 10. This corresponds to the information notification target in the lower part of the setting screen shown in FIG. 8. For example, when “automatic terminal” and “reception desk” are selected as information notification targets, as shown in FIG. 6 and FIG. If it is determined that the insurance card information confirmation condition is satisfied, information indicating that re-acquisition of the insurance card information is necessary is displayed on each terminal 11 to 13 and notified to the patient or the person in charge of reception.

  For example, when the number of the automatic reception terminals 11 and 12 is small and the reception is congested if the processing here is prolonged, the automatic reception terminals can be excluded from the information notification target. In this case, even when the re-acquisition of insurance card information is necessary, the patient reception process is completed without notifying the patient from the automatic reception terminals 11 and 12. On the other hand, information indicating that re-acquisition of insurance information is required is notified to the window reception terminal 13, and the person in charge of the window reception terminal 13 that has received the notification finishes the reception process at the automatic reception terminals 11 and 12. Call the patient and re-acquire the insurance card information.

  In addition, as a notification target indicating that re-acquisition of insurance card information is necessary, a terminal provided at a consultation counter or a payment counter can be selected. The notification information indicating that it is necessary to reacquire insurance card information is maintained until the insurance card information is reacquired. For example, if the patient goes to the consultation desk without noticing the call to the reception desk, the person in charge of the consultation desk who has confirmed the notification information on the terminal receives the insurance card from the patient and re-acquires the insurance card information. The insurance card information is reacquired by performing the procedure or guiding the patient to the reception desk. Also, if the information is not reacquired at the consultation counter, the person in charge at the checkout counter checks the notification information on the terminal, receives the insurance card from the patient, and re-acquires the insurance card information. be able to. In this way, by making it possible to select a plurality of terminals as information notification targets, it is possible to reliably confirm information relating to the insurance card until the patient's medical expenses are determined.

  The medical certificate information confirmation condition can also be set by selecting the condition on the setting screen shown in FIG. Unlike a health insurance card, a medical card becomes invalid if it no longer meets the conditions stipulated by the bearer, so it is independent of the insurance card information confirmation conditions so that information is frequently re-acquired under stricter conditions than the insurance card. It is now possible to manage medical certificate information confirmation conditions. The medical card is used not only for re-acquisition of information but also when newly registering medical card information or deleting registered medical card information.

  For example, if the first condition of the setting screen shown in FIG. 9 is validated, whether the medical card issuance condition managed by the information management terminal 16 is satisfied based on the information included in the insurance card information and the electronic medical record data It is determined whether or not. Then, for a patient who newly satisfies the medical certificate issuance condition, processing for newly acquiring medical certificate information and registering it in the health insurance information database 17 is started. In addition, when a patient who satisfies the medical certificate issuance condition does not satisfy the condition, a process for deleting the medical certificate information of the patient from the health insurance information database 17 is started.

  Specifically, for example, a patient who has lived in a certain city may move to a neighboring city, or may reach a qualifying age so that he or she becomes a new medical certificate issuer. In order to cope with such a case, in the information management terminal 16, medical certificate issuance conditions for age and address are set. The information management terminal 16 recognizes that this patient is newly in a condition that satisfies the medical card issuance condition by comparing the patient's age and address information included in the insurance card information and the medical card issuance condition. Then, a screen prompting acceptance of the medical certificate is displayed on the terminals 11 to 13, and processing for acquiring medical certificate information is started. On the other hand, if a patient who had a medical certificate in the past does not meet the medical certificate issuance conditions due to, for example, an address change, or if the age does not meet the medical certificate issuance conditions, the medical certificate is set. When the expired time limit has passed, a screen for prompting confirmation of whether or not the medical certificate has been invalidated is displayed on the terminals 11 to 13, and processing for deleting the medical certificate information is started.

  The process for determining whether or not the medical certificate information confirmation condition is satisfied is performed, for example, in each condition determination step (S8, S17, S20, S38, and S45) shown in FIGS. When a medical certificate issuance condition is newly satisfied, or when a medical certificate issuance condition that has been satisfied in the past is no longer satisfied, information for notifying this is displayed on the terminals 11 to 13. Is done. A process for confirming the validity of the medical certificate is performed according to the notified information. For example, new registration of medical certificate information in the health insurance information database 17 or deletion of registered data is performed by the window reception terminal 13.

  The notification target for notifying the acquisition or deletion of medical card information can also be set by selecting a terminal in the same manner as the insurance card information confirmation condition. As for the medical certificate, for example, a specific disease may be a condition for issuing a medical certificate. Therefore, a terminal used in the examination room is included in the terminals that can be selected as a notification target.

  For example, when a patient who did not present a medical certificate at the time of reception is entered into the electronic medical record on the terminal indicating that the patient is a specific disease that satisfies the medical certificate issuance condition, A screen indicating that the patient does not accept the medical certificate while satisfying the medical certificate issuing condition is displayed. For example, a doctor or nurse may check this information and urge the patient to accept a medical certificate if the patient already has a medical certificate, or a medical certificate if the patient does not have a medical certificate. Can be explained to the patient. On the other hand, even when the patient does not satisfy the medical certificate issuance condition, this can be notified to each terminal selected as the information notification target.

  Each terminal used from the reception desk to the checkout counter can share information about the medical card, so check the medical card before you decide on the patient's medical cost, It becomes possible to decide.

  In this way, conditions that require confirmation of insurance card information and medical card information can be selected and set, so that preset conditions are determined according to the operation at the hospital 10 and set in advance. It is possible to notify that information confirmation is necessary at the same timing. In addition, since it is possible to select and set a target for notifying that information confirmation is necessary, it is possible to flexibly cope with the operation at the hospital 10.

  In addition, the conditions for determining the necessity of information confirmation can be set for medical cards independently of the settings for insurance cards. Therefore, depending on the characteristics of medical cards, the conditions for issuing them are limited compared to insurance cards. Operation becomes possible. In addition, by managing the medical certificate issuance conditions by the information management terminal 16, when there is a possibility that a medical certificate is newly issued or the medical certificate becomes invalid, this is notified to the terminals 11 to 13, You can check the latest information on medical certificates. Therefore, it is possible to easily and accurately determine the medical cost to be charged to the patient, and it becomes necessary to perform a medical cost return procedure for the patient who has forgotten to present the medical certificate. It is possible to avoid a situation in which payment is not made.

  In addition, although FIG. 1 demonstrated the large-scale hospital 10 as an example, a present Example is not limited to this. For example, in the case of a small hospital, as shown in FIG. 10, only the information management terminal 16 that manages the health insurance information database 17 can be installed and used in the hospital 10. By connecting the electronic medical record database 15 and the scanner 14 to the information management terminal 16, the information management terminal 16 can also function as the window reception terminal 13. If the information management terminal 16 is connected to the insurance card database 41 and the medical card database 42 via the network 20, the system shown in FIG. 10 can realize the above-described processing with reference to FIG. Is possible. In this case, since the system scale introduced into the hospital 10 is small, the introduction cost can be suppressed.

  Moreover, as shown in FIG. 11, only the window reception terminal 13 to which the scanner 14 is connected can be installed and used in the hospital 10. For example, the management of the information management terminal 16 and the electronic medical record database 15 is outsourced to a specialist 40, and the information management terminal 16 and the window reception terminal 13 of the hospital 10 that are located away from the hospital 10 are connected via the network 21. Connecting. Thus, the system shown in FIG. 11 can realize the above-described processing with reference to FIG. 1 and obtain the same effect. In this case, it is necessary to entrust management of the electronic medical record database 15 and the health insurance information database 17 to the specialist 40, but it is not necessary to provide a database administrator in the hospital 10, and the introduction cost of the system is also increased. Can be suppressed. Further, by entrusting the management of the electronic medical record database 15 and the health insurance information database 17 to an expert, reliable data management becomes possible.

  As described above, according to the present embodiment, medical card information can be managed in addition to insurance card information. In addition, by automating the generation of insurance card and medical certificate images, extracting information from the generated images, and managing the extracted character information, the reception process at the hospital 10 can be performed quickly and the labor related to the reception process can be reduced. be able to. In addition to the information written on the insurance card and medical certificate, images of the insurance card and medical card can also be stored and managed in the database, so even if there is a problem with the insurance card information and medical card information The information can be corrected by confirming the contents on the image in the same way as confirming the actual insurance card and medical certificate.

  In addition, unlike a health insurance card, a medical card that is issued only to some patients who meet a predetermined issuance condition and has a limited expiration date is managed under conditions independent of the insurance card management conditions. Appropriate management according to the characteristics of the medical certificate can be performed, for example, confirmation work is performed at a different cycle.

  In addition to setting conditions such as the patient's age and address that require confirmation of medical certificate information, it is determined whether the information obtained from insurance cards etc. satisfies the setting conditions, and a new medical certificate is issued. If the medical certificate may be invalidated, it will be reported and the confirmation work related to the medical certificate will be performed, so the medical certificate information will be updated as necessary and the patient will be charged Costs can be determined easily and accurately.

  In addition, since the insurance card information and medical certificate information are automatically checked by inquiring to the insurer who issued the insurance card and the bearer who issued the medical certificate, the hospital 10 receives the insurance card and the bearer. When making a claim, it is possible to avoid a situation in which the medical expenses are not paid to the hospital 10 because the insurance card or medical certificate is invalid.

  As described above, the present invention is a useful technique for determining a medical cost of a patient based on an insurance card and a medical card in a hospital and charging the insurer or a bearer with the medical cost.

DESCRIPTION OF SYMBOLS 1 Health insurance information management system 10 Hospital 11 1st automatic reception terminal 12 2nd automatic reception terminal 13 Window reception terminal 14 Scanner 15 Electronic medical record database 16 Information management terminal 17 Health insurance information database 20, 21 Network 30 Control part 31 Operation part 32 Display unit 33 Examination ticket receiving unit 34 Communication unit 35 Receipt slip issuing unit 36 Insurance card receiving unit 37 Medical certificate receiving unit 40 Specialized contractor 41 Insurance card database 42 Medical card database

Claims (8)

A reception terminal for obtaining medical certificate information from a medical certificate received from a patient;
An electronic medical record database for managing the examination information of the patient as an electronic medical record;
A health insurance information database for managing the medical certificate information;
The health insurance information database is managed based on the medical certificate information acquired at the reception terminal, and the information related to the insurance card or the information related to the medical certificate managed in the health insurance information database is included in the electronic medical record database. An information management terminal that maintains consistency of the information between the electronic medical record database and the health insurance information database;
With
The reception terminal displays a screen for prompting acquisition of the medical certificate information when the received information includes information that satisfies a medical certificate issuance condition for issuing the medical certificate. Do
Health insurance information management system. A reception terminal for obtaining medical certificate information from a medical certificate received from a patient;
An electronic medical record database for managing the examination information of the patient as an electronic medical record;
A health insurance information database for managing the medical certificate information;
The health insurance information database is managed based on the medical certificate information acquired at the reception terminal, and the information related to the insurance card or the information related to the medical certificate managed in the health insurance information database is included in the electronic medical record database. An information management terminal that maintains consistency of the information between the electronic medical record database and the health insurance information database;
With
The information management terminal, when the information received at the receiving terminal, the electronic medical record database, and the health insurance information database include information that satisfies a medical certificate issuing condition for issuing the medical certificate And displaying a screen for prompting acquisition of the medical certificate information on the reception terminal.
Health insurance information management system. The information management terminal includes information indicating that the patient received at the reception terminal has the medical certificate in the electronic medical record database and the health insurance information database, and information received at the reception terminal When the electronic medical record database and the health insurance information database include information indicating that the medical certificate issuance conditions are not satisfied, the medical certificate information is urged to be deleted on the reception terminal. The health insurance information management system according to claim 1 or 2, wherein a screen is displayed. The medical issuance conditions, according to claim 1, wherein the issue of the medical certificate is a condition based on the age of the patient defined by the payer to bear part of the medical expenses of patients The health insurance information management system according to any one of the above. The medical issuance conditions, claim 1, wherein the issue of the medical certificate is a condition based on the residence of the patient defined by the payer to bear part of the medical expenses of patients The health insurance information management system according to any one of the above. The medical issuance conditions, any one of the preceding claims, characterized in that by issuing the medical certificate is a condition based upon a specific disease that is defined by the payer to bear part of the medical expenses of patients The health insurance information management system according to item 1. A reception terminal for obtaining medical certificate information from a medical certificate received from a patient;
An electronic medical record database for managing the examination information of the patient as an electronic medical record;
A health insurance information database for managing the medical certificate information;
While managing the health insurance information database based on the medical certificate information acquired at the reception terminal, and comprising an information management terminal for maintaining the consistency between the electronic medical record database and the health insurance information database,
The reception terminal displays a screen for prompting acquisition of the medical certificate information when the received information includes information that satisfies a medical certificate issuance condition for issuing the medical certificate. Health insurance information management system. A reception terminal for obtaining medical certificate information from a medical certificate received from a patient;
An electronic medical record database for managing the examination information of the patient as an electronic medical record;
A health insurance information database for managing the medical certificate information;
While managing the health insurance information database based on the medical certificate information acquired at the reception terminal, and comprising an information management terminal for maintaining the consistency between the electronic medical record database and the health insurance information database,
The information management terminal, when the information received at the receiving terminal, the electronic medical record database, and the health insurance information database include information that satisfies a medical certificate issuing condition for issuing the medical certificate A health insurance information management system, wherein a screen for prompting acquisition of the medical certificate information is displayed on the reception terminal.

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