Medical insurance docking protocol processing method and medical insurance system

Abstract

The invention discloses a medical insurance docking protocol processing method and a medical insurance system, and relates to the field of medical insurance cross-region universality, and the medical insurance docking protocol processing method comprises the following steps: 1, collecting or receiving medical insurance customer information; 2, dividing the medical insurance customer information into an invariable part and a variable part; and step 3, carrying out unified coding on the invariant part, and carrying out structured extraction on the variable part through an expression rule and / or protocol analysis so as to realize a universal medical insurance view.

Description

Technical Field

[0001] The present invention relates to the general field of cross-regional medical insurance, and in particular to a medical insurance docking agreement processing method, and also to a medical insurance system. Background Art

[0002] At present, the interface design scheme of drugstores, clinics, hospitals HIS and medical insurance systems involves two parts. The corresponding program design is completed by the drugstores, clinics, hospital business end and the medical insurance center interface connection respectively. These two parts of the program are used on the HIS client to complete medical insurance related business together. Code needs to be developed for the interface connection of a regional city medical insurance. A set of code needs to be developed for each region. If it is to be promoted nationwide, the development workload is large and the resources are consumed. The abstraction level is low, the code reuse is not high, and the maintenance and iteration workload is large. There will be multiple sets of UI, and there will be a set of UI for each regional medical insurance. Summary of the invention

[0003] In order to solve the technical problem, the present invention proposes the following solution: A method for processing a medical insurance connection agreement comprises the following steps: Step 1: Collect or receive medical insurance customer information; Step 2, dividing the medical insurance customer information into a constant part and a variable part; Step 3: uniformly encode the unchanged parts, and perform structured extraction on the variable parts through expression rules and / or protocol parsing to achieve universal medical insurance.

[0004] Preferably, in step 2, step 2.1 is also included, dividing the medical insurance services into the following areas: merchants, insured persons, commodities, transactions, reconciliation, service packages, purchase and sales, and data synchronization.

[0005] Preferably, the changed part is converted into the Json format of the medical insurance agreement, so that the medical insurance agreements in different regions can be parsed according to the configuration of the local area.

[0006] The present invention also relates to a medical insurance system using the above-mentioned medical insurance docking protocol processing method, including a client, a cloud from which pre-stored content can be called, a protocol adapter using the medical insurance docking protocol processing method, and a third-party organization.

[0007] Preferably, the client includes a domain model, a client call and an execution engine.

[0008] Finally, the domain models include medical insurance catalogue, card reading transactions, chronic disease reimbursement, account reconciliation and settlement, purchase and sales, prescription management and drug supervision.

[0009] Preferably, the client calls information for calling the cloud, and the cloud includes a cloud microservice cluster basic capability module, a baseline capability iteration module and a customized capability iteration module.

[0010] Preferably, the protocol adapter is adapted to national and provincial medical insurance benchmarks, municipal and district medical insurance agreements, drug supervision agreements, and other special supervision agreements.

[0011] Preferably, the medical insurance treatment includes the following subdomains: medical insurance merchant subdomain, medical insurance merchant product subdomain, medical insurance supervision subdomain, medical insurance service package subdomain, medical insurance bill subdomain, medical insurance transaction subdomain and medical insurance participant subdomain.

[0012] Therefore, through the present invention: abstract the common business logic of medical insurance in each region and define the data model. A set of codes and configured medical insurance protocols realize low code, further reduce the time of repeated development and the time of repeated code construction. A set of UI is promoted nationwide to display corresponding businesses and functions according to the policies and needs of each region. It can efficiently build the core logic of medical insurance, extract the protocol part, and realize low-code configuration. It can shorten the time of medical insurance connection in a single city and allow multiple cities to connect to medical insurance concurrently.

[0013] The following is a description with reference to the accompanying drawings, which include: BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Figure 1 It shows the connection between the method of the present invention and other related parties when working on the user's computer; Figure 2 The sub-domains in which the method of the present invention is implemented are shown; Figure 3 The input and output sections of the medical insurance system of the present invention are shown; Figure 4 It shows various roles and services involved in the medical insurance system of the present invention; Figure 5 The hierarchical relationship of the medical insurance system of the present invention is shown; Figure 6 The unified protocol processing flow of the present invention is shown; Figure 7 The relationship between the various parties of the medical insurance system of the present invention is shown; Figure 8 A mind map showing various elements of the medical insurance system of the present invention for testing; Fig. 9 and Fig.10 The user interface of the medical insurance system of the present invention is shown; Fig.11 The plug-in introduced into the medical insurance system of the present invention is shown; Fig.12 It shows the relationships and calls between the parties coordinated by the protocol; Fig.13 The input and output of the protocol conformance implemented during merchant initialization are shown. DETAILED DESCRIPTION

[0015] like Figure 1 As shown, the software layout model of the system is a standard SAAS model, which is mainly divided into two modules: the medical insurance cloud platform and the medical insurance client, which work together to realize standard protocol configuration, precise customer operation, and simplified horizontal expansion. Figure 2 Zhongyun Platform is a standard BS architecture application developed in Java language. It performs domain design, module division, upstream and downstream dependency management, data modeling, etc. based on DDD domain-driven design concept. Figure 3 The backend of the Zhongyun platform uses a microservice architecture to design and split various fields. The overall scope is divided into several core services, including merchants, insured persons, commodities, transactions, reconciliation, service packages, purchase and sales, data synchronization, etc. The Dubbo framework is used within the microservice for RPC communication calls.

[0016] Merchant services: Mainly responsible for maintaining merchant-related information, mainly for pharmacies, clinics and other medical institutions, including but not limited to merchant basic information, physician, pharmacist information, employee information, sign-in, sign-out, shift handover information... etc.

[0017] Insured person service: Mainly maintains the personnel information of each merchant who visits and purchases medicines, including the basic information of the insured, card reading records, and the registration of the insured. Product service: Maintains product information for institutions, matches the medical insurance catalog code, uploads and cancels the matching relationship, etc. Transaction service: Order center service, realizes the full process management of order transactions for customers, including medical information, prescription information, order information, transaction flow information, account flow information, etc. Reconciliation service: This service is a downstream service of the transaction service, responsible for processing the orders and flow generated by the transaction, supports the configuration of bill generation rules in the domain model according to the differences in various regions, and the scheduled task realizes the generation of management bills according to different rules. Service package: The internal structure is composed of multiple business sub-modules such as dictionaries, interface resource packages, function adapters, and software packages, which are combined on demand. Each business sub-module is an abstraction of different differences in the medical insurance docking agreement, and each module is flexibly combined to achieve the effect of adapting to the differences in various regions. Purchase, sales, and inventory: This service is mainly responsible for collecting and recording the purchase, sale, return, and inventory change information of institutional commodities, and generating valid data for reporting according to the data generation rules configured within the domain. Data synchronization: Data synchronization service is a basic service that provides standard data synchronization solutions for various services, including full and incremental synchronization, incremental data updates, etc. The medical insurance client is a standard CS architecture application developed in Java. It uses Jetty as a web container internally and is independently deployed on the client terminal to provide services to customers. When the client starts, it will first obtain the institution information from the merchant service, find the service package opened by the institution, and download the relevant resources associated with the service package to the client's local area. After the relevant resources are downloaded, the client will adapt and parse according to the standard protocol to meet the requirements of regional characteristics. In the process of executing the request, the client uses the self-developed execution engine to dynamically convert the regional configuration into a standardized request, and executes the request through a dynamic proxy server according to the protocol definition standard.

[0018] Figure 4 Various roles and services related to the present invention are shown. Figure 5 The architecture and layers involved in the present invention are shown. Figure 6The process of unified protocol processing in the present invention is shown. The black dots on the left and the black dots on the right represent the graphical user interface (UI) of the medical insurance system of the present invention respectively. When the user inputs data through the graphical user interface (UI), the protocol processing system of the present invention performs standardized model processing on the input data at the serialization adapter layer to convert it into the data format stored in the medical insurance system of the present invention. In the standardized model processing, the pre-set conditions are used to check the input data. If the conditions are met, the input parameter expression (set) processing is performed, and then the input post-expression processing is performed, thereby forming data in a third-party format, and the third-party data is called by the data that conforms to the third-party format, thereby forming data that conforms to the third-party data format and policy for output. Before outputting from the graphical user interface, the data that conforms to the third-party data format and policy needs to be converted into the expected data that conforms to the format of the medical insurance system of the present invention. Therefore, a check is performed first, and after passing, the output pre-expression processing is performed, and then the input parameter expression (set) processing is performed, so that the standard model output of the medical insurance system is met and displayed on the graphical user interface. Figure 7 The principle of implementing the medical insurance system of the present invention is shown in the figure. It includes the medical insurance bureau service provider, the client computer and the cloud calling system, and completes multi-task concurrency through the message queue. Its technical architecture must meet the principle of openness, can communicate with external systems and provide standard interfaces. The system architecture is designed and developed in a three-tier structure. The presentation layer is designed using the MVC model, and the middle layer uses componentized design to implement module functions. The system must be a C / S architecture based on the desktop client, which can support XP system and windows7-11 system. The server operating system supports the mainstream operating systems of Redhat and CentOS. The system database uses: Mysql mainstream relational database, Redis non-relational database. Large data volume search processing uses: ElasticSearch. Client data synchronization transmission uses: Springboot, Jetty, MQTT.

[0019] Figure 8A mind map showing the tests conducted after the conception of Benfu Ainai's medical insurance system was completed, including basic configuration, sign-in, card reading, medical insurance settlement and medical insurance management. The following steps were performed: Step 1, maintaining the subcomponents of the service package (medical insurance catalog, interface resource package, function adapter, dictionary package) on the medical insurance cloud platform; Medical Insurance Catalog: A collection of catalogs that record all reimbursable drugs in the region, imported into the cloud platform in Excel format, the cloud platform parses the fields to form a data table stored in the mysql database and generates a medical insurance catalog ID; Interface Resource Package: The main content of this item is a compressed file in a fixed format, which stores some dynamic library files and business templates provided by the Medical Insurance Bureau. After uploading the file to the cloud platform, an interface resource package ID will be generated; Function Adapter: It mainly maintains regional difference configuration and interface protocol configuration, which is composed of configuration nodes of multiple business scenarios. The client will pull all configuration nodes of the corresponding function adaptation to the local for parsing and adaptation according to the association relationship of the service package; Dictionary: The dictionary package is a binding collection of a series of dictionaries of different business types, which mainly records the mapping relationship between external enumeration and internal enumeration and some static constant configurations required for system operation.

[0020] Step 2: After the upload and maintenance of each subcomponent in step 1 is completed, the medical insurance cloud will store the corresponding data in the server or database according to different scenarios and generate the corresponding component number; Step 3: Create a service package. A service package is a collection of sub-component binding relationships. Fig. 9 shown.

[0021] Step 4: Enable medical insurance services for the two designated institutions (SaaS pharmacy customers) and select the created service package and agency. Fig.10 shown.

[0022] Step 5: After opening the customer's Smart Road POS cashier, the service package information activated by the current institution will be searched, and the subcomponents associated with the service package will be pulled to the local client. The differences will be adapted through the standardized protocol. At this time, the medical insurance settlement transaction can be carried out normally according to the regional configuration; Step 6, print the receipt, print settings, the settlement form (medical insurance receipt, chronic disease receipt) is printed successfully, and the data is correct.

[0023] Therefore, it can be concluded that: A method for processing a medical insurance connection agreement comprises the following steps: Step 1: Collect or receive medical insurance customer information; Step 2, dividing the medical insurance customer information into a constant part and a variable part; Step 3: uniformly encode the unchanged parts, and perform structured extraction on the variable parts through expression rules and / or protocol parsing to achieve universal medical insurance.

[0024] Preferably, in step 2, step 2.1 is also included, dividing the medical insurance services into the following areas: merchants, insured persons, commodities, transactions, reconciliation, service packages, purchase and sales, and data synchronization.

[0025] Preferably, the changed part is converted into the Json format of the medical insurance agreement, so that the medical insurance agreements in different regions can be parsed according to the configuration of the local area.

[0026] The present invention also relates to a medical insurance system using the above-mentioned medical insurance docking protocol processing method, including a client, a cloud from which pre-stored content can be called, a protocol adapter using the medical insurance docking protocol processing method, and a third-party organization.

[0027] Preferably, the client includes a domain model, a client call and an execution engine.

[0028] Finally, the domain models include medical insurance catalogue, card reading transactions, chronic disease reimbursement, account reconciliation and settlement, purchase and sales, prescription management and drug supervision.

[0029] Preferably, the client calls information for calling the cloud, and the cloud includes a cloud microservice cluster basic capability module, a baseline capability iteration module and a customized capability iteration module.

[0030] Preferably, the protocol adapter is adapted to national and provincial medical insurance benchmarks, municipal and district medical insurance agreements, drug supervision agreements, and other special supervision agreements.

[0031] Preferably, the medical insurance treatment includes the following subdomains: medical insurance merchant subdomain, medical insurance merchant product subdomain, medical insurance supervision subdomain, medical insurance service package subdomain, medical insurance bill subdomain, medical insurance transaction subdomain and medical insurance participant subdomain.

[0032] Therefore, through the present invention: abstract the common business logic of medical insurance in each region and define the data model. A set of codes and configured medical insurance protocols realize low code, further reduce the time of repeated development and the time of repeated code construction. A set of UI is promoted nationwide to display corresponding businesses and functions according to the policies and needs of each region. It can efficiently build the core logic of medical insurance, extract the protocol part, and realize low-code configuration. It can shorten the time of medical insurance connection in a single city and allow multiple cities to connect to medical insurance concurrently. Fig.11It shows that the execution engine supports a set of codes to connect to different medical insurance regional coordination rules and the medical insurance LocalServer plug-in solution. A set of codes and different configurations can realize the implementation details of the medical insurance interface function connection in various regions. It includes three parts: local localserver code, cloud data synchronization code, and protocol configuration parsing code. The first part is the core process of medical insurance business, including medical insurance catalog download, matching, comparison upload, medical registration, medical insurance settlement, refund, comparison, liquidation and other businesses. It is developed in Java language and implemented according to the abstract core process of each region of medical insurance. It realizes self-developed MVC, IoC container, web container startup process, medical insurance business initialization, device management, mqtt message notification and other functions. In the second part, the cloud code uses SpringBoot, which is a development mode based on the Spring framework, which can quickly build a Web application. Using the SpringBoot framework can simplify the development process and improve development efficiency. At the same time, it integrates commonly used components in Spring to reduce the amount of code. The persistence layer is constructed using the mybatis framework to save customer data to the MySQL database. Dubbo framework is used for remote calls between microservices. It is a high-performance RPC framework based on Java, mainly used for service governance and microservice architecture. Dubbo can be used to implement service registration, discovery, load balancing and other functions, improving the scalability and reliability of the system. The core process of the medical insurance docking interface includes core business processes such as medical insurance catalog matching, settlement, reconciliation, and liquidation. The implementation of Localserver local code and cloud data storage can ensure that business data can be synchronized by itself after the customer's local computer is lost to ensure that the data is not lost. The calls between medical insurance use the http protocol to communicate, and the protocol parsing configuration uses the json format for medical insurance catalogs, card reading, outpatient chronic and special diseases, settlement, reconciliation, and liquidation. The third part of the medical insurance agreement Json format solves the problem of differentiated medical insurance agreements in different regions. Each region implements protocol parsing according to the configuration of the local area. Finally, the architecture shown in the figure is achieved.

[0033] Fig.12 It shows the relationship between the third-party organization, the client, and the cloud, and implements correct input and output across regions and protocols around the client.

[0034] Fig.13 It shows that when the merchant is initialized, the client input and output standardization is achieved across regions and protocols.

[0035] The preferred embodiments of the present invention are described above by way of example with reference to the accompanying drawings. However, those skilled in the art should appreciate that, without departing from the scope of the claims attached to the present invention, improvements such as combination, deletion and addition may be made to form different solutions.

Claims

1. A method for processing a medical insurance connection agreement, characterized in that: The steps include: Step 1: Collect or receive medical insurance customer information; Step 2, dividing the medical insurance customer information into a constant part and a variable part; Step 3: uniformly encode the unchanged parts, and perform structured extraction on the variable parts through expression rules and / or protocol parsing to achieve universal medical insurance.

2. The method for processing the medical insurance connection agreement according to claim 1, characterized in that: In the step 2, step 2.1 is also included, which divides the medical insurance services into the following areas: merchants, insured persons, commodities, transactions, reconciliation, service packages, purchase and sales, and data synchronization.

3. The method for processing the medical insurance connection agreement according to claim 2, characterized in that: The changed part is converted into the Json format of the medical insurance agreement, so that the medical insurance agreements in different regions can be parsed according to the configuration of the local area.

4. A medical insurance system using the medical insurance connection protocol processing method according to any one of claims 1 to 3, characterized in that: It includes a client, a cloud from which pre-stored content can be called, a protocol adapter using the medical insurance docking protocol processing method, and a third-party organization.

5. The medical insurance system according to claim 4, characterized in that: The client includes a domain model, a client call, and an execution engine.

6. The medical insurance system according to claim 5, characterized in that: The domain models include medical insurance catalogue, card reading transactions, chronic disease reimbursement, account reconciliation and settlement, purchase and sales, prescription management and drug supervision.

7. The medical insurance system according to claim 6, characterized in that: The client calls information for calling the cloud, which includes a cloud microservice cluster basic capability module, a baseline capability iteration module, and a customized capability iteration module.

8. The medical insurance system according to claim 7, characterized in that: The protocol adapter is adapted to national and provincial medical insurance benchmarks, municipal and district medical insurance agreements, drug supervision agreements, and other special supervision agreements.

9. The medical insurance system according to claim 8, characterized in that: The medical insurance treatment includes the following subdomains: medical insurance merchant subdomain, medical insurance merchant product subdomain, medical insurance supervision subdomain, medical insurance service package subdomain, medical insurance bill subdomain, medical insurance transaction subdomain and medical insurance participant subdomain.

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