Charging monitoring method and system for hospital information system, and electronic equipment

Abstract

The invention provides a charge monitoring method and system for a hospital information system and electronic equipment, and the method comprises the steps: analyzing historical medical charge data in an HIS system of each medical unit based on related standard information, determining an abnormal charge event of each medical project in each department, and generating an abnormal reference file; for each medical project of each department in the abnormal reference file, acquiring first actual medical charge data associated with a target medical unit HIS system in a monitoring period, determining an associated violation type, acquiring a target detection library matched with the first violation type, and automatically checking the first actual medical charge data according to the target detection library; collecting associated multi-dimensional checking information under the second violation type to check the first-time medical charging data, and determining first abnormal information according to two checking results; according to the invention, abnormity checking of the charging data in the HIS system can be carried out through the intelligent monitoring system, the monitoring efficiency is improved, and the monitoring accuracy is high.

Description

Technical Field

[0001] The present application relates to the technical field of HIS system monitoring, and in particular to a fee monitoring method, system and electronic equipment for a hospital information system. Background Art

[0002] The hospital uses the Hospital Information System (HIS) to comprehensively manage the flow of personnel, logistics and finances in the hospital and its departments, collect, store, process, extract, transmit and summarize the data generated at each stage of medical activities, and process them into various information, thereby providing comprehensive automated management and various service information systems for the overall operation of the hospital.

[0003] In practice, when hospitals settle fees through the HIS system, various problems may arise. When patients discover problems, they need to deal with them, which takes a long time and is cumbersome, resulting in low efficiency. In addition, it may also damage the rights and interests of patients, or lead to miscalculations of medical insurance and waste of medical insurance resources. The current monitoring method for HIS system charges is usually manual regular inspections, and any problems found are fed back to relevant departments for processing, which has low coverage and low monitoring efficiency. Summary of the invention

[0004] In view of this, the purpose of this application is to provide a hospital information system fee monitoring method, system and electronic equipment, which can perform abnormal verification of fee data in the target medical unit HIS system through an intelligent monitoring system, thereby improving monitoring efficiency and high monitoring accuracy.

[0005] In a first aspect, an embodiment of the present application provides a fee monitoring method for a hospital information system, which is applied to a monitoring system, and the method includes:

[0006] Based on the relevant standard documents, the relevant standard information of each medical project in each department of the medical unit is analyzed, and the historical medical charge data in the HIS system of multiple medical units is analyzed to determine the abnormal charge events of each medical project in each department, and generate abnormal reference files for each department; wherein the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information;

[0007] For each medical item of each department in the abnormal reference file, determine the monitoring period for the medical item, and obtain the first actual medical charge data of the HIS system of the target medical unit within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated as time goes by;

[0008] Determine the violation type associated with the medical project from the abnormal reference file; when the violation type includes a first violation type that meets the automatic detection condition, obtain a target detection library that matches the first violation type, and automatically verify the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collect multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determine a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type;

[0009] First abnormal information for the first actual medical charge data is determined according to the first verification result and the second verification result.

[0010] In a second aspect, an embodiment of the present application further provides a charging monitoring system for a hospital information system, the device comprising:

[0011] A file construction module is used to analyze the relevant standard information of each medical project in each department of the medical unit based on the relevant standard files, analyze the historical medical charge data in the HIS systems of multiple medical units, determine the abnormal charge events of each medical project in each department, and generate abnormal reference files for each department; wherein the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information;

[0012] A monitoring module, for determining a monitoring period for each medical item in each department in the abnormal reference file, and obtaining the first actual medical charge data of the target medical unit HIS system within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated over time; determining the violation type associated with the medical item from the abnormal reference file, when the violation type includes a first violation type that meets the automatic detection condition, obtaining a target detection library that matches the first violation type, and automatically checking the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collecting multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determining a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type;

[0013] The abnormality determination module is used to determine first abnormality information for the first actual medical charge data according to the first verification result and the second verification result.

[0014] In the third aspect, an embodiment of the present application also provides an electronic device, comprising: a processor, a memory and a bus, wherein the memory stores machine-readable instructions executable by the processor, and when the electronic device is running, the processor and the memory communicate through the bus, and when the machine-readable instructions are executed by the processor, the steps of the fee monitoring method for the hospital information system as described in any one of the first aspects are performed.

[0015] In a fourth aspect, an embodiment of the present application further provides a computer-readable storage medium, on which a computer program is stored. When the computer program is executed by a processor, the steps of the fee monitoring method for a hospital information system as described in any one of the first aspects are executed.

[0016] The present application provides a fee monitoring method, system and electronic equipment for a hospital information system. The method is applied to a monitoring system, specifically including analyzing the historical medical fee data in each medical unit HIS system based on relevant standard information, determining the abnormal fee events of each medical item in each department and generating an abnormal reference file; for each medical item in each department in the abnormal reference file, obtaining the first actual medical fee data associated with the target medical unit HIS system during the monitoring period, and determining the associated violation type, obtaining the target detection library matching the first violation type and automatically verifying the first actual medical fee data accordingly; and collecting the multi-dimensional verification information associated with the second violation type to verify the first-time medical fee data, and determining the first abnormal information based on the two verification results. In the above manner, the abnormal verification of the fee data in the target medical unit HIS system can be performed through an intelligent monitoring system, which improves the monitoring efficiency and has high monitoring accuracy. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] In order to more clearly illustrate the technical solutions of the embodiments of the present application, the drawings required for use in the embodiments will be briefly introduced below. It should be understood that the following drawings only show certain embodiments of the present application and therefore should not be regarded as limiting the scope. For ordinary technicians in this field, other related drawings can be obtained based on these drawings without paying creative work.

[0018] Figure 1 A flowchart of a fee monitoring method for a hospital information system provided by an embodiment of the present application is shown;

[0019] Figure 2 A schematic diagram showing an exception reference file;

[0020] Figure 3 A flowchart of another method for monitoring charges in a hospital information system provided by an embodiment of the present application is shown;

[0021] Figure 4 A schematic diagram of the structure of a hospital information system provided by an embodiment of the present application is shown;

[0022] Figure 5 A schematic structural diagram of an electronic device provided in an embodiment of the present application is shown. DETAILED DESCRIPTION

[0023] To make the purpose, technical scheme and advantages of the embodiments of the present application clearer, the technical scheme in the embodiments of the present application will be clearly and completely described below in conjunction with the drawings in the embodiments of the present application. It should be understood that the drawings in the present application only serve the purpose of explanation and description and are not used to limit the scope of protection of the present application. In addition, it should be understood that the schematic drawings are not drawn in real proportion. The flowchart used in this application shows the operations implemented according to some embodiments of the present application. It should be understood that the operations of the flowchart can be implemented out of order, and the steps without logical context can be reversed in order or implemented simultaneously. In addition, those skilled in the art can add one or more other operations to the flowchart under the guidance of the content of the present application, or remove one or more operations from the flowchart.

[0024] In addition, the described embodiments are only a part of the embodiments of the present application, rather than all the embodiments. The components of the embodiments of the present application described and shown in the drawings here can be arranged and designed in various configurations. Therefore, the following detailed description of the embodiments of the present application provided in the drawings is not intended to limit the scope of the application claimed for protection, but merely represents the selected embodiments of the present application. Based on the embodiments of the present application, all other embodiments obtained by those skilled in the art without making creative work belong to the scope of protection of the present application.

[0025] It should be noted that the term "comprising" will be used in the embodiments of the present application to indicate the existence of the features declared thereafter, but does not exclude the addition of other features.

[0026] like Figure 1 As shown, the embodiment of the present application provides a charging monitoring method for a hospital information system, which is applied to a monitoring system; the method comprises:

[0027] S101. Based on the relevant standard documents, the relevant standard information of each medical project in each department of the medical unit is analyzed, and the historical medical charging data in the HIS systems of multiple medical units are analyzed to determine the abnormal charging events of each medical project in each department, and generate abnormal reference files for each department; wherein, the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information.

[0028] S102, for each medical item of each department in the abnormal reference file, determine the monitoring period for the medical item, and obtain the first actual medical charge data of the HIS system of the target medical unit within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated over time;

[0029] S103, determining the violation type associated with the medical project from the abnormal reference file, when the violation type includes a first violation type that meets the automatic detection condition, obtaining a target detection library that matches the first violation type, and automatically checking the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collecting multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determining a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type;

[0030] S104: Determine first abnormal information for the first actual medical charge data according to the first verification result and the second verification result.

[0031] The fee monitoring method of the hospital information system provided in the embodiment of the present application can verify the fee data in the HIS system of the target medical unit through an intelligent monitoring system, thereby improving the monitoring efficiency and the monitoring accuracy.

[0032] The above S101-S104 are further described below:

[0033] S101. Based on the relevant standard documents, the relevant standard information of each medical project in each department of the medical unit is analyzed, and the historical medical charging data in the HIS systems of multiple medical units are analyzed to determine the abnormal charging events of each medical project in each department, and generate abnormal reference files for each department; wherein, the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information.

[0034] In an embodiment of the present application, the relevant standard documents of different medical units may be the same or different; for example, each administrative region corresponds to a unified standard requirement document, which includes unified standard requirement information; in addition, each administrative region may also have an exclusive administrative district requirement document, which includes administrative district requirement information; the above-mentioned relevant standard information may include unified standard requirement information, or may include the above-mentioned unified standard requirement information and administrative district requirement information.

[0035] For example, the above-mentioned relevant standard documents can be the "Diagnosis and Treatment Catalog", "Technical Specifications for Medical Service Items", "Price Specifications for Medical Service Items", etc., and the corresponding relevant standard information can be: 1. Cardiovascular Medicine: Requires the authenticity of the use of disposable high-value consumables such as catheters, guidewires, pacemakers, stents, balloons, etc.; 2. Cardiovascular Medicine: Central venous puncture and catheterization are excluded, and the central venous kit is the exception. Other nursing kits cannot be charged; 3. Orthopedics: Charges for the use of endoscopes in certain orthopedic operations. Note: If the name of the operation has been clearly stated as "endoscope", no additional charges will be made; in the "Diagnosis and Treatment Catalog", the dressing fee is charged according to the corresponding level of "wound surface".

[0036] The historical medical charge data for each medical item in each department from multiple different medical units within a preset historical time period is obtained, and the historical medical charge data is analyzed and processed through the above-mentioned relevant standard information. Specifically, for each department, the relevant standard information of the department for each medical item is obtained. Here, the relevant standard information of different departments is different. Usually, the relevant standard information of different departments will be included in the relevant standard files respectively. Then, according to the relevant standard information of each medical item, the historical medical charge data of each medical item in the department is analyzed to determine the abnormal charge events in each medical item in the department, and determine the abnormal charge type, relevant standard information and event detailed information associated with each abnormal charge event.

[0037] For example, for a certain historical medical charge data related to bone density, the project content and corresponding charge information of the historical medical charge data are analyzed through the matching relevant standard information, and it is found that there is an abnormal event of "conducting bone density measurement and other projects without charging according to the pricing standard". At the same time, the abnormal charge type associated with each abnormal charging event is determined (such as exceeding the standard charge, switching charges), the reference basis information in the relevant standard documents (such as the "Diagnosis and Treatment Catalog", the unit of measurement for bone density measurement is "times") and the specific description information of the event (for example, the "Medical Service Item Price Specification" stipulates that the unit of measurement for bone density measurement is "times"; a hospital conducts "bone density measurement" for patients, measuring three parts of the lumbar spine, hip, and forearm respectively, and should charge for one "bone density measurement", but the hospital actually charged three times, which is an excessive charge).

[0038] Then, an abnormal reference file for each department is generated according to the abnormal charging events in each medical project in each department and the abnormal charging type, relevant standard information and event detailed information associated with each abnormal charging event.

[0039] Among them, the generated exception reference file is as follows Figure 2 Specifically, the abnormal reference file is divided into various departments, and each department is divided into various medical projects, and finally the following is generated: Figure 2The abnormal reference file shown. With the abnormal reference file, the actual medical charge data in the HIS system of the target medical unit can be monitored through the abnormal reference file.

[0040] In an embodiment of the present application, regularly updating the abnormal reference file includes: supplementing the abnormal charging events and related information in the above-mentioned abnormal reference file (the relevant information includes the abnormal charging type associated with the abnormal charging event, relevant standard information and event details), and may also include deleting the corresponding abnormal events and related information whose number is less than a first preset threshold according to the monitoring results of the first actual medical charging data in the above-mentioned abnormal reference file.

[0041] S102. For each medical item in each department in the abnormal reference file, determine the monitoring period for the medical item, and obtain the first actual medical charge data of the target medical unit HIS system within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated as time goes by.

[0042] In the embodiment of the present application, because there is an abnormal reference file, the historical medical charge data in the HIS system of the target medical unit can be analyzed through the abnormal reference file. Here, each department and / or each medical project has a corresponding monitoring period. Usually, the monitoring period of each medical project is different. For example, the monitoring period of blood purification, fractures and other projects is long, and the monitoring period of general internal medicine is short. The monitoring period of each department is at least equal to the monitoring period of the medical project with the maximum monitoring period it includes; the monitoring periods of various departments can be the same or different. After the monitoring period of each medical project is determined, the first actual medical charge data of the HIS system of the target medical unit within the monitoring period is obtained.

[0043] S103. Determine the violation type associated with the medical project from the abnormal reference file. When the violation type includes a first violation type that meets the automatic detection condition, obtain a target detection library that matches the first violation type, and automatically verify the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collect multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determine a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type.

[0044] In the embodiment of the present application, after obtaining the first actual medical charge data of each medical project, the first actual medical charge data of the medical project is directly monitored based on the abnormal reference file. The specific monitoring method includes: determining the violation type associated with the medical project from the abnormal reference file, if the violation type includes the first violation type that meets the automatic detection condition, such as the repeated charge violation type, the over-standard charge violation type and the decomposed charge violation type, the first actual medical charge data is automatically checked by the target detection library matched with the first violation type to obtain the first verification result; specifically, the method for automatically checking the first violation type includes: judging whether the medical event and charge information in the first actual medical charge data of the medical project have a similarity greater than a second preset threshold with the target detection library, and obtaining the first verification result according to the judgment result; here, the first verification result includes: actual abnormal events, relevant violation information (here, the relevant violation information includes violation basis and violation type) and event specific description. Among them, the above-mentioned method of calculating similarity is: determining each medical event with charge information in the first actual medical charge data, and calculating the similarity between the medical event and each type of event in the target detection library, if the similarity is greater than the second preset threshold, it is determined to be an abnormal event.

[0045] If the violation type also includes a second violation type that meets the multi-dimensional detection condition, the multi-dimensional verification information associated with the first actual medical charge data under the second violation type is collected, and a second verification result of the first actual medical charge data under the second violation type is determined according to the multi-dimensional verification information;

[0046] Here, the second verification result also includes: actual abnormal events, relevant violation information (relevant violation information includes violation basis and violation type) and specific description of the event. For example, the actual abnormal event: "Orthopedics: Different TCM orthopedic manipulation reduction techniques are charged interchangeably"; relevant basis (i.e. relevant standard information): "In the "Diagnosis and Treatment Catalog", TCM fracture manipulation reduction techniques have different diagnosis and treatment items according to different parts and operation methods"; violation type: "interchange of charges"; specific description of the event: "A TCM physician in a hospital used traction, hyperextension and compression to reduce spinal fractures in patients. He should have charged "fracture manipulation reduction" (unit price A yuan), but actually charged "large manipulation treatment for lumbar disc herniation under anesthesia" (unit price B yuan), which is interchangeable charges", where B is greater than A. Here, the second violation type may be different from the first violation type, or the second violation type may include at least part of the first violation type;

[0047] That is to say, for the second violation type, it is necessary to collect multi-dimensional verification information, and these multi-dimensional verification information correspond to multiple multi-dimensional detection nodes (the acceptance information of the detection node is the multi-dimensional verification information). Here, the above-mentioned multi-dimensional detection nodes include at least one of the following: case record node, document or inspection result node, laboratory on-site inspection node, purchase and sales verification node, non-medical insurance verification node, qualification verification node, financial information verification node, responsible person inquiry node and patient verification node; then, the second verification result of the first actual medical charge data under the second violation type is determined according to the multi-dimensional verification information of the above-mentioned multi-dimensional detection nodes.

[0048] S104: Determine first abnormal information for the first actual medical charge data according to the first verification result and the second verification result.

[0049] In an embodiment of the present application, when the first actual medical charge data has only the first verification result, the first abnormal information for the first actual medical charge data is determined based on the first verification result; when the first actual medical charge data has only the second verification result, the first abnormal information for the second actual medical charge data is determined based on the second verification result; when the first verification result and the second verification result are included at the same time, the first abnormal information for the first actual medical charge data is determined jointly based on the two verification results.

[0050] It should be noted that when the monitoring system is just put into use, the first abnormal information given by the monitoring system is sent to the monitoring staff for review, and the final first abnormal information is determined based on the review results. That is to say, the monitoring staff can adjust the first abnormal information based on the review results to obtain the final first abnormal information to further ensure the reliability of the monitoring results; the monitoring system and the above-mentioned method provide assistance to the monitoring staff, which greatly improves the monitoring efficiency of the monitoring staff. At the same time, the method of the embodiment of the present application also ensures high monitoring accuracy.

[0051] The fee monitoring method of the hospital information system provided in the embodiment of the present application can verify the fee data in the HIS system of the target medical unit through an intelligent monitoring system, thereby improving the monitoring efficiency and the monitoring accuracy.

[0052] In the fee monitoring method for a hospital information system provided in an embodiment of the present application, the target detection library matching the first violation type is determined through the following steps 11 to 13:

[0053] Step 11. Determine the duplicate charging violation type from the abnormal reference file, and extract duplicate charging violation information between multiple first target medical events and multiple first target medical events from the first abnormal charging event associated with the duplicate violation type, relevant standard information and first event detailed information, and generate a first detection library based on the extraction results.

[0054] In an embodiment of the present application, for example, the duplicate charging violation type includes duplicate charging, and its associated first abnormal charging event includes "carrying out coronary intervention projects and repeatedly charging coronary angiography fees", and its associated first event detailed information is "Example: In the "Medical Service Item Price Specifications", intracoronary ultrasound thrombolysis, item content: coronary angiography. The hospital charges for intracoronary ultrasound thrombolysis and coronary angiography. Among them, coronary angiography is a duplicate charge." Coronary angiography is a duplicate charge. ...

[0055] Step 12: determine the type of excessive charging violation from the abnormal reference file, and extract the second target medical event and the excessive charging violation information of the second target medical event from the second abnormal charging event, relevant standard information and second event detailed information associated with the excessive violation type, and generate a second detection library based on the extraction results.

[0056] In an embodiment of the present application, for example, the violation type of exceeding the standard charge includes exceeding the standard charge, and its associated second abnormal charge event includes "illegal charging for low-frequency pulse treatment", and its associated second event detailed information is "Example: A hospital uses a low-frequency pulse therapy device. The instruction manual of the device indicates that two channels are a group, but the hospital actually charges a single channel as a group". According to the above-mentioned second abnormal charge event and the second event detailed information, the extracted second target medical event is "low-frequency pulse treatment, standard two channels are charged as a group, but actually a single channel is charged as a group, based on the "low-frequency pulse therapy device instruction manual". Therefore, the second detection library includes: low-frequency pulse treatment, standard two channels are charged as a group, but actually a single channel is charged as a group, based on the "low-frequency pulse therapy device instruction manual".

[0057] Step 13: determining the decomposed charging violation type from the abnormal reference file, and extracting the third target medical event, multiple decomposed events associated with the third target medical event, and decomposed charging violation information of the multiple decomposed events from the third abnormal charging event associated with the decomposed charging violation type, the relevant standard information, and the third event detailed information, and generating a third detection library according to the extraction results;

[0058] In the embodiment of the present application, for example, the violation type of decomposition charge is decomposition charge, and its associated third abnormal charge event is "decomposing the hemodialysis filtration item into multiple items and charging them separately", and the detailed information of the third event is "Example: In the "Price Specifications for Medical Service Items", the unit price of hemodialysis filtration is C yuan / time, the unit price of hemodialysis is D yuan / time, and the unit price of hemofiltration is C yuan / time. A hospital uses a hemodialysis filtration machine to perform hemodialysis and filtration treatment on patients with chronic renal failure. It should charge a "hemodialysis filtration" fee of C yuan, but actually charges a "hemodialysis" fee of D yuan and a "hemofiltration" fee of C yuan, which is a decomposition charge", among which C is greater than D, and its associated relevant standard information is: "In the "Diagnosis and Treatment Catalog", the connotation of the hemodialysis filtration item is to use a hemodialysis filtration machine and corresponding pipelines to draw the patient's blood out of the body and use a hemofilter for hemodialysis and filtration treatment". By analyzing the above-mentioned third abnormal charging event and the detailed information of the third event, it is concluded that "the use of a hemodialysis filter machine for hemodialysis plus filtration treatment should charge a "hemodialysis filtration" fee of C yuan, but the actual collection of "hemodialysis" fee D yuan and "hemofiltration" fee C yuan is a decomposed charge; the basis is: "In the "Diagnosis and Treatment Catalog", the connotation of the hemodialysis filtration project is the use of a hemodialysis filter machine and corresponding pipelines to draw the patient's blood out of the body and use a hemofilter for hemodialysis plus filtration treatment."

[0059] Therefore, it is concluded that the above-mentioned third testing library includes: the use of a hemodialysis filter machine for hemodialysis plus filtration treatment should charge "hemodialysis filtration" fees, rather than "hemodialysis" fees and "hemofiltration" fees, based on "In the Diagnosis and Treatment Catalog, the connotation of the hemodialysis filtration project is the use of a hemodialysis filter machine and corresponding pipelines to draw the patient's blood out of the body and use a hemofilter for hemodialysis plus filtration treatment."

[0060] In an embodiment of the present application, candidate violation types are determined from the above-mentioned abnormal reference file, and target medical events and related violation information are extracted from the target abnormal charging events, related standard information and target event specific description information associated with the candidate violation types. A target detection library is generated based on the extraction results, which can comprehensively record abnormal situations and facilitate manual verification through reference to relevant standard information.

[0061] Among them, the three violations mentioned above, namely, repeated charging, split charging, and over-standard charging, may overlap. Repeated charging refers to the separate charging of inspection items that already include sub-items or operations. Split charging means that the cost of an inspection item is broken down into multiple sub-items, and the total cost is higher than the original item cost. Over-standard charging refers to charging that exceeds the charging standards stipulated in the policy, including failure to update the item price in a timely manner, charging in violation of the policy, and failure to reduce fees according to the policy for combined inspection items.

[0062] Step 14: Generate the target detection library according to the first detection library, the second detection library and the third detection library.

[0063] In the embodiment of the present application, the above three detection libraries together constitute a target detection library; it should be noted here that the generation of the above three detection libraries can be carried out simultaneously or in any order.

[0064] Further, in the fee monitoring method of the hospital information system provided in the embodiment of the present application, the above-mentioned collecting the multi-dimensional verification information associated with the first actual medical fee data under the second violation type, and determining the second verification result of the first actual medical fee data under the second violation type according to the multi-dimensional verification information, includes the following steps:

[0065] Step 21. For the first actual medical charge data, determine the multidimensional detection nodes of the associated medical items and obtain the acceptance information corresponding to the multidimensional detection nodes respectively; wherein, different second violation types are associated with different multidimensional detection nodes; the second violation types at least include non-medical insurance type, non-real type and substitution charge type; the multidimensional detection nodes include at least one of the following: case record node, document node, inspection result node, laboratory on-site inspection node, purchase and sales verification node, non-medical insurance verification node, qualification verification node, financial information verification node, responsible person inquiry node and patient verification node.

[0066] In an embodiment of the present application, if the violation type associated with the medical project also includes a second violation type that meets the multi-dimensional detection conditions, then for the second violation type, it is necessary to collect multi-dimensional verification information of the first actual medical charge data. Specifically, the medical project is configured with a multi-dimensional detection node, and the acceptance information corresponding to the multi-dimensional detection node can be obtained through the multi-dimensional detection node; the above-mentioned multi-dimensional detection node includes at least one of the following: case record node, document or inspection result node, laboratory on-site inspection node, purchase and sales verification node, non-medical insurance verification node, qualification verification node, financial information verification node, responsible person inquiry node and patient verification node.

[0067] For example, for cardiovascular medicine, the abnormal charging event is "the number of disposable high-value consumables actually used in the cardiology department for treatment such as vascular intervention does not match the number charged", and the "case record node", "documentary information node", "examination result node - such as surgery information node", "responsible person inquiry node", "inventory verification node" and patient verification node are pre-configured. By configuring the above nodes and obtaining the corresponding acceptance information of the above nodes, multi-dimensional verification information is obtained.

[0068] Different second violation types are associated with different multi-dimensional detection nodes; the second violation types include at least non-medical insurance type, non-real type and substitution charge type; here, non-medical insurance type refers to the type of "including items that are not within the scope of medical insurance payment into medical insurance fund settlement", "non-real type" refers to the type of "forging or fabricating medical service items or charging repeatedly", and substitution charge type refers to "not implementing the payment name and price standard of the original drugs, medical treatment items, medical consumables, equipment or medical service facilities, but substituting them into the name and price standard in the medical insurance catalog for settlement". The multi-dimensional detection nodes of the above three different second violation types are usually different.

[0069] Step 22: Determine a second verification result of the first actual medical charge data under the second violation type by analyzing the acceptance information corresponding to the multi-dimensional detection nodes respectively.

[0070] In the embodiment of the present application, after obtaining the multi-dimensional detection node, the second verification result of the first actual medical charge data under the second violation type can be obtained by comprehensively calculating the scores of the above-mentioned multi-dimensional verification information.

[0071] Here, each multidimensional detection node has a corresponding weight, and each multidimensional node has relevant information content. The score of the multidimensional verification information is calculated jointly by the information content and weight of each multidimensional node.

[0072] In the embodiment of the present application, for each medical item of each department in the abnormal reference file, the matched first actual medical charge data is detected for abnormality through the abnormal reference file. However, the comprehensiveness of the abnormal reference file is limited. Therefore, the embodiment of the present application monitors the second actual medical charge data (which may be the above-mentioned first actual medical charge data, may overlap with the first actual medical charge data, or may include all medical charge data) through another mechanism, so as to monitor abnormalities more comprehensively.

[0073] Here, according to statistics of flight inspections over the years, substitution of items is the most common violation in clinical testing, mainly in the following situations: 1. Substituting the actual low-charge standard methodology with the high-charge standard methodology; 2. Substituting the item charges of the high medical insurance payment standard for the item charges of the low actual charge standard; 3. Substituting the self-paid or unapproved test items with the medical insurance payment items for settlement. By setting the multi-dimensional detection nodes and obtaining the corresponding acceptance information, this type of violation can be effectively identified.

[0074] In addition, there are other anomalies, including: 1. Medical institutions provide medical insurance testing services in violation of professional norms, including conducting clinical gene amplification tests without registration, laboratory personnel not undergoing technical training, and not operating in gene amplification testing laboratories; 2. Third-party agency testing fees are included in medical insurance payments in violation of regulations, including medical institutions entrusting testing projects to third-party institutions and including them in medical insurance reimbursement, and third-party institutions violate medical service price regulations to carry out entrusted testing projects; 3. Personnel qualifications do not match, including medical personnel who implement specific operations, issue reports, and review reports do not have relevant medical qualifications for testing, or impersonate other personnel to review and sign reports; 4. Focus on the implementation of testing projects by lower-level medical institutions during night shifts and holidays. Similarly, by setting up multi-dimensional detection nodes and obtaining corresponding acceptance information, the above-mentioned multiple types of violations can also be effectively identified.

[0075] Further, such as Figure 3 As shown, in the charging monitoring method of the hospital information system provided in the embodiment of the present application, the method also includes:

[0076] S301. For each medical item of each department in the target medical unit, determine a monitoring period for the medical item, and obtain second actual medical charge data of the HIS system within the monitoring period.

[0077] Here, each medical item in each department of the target medical unit does not conflict with each medical item in each department in the abnormal reference file. The two can be different and can overlap. Here, too, each medical item has a corresponding monitoring period, and the second actual medical charge data within the corresponding monitoring period is still obtained. The monitoring period here can be updated over time. For example, 2 months is a monitoring period, and the second actual medical charge data is collected every two months.

[0078] S302. For the second actual medical charge data, obtain the test information of the associated medical items, and monitor the matching of the medical order information, test items and test reports in the test information to obtain a first monitoring result; at the same time, determine whether the associated medical items include multiple test items of the same type, and if so, monitor the test results of multiple test items of the same type and their matching with the number of test reports; and, determine the stages of the test items and monitor the correlation between the test items of different stages based on the test results of the previous stage; and, detect the duplication of multiple test items with each other and multiple test items with completed test items to obtain a second monitoring result.

[0079] In the embodiment of the present application, firstly, it is examined whether it is "falsely recorded test fees", and the test items that have not been actually carried out are included in the calculation of the patient's medical expenses. There are the following situations: 1. There is no doctor's order or the test items are packaged and charged beyond the scope of the doctor's order, and no test report is issued. When the system is implemented, multiple information acquisition nodes are set, namely the doctor's order information node, the test and inspection item node and the test report node in the test information, and the certification information of these three nodes is obtained, and the results are automatically calculated or manually calculated to give results. In practice, when there is no doctor's order or the test items are packaged and charged beyond the scope of the doctor's order, and no test items are tested, and no test report is issued, it is an abnormal situation, and the first monitoring result corresponding to the abnormal information is generated accordingly; secondly, it is determined whether the associated medical items include multiple test and inspection items of the same type. If so, the test results of multiple test and inspection items of the same type and their matching with the number of test reports are monitored, that is, it is determined whether the associated medical items include the same type of antigen and antibody test items. If so, the antigen and antibody test items with stable test results are tested repeatedly, and only one test report is issued;

[0080] At the same time, determine the stages of testing and inspection items, including the initial stage and the secondary stage, and monitor the correlation between testing and inspection items in different stages based on the test results of the previous stage, for example, whether the fees for the secondary stage testing service items are charged when the initial stage testing medical service items are not confirmed to be positive; and the duplication between multiple testing item packages, and whether repeated charges are still made when the conditions for having a report are met, and generate a second monitoring result for the actual medical charge data based on the above monitoring results.

[0081] Specifically, when the following situations exist in the medical items associated with the second actual medical charge data, they are all abnormal situations: 1. No doctor's order or the package charges are beyond the scope of the doctor's order, and the test items are not tested, and no test report is issued; 2. Some antigen and antibody test items with stable test results are tested repeatedly, and only one test report is issued; 3. When the initial stage test medical service items are not confirmed to be positive, the second stage test service items are charged; 4. The patient or family members test themselves, and the medical institution still charges the test service items; 5. Individual items in different test item packages are repeated and carried out at the same time, resulting in repeated charges. According to the monitoring results of the above 5 abnormal situations, the second monitoring results for the medical items associated with the second actual medical charge data are obtained.

[0082] S303: Determine second abnormal information for the second actual medical charge data according to the first monitoring result and the second monitoring result.

[0083] Here, the second abnormal information includes: the inclusion of test items that have not been actually carried out into the calculation of patient medical expenses, specifically including 1. No doctor's order or exceeding the scope of the doctor's order, the package charges for untested test items, and no test report is issued; 2. Repeated testing of some antigen and antibody test items with stable test results, and only one test report is issued; 3. When the initial stage test medical service items are not confirmed to be positive, the fee for the second stage test service items is charged; 4. The patient or family members test themselves, and the medical institution still charges the test service item fee; 5. Individual items in different test item packages are repeated and carried out at the same time, resulting in duplicate charges. Through the above monitoring method, it is possible to identify situations that cannot be identified by abnormal reference files, and further improve the monitoring of other abnormal situations.

[0084] Furthermore, in the fee monitoring method of the hospital information system provided in the embodiment of the present application, the method further includes:

[0085] After obtaining the test information associated with the second actual medical charge data, determine the condition information in the test information, and calculate the correlation between each test item in the test information and the condition information, and update the second abnormal information according to the monitoring result of the correlation between each test item and the condition information.

[0086] In practice, there is another violation, that is, the implementation of unnecessary or low-disease-related test items in violation of the diagnosis and treatment norms, which includes the following situations: 1. Package tests without considering the patient's condition needs; 2. Including special test items in routine examinations; 3. The same or similar test items are carried out at the same time; 4. Repeated high-frequency testing of routine items without indications; 5. Violation of specific group inspection regulations. Therefore, in the embodiment of the present application, by determining the disease information in the test information, and calculating the correlation between each test item in the test information and the disease information, the second abnormal information is updated according to the monitoring result of the correlation between each test item and the disease information; or directly based on the input judgment result, it is fed back to the system and the second abnormal information is updated according to the judgment result.

[0087] In the embodiment of the present application, the second abnormal information is updated according to the above situation, which can cover the violation situation more comprehensively.

[0088] In addition, special medical imaging examinations have their own uniqueness. According to different imaging principles, imaging examinations are divided into the following categories: one is X-ray imaging; two is computer tomography (CT); three is ultrasound imaging; four is magnetic resonance imaging; and five is molecular imaging and nuclear medicine.

[0089] Therefore, it is necessary to monitor and cover the special medical imaging examinations. Further, in the fee monitoring method of the hospital information system provided in the embodiment of the present application, the method also includes:

[0090] After obtaining the second actual medical charge data, determine whether the associated medical item is a special medical imaging examination. If so, determine whether it is an excessive examination by analyzing the monitoring of the detection and inspection items in the second actual medical charge data, and determine the third abnormal information for the second actual medical charge data based on the judgment result; wherein, the excessive examination includes physical examination-style hospitalization items, examination items exceeding the preset frequency, upgraded examination items and set examination items.

[0091] In the embodiment of the present application, it is also necessary to determine whether the medical project associated with the second actual medical charge data is a medical imaging special examination. If so, it is further determined whether the second actual medical charge data is excessive examination, specifically including determining whether it is (1) physical examination hospitalization: that is, without clear indications, multiple types and multiple parts (generally whole body) imaging examinations are performed during a short-term hospitalization; (2) examinations exceeding the normal frequency (examinations greater than the third threshold number): many imaging examinations contain radiation, which are harmful to the human body. Multiple imaging examinations generally require a necessary interval. If a medical institution performs X-ray, CT and other imaging examinations on a patient multiple times in a short period of time, it is suspected of excessive examination; (3) upgraded examination: that is, generally using imaging examinations to replace general examinations, and using high-priced imaging examinations to replace low-priced imaging examinations. Different imaging examination methods have their own characteristics, and each has its own strengths and weaknesses in the field of disease diagnosis. For details, please refer to the disease guidelines and expert consensus. In pursuit of profits, some medical institutions ignore the characteristics of the disease and generally perform imaging examinations on patients, or directly use CT instead of X-ray or B-ultrasound examinations. (4) Charging for package examinations: that is, when a certain imaging examination is performed on a certain ward or even the entire hospital, it must be combined with specific items or multiple other imaging examinations, and the combined imaging examinations have no direct correlation with the patient's age, gender, and disease. Nowadays, imaging examination equipment is becoming more and more advanced, and more and more examination methods can be provided, and all are completed automatically by computer. As a result, some medical institutions perform imaging examinations on patients based on the functions of the equipment and charge generally. For example, the "X-ray computed tomography (CT) imaging" item specified in the relevant standard information is "used for blood vessels, gallbladder, CTVE, heart and brain, bone three-dimensional imaging, etc.", but some medical institutions perform three-dimensional imaging on all patients who undergo CT, regardless of the disease and examination site, and charge; and determine the third abnormal information for the second actual medical charge data based on the above judgment results.

[0092] Here, the specific judgment process is still to prepare the similarity calculation method of the inspection library in advance, or to set the corresponding information node, and the relevant department will directly give the verification result and generate the third abnormal information according to the result.

[0093] By monitoring and covering the above-mentioned special medical imaging examination on the second actual medical charging data, the third abnormal information in the special medical imaging examination is further determined, and the abnormal situation of the charging data is further comprehensively covered.

[0094] In practice, special medical imaging examinations also include repeated charges, charges exceeding the standard, charges for split items, and charges switching, which can all be monitored through abnormal reference documents.

[0095] Here, in the special medical imaging examination,

[0096] 1. Duplicate charges include: medical institutions repeatedly charge for a certain diagnosis and treatment service item more than the actual number provided, or charge for other items and consumables included in the content of a certain diagnosis and treatment item when charging for a certain diagnosis and treatment item. Common situations include:

[0097] (1) Illegal charging of consumables that cannot be charged separately: For example, charging for ultrasound coupling agent during B-ultrasound examination (common ultrasound coupling agent is not included as an excluded item in most places, and its price is included in the ultrasound examination fee and cannot be charged separately).

[0098] (2) Over-billing of consumables: For example, when performing CT or MRI enhanced scans of two or more parts at the same time, one set of consumables is actually used, but multiple sets of consumables are charged according to the parts examined. This is usually caused by the hospital setting up a charging package for imaging examinations + consumables for the convenience of charging.

[0099] (3) Repeated charges due to misinterpretation of pricing units: Different imaging examination methods and examination sites have different pricing units, including time, number of times, number of exposures, site, organ, limb, blood vessel, etc. Some medical institutions do not implement standard pricing units, resulting in repeated charges. For example, the hospital should charge for items by time, but it charges multiple times according to the number of examination sites or blood vessels; the spine CT should be charged for every three vertebrae, but the hospital charges for each vertebra; the C-arm intraoperative fluoroscopy fee is charged according to the total operation time (it should be charged according to the time the C-arm is used).

[0100] (4) Illegal collection of "ultrasound computer graphic report": First, except for ultrasound examinations, the graphic report fees of most imaging examinations are included in the project fees and cannot be charged separately (except for film). If a medical institution charges computer graphic report fees when performing non-ultrasound examinations and the examination items do not have the excluded content of graphic reports, it constitutes duplicate charges. Second, when an ultrasound examination is performed on multiple parts or multiple examination methods are used, only one computer graphic report fee should be charged, but multiple are charged repeatedly. Third, in the large category of image record additional charges to which computer graphic reports belong, there are duplicate charges for each image record item, such as charging both "computer graphic report" and "color film report" for the same examination.

[0101] 2. Excessive charges refer to charges by medical institutions that exceed the payment standards stipulated by medical insurance. Common situations include:

[0102] (1) Various types of extra charges exceeding the standard: When multiple similar imaging examinations are performed at one time, extra charges may be involved. For example, the Digital Radiography (DR) system is charged based on the number of exposures, and generally charges for extra charges starting from the second exposure. If the hospital does not charge the full price when it should, or charges extra charges before the standard for extra charges is met, or charges above the upper limit, it will constitute extra charges.

[0103] (2) Excessive charges related to performance and model: Some imaging examination charges are related to the performance and model of the examination instrument and supporting consumables, such as the number of rows of spiral CT machines, the field strength of MRI machines, etc. If the charges are higher than the standards corresponding to the actual performance model, they constitute excessive charges.

[0104] 3. Fees for decomposition projects

[0105] Refers to the behavior of medical institutions breaking down a project into its various steps or components and charging them separately, and the sum of the separate charges is greater than the charges of the broken-down diagnosis and treatment items. For example, routine B-ultrasound examinations are charged by part, with the abdomen (including liver, gallbladder, spleen, pancreas, and kidneys) costing E yuan, while single-organ B-ultrasound examinations cost F yuan per organ (G yuan is added for each additional organ). The hospital breaks down the abdominal B-ultrasound into 6 single organs and charges H yuan; H>E.

[0106] IV. Charges for switching between medical treatment items and service facilities

[0107] Refers to the behavior of medical institutions reporting that the drugs, medical consumables or treatment items charged for are inconsistent with the actual operation and use, resulting in increased charges or increased medical insurance fund expenditures. Common violations include:

[0108] (1) Replace low-cost imaging examinations with high-cost imaging examinations. For example, replace B-ultrasound-guided clinical examinations with color Doppler ultrasound-guided clinical examinations; replace B-ultrasound examinations of superficial tissues and organs with color Doppler ultrasound examinations of superficial organs.

[0109] (2) Replace imaging examinations that are not covered by medical insurance with imaging examinations that are covered by medical insurance. For example, some medical institutions replace PET-CT that is not covered by medical insurance with multi-site CT examinations to achieve the purpose of using medical insurance funds to pay for it; some medical institutions replace ultrasound treatment projects and ultrasound research projects that are not covered by medical insurance with ultrasound examinations.

[0110] In the embodiment of the present application, after determining the first abnormal information and the second abnormal information of each medical project in each department, it is also necessary to statistically determine the abnormal level for the medical project or the department. Here, the abnormal level of the department is mainly statistically determined;

[0111] Furthermore, the charging monitoring method of the hospital information system provided in the embodiment of the present application further includes:

[0112] For each department, the abnormality level for the department is determined according to the medical projects associated with the department and the first abnormality information, the second abnormality information and the third abnormality information associated with each medical project: Where D represents the set of departments; P d represents the set of medical items in department d; T p A represents the set of charging exception types for medical project p; p,t represents the abnormality score of medical item p in charge abnormality type t (can be a value, grade or other quantitative index); W t : The weight of the abnormal charging type t, and satisfies ∑ t W t =1).

[0113] The fee monitoring method for the hospital information system provided in the present application can perform abnormal verification of fee data in the HIS system through an intelligent monitoring system, thereby improving monitoring efficiency and high monitoring accuracy.

[0114] Based on the same inventive concept, the embodiment of the present application also provides a fee monitoring system for a hospital information system corresponding to the fee monitoring method for a hospital information system. Since the principle of solving the problem by the device in the embodiment of the present application is similar to the fee monitoring method for a hospital information system in the embodiment of the present application, the implementation of the device can refer to the implementation of the method, and the repeated parts will not be repeated.

[0115] Reference Figure 4 As shown, a charging monitoring system of a hospital information system provided in an embodiment of the present application includes:

[0116] The file construction module 401 is used to analyze the relevant standard information of each medical project in each department of the medical unit based on the relevant standard file, analyze the historical medical charge data in the HIS system of multiple medical units, determine the abnormal charge events of each medical project in each department, and generate the abnormal reference file of each department; wherein the abnormal reference file describes the abnormal situation of each department in each medical project according to the relevant standard information;

[0117] The first monitoring module 402 is used to determine the monitoring period for each medical item of each department in the abnormal reference file, and obtain the first actual medical charge data of the target medical unit HIS system within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated over time; determine the violation type associated with the medical item from the abnormal reference file, when the violation type includes a first violation type that meets the automatic detection condition, obtain a target detection library that matches the first violation type, and automatically check the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collect the multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determine the second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type;

[0118] The abnormality determination module 403 is used to determine first abnormality information for the first actual medical charge data according to the first verification result and the second verification result.

[0119] Further, in the fee monitoring system of the hospital information system provided in the embodiment of the present application, the file construction module 401 is specifically used for:

[0120] Obtain historical medical fee data for each medical item in each department from multiple different medical units within a preset historical time period;

[0121] For each department, obtain the relevant standard information for each medical item in the department, and analyze the historical medical charge data of each medical item in the department based on the relevant standard information, determine the abnormal charge events in each medical item in the department, and determine the abnormal charge type associated with each abnormal charge event, the reference basis information in the relevant standard documents, and the specific description information of the event;

[0122] An abnormal reference file for each department is generated based on the abnormal charging events in each medical project in each department and the abnormal charging type, relevant standard information and event detailed information associated with each abnormal charging event.

[0123] Furthermore, the charging monitoring system of the hospital information system provided in the embodiment of the present application also includes:

[0124] a target detection library construction module, configured to determine a duplicate charging violation type from the abnormal reference file, extract a plurality of first target medical events and duplicate charging violation information between the plurality of first target medical events from the first abnormal charging event associated with the duplicate violation type, the relevant standard information and the first event detailed information, and generate a first detection library according to the extraction result;

[0125] Determine the type of over-standard charging violation from the abnormal reference file, extract the second target medical event and the over-standard charging violation information of the second target medical event from the second abnormal charging event, relevant standard information and second event detailed information associated with the over-standard violation type, and generate a second detection library according to the extraction result;

[0126] Determine the decomposed charging violation type from the abnormal reference file, and extract the third target medical event, multiple decomposed events associated with the third target medical event, and decomposed charging violation information of the multiple decomposed events from the third abnormal charging event associated with the decomposed charging violation type, the relevant standard information, and the third event detailed information, and generate a third detection library according to the extraction results;

[0127] The target detection library is generated according to the first detection library, the second detection library and the third detection library.

[0128] Further, in the charge monitoring system of the hospital information system provided in the embodiment of the present application, the first monitoring module 402 collects multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determines the second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information, including:

[0129] For the first actual medical charge data, determine the multi-dimensional detection nodes of the medical items associated with it and obtain the acceptance information corresponding to the multi-dimensional detection nodes respectively; wherein different second violation types are associated with different multi-dimensional detection nodes; the second violation types at least include non-medical insurance type, non-real type and substitution charge type; the multi-dimensional detection nodes include at least one of the following: case record node, document node, inspection result node, laboratory on-site inspection node, purchase and sales verification node, non-medical insurance verification node, qualification verification node, financial information verification node, responsible person inquiry node and patient verification node;

[0130] By analyzing the acceptance information respectively corresponding to the multi-dimensional detection nodes, a second verification result of the first actual medical charge data under the second violation type is determined.

[0131] Furthermore, the charging monitoring system of the hospital information system provided in the embodiment of the present application also includes:

[0132] The second monitoring module is used to determine the monitoring period for each medical project of each department in the target medical unit, and obtain the second actual medical charge data of the HIS system within the monitoring period; for the second actual medical charge data, obtain the test information of the associated medical project, and monitor the matching of the medical order information, test and inspection items and the test report in the test information to obtain the first monitoring result; at the same time, determine whether the associated medical project includes multiple test and inspection items of the same type, and if so, monitor the test results of multiple test and inspection items of the same type and their matching with the number of test reports; and determine the stages of the test and inspection items and monitor the correlation between the test and inspection items in different stages based on the test results of the previous stage; and detect the duplication of multiple test and inspection items with each other and multiple test and inspection items with completed test and inspection items to obtain the second monitoring result; determine the second abnormal information for the second actual medical charge data based on the first monitoring result and the second monitoring result.

[0133] Furthermore, the charging monitoring system of the hospital information system provided in the embodiment of the present application also includes:

[0134] The update module is used to determine the disease condition information in the detection information after obtaining the detection information associated with the second actual medical charge data, and calculate the correlation between each detection and inspection item in the detection information and the disease condition information, and update the second abnormal information according to the monitoring result of the correlation between each detection and inspection item and the disease condition information.

[0135] Furthermore, the charging monitoring system of the hospital information system provided in the embodiment of the present application also includes:

[0136] The third monitoring module is used to determine whether the medical item associated with the second actual medical charge data is a special medical imaging examination after obtaining the second actual medical charge data. If so, it is used to determine whether it is an excessive examination by analyzing the detection and inspection item monitoring in the second actual medical charge data, and determine the third abnormal information for the second actual medical charge data according to the judgment result; wherein, the excessive examination includes physical examination-style hospitalization items, examination items exceeding the preset frequency, upgraded examination items and set examination items.

[0137] Furthermore, the charging monitoring system of the hospital information system provided in the embodiment of the present application also includes:

[0138] The abnormality level determination module is used to determine the abnormality level for each department according to the medical projects associated with the department and the first abnormality information, the second abnormality information and the third abnormality information associated with each medical project: Where D represents the set of departments; P d represents the set of medical items in department d; T p A represents the set of charging exception types for medical project p; p,t W represents the abnormality score of medical item p on charge abnormality type t; t : The weight of the abnormal charging type t, and satisfies ∑ t W t =1).

[0139] The charging monitoring system of the hospital information system provided in the present application can perform abnormal verification of charging data in the HIS system through an intelligent monitoring system, thereby improving monitoring efficiency and high monitoring accuracy.

[0140] like Figure 5 As shown, an electronic device 500 provided in an embodiment of the present application includes: a processor 501, a memory 502 and a bus, wherein the memory 502 stores machine-readable instructions executable by the processor 501. When the electronic device is running, the processor 501 communicates with the memory 502 through the bus, and the processor 501 executes the machine-readable instructions to perform the steps of the fee monitoring method of the hospital information system as described above.

[0141] Specifically, the above-mentioned memory 502 and processor 501 can be general-purpose memories and processors, which are not specifically limited here. When the processor 501 runs the computer program stored in the memory 502, it can execute the charging monitoring method of the above-mentioned hospital information system.

[0142] Corresponding to the above-mentioned fee monitoring method for the hospital information system, an embodiment of the present application also provides a computer-readable storage medium, on which a computer program is stored. When the computer program is executed by a processor, the steps of the above-mentioned fee monitoring method for the hospital information system are executed.

[0143] The electronic device and storage medium provided in real time by the present application can process each target area at a macro level and handle the abnormality of each energy storage cabinet according to the abnormality of the energy storage cabinet in each designated area in the target area, and can handle the abnormality of the energy storage cabinet in a more comprehensive, efficient and matching manner.

[0144] Those skilled in the art can clearly understand that, for the convenience and simplicity of description, the specific working process of the system and device described above can refer to the corresponding process in the method embodiment, and will not be repeated in this application. In the several embodiments provided in this application, it should be understood that the disclosed system, device and method can be implemented in other ways. The device embodiments described above are merely schematic. For example, the division of the modules is only a logical function division. There may be other division methods in actual implementation. For example, multiple modules or components can be combined or integrated into another system, or some features can be ignored or not executed. Another point is that the mutual coupling or direct coupling or communication connection shown or discussed can be through some communication interfaces, indirect coupling or communication connection of devices or modules, which can be electrical, mechanical or other forms.

[0145] The modules described as separate components may or may not be physically separated, and the components shown as modules may or may not be physical units, that is, they may be located in one place or distributed on multiple network units. Some or all of the units may be selected according to actual needs to achieve the purpose of the solution of this embodiment.

[0146] In addition, each functional unit in each embodiment of the present application may be integrated into one processing unit, or each unit may exist physically separately, or two or more units may be integrated into one unit.

[0147] If the functions are implemented in the form of software functional units and sold or used as independent products, they can be stored in a non-volatile computer-readable storage medium that is executable by a processor. Based on this understanding, the technical solution of the present application, or the part that contributes to the prior art or the part of the technical solution, can be embodied in the form of a software product, which is stored in a storage medium and includes several instructions for a computer device (which can be a personal computer, server, or network device, etc.) to perform all or part of the steps of the method described in each embodiment of the present application. The aforementioned storage medium includes: various media that can store program codes, such as USB flash drives, mobile hard drives, ROM, RAM, magnetic disks, or optical disks.

[0148] The above are only specific implementations of the present application, but the protection scope of the present application is not limited thereto. Any technician familiar with the technical field can easily think of changes or substitutions within the technical scope disclosed in the present application, which should be included in the protection scope of the present application. Therefore, the protection scope of the present application should be based on the protection scope of the claims.

Claims

1. A fee monitoring method for a hospital information system, characterized in that: Applied to a monitoring system; the method comprises: Based on the relevant standard documents, the relevant standard information of each medical project in each department of the medical unit is analyzed, and the historical medical charge data in the HIS system of multiple medical units is analyzed to determine the abnormal charge events of each medical project in each department, and generate abnormal reference files for each department; wherein the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information; For each medical item of each department in the abnormal reference file, determine the monitoring period for the medical item, and obtain the first actual medical charge data of the HIS system of the target medical unit within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated as time goes by; Determine the violation type associated with the medical project from the abnormal reference file; when the violation type includes a first violation type that meets the automatic detection condition, obtain a target detection library that matches the first violation type, and automatically verify the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collect multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determine a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type; First abnormal information for the first actual medical charge data is determined according to the first verification result and the second verification result.

2. The fee monitoring method of the hospital information system according to claim 1, characterized in that: The method of analyzing the relevant standard information of each medical item in each department of a medical unit based on the relevant standard documents and the historical medical charge data in the HIS systems of multiple medical units to determine the abnormal charge events of each medical item in each department and generate abnormal reference files for each department includes: Obtain historical medical fee data for each medical item in each department from multiple different medical units within a preset historical time period; For each department, obtain the relevant standard information for each medical item in the department, and analyze the historical medical charge data of each medical item in the department based on the relevant standard information, determine the abnormal charge events in each medical item in the department, and determine the abnormal charge type associated with each abnormal charge event, the reference basis information in the relevant standard documents, and the specific description information of the event; An abnormal reference file for each department is generated based on the abnormal charging events in each medical project in each department and the abnormal charging type, relevant standard information and event detailed information associated with each abnormal charging event.

3. The charging monitoring method of the hospital information system according to claim 1, characterized in that: Determine the target detection library matching the first violation type in the following manner: Determine a duplicate charge violation type from the abnormal reference file, extract duplicate charge violation information between a plurality of first target medical events and a plurality of first target medical events from the first abnormal charge event associated with the duplicate violation type, the relevant standard information, and the first event detailed information, and generate a first detection library according to the extraction result; Determine the type of over-standard charging violation from the abnormal reference file, extract the second target medical event and the over-standard charging violation information of the second target medical event from the second abnormal charging event, relevant standard information and second event detailed information associated with the over-standard violation type, and generate a second detection library according to the extraction result; Determine the decomposed charging violation type from the abnormal reference file, and extract the third target medical event, multiple decomposed events associated with the third target medical event, and decomposed charging violation information of the multiple decomposed events from the third abnormal charging event associated with the decomposed charging violation type, the relevant standard information, and the third event detailed information, and generate a third detection library according to the extraction results; The target detection library is generated according to the first detection library, the second detection library and the third detection library.

4. The charging monitoring method of the hospital information system according to claim 1, characterized in that: The collecting of multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determining a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information, includes: For the first actual medical charge data, determine the multi-dimensional detection nodes of the medical items associated with it and obtain the acceptance information corresponding to the multi-dimensional detection nodes respectively; wherein different second violation types are associated with different multi-dimensional detection nodes; the second violation types at least include non-medical insurance type, non-real type and substitution charge type; the multi-dimensional detection nodes include at least one of the following: case record node, document node, inspection result node, laboratory on-site inspection node, purchase and sales verification node, non-medical insurance verification node, qualification verification node, financial information verification node, responsible person inquiry node and patient verification node; By analyzing the acceptance information respectively corresponding to the multi-dimensional detection nodes, a second verification result of the first actual medical charge data under the second violation type is determined.

5. The fee monitoring method of the hospital information system according to claim 1, characterized in that: The method also includes: For each medical item of each department in the target medical unit, determine a monitoring period for the medical item, and obtain second actual medical charge data of the HIS system within the monitoring period; For the second actual medical charge data, the test information of the medical items associated with it is obtained, and the matching of the medical order information, the test items and the test report in the test information is monitored to obtain a first monitoring result; at the same time, it is determined whether the medical items associated with it include multiple test items of the same type, and if so, the test results of the multiple test items of the same type and their matching with the number of test reports are monitored; and, the stages of the test items are determined and the correlation between the test items of different stages based on the test results of the previous stage is monitored; and, the duplication between the multiple test items and the multiple test items and the completed test items is detected to obtain a second monitoring result; According to the first monitoring result and the second monitoring result, second abnormal information for the second actual medical charge data is determined.

6. The fee monitoring method of the hospital information system according to claim 5, characterized in that: The method further comprises: After obtaining the test information associated with the second actual medical charge data, determine the condition information in the test information, and calculate the correlation between each test item in the test information and the condition information, and update the second abnormal information according to the monitoring result of the correlation between each test item and the condition information.

7. The fee monitoring method of the hospital information system according to claim 6, characterized in that: The method further comprises: After obtaining the second actual medical charge data, determine whether the associated medical item is a special medical imaging examination. If so, determine whether it is an excessive examination by analyzing the monitoring of the detection and inspection items in the second actual medical charge data, and determine the third abnormal information for the second actual medical charge data based on the judgment result; wherein, the excessive examination includes physical examination-style hospitalization items, examination items exceeding the preset frequency, upgraded examination items and set examination items.

8. The charging monitoring method of the hospital information system according to claim 6 or 7, characterized in that: The method further comprises: For each department, the abnormality level for the department is determined according to the medical projects associated with the department and the first abnormality information, the second abnormality information and the third abnormality information associated with each medical project: Where D represents the set of departments; P d represents the set of medical items in department d; T p A represents the set of charging exception types for medical project p; p,t W represents the abnormality score of medical item p on charge abnormality type t; t : The weight of the abnormal charging type t, and satisfies ∑ t W t =1).

9. A fee monitoring system for a hospital information system, characterized in that: The device comprises: A file construction module is used to analyze the relevant standard information of each medical project in each department of the medical unit based on the relevant standard files, analyze the historical medical charge data in the HIS systems of multiple medical units, determine the abnormal charge events of each medical project in each department, and generate abnormal reference files for each department; wherein the abnormal reference files describe the abnormal situations of each department in each medical project based on the relevant standard information; A monitoring module, for determining a monitoring period for each medical item in each department in the abnormal reference file, and obtaining the first actual medical charge data of the target medical unit HIS system within the monitoring period; wherein each monitoring period corresponds to a monitoring time period, and the monitoring time period is updated over time; determining the violation type associated with the medical item from the abnormal reference file, when the violation type includes a first violation type that meets the automatic detection condition, obtaining a target detection library that matches the first violation type, and automatically checking the first actual medical charge data according to the target detection library to obtain a first verification result of the first actual medical charge data under the first violation type; when the violation type also includes a second violation type that meets the multi-dimensional detection condition, collecting multi-dimensional verification information associated with the first actual medical charge data under the second violation type, and determining a second verification result of the first actual medical charge data under the second violation type according to the multi-dimensional verification information; the second violation type is different from the first violation type, or the second violation type includes at least part of the first violation type; The abnormality determination module is used to determine first abnormality information for the first actual medical charge data according to the first verification result and the second verification result.

10. An electronic device, characterized in that: include: A processor, a memory and a bus, wherein the memory stores machine-readable instructions executable by the processor, and when the electronic device is running, the processor and the memory communicate via the bus, and when the machine-readable instructions are executed by the processor, the steps of the fee monitoring method for a hospital information system as described in any one of claims 1 to 8 are performed.

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