Medical insurance cloud service integrated management system based on distributed cloud architecture

Abstract

The invention provides a medical insurance cloud service integrated management system based on a distributed cloud architecture. The system comprises a distributed cloud architecture platform, a self-service terminal, an insured person terminal, a mobile terminal subsystem, an auditing terminal, a management terminal and a medical insurance consultation subsystem. The self-service terminal, the insured person terminal, the mobile terminal subsystem, the auditing terminal, the management terminal and the medical insurance consultation subsystem perform data interaction with the distributed cloud architecture platform, and the distributed cloud architecture platform comprises a central cloud platform and a plurality of sub-cloud platforms. According to the distributed cloud architecture platform, a hierarchical distributed storage system is combined with an elastic computing resource allocation mechanism to realize transmission and storage of the medical insurance data between the distributed cloud architecture platforms, and the technical scheme provided by the invention can improve the data management efficiency and security and enhance the convenience and accuracy of medical insurance services.

Description

Technical Field

[0001] This document relates to the field of medical insurance service technology, and in particular to a medical insurance cloud service comprehensive management system based on a distributed cloud architecture. Background Art

[0002] The medical insurance platform is crucial to the operation of medical insurance business, and its technical architecture affects the convenience and efficiency of people enjoying medical insurance services. At present, the medical insurance platform in most regions of my country adopts the traditional centralized architecture. For data storage, a single relational database, such as Oracle and MySQL, is often used. In the early stage, the amount of medical insurance data was small and the business was simple, which could be coped with. With the increase in the number of insured people and the surge in medical data, the disadvantages were fully revealed. The storage capacity is limited, and frequent reading and writing are prone to bottlenecks, resulting in slow system response. The data processing capacity of the centralized architecture is also limited. The number of processor cores is fixed, and it is difficult to cope with massive concurrent requests. When real-time settlement of medical treatment in other places is required, a large number of patients submit applications, and the system often delays and freezes, which cannot meet the real-time requirements, causing inconvenience to patients. In terms of network architecture, based on the centralized network layout and relying on fixed backbone network lines, medical institutions in remote areas have high latency problems in accessing the medical insurance network. When some township health centers in mountainous areas upload diagnosis and treatment data, there is network latency that affects data synchronization, and repeated uploads are often required, reducing efficiency.

[0003] The centralized architecture has great security risks. If the central server is attacked, fails or encounters natural disasters, the system is easily paralyzed. Therefore, a medical insurance cloud service comprehensive management system based on a distributed cloud architecture is proposed to solve the shortcomings of the centralized architecture. Summary of the invention

[0004] The present invention provides a distributed cloud architecture medical insurance cloud service integrated management system, which is characterized by comprising:

[0005] Distributed cloud architecture platform, self-service terminal, insured person terminal, mobile terminal subsystem, audit terminal, management terminal and medical insurance consultation subsystem; the self-service terminal, insured person terminal, mobile terminal subsystem, audit terminal, management terminal and medical insurance consultation subsystem all interact with the distributed cloud architecture platform for data;

[0006] The distributed cloud architecture platform includes a central cloud platform and multiple sub-cloud platforms. The distributed cloud architecture platform adopts a hierarchical distributed storage system combined with an elastic computing resource allocation mechanism to achieve the transmission and storage of medical insurance data between distributed cloud architecture platforms;

[0007] The self-service terminal subsystem is deployed in the hospital using multimodal interaction technology to provide medical services and generate patient medical data to upload to the distributed cloud architecture platform;

[0008] The insured person terminal provides an entry point for the insured person to handle medical insurance business. The insured person's medical insurance information and operation records are stored in the form of blockchain. When sending a medical insurance request, encryption technology and digital signatures are used to ensure the authenticity and integrity of the request;

[0009] The mobile terminal subsystem is used to provide a payment platform interface to enable the insured person to pay the personal payment portion after completing the medical insurance reimbursement;

[0010] The review end is used to review the medical insurance request sent by the insured person end and generate the medical insurance review result;

[0011] The management end uses the data uploaded by the self-service terminal, the medical terminal and the insured person terminal to automatically identify and review the data based on the medical insurance catalog and reimbursement rules using a preset deep learning model to obtain the medical insurance review results;

[0012] The medical insurance consultation subsystem is used to provide medical insurance consultation services to insured persons and upload the generated fairy tale technology to the distributed cloud architecture platform.

[0013] By adopting the embodiments of the present invention, a hierarchical distributed storage system can be used to perform intelligent storage allocation based on the access popularity and importance of medical insurance data, solving the problem of limited storage capacity and read-write performance under a centralized architecture, and improving the response speed of the system. The elastic computing resource allocation mechanism allows the system to dynamically adjust resources based on business load, and can achieve efficient processing in the face of massive concurrent requests such as real-time settlement of medical treatment in other places, greatly optimizing the patient's medical experience. At the network architecture level, the distributed cloud architecture gets rid of excessive reliance on centralized networks, effectively solves the problem of high network latency in medical institutions in remote areas, ensures the timeliness and stability of data synchronization, and comprehensively improves the operating efficiency of medical insurance services. The use of blockchain technology enhances the security and reliability of the medical insurance platform. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] In order to more clearly illustrate one or more embodiments of this specification or the technical solutions in the prior art, the drawings required for use in the embodiments or the description of the prior art will be briefly introduced below. Obviously, the drawings described below are only some embodiments recorded in this specification. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative labor.

[0015] Figure 1 A schematic diagram of a medical insurance cloud service integrated management system based on a distributed cloud architecture according to an embodiment of the present invention;

[0016] Figure 2 This is an architecture diagram of a medical insurance cloud service integrated management system based on a distributed cloud architecture according to an embodiment of the present invention. DETAILED DESCRIPTION

[0017] In order to enable those skilled in the art to better understand the technical solutions in one or more embodiments of this specification, the following will be combined with the drawings in one or more embodiments of this specification to clearly and completely describe the technical solutions in one or more embodiments of this specification. Obviously, the described embodiments are only part of the embodiments of this specification, not all of the embodiments. Based on one or more embodiments of this specification, all other embodiments obtained by ordinary technicians in this field without creative work should fall within the scope of protection of this document.

[0018] System Example

[0019] According to an embodiment of the present invention, a medical insurance cloud service integrated management system based on a distributed cloud architecture is provided. Figure 1 Schematic diagram of a medical insurance cloud service integrated management system based on a distributed cloud architecture according to an embodiment of the present invention. Figure 1 As shown, the medical insurance cloud service integrated management system based on the distributed cloud architecture of the embodiment of the present invention specifically includes:

[0020] Distributed cloud architecture platform, self-service terminal, insured person terminal, mobile terminal subsystem, audit terminal, management terminal and medical insurance consultation subsystem; the self-service terminal, insured person terminal, mobile terminal subsystem, audit terminal, management terminal and medical insurance consultation subsystem all interact with the distributed cloud architecture platform for data;

[0021] The distributed cloud architecture platform includes a central cloud platform and multiple sub-cloud platforms. The distributed cloud architecture platform adopts a hierarchical distributed storage system combined with an elastic computing resource allocation mechanism to achieve the transmission and storage of medical insurance data between distributed cloud architecture platforms;

[0022] The self-service terminal subsystem is deployed in the hospital using multimodal interaction technology to provide medical services and generate patient medical data to upload to the distributed cloud architecture platform;

[0023] The insured person terminal provides an entry point for the insured person to handle medical insurance business. The insured person's medical insurance information and operation records are stored in the form of blockchain. When sending a medical insurance request, encryption technology and digital signatures are used to ensure the authenticity and integrity of the request;

[0024] The mobile terminal subsystem is used to provide a payment platform interface to enable the insured person to pay the personal payment portion after completing the medical insurance reimbursement;

[0025] The review end is used to review the medical insurance request sent by the insured person end and generate the medical insurance review result;

[0026] The management end uses the data uploaded by the self-service terminal, the medical terminal and the insured person terminal to automatically identify and review the data based on the medical insurance catalog and reimbursement rules using a preset deep learning model to obtain the medical insurance review results;

[0027] The medical insurance consultation subsystem is used to provide medical insurance consultation services to insured persons and upload the generated fairy tale technology to the distributed cloud architecture platform.

[0028] The hierarchical distributed storage system combined with the elastic computing resource allocation mechanism specifically includes:

[0029] Based on the access frequency characteristics of medical insurance data, data accessed within a preset time period is stored in the storage layer composed of solid-state drive arrays, and data not accessed within the preset time period is migrated to mechanical hard disk cluster storage. The popularity of medical insurance data is regularly evaluated, and data is automatically transferred between the storage layer composed of solid-state drive arrays and mechanical hard disk clusters.

[0030] A distributed file system is used to build a cross-regional multi-node file storage network, and medical insurance data is stored in each node in a dispersed manner. The consistent hashing algorithm is used to achieve balanced distribution and rapid positioning of data.

[0031] When medical insurance data is transmitted between sub-cloud platforms, a distributed ledger based on blockchain is used to encrypt and store the medical insurance data and trace its source reliably, and a smart contract mechanism is used to realize the automated execution and supervision of medical insurance business rules.

[0032] The insured person end is further provided with an intelligent reminder function, which provides the insured person with personalized medical insurance business processing reminders by obtaining the insured person's medical insurance usage habits, health status and medical insurance policy changes.

[0033] The self-service terminal adopts multimodal interaction technology to directly read the medical examination image data of the insured person and upload it to the distributed cloud architecture platform for auxiliary diagnosis and medical record archiving.

[0034] The mobile terminal subsystem further integrates a medical insurance drug query function, and the insured person can query the information of the drug in the medical insurance catalog by scanning the drug barcode or entering the drug name, including: reimbursement ratio and self-payment amount range.

[0035] The management end is provided with a data visualization module, which can visualize the medical insurance business data, audit result data, and insured person statistical data in the form of charts.

[0036] The distributed cloud architecture platform uses an adaptive load balancing algorithm to monitor the CPU usage, memory occupancy, network bandwidth utilization and data storage capacity of each sub-cloud platform and the central cloud platform in real time, and automatically and dynamically allocates medical insurance data processing tasks and user requests to sub-cloud platforms with lighter loads for processing. It can automatically adjust load balancing strategies and resource allocation plans according to changes in the real-time traffic and business types of medical insurance business.

[0037] The medical insurance consultation subsystem specifically includes:

[0038] The intelligent customer service module is used to receive users' medical insurance consultation questions, understand and analyze them, and obtain corresponding answers based on the pre-built medical insurance knowledge base;

[0039] The customer information management module is used to collect, store and manage the user's basic information, medical insurance information and the user's consultation history. The basic information includes: name, gender, age, ID number, contact information; the medical insurance information includes: insurance type, insurance time, insurance area and payment record;

[0040] The work order processing module is used to receive and process medical insurance consultation questions submitted by users that cannot be solved immediately. It automatically or manually assigns work orders to corresponding professional customer service personnel or business departments according to the type and urgency of the medical insurance consultation questions, tracks and records the entire process of work order processing, and promptly feedbacks the work order processing status to users;

[0041] Data statistics and analysis module, used to collect statistics and analyze various data in the medical insurance consultation subsystem;

[0042] The system docking module is used to realize the docking of the medical insurance consultation subsystem with other related systems.

[0043] The audit end performs audit judgment based on a preset medical insurance knowledge graph, and the preset medical insurance knowledge graph construction process includes:

[0044] First, we collected multi-source medical insurance data and used natural language processing technology to clean up unstructured policy documents and case texts, remove redundant information, correct typos, and unify the format, and then convert them into structured text data.

[0045] Extract key entities from structured data, including: insured persons, medical institutions, drug names, disease diagnoses, and treatment methods, and establish a preliminary entity relationship model based on the semantic relationships between the key entities;

[0046] Introduce domain expert knowledge for manual verification and optimization;

[0047] Deploy the optimized knowledge graph to the distributed cloud architecture.

[0048] Figure 2 This is an architecture diagram of a medical insurance cloud service integrated management system based on a distributed cloud architecture according to an embodiment of the present invention. Figure 2 It can be seen that the medical insurance cloud service integrated management system based on the distributed cloud architecture of the embodiment of the present invention includes: a user layer, an application layer, a support layer, a data layer and a facility layer;

[0049] The user layer covers various key roles in the medical insurance ecosystem, including medical institution managers, who are responsible for the overall operation and management of the hospital and interact with the medical insurance system to ensure the smooth development of the hospital's medical insurance business; practicing physicians and practicing pharmacists, who are directly involved in the patient's diagnosis and treatment process, prescribing, providing pharmaceutical services, etc., and their operations are closely linked to medical insurance reimbursement and other links; medical insurance management personnel, who are responsible for core business operations such as the implementation of medical insurance policies, the review and settlement of medical insurance expenses; administrative managers, who control the process and norms of medical insurance work from a macro level; and insured persons, who are the ultimate beneficiaries of medical insurance services and the main service objects of the system. They handle various medical insurance businesses such as enrollment, reimbursement, and inquiry through the system.

[0050] The application layer specifically includes:

[0051] Internet + General Medical Services - Insured Persons: This module provides insured persons with convenient Internet medical service channels. Insured persons can make appointments, consult online, view medical records, etc. through the online platform, breaking the limitations of time and space and improving the medical experience. For example, insured persons can have video consultations with doctors at home through mobile phone applications, and doctors will issue electronic prescriptions based on their condition, which is convenient for insured persons to purchase medicines and reimbursements in the future.

[0052] Medical insurance "dual channel" prescription management: mainly used to manage the circulation of prescriptions under the medical insurance "dual channel" model. Under this model, after the insured patients are prescribed by designated medical institutions, they can choose to purchase medicines at designated medical institutions or designated retail pharmacies and enjoy the same medical insurance reimbursement treatment. This functional module ensures the accurate and safe circulation of prescriptions between medical institutions and pharmacies, and strictly manages the review, allocation, settlement and other links of prescriptions to ensure the rational use of medical insurance funds and the drug rights of patients.

[0053] Internet + diagnosis and treatment supervision services: Through the use of big data, artificial intelligence and other technologies, the Internet diagnosis and treatment process is monitored in real time and analyzed afterwards. For example, it monitors whether the doctor's diagnosis and treatment behavior is standardized, whether the prescription is reasonable, whether the medical insurance reimbursement complies with regulations, etc., timely discovers and warns of possible violations, ensures the quality and safety of medical insurance services, and maintains the safe operation of medical insurance funds.

[0054] Prescription renewal for chronic diseases: In view of the long-term medication characteristics of chronic disease patients, a convenient prescription renewal service is provided. After the initial diagnosis and treatment and the determination of the long-term medication plan, the patient can apply for prescription renewal online or offline. The doctor will review the patient's condition and medication record. After the review is passed, the prescription renewal can be issued. The patient can purchase medicine at designated medical institutions or pharmacies with the prescription renewal and enjoy medical insurance reimbursement. This function greatly reduces the inconvenience of frequent medical treatment for chronic disease patients and improves the patient's compliance and quality of life.

[0055] Delivery management: When patients choose to purchase medicines at designated retail pharmacies, this module is responsible for coordinating the drug delivery process, including selecting appropriate delivery methods (such as express delivery, pharmacy delivery, etc.), tracking delivery progress, and handling problems during the delivery process (such as damaged drugs, delivery delays, etc.), ensuring that patients can receive the purchased drugs in a timely and accurate manner, and improving patients' drug purchase experience.

[0056] Rule management: Centrally manage various rules in medical insurance business, such as medical insurance reimbursement rules (including reimbursement ratio, reimbursement scope, deductible, cap, etc.), diagnosis and treatment specifications, drug catalog management rules, etc. System administrators can use this module to flexibly configure and update rules to ensure that the system can adapt to changes in medical insurance policies in a timely manner, while ensuring the compliance and consistency of medical insurance business.

[0057] System connection: realize seamless connection between the medical insurance system and other external systems (such as hospital information systems, social security systems, tax systems, etc.) to ensure real-time interaction and sharing of data. For example, connect with the hospital information system to obtain the patient's diagnosis and treatment information and cost details for medical insurance reimbursement settlement; connect with the social security system to synchronize the basic information and insurance status of the insured persons; connect with the tax system to handle tax-related matters of medical insurance expenses, etc. Through system connection, the collaborative efficiency of medical insurance business is improved, information islands are reduced, and more convenient and efficient services are provided to insured persons.

[0058] The support layer specifically includes:

[0059] Core business area business middle platform: focuses on supporting the core business processes of medical insurance, such as the settlement and reimbursement of medical insurance expenses, the income and expenditure management of medical insurance funds, and the review and recognition of medical insurance benefits. It standardizes and modularizes these core business processes to form reusable business components, providing stable and efficient service support for upper-level applications. For example, when an insured person submits an application for medical insurance reimbursement, the core business area business middle platform will call the corresponding reimbursement review component to review the application according to the preset rules and processes to ensure the accuracy and efficiency of the reimbursement business.

[0060] Public Service Area Business Middle Platform: Provides some public service functions, such as user authentication, permission management, message notification, etc. These functions are basic services that may be needed by multiple application modules in the entire system. By centralizing them in the public service area business middle platform for unified management and provision, the maintainability and scalability of the system can be improved. For example, when a user logs in to the system, the identity authentication component of the public service area business middle platform will verify the user's identity information to ensure that only legitimate users can access the system; when there is important information in the system that needs to be notified to the user, the message notification component will push the information to the user in a timely manner through SMS, email, etc. according to the user's settings and preferences.

[0061] HSAF core framework: provides a complete distributed application development framework, including service governance, configuration management, service registration and discovery, etc., to help developers quickly build distributed, highly available, and scalable medical insurance application systems. For example, when adding a new medical insurance reimbursement service to the system, developers can use the service registration and discovery functions of the HSAF core framework to register the service to the service registration center. Other modules that need to call the service can easily find and call it through the service discovery mechanism, realizing the decoupling and flexible deployment of services.

[0062] HSA Adaptation Framework: It is used to adapt different underlying technologies and infrastructures, so that the system can run stably in different cloud environments or data centers. It shields the differences in underlying technologies and provides a unified interface and service calling method for upper-layer applications. For example, when the system needs to be migrated from one cloud platform to another, the HSA Adaptation Framework can ensure that the application does not need to make a lot of code modifications, but only needs simple configuration adjustments to run normally in the new cloud environment, reducing the migration cost and technical risks of the system.

[0063] Distributed service: Split the business functions of the system into multiple independent service units, which can be deployed on different servers and communicate and collaborate through the network. This distributed architecture can improve the processing power and availability of the system. When a service unit fails, it will not affect the operation of the entire system, and other service units can continue to provide services. For example, the medical insurance fee settlement service can be used as an independent distributed service. When the number of insured persons is large and the number of concurrent settlement requests is large, the system's processing power can be improved by increasing the number of instances of the settlement service to meet business needs.

[0064] Distributed cache: used to cache frequently accessed data in the system, such as basic information of insured persons and drug catalog information, to reduce the number of database accesses and improve the system's response speed. For example, when an insured person inquires about the balance of his or her medical insurance account, the system will first search from the distributed cache. If the information exists in the cache, it will be directly returned to the user without querying the database, which greatly shortens the query time and improves the user experience.

[0065] Distributed data access: It provides a distributed data access method, which enables the system to efficiently access and process data distributed on multiple database nodes. It can realize functions such as data read-write separation, sub-library and sub-table, and improve the performance and scalability of the database. For example, with the increase in the number of insured persons, the amount of medical insurance data continues to increase. Through distributed data access, the insured person information data can be distributed and stored on multiple database nodes. When the insured person information needs to be queried, the system can distribute the query request to each node according to certain rules, and process it in parallel to improve the query efficiency.

[0066] Distributed log: used to collect and manage log information generated by each node in the system, which facilitates system operation and maintenance personnel to conduct troubleshooting, performance analysis and security audits. The distributed log system can centrally store and manage logs scattered on different servers, and provide a unified log query and analysis interface. For example, when an abnormality occurs in the system, the operation and maintenance personnel can quickly locate the abnormal node and related log information through the distributed log system, analyze the cause of the problem and repair it.

[0067] Message queue: used to pass messages between different components of the system to achieve asynchronous communication and decoupling. For example, when an insured person submits a medical insurance reimbursement application, the reimbursement application information can be put into the message queue first, and then the background reimbursement review service obtains the application information from the message queue for processing. This can avoid long waiting times on the front-end page when the reimbursement application is submitted, improving the system's response speed and user experience. At the same time, the message queue can also act as a buffer. When the review service's processing capacity is insufficient, the message can be temporarily stored in the queue and processed when the review service is idle, ensuring the stability and reliability of the system.

[0068] The data layer specifically includes:

[0069] Catalog information: includes the medical insurance drug catalog, diagnosis and treatment project catalog, medical service facility catalog, etc. The medical insurance drug catalog records in detail the name, specification, dosage form, medical insurance payment category and other information of reimbursable drugs, and is one of the important bases for medical insurance reimbursement; the diagnosis and treatment project catalog covers the names, codes, charging standards and other contents of various medical examinations, treatments, surgeries and other projects, which are used to standardize the scope and standards of medical insurance reimbursement for diagnosis and treatment services; the medical service facility catalog includes the charging standards and reimbursement regulations for facilities such as hospitalization bed fees and outpatient (emergency) observation bed fees, ensuring that insured persons can be reimbursed in accordance with medical insurance policies when enjoying medical service facilities. Prescription information: records the content of the prescriptions issued by doctors for patients, including basic information of patients, prescription date, drug name, dosage, usage, doctor's signature, etc. This information is not only the basis for patients to purchase and reimburse drugs, but also an important object of medical insurance supervision. Through the analysis of prescription information, the rationality of doctors' drug use and the compliance of medical insurance reimbursement can be monitored. Basic information of the insured: covers the insured's name, ID number, gender, age, insurance status, insurance category (such as employee medical insurance, resident medical insurance, etc.), insured unit (for employee medical insurance), etc. This information is the basis for the medical insurance system to identify the insured's identity and determine the insurance benefits, and runs through the entire medical insurance business process of the insured, such as insurance, medical treatment, and reimbursement. User information: In addition to the insured's basic information, it also includes account information, authority information, operation logs, etc. of various users such as medical institution managers, practicing physicians, practicing pharmacists, and medical insurance management managers. This information is used for system user management and authority control to ensure that different users can only access and operate functions and data within their authority, and to ensure the security of the system and the confidentiality of data. Designated institution information: records the basic information of medical institutions designated by medical insurance (such as hospitals, community health service centers, etc.) and designated retail pharmacies, including institution name, address, contact information, validity period of medical insurance designated qualification, service scope, etc. This information is an important reference for the insured to choose the place to go to the hospital and buy medicine. It is also the basis for the medical insurance department to manage and supervise the designated institutions. The medical insurance department can monitor the medical insurance business of the designated institutions in real time through the system to ensure that they provide services to the insured in accordance with the medical insurance policies and agreements. Prescription auxiliary calculation information: may include drug price information, medical insurance reimbursement ratio, self-payment amount, pooling payment amount and other auxiliary information related to prescription cost calculation. This information plays a key role in the medical insurance reimbursement settlement process. The system accurately calculates the insured person's self-payment and the medical insurance fund's payment based on the prescription auxiliary calculation information to ensure the accuracy and fairness of the medical insurance fee settlement. Importance of data management: The data layer is the core of the entire medical insurance system. The accuracy, integrity and security of its data are directly related to the normal operation of the medical insurance business and the vital interests of the insured. Therefore, it is necessary to establish a strict data management mechanism, including data collection, storage, backup, recovery, update, security protection and other aspects to ensure the quality and availability of data.For example, back up data regularly to prevent data loss; use encryption technology to encrypt and store sensitive data to ensure data security; establish a data quality monitoring mechanism to promptly detect and correct errors and anomalies in the data, etc.

[0070] The facilities layer specifically includes:

[0071] Virtual machines: Virtualization technology is used to divide the computing resources of a physical server into multiple independent virtual machines. Each virtual machine can run an independent operating system and application program, which is isolated and flexible. In the medical insurance system, multiple virtual machines can be created according to different business needs, such as creating a dedicated virtual machine cluster for medical insurance fee settlement services, and creating a separate virtual machine for user authentication services, etc., to achieve reasonable allocation and isolation of resources, improve resource utilization and system reliability. When a virtual machine fails, it will not affect the business operation of other virtual machines. At the same time, the virtual machine can be quickly migrated to other physical servers to achieve rapid business recovery.

[0072] Containers: Compared with virtual machines, containers are more lightweight, start faster, and consume less resources. Containers can package applications and their dependent operating environments into an independent unit, which can be quickly deployed and run in different computing environments. In the medical insurance system, container technology can be used to deploy some microservice applications, such as medical insurance reimbursement microservices, drug catalog query microservices, etc., to facilitate rapid iteration and expansion. For example, when the volume of medical insurance reimbursement business suddenly increases, multiple reimbursement microservice container instances can be quickly created to cope with business peaks. After the business volume decreases, the redundant container instances can be easily destroyed to achieve elastic scaling of resources.

[0073] Distributed storage: Data is stored in multiple storage nodes in a distributed manner, and redundant data storage and high availability are achieved through technologies such as distributed file systems or object storage. Distributed storage can provide massive storage capacity to meet the growing data storage needs of the medical insurance system, while also having good scalability and fault tolerance. For example, a large amount of medical record data, imaging data, etc. in the medical insurance system can be stored in distributed storage. When a storage node fails, the data will not be lost, and the system can automatically recover data from other nodes to ensure business continuity.

[0074] SAN (Storage Area Network): is a high-speed dedicated network used to connect servers and storage devices, providing high-performance block-level data storage services. SAN usually has the characteristics of low latency and high bandwidth, and is suitable for business scenarios with high storage performance requirements, such as the storage of medical insurance databases. Through SAN, servers can access data on storage devices like accessing local disks, improving the data reading and writing speed and the overall performance of the system. For example, the medical insurance fee settlement database can be deployed on SAN storage to ensure the rapid processing of settlement business and efficient reading and writing of data.

[0075] Intranet: used to connect various components and servers within the medical insurance system to ensure high-speed and secure transmission of data within the system. Intranets usually use private network addresses and are isolated from external networks to prevent attacks and interference from external networks. For example, servers, databases, and application servers within medical insurance agencies communicate through the intranet to achieve internal processing and data interaction of medical insurance business.

[0076] Extranet: provides a connection channel between the medical insurance system and external users (such as insured persons, medical institutions, pharmacies, etc.), enabling external users to access related services of the medical insurance system through the Internet. In order to ensure the security of the extranet, firewalls, intrusion detection systems, SSL encryption and other security measures are usually adopted to prevent security threats from external networks. For example, insured persons can access the medical insurance system's insurance query, reimbursement application and other services through the extranet, and medical institutions can upload patients' diagnosis and treatment information to the medical insurance system through the extranet for reimbursement settlement.

[0077] CA (Certificate Authority): Responsible for issuing digital certificates to verify the identities of each node and user in the system, ensuring the authenticity of the identities of both parties in communication and the integrity and confidentiality of the data. For example, when an insured person logs into the medical insurance system, the system will verify the identity of the insured person through the digital certificate issued by the CA to prevent illegal users from impersonating the insured person to access the system; data transmission between medical insurance agencies and designated medical institutions can also be encrypted and signed through digital certificates to ensure that the data is not tampered with or stolen during transmission.

[0078] Security system: covers a series of security technologies and management measures, including access control, security audit, vulnerability scanning, anti-virus, data encryption, etc., to ensure the security of the medical insurance system from multiple levels. For example, through access control strategies, the access rights of different users to system resources are restricted to prevent unauthorized operations; the security audit system records the user's operation behavior and system events in the system to facilitate subsequent tracing and analysis; regular vulnerability scanning and security assessments are carried out to promptly discover and repair security vulnerabilities in the system; anti-virus software is deployed to prevent viruses and malware from attacking the system; sensitive data is encrypted for storage and transmission to protect data security. The security system is an important guarantee for the stable operation of the medical insurance system, ensuring the safe and reliable development of medical insurance business and protecting the privacy of participants and the security of medical insurance funds.

[0079] By adopting the embodiments of the present invention, a hierarchical distributed storage system can be used to perform intelligent storage allocation based on the access popularity and importance of medical insurance data, solving the problem of limited storage capacity and read-write performance under a centralized architecture, and improving the response speed of the system. The elastic computing resource allocation mechanism allows the system to dynamically adjust resources based on business load, and can achieve efficient processing in the face of massive concurrent requests such as real-time settlement of medical treatment in other places, greatly optimizing the patient's medical experience. At the network architecture level, the distributed cloud architecture gets rid of excessive reliance on centralized networks, effectively solves the problem of high network latency in medical institutions in remote areas, ensures the timeliness and stability of data synchronization, and comprehensively improves the operating efficiency of medical insurance services. The use of blockchain technology enhances the security and reliability of the medical insurance platform.

[0080] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, rather than to limit it. Although the present invention has been described in detail with reference to the aforementioned embodiments, those skilled in the art should understand that they can still modify the technical solutions described in the aforementioned embodiments, or replace some or all of the technical features therein with equivalents. However, these modifications or replacements do not cause the essence of the corresponding technical solutions to deviate from the scope of the technical solutions of the embodiments of the present invention.

Claims

1. A medical insurance cloud service integrated management system based on a distributed cloud architecture, characterized in that: include: Distributed cloud architecture platform, self-service terminal, insured terminal, mobile terminal subsystem, review terminal, management terminal and medical insurance consultation subsystem; The self-service terminal, the insured person terminal, the mobile terminal subsystem, the review terminal, the management terminal and the medical insurance consultation subsystem all interact with the distributed cloud architecture platform for data; The distributed cloud architecture platform includes a central cloud platform and multiple sub-cloud platforms. The distributed cloud architecture platform adopts a hierarchical distributed storage system combined with an elastic computing resource allocation mechanism to achieve the transmission and storage of medical insurance data between distributed cloud architecture platforms; The self-service terminal subsystem is deployed in the hospital using multimodal interaction technology to provide medical services and generate patient medical data to upload to the distributed cloud architecture platform; The insured person terminal provides an entry point for the insured person to handle medical insurance business. The insured person's medical insurance information and operation records are stored in the form of blockchain. When sending a medical insurance request, encryption technology and digital signatures are used to ensure the authenticity and integrity of the request; The mobile terminal subsystem is used to provide a payment platform interface to enable the insured person to pay the personal payment portion after completing the medical insurance reimbursement; The review end is used to review the medical insurance request sent by the insured person end and generate the medical insurance review result; The management end uses the data uploaded by the self-service terminal, the medical terminal and the insured person terminal to automatically identify and review the data based on the medical insurance catalog and reimbursement rules using a preset deep learning model to obtain the medical insurance review results; The medical insurance consultation subsystem is used to provide medical insurance consultation services to insured persons and upload the generated fairy tale technology to the distributed cloud architecture platform.

2. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The hierarchical distributed storage system combined with the elastic computing resource allocation mechanism specifically includes: Based on the access frequency characteristics of medical insurance data, data accessed within a preset time period is stored in the storage layer composed of solid-state drive arrays, and data not accessed within the preset time period is migrated to mechanical hard disk cluster storage. The popularity of medical insurance data is regularly evaluated, and data is automatically transferred between the storage layer composed of solid-state drive arrays and mechanical hard disk clusters. A distributed file system is used to build a cross-regional multi-node file storage network, and medical insurance data is stored in each node in a dispersed manner. The consistent hashing algorithm is used to achieve balanced distribution and rapid positioning of data.

3. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: When medical insurance data is transmitted between sub-cloud platforms, a distributed ledger based on blockchain is used to encrypt and store the medical insurance data and trace its source reliably, and a smart contract mechanism is used to realize the automated execution and supervision of medical insurance business rules.

4. The system according to claim 1, characterized in that The insured person end is further provided with an intelligent reminder function, which provides the insured person with personalized medical insurance business processing reminders by obtaining the insured person's medical insurance usage habits, health status and medical insurance policy changes.

5. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The self-service terminal adopts multimodal interaction technology to directly read the medical examination image data of the insured person and upload it to the distributed cloud architecture platform for auxiliary diagnosis and medical record archiving.

6. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The mobile terminal subsystem further integrates a medical insurance drug query function, and the insured person can query the information of the drug in the medical insurance catalog by scanning the drug barcode or entering the drug name, including: reimbursement ratio and self-payment amount range.

7. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The management end is provided with a data visualization module, which can visualize the medical insurance business data, audit result data, and insured person statistical data in the form of charts.

8. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The distributed cloud architecture platform uses an adaptive load balancing algorithm to monitor the CPU usage, memory occupancy, network bandwidth utilization and data storage capacity of each sub-cloud platform and the central cloud platform in real time, and automatically and dynamically allocates medical insurance data processing tasks and user requests to sub-cloud platforms with lighter loads for processing. It can automatically adjust load balancing strategies and resource allocation plans according to changes in the real-time traffic and business types of medical insurance business.

9. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1 is characterized in that: The medical insurance consultation subsystem specifically includes: The intelligent customer service module is used to receive users' medical insurance consultation questions, understand and analyze them, and obtain corresponding answers based on the pre-built medical insurance knowledge base; The customer information management module is used to collect, store and manage the user's basic information, medical insurance information and the user's consultation history. The basic information includes: name, gender, age, ID number, contact information; the medical insurance information includes: insurance type, insurance time, insurance area and payment record; The work order processing module is used to receive and process medical insurance consultation questions submitted by users that cannot be solved immediately. It automatically or manually assigns work orders to corresponding professional customer service personnel or business departments according to the type and urgency of the medical insurance consultation questions, tracks and records the entire process of work order processing, and promptly feedbacks the work order processing status to users; Data statistics and analysis module, used to collect statistics and analyze various data in the medical insurance consultation subsystem; The system docking module is used to achieve the docking of the medical insurance consultation subsystem with other related systems.

10. The medical insurance cloud service integrated management system based on distributed cloud architecture according to claim 1, characterized in that: The audit end performs audit judgment based on a preset medical insurance knowledge graph, and the preset medical insurance knowledge graph construction process includes: First, we collected multi-source medical insurance data and used natural language processing technology to clean up unstructured policy documents and case texts, remove redundant information, correct typos, and unify the format, and then convert them into structured text data. Extract key entities from structured data, including: insured persons, medical institutions, drug names, disease diagnoses, and treatment methods, and establish a preliminary entity relationship model based on the semantic relationships between the key entities; Introduce domain expert knowledge for manual verification and optimization; Deploy the optimized knowledge graph to the distributed cloud architecture.

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